Normal Intrapartum ime from the onset of true labor until the birth of the infant and placenta Theories of the onset of labor Progesterone - Estrogen Ratios Oxytocin Stimulation Prostaglandins Fetal Cortisol level increase Uterine Distention- cervical pressure 4 P’s 1. PASSAGE False Pelvis (UPPER PART ) True Pelvis ( in terms of station) -Pelvic inlet -Mid pelvis -Pelvic outlet Dilatation and Effacement Stations Pelvis type Gynecoid (gainecoid)- most common for NSVD( normal vaginal delivery) Android - increased use of forceps/vacuum Anthropoid - common OP position (baby has a difficult time to come out) baby is on the back Platypelloid - common for C/S
Station p.345 Evolve. Relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines and is a measure of the degree of descent of the presenting part of the fetus through the birth canal. The placement of the presenting part is measured in centimeters above or below the ischial spines WHEN THE HEAD IS AT 0 IS REFERED TO AS ENGAGED For example, when the lowermost portion of the presenting part is 1 cm above the spines, it is noted as being
minus (+)1. At the level of the spines the station is referred to as 0 (zero). When the presenting part is 1 cm below the spines, the station is said to be plus (-)1. Birth is imminent when the presenting part is at +4 to +5 cm. 2. PASSENGER Fetal Head - The fetal skull is composed of two parietal bones, two temporal bones, the frontal bone, and the occipital bone. These bones are united by membranous sutures: the sagittal, lambdoidal, coronal, and frontal. Membrane-filled spaces called fontanels are located where the sutures intersect. - The two most important fontanels are the anterior( 18 month) and posterior ( 8 to 12) Fetal Attitude - Relationship of fetal parts to maternal uterus and pelvis/ to one another Flexion (ideal) Extension : labor will be more difficult Fetal Lie - Relationship of fetal spine to maternal spine Longitudinal (cephalic or breech) Transverse (c-sec) Fetal Presentation Part of fetus closest to cervix. Refers to the body part of the fetus that enters the maternal pelvis first Crown of the head (Cephalic): occiput It can be further classified in -Vertex presentation: It’s the most common , the head is flexed onto the chest The landmark for the Vertex presentation is the Occiput -Military presentation The head is not flexed or extended -Brow presentation The head is partially extended -Face presentation The fetal head is hyperextended Breech presentation: sacrum Buttocks or feet are the presenting part.
- Fall '15