OB week 3.ppt - Chapter 8 Intrapartum Assessment and...

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Chapter 8 Intrapartum Assessment and Interventions
OBJECTIVESOBJECTIVESThe learner will be able toDefine key termsDescribe the four stages of labor and the related nursing and medical careDemonstrate understanding of supportive care of the laboring womanIdentify the five Psof laborDescribe the mechanism of spontaneous vaginal delivery and related nursing care
Intrapartum PeriodIntrapartum PeriodBegins with the onset of regular contractions and ends with the delivery of the placentaTriggered by maternal factors and fetal factors
ONSET OF LABORUsually begins between 38 & 42 weeksMechanism is unknown
LABOR PROCESSLABOR PROCESSPremonitory signs of labor are Lightening: Descent of the fetus into the pelvisBaby is not on the diaphragmBraxton-Hicks Contractions: Irregular contractions that do not result in cervical changeCervical Ripening: Softening of the cervix, effacement (thinning)Surge in Energy: Nesting, cleaningGastrointestinal Changes: Nausea, vomiting, diarrhea, weight lossMay feel sick Backache: Lower back pain28 weeks, not huge, but has back pain--- preterm laborPressure: Lower pelvic and vaginal pressureBloody show: Brownish/blood-tinged cervical mucousSpontaneous Rupture of Membranes (SROM): Leaking of amniotic fluid
FACTORS AFFECTING LABOR FACTORS AFFECTING LABOR (5 PS)(5 PS)1.Powers (the contractions)2.Passage (the pelvis)3.Passenger (the fetus)4.Psyche (the response of woman)5.Position (maternal postures and physical positions to facilitate labor)
ASSESSMENT OF UTERINE CONTRACTIONSCharacteristics of contractionsFrequencyDurationIntensityPalpationPhases of uterine contractionsIncrementAcmeDecrement
Powers (Maternal Pushing Efforts)“Bearing down” sensationUrge to pushNo urge to push?Pushing “too early”?
Passage(Pelvis) Importance of maternal pelvic structuresCephalopelvic disproportion (CPD)Suspect if presenting part does not engage in pelvis (0 station)
PELVIC TYPESGynecoid:50%. Adequate dimensions for birth. The best.Android:Male type. 20%. Inadequate outlet dimensions for birth. C-section may be required.Anthropoid:25%. Adequate dimensions for birth.Platypelloid:5%. Outlet may be inadequate (anterior-posterior dimension). May need c-section.
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