Intrapartum and Postpartum Care PDF

3. Intrapartum & postpartum care Stress and Pregnancy o Stress hypothesis for perinatal outcomes- focuses on 2 types & time periods of psychosocial stress ▪ Acute stress during preg and lifetime exposure to stressors prior to conception o Acute perinatal stressors may be...

3. Intrapartum & postpartum care Stress and Pregnancy o Stress hypothesis for perinatal outcomes- focuses on 2 types & time periods of psychosocial stress ▪ Acute stress during preg and lifetime exposure to stressors prior to conception o Acute perinatal stressors may be preg-related anxiety or major life events o Pre-conceptional stressors- major life event that occurred unrelated to pregnancy (Can be chronic) Disparities Statistics o Non-Hispanic black women experience maternal deaths at 3-4X that of white women o Half of all pregnancy-related deaths were caused by hemorrhage, CV & coronary conditions, cardiomyopathy, pre/eclampsia, embolism or infection Changes of Late Pregnancy (Intrapartum) o Uterine contractions increase in strength and frequency ▪ Braxton-Hicks contractions o “Lightening” ▪ shape of abd changes, sensation that baby is lighter ▪ Fetal head descends into pelvis- breathing may improve, need to urinate more o Ruptured Membranes (ROM) ▪ Sudden gish of liquid or constant leakage of fluid (Water broke) o Bloody show ▪ Passage of blood-tinged mucus, cervix begins to thin (effacement), mucus plug is expelled along w/ bleeding from small blood vessels ▪ Cervical effacement common before true labor- internal os is drawn into lower uterine segment, thinning o True Labor ▪ Regular, painful uterine contractions, causing cervical dilation and birth Braxton Hicks VS True Labor o Labor o Most pt undergo spontaneous labor between 37-42 wks o Go to hospital: contractions every 5 mins X 1 hour, water break, significant bleeding, significant decrease fetal movement o Initial evaluation ▪ Leopold maneuvers- series of 4 palpations of the uterus & fetus through abd wall Aids in determining: o fetal lie: relation of long axis of fetus to maternal long axis, longitudinal MC o presentation: portion of fetus lowest in birth canal (breech or cephalic) o position: relation of fetal presenting part to right or left side of maternal pelvis ▪ Fetal heart tones Reassuring patterns: absence of late or variable decelerations, moderate FHR variability (6- 25 BPM), age-appropriate FHR accelerations  Non-Reassuring: absent/minimal variability w/ decelerations or bradycardia, recurrent late or variable decelerations, bradycardia: FHR