Intrapartum Care PDF

INTRAPARTUM CARE Nursing care of a family during labor. Definition of Labor:. Oxytocin stimulation works together with prostaglandins III\. The Components of Labor 4\. The psyche, or a woman's psychological state which may either encourage or inhibit PASSENGER Fetal attitude describes the posit...

INTRAPARTUM CARE Nursing care of a family during labor. Definition of Labor:. Oxytocin stimulation works together with prostaglandins III\. The Components of Labor 4\. The psyche, or a woman's psychological state which may either encourage or inhibit PASSENGER Fetal attitude describes the position of specific Fetal lie describes how the fetus's spine lines up with its birth FETAL PRESENTATION Fetal position -the relationship of the presenting part to a specific quadrant and the side of the pregnant persons pelvis. 4 quadrant 1.Rigth anterior 2.Left anterior 3.Rigth posterior 4.Left posterior vertex presentation-occiput Face presentation- chin or mentum Breech presentation- sacrum Shoulder presentation- scapula or the acromion process. V. Mechanisms (Cardinal Movements) of Labor Nulliparas: descent occurs during 2nd stage Multiparas: descent usually begins with engagement Occurs due to : 1.Pressure of amniotic fluid 2.Direct pressure on the breech by the fundus during contractions 3\. Bearing-down of maternal abdominal muscles 2.Flexion As descent is completed, and the fetal head touches the pelvic floor, the head bends forward onto the chest, causing the smallest anteroposterior diameter Due to resistance from the cervix, pelvic walls, or pelvic floor Chin is brought towards the chest Shifts from longer occipitofrontal diameter (12cm) to shorter Suboccipito bregmatic diameter (9.5cm Internal Rotation As the head flexes at the end of descent, the occiput rotates so the head is brought into the relationship to the outlet of the pelvis. This movement brings the shoulders, coming next into the optimal position to enter the inlet 4.Extension As the occiput of the fetal head is born, the back of the neck stops beneath the pubic arch and acts as a pivot for the rest of the head \>The head extends and the foremost parts of the head, the face and chin are born 5\. External Rotation Cervical Changes Effacement means that the cervix stretches and gets thinner. Dilatation means that the cervix opens. \> As labor nears, the cervix may start to thin or stretch (efface) and open (dilate). \>This prepares the cervix for the baby to pass through the birth canal (vagina). VI\. The Stages of Labor The first stage of dilatation, which begins with the initiation of true labor contractions and ends when the cervix is fully dilated The second stage, extending from the time of full dilatation until the infant is born The third or placental stage, lasting from the time the infant is born until after the delivery of the placenta The first 1-4 hours after birth of the placenta is sometimes termed as the "fourth stage" to emphasize the importance of close maternal observation needed at this time First Stage Begins with the initiation of true labor contractions and ends when the cervix is fully dilated Takes about 12 hours to complete and divided into three segments: a\. Latent Phase Also known as the early phase begins at the onset of regularly perceived uterine contractions and ends when rapid cervical dilatation begins Contractions are mild and short lasting - 20 to 40 sec. Cervical effacement occurs and the cervix dilates minimally If a woman wants an analgesia at this point, she should not be denied of it, but if given early, this could prolong this phase Nursing Management: Can be managed by controlled breathing during uterine contractions if the woman is psychologically prepared for labor Encouraged woman to walk Encourage woman to do some preparation at this point such as doing last minute packing for her stay in the hospital Woman can give instructions to older children for her departure and upcoming birth If desired by the woman: pain relief such as aroma therapy, distraction or even acupuncture Encourage woman to be active and to use any nonpharmacologic measures she finds effective b\. The Active Phase Cervical dilatation occurs more rapidly Contractions grow stronger, lasting 40-60 sec and occur approx. every 3 to 5 minutes Show (increased vaginal secretions) and spontaneous rupture of the membranes may occur c\. The Transition Phase \> Contractions reach their peak of intensity, occurring every 2 to 3 minutes With a duration of 60 to 70 sec. Nursing Management: Encourage woman to be active participant by keeping active and assuming whatever position is most comfortable for her during this time Lying flat on her back should be avoided during this time c\. The Transition Phase Contraction reach their peak of intensity; every 2-3 minutes with a duration of 60 to 70 seconds and a maximum cervical dilatation of 8 to 10 cm Woman is experiencing an intense discomfort that is so strong May accompanied with nausea and vomiting With loss of control, anxiety, panic or irritability The irresistible urge to push usually begins 2\. The Second Stage The time span from full dilatation and cervical effacement to birth of the infant A woman typically feels contractions change from the char. of crescendo-decrescendo pattern to an uncontrollable urge to push As the fetal head pushes against the vaginal introitus, this opens and the fetal scalp appears at the opening to the vagina and enlarges from the size of a dime, to a quarter, then a half-dollar This is termed as "crowning" 3\. The Third Stage Known as the placental stage Begins with birth of the infant and ends with the delivery of the placenta After the birth of an infant, the uterus can be palpated as a firm, rounded mass just below the level of the umbilicus After a few minutes of rest, uterine contractions begin again and the organ assumes a discoid shape It retains this new shape until the placenta has separated, aprrox. 5 minutes after the birth of the infant. II\. TWO PHASES INVOLVED PUERPERIUM-KNOWN AS THE POSTPARTAL PERIOD --REFERS TO THE 6-WEEK PERIOD AFTER CHILDBIRTH FOURTH STAGE Maternal Danger Signs of Labor 1.High or Low BP A systolic pressure \> 140mmHg & a diastolic pressure 90mmHg or an increase in systolic pressure \> 30mmHg or in the diastolic pressure of \> than 15mmHg (the basic criteria for gestational hypertension) should be reported Falling BP should also be reported because it may be a sign of intrauterine hemorrhage Others signs: apprehension, increased PR and pallorhypovolemic shock 2.Abnormal Pulse Most women during pregnancy has a PR of 70-80 beats per minute Usually increased during the second stage of labor because of the exertion PR \> 100 beats per minute during labor is unusual- indication of hemorrhage 3\. Inadequate or prolonged Contractions 4.Abnormal Lower Abdominal Contour \> Full bladder is dangerous: 1.Bladder may be injured by the pressure of the fetal head 2.Pressure of the full bladder may not allow the fetal head to descend Nsg Mgt: Urge woman to void every 2 hours during labor 5\. Increasing Apprehension Fetal Danger Signs of Labor Fetal Heart Rate Patterns 1\. Accelerations \> Normal increases in FHR caused by fetal movement, a change in maternal position or administration of an analgesic. 2\. Deceleration \> Normal decreases in FHR resulting from pressure on the Fetal head during contractions \> a transient decrease in heart rate that coincides with the Onset of a uterine contraction, resulting in vagal stimulation and slowing of the heart rate 3\. Late Decelerations Decelerations that are delayed after the onset of contractions that suggest decreased blood flow to the uterus gradual decrease in the fetal heart rate typically following the uterine contraction Causes: a\. uteroplacental insuffiency ( not enough oxygen to the baby), b\. amniotic fluid infection which can occur due to excessively long labor after the water has been broken c\. low maternal blood pressure 4\. Prolonged Decelerations Decelerations that are a decrease from the FHR baseline of 15 beats per minute or more and last longer than 2 to 3 minutes but less than 10 minutes. 5\. Variable Decelerations Decelerations that occur at unpredictable times in relation to contractions that indicate compression of the umbilical cord 6\. The sinusoidal pattern In a fetus that is severely anemic or hypotoxic, central nervous system control of heart pacing may be so impaired that the FHR pattern resembles a smooth, frequently undulating wave with a cycle frequency of 3 to 5 per minute and persisting 20 minutes or more