The Intrapartal Period PDF

N O R TH W ES T ERN U N IV ER SI TY , I N C Laoag City, Ilocos Norte THE INTRAPARTAL PERIOD LABOR- a series of physiologic and mechanical processes by which the products of conception (baby, placenta, and fetal membranes) are expelled...

N O R TH W ES T ERN U N IV ER SI TY , I N C Laoag City, Ilocos Norte THE INTRAPARTAL PERIOD LABOR- a series of physiologic and mechanical processes by which the products of conception (baby, placenta, and fetal membranes) are expelled from the birth canal. Synonyms : Parturition, travail, accouchement, confinement A. PREMONITORY SIGNS / PRODROMAL SIGNS OF LABOR 1. Lightening - descent of the presenting part into the true pelvis SIGNS OF LIGHTENING 1. relief of dyspnea 2. relief of abdominal tightness 3. increased frequency of urination, varicosities, pedal edema because of pressure on the bladder and pelvic griddle. 4. shooting pains down the legs because of pressure on the sciatic nerves. 5. increased amount of vaginal discharge 2. Braxton Hicks Contraction aka False labor contractions  Painless, erratic uterine contractions that occur toward the end of pregnancy. They ready the cervix for labor, but cervical dilation does not occur with them. a. Do not dilate the cervix b. Contractions are felt in the abdomen c. Relieved by walking, edema d. generally painless but may be quite annoying 3. Slight Loss Weight  Increase in urine production can lead to a wt. loss bet.1 and 3 lb on to two days before labor. 4. Increased Energy – burst of adrenaline to provide energy for labor  a woman may awaken on the morning of labor full of energy in contrast to the feeling of chronic fatigue that she has been feeling for the previous month.  boost in epinephrine release which initiated by a decreased in progesterone production by the placenta 5. Backache – beginning but unrecognized uterine contractions  labor contractions begin in the back, an intermittent backache stronger than usual may be the first symptom a woman notice 6. Ripening of the Cervix – prostaglandins soften the cervix to allow for shortening and dilatation.  Goodle’s sign – the cervix feels soften than usual to palpation – similar to the consistency of an earlobe  “Butter soft” – at term the cervix becomes still soften and its tips forward. NCM 107: CARE OF THE MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS) Page 1 of 12  N O R TH W ES T ERN U N IV ER SI TY , I N C Laoag City, Ilocos Norte B. SIGNS OF TRUE LABOR - involve both uterine and cervical changes a. Uterine Contractions – true labor contractions usually begin in the back and sweep forward across the abdomen.  Gradually increase in frequency and intensity over a period of hours  Typical time 5 mins. apart b. Show / Bloody show  As the cervix softens and ripens, the mucus plug that filled the cervical canal during pregnancy is expelled  The exposed cervical capillaries seep blood as a result of pressure exerted by the fetus.  A blood mixed w/ mucus, taken on a pink tinge c. Rupture of membrane  Labor may begin with rupture of the membrane experienced either as a sudden gush or as scanty, slow seeping of clear fluid from the vagina.  AF continues to produced until delivery of the membranes after the birth of the child, so no labor is ever “dry”  EROM – can actually be advantageous as it can cause the fetal head to settle into pelvis, aiding cervical dilatation and shortening labor.  Two risk associated with ruptured membranes; a. intrauterine infection b. prolapsed of the umbilical cord NCM 107: CARE OF THE MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS) Page 2 of 12  N O R TH W ES T ERN U N IV ER SI TY , I N C Laoag City, Ilocos Norte ESSENTIAL FACTORS OF LABOR (Passenger, Passage, Power, and Psyche) The 4Ps of Labor 1. Passenger – fetus (position, presentation, attitude)  fetal head is the largest presenting part, ¼ of its length  Bones – 8 bones (sphenoid, 2 temporal, ethmoid, frontal, occipital & 2 parietal bones)  Sutures / intermembranous spaces -allows molding and further brain development  Molding – the overlapping of the sutures of the skull to permit passage of the head to the pelvis o Sagittal suture – located between parietal bones o Coronal suture – located between parietal & frontal bones o Lambdoidal suture – located between parietal & occipital bones o Frontal suture – located between frontal bones  Fontanels o 6 fontanels only 2 palpable  anterior fontanel/Bregma  diamond in shape  3cm x 4cm size  close 12-18 mos post delivery  ↑ 5cm – hydrocephalus NCM 107: CARE OF THE MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS) Page 3 of 12  N O R TH W ES T ERN U N IV ER SI TY , I N C Laoag City, Ilocos Norte  posterior fontanel/lambda  triangular in shape  1 x 1cm size  close 2-3mos post delivery  Fetal Lie  Lie – relationship between the long (cephalocaudal) axis, of the fetal body and the long axis of mother. Two Types: 1. Longitudinal Lie (Parallel)/ Vertical - fetus is lying lengthwise in the mothers abdomen 2. Transverse Lie (Perpendicular)/Horizontal lie - fetus is lying crosswise in the mother’s abdomen  Fetal Presentation and Presenting Part  Presenting part – fetal part that enters to the true pelvis first NCM 107: CARE OF THE MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS) Page 4 of 12  N O R TH W ES T ERN U N IV ER SI TY , I N C Laoag City, Ilocos Norte Cephalic presentation – head comes first out most frequent type of presentation 1. Vertex presentation - head is completely flexed so the chin touches the chest - the most ideal type of presentation - SOB (9.5 cm); occiput as the presenting part 2. Face presentation – head is sharply extended causing the occiput to come in contact with the back of the fetus. - face as the presenting part 3. Brow presentation - head is extended or bent backward causing OM diameter (13.5 cm) - brow or sinciput as the presenting part 4. Chin / mentum presentation – the most very poor presentation - the head is hyperextended - chin as presenting part NCM 107: CARE OF THE MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS) Page 5 of 12  N O R TH W ES T ERN U N IV ER SI TY , I N C Laoag City, Ilocos Norte Breech presentation – the feet or buttocks comes out first during delivery 1. Complete breech – the feet and legs are flexed on the thighs and the thighs are flexed on the abdomen. 2. Incomplete breech  Frank breech – thigh resting on abdomen while legs extend to the head - buttocks are the presenting part; common type of breech presentation  Footling breech- one or both feet are the presenting part NCM 107: CARE OF THE MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS) Page 6 of 12  N O R TH W ES T ERN U N IV ER SI TY , I N C Laoag City, Ilocos Norte Shoulder Presentation – the fetus is lying perpendicular to the long axis of the mother ; scapular / acromion is the presenting part. - vaginal delivery is not possible Compound Presentation – occurs when there is prolapsed of the fetal hand alongside the vertex, breech or shoulder. NCM 107: CARE OF THE MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS) Page 7 of 12  N O R TH W ES T ERN U N IV ER SI TY , I N C Laoag City, Ilocos Norte Position – relationship of the fetal presenting part to specific quadrant of the mother’s pelvis. OCCIPUT ANTERIOR – head down, facing OCCIPUT POSTERIOR – head down, facing your back, the easiest position for the fetal head your tummy. The occiput posterior position can to traverse the maternal pelvis which allows the make labor and delivery more challenging. fetus to move more easily through the pelvis. The baby's head may not align as well with the Less painful and less discomfort mother's pelvis, which can lead to a slower descent through the birth canal and a more extended labor. More painful and uncomfortable. NCM 107: CARE OF THE MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS) Page 8 of 12  N O R TH W ES T ERN U N IV ER SI TY , I N C Laoag City, Ilocos Norte 2. Passages of Labor – vagina & pelvis Pelvis - the bones that form a bowl-shaped structure in the area below the waist at the top of the legs, and to which the leg bones and spine are joined. 4 main pelvic types 1. Gynecoid – round, wide, deeper, most ideal for childbirth - transverse diameter (10 cm) is larger than AP diameter 2. Android – heart shape “male pelvis” - AP diameter is wider than its transverse diameter 3. Anthropoid – oval “ape-like pelvis“ AP diameter wider than transverse narrow 4. Platypelloid – flat pelvis; rarest type; transverse diameter is wider than its AP diameter – c/s for delivery NCM 107: CARE OF THE MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS) Page 9 of 12  N O R TH W ES T ERN U N IV ER SI TY , I N C Laoag City, Ilocos Norte  Divisions of Pelvis a. False pelvis – the upper flaring portion of ilium - provide support to the uterus during pregnancy and to direct the fetus to the true pelvis during labor. b. True pelvis - forms the passageway of the fetus during labor consist the following parts: 1. Inlet or pelvic brim- the entrance of true pelvis. The pelvic inlet, also known as the pelvic brim, is the uppermost part of the pelvic canal. 2. Outlet – lowest part of the pelvic canal. 3. Canal – situated between inlet and outlet. NCM 107: CARE OF THE MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS) Page 10 of 12  N O R TH W ES T ERN U N IV ER SI TY , I N C Laoag City, Ilocos Norte 3. Power: Uterine contractions  Characteristic of uterine contractions: - the forces acting to expel the fetus & placenta  involuntary contractions  voluntary bearing down efforts  characteristics: wave like  timing: frequency, duration, intensity  myometrium – power of labor  Monitoring the contractions & fetal heart tone  Increment/Cresendro - beginning of contraction until it increases  Apex/Acne – height of contraction  Decrement/Decresendro – from height of contraction until it decreases  Duration – beginning of contraction to the end of the same contraction  Interval – from end of contraction to the beginning of the next contraction  Frequency – from the beginning of 1 contraction to the beginning of next contraction  Intensity – strength of uterine contraction  Mild contraction - slightly tense fundus that is easy to indent with fingertips  Moderste contractions - firm fundus that is difficult to indent with fingertips  Strong contractions - rigid board like fundus that is almost possible to indent with fingertips if contract – blood vessel constricts; the fetus will get the oxygen on the placenta reserve which is capable of giving oxygen to the fetus up to 1min. NCM 107: CARE OF THE MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS) Page 11 of 12  N O R TH W ES T ERN U N IV ER SI TY , I N C Laoag City, Ilocos Norte 4. Psyche/person  Maternal attitude during labor  psychological stress exists when the mother is fighting the labor experience.  Women who manage best in labor are those who have a strong sense of self- NCM 107: CARE OF THE MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS) Page 12 of 12