normal intrapartum

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LABOR

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Normal Intrapartum

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Page 1: Normal Intrapartum

LABOR

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THEORIES ON THE ONSET OF LABOR

Progesterone - Estrogen Ratios

Oxytocin Stimulation

Prostaglandins

Fetal Cortisol level increase

Uterine Distention- cervical pressure

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Four P’s

P PASSAGE

P PASSENGER

P POWER

P PSYCHE

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PASSAGE (The Pelvis)

False Pelvis True Pelvis

Pelvic inletMid pelvisPelvic outlet

Dilatation and Effacement Stations

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Pelvis Types

Gynecoid - most common for NSVD

Android - increased use of forceps/vacuum

Anthropoid - common OP position

Platypelloid - common for C/S

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PASSENGER (The Fetus)

Fetal Head Fetal Attitude Fetal Lie Fetal Presentation Fetal Position

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Passenger Fetal attitude: relationship of fetal parts to maternal uterus and pelvis Flexion (ideal) Extension: labor will be more

difficult Lie: relationship of fetal spine to

maternal spine Longitudinal (cephalic or

breech) Transverse (c-sec)

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Passenger con’t…

Fetal presentation: part of fetus closest to cervix Crown of the head: occiput Chin: mentum Shoulder: scapula Breech: sacrum

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Passenger cont’d… Fetal position: relationship of presenting part to the

four quadrants of maternal pelvis; right/left, anterior/posterior quadrants First letter: mother’s right or left (R, L) Second letter: fetal presenting part (O, S, M, Sc) Third letter: mother’s anterior, posterior, or transverse

(A,P,T)

****ideal position: ROA or LOA

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POWER(The Forces of Labor)

Primary Forces-Uterine Contractions Frequency Duration Intensity

Secondary Forces Abdominal muscles Perineal muscles Pelvic floor muscles

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PSYCHE(The Patient’s Psychological State)

PSYCHE

Motivation for the pregnancy Childbirth Education Sense of Mastery, Self esteem Positive Relationship with Mate Maintaining Control Support System during Labor Not Being Alone during Labor Trust in Medical Personnel

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SIGNS /SYMPTOMS OF LABOR

Backache

Nausea/Vomiting

Indigestion

Diarrhea

Cervical changes

Bloody Show

Rupture of membranes

Sudden burst of energy

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Stages of Labor First Stage - from onset of true labor to

complete dilatation of the cervix

Latent/Early Phase (0-3 cm) Active Phase (4-7 cm) Transition (8-10 cm)

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Stages of Labor Second Stage- from complete dilatation to

birth of the infant

Third Stage- from birth to delivery of the placenta

Fourth Stage - From delivery of the placenta up to four hours after birth

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CARDINAL FETAL MOVEMENTS

ENGAGEMENT

DESCENT

FLEXION

INTERNAL ROTATION

EXTENSION

RESTITUTION

EXTERNAL ROTATION

EXPULSION

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Labor Analgesics Demerol, Stadol, Nubain

Maternal Side Effects:Respiratory DepressionNausea/VomitingDrowsiness, Dizziness

Fetal Side Effects:Respiratory DepressionLethargy

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Poor fetal heart tones Maternal respiratory depression Known allergy

Nursing Implications Monitor fetal and maternal response Administer narcan/ naloxone prn - Route,

dose

Contraindications

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Anesthesia for Labor

Regional Anesthesia Epidural Spinal Pudenal Local

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General Anesthesia Advantages

Faster access Disadvantages

No support person Discomfort to mother

Anesthesia for Labor

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Nursing Responsibilities For Epidurals

Bolus Baseline vital signs and lab work available Ensure client has an empty bladder Position the patient Ongoing monitoring of mother and baby

For General As above Cricoid pressure

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Pitocin/Oxytocin

Uses To induce / augment labor To stimulate contractions after birth

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Contraindications

Prone to uterine rupture Cephalopelvic disproportion Malpresentation Presence of fetal distress Preterm infant

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Side Effects

Abruptio placenta Water intoxication Fetal hypoxia History of rapid labor and/or birth Uterine rupture

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Fetal Monitoring External Monitoring

Tocodynameter Ultrasound

Internal Monitoring IUPC FSE

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Fetal Monitoring Baseline

Tachycardia >160 bpm Bradycardia <120 bpm

Acceleration – 15 bpm x 15 secs Decelerations

Early - Head compression Late - Placental insufficiency Variables- Cord compression

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