NIII Intrapartal

Start Studying!

Terms

undefined, object

copy deck

Define Intrapartal: The period from the onset of labor to its termination, marked by delivery of the placenta
Describe the 3 phases of the first stage of labor.: Latent phase 0-3cm(effacement)
Acive phase 4-7cm
Transition 8-10cm
LAT
Second stage of labor: Continues ofter the cevix is dilated to 10cm until the delivery of your baby.
Fergusons reflex-release of oxytocin by cervical and vaginal distention during labor.
Third stage of labor: Delivery of the placenta and membranes
How many stages of labor are there?: 4 stages
If the fetal head is presenting in a LOA position, where will the head placement be?: Left occiput anterior
Name the 4 fetal cranial sutures: Frontal, Coronal, Sagital, Lamboidal
Name the bones of the fetal cranial vault: 2 Frontal bones
2 Parietal bones
1 Occipital bone
Name the 4 fontanelles and there location: 1)Anterior fontanelle-Bregma=the diamond soft spot

2)Posterior fontanelle-the diamond shaped soft spot

3)sphenoid fontanelle-the irregularly shaped area on eithe side of the cranium where the frontal bone and the anterior tip of the parietal bone and the temporal bone and the greater wing of the sphenoid bone meet

4)Mastoid fontanelle-behind the ear
Identify the 5 areas used to identify the fetal head during intrapartal delivery: 1)Mentum-the fetal chin
2)Sinciput-the anterior area known as the brow
3)Bregma-the junction of the sagital and coronal sutures at the top of the skull
4)Vertex-the area between the anterior and posterior fontanelles
4)Occiput-the are of the fetal skull occupied by the occipital bone, beneath the posterior fontanelle
Give the 7 factors that can effect or complicate L&D: 1)Age <16, 35>
2)Position of fetus-Breech, posterior, transverse
3)Previous pregnancy experiences-bad experience, fear
4)Size of the fetus-CPD(cephalopelvic disproportion)
5)Maternal medical problems-hypertension, diabetes
6)Preparations for labor and delivery
7)Use fo analgesia/anesthesia-too early, stop; too late, no effect
The 4 pelvic types: Gynecoid=rounded w/easy delivery
Android=heart shaped w/cesearen delivery
Anthropoid w/vag w/forceps
Platypelloid=oval shape w/vag spontanious delivery
List the 4 soft tissues: Cervix
Vagina
Lower uterine segment
Floor muscles
What occurs involuntary with primary powers: Cervical dilation-the cervical OS and cervical widen from <1-10cm allowing birth of fetus

Effacement-this refers to the tinning of the cervix in preparation for birth, and is expressed in percentages. You'll be 100% effaced when you begin pushing
Secondary powers are voluntary actions, what are they?: 2nd stage of labor
-Maternal bearing down (pushing)-after the cervix is completely dilated, the maternal abd. muscul. contract as the woman pushes. The pushing aids in expulsion of the fetus and the placenta

Will be written or documented as such:
cm/%/+,0,-
What are the 9 signs of impending labor?: 1)Lightening-dropping/engagement

2)Braxton Hicks

3)Cervical softening

4)Incresed vaginal secretions

5)show-a pinkish mucous discharge from the vagina

6)Backache-sciatic nerve pressure

7)Urinary fequency-mechanical pressure

8)Spurt of energy

9)weightloss
What are the physiological adaptations to labor in each system of the maternal: Cardio-increase CO during labor, increase BP, decrease uterine perfusion

Respirotory-increases in resperations and oxygen

Renal-increased pressure, decreased tone of the bladder, cath. q2h-q4h

GI-NPO, dry mouth, dehydration, N/V, fergusons,

Endocrine-progesterone decreases, estrogen increases, prostaglandin increases, oxytocin increases, metabolism increases
What are the universal concerns of labor patients: 1)Relief from pain
2)understanding what's happening
3)Patient vulnerable-pt. has a say as to what staff in room!
Admission assessment of a labor patient: GTPAL EDC
Contration Pattern
Membranes-color, odor
Bloody show
Allergies
Pt. History
Family History
Last solid foods/liquids-OR issue
Vital signs-FHR
Vaginal exam
Station
Effacement
Dilation
Presentation
Current Medications
Antepartal Testing
Weight(presently for anasthesia)
What are the Cardinal Movements (mechanisms of labor)-positions the infant goes throught delivery: Cardinal Movements of Labor

Engagement: Mechanism by which the greatest transverse diameter of the head in vertex (biparietal diameter) passes through the pelvic inlet (usually 0 station). The head usually enters the pelvis in the transverse or oblique - the inlet is a transverse oval.
Descent: This occurs intermittently with contractions and is brought about by one or more forces: Pressure of the amniotic fluid, direct pressure of the fundus upon the breech, contractions of abdominal muscles (2nd stage) and extension and straightening of the fetal body.
Flexion: As soon as the vertex meets resistance from the cervix, walls of the pelvis or the pelvic floor, flexion results. The chin is brought into contact with the fetal thorax and the resenting diameter is changed from occipitofrontal to suboccipitobregmatic (9.5 cms.)
Internal Rotation: After engagement, as the head descends, the lowermost portion of the head (usually the occiput) meets resistance from one side or the other of the pelvic floor and is rotated about 45 degrees anteriorly to the midline under the symphysis. Internal rotation brings the AP diameter of the head in line with the AP diameter of the pelvic outlet.
Extension: With further descent and full flexion of the head, the nucha (the base of the occiput) becomes impinged under the symphysis. Upward resistance from the pelvic floor causes the head to extend, with the bregma, brow, nose, mouth and chin being born successively.
Restitution: When the head is free of resistance, it untwists, causing the occiput to move about 45 degrees back to its original left or right position. The sagittal suture has now resumed its normal right angeled relationship to the transverse (bisacromial) diameter of the shoulders.
External Rotation: While the head has been descending to the pelvic floor, the shoulders have entered the pelvis and engaged with the bisacromial diameter in the transverse or in an oblique diameter. With the descent, the leading (anterior)shoulder meets the resistance of the side of the pelvic floor and is rotated anteriorly toward the midline under the symphysis. This movement brings the long axis of the shoulders in line with the long axis of the pelvic outlet. The movement of the shoulders causes the occiput to rotate another 45 degrees, to the transverse position.
Expulsion: Delivery of the anterior shoulder, posterior shoulder, and the rest of the body.
Danger signs during labor: -Meconium staining of amniotic fluid
-Multiple gestation
-Fetal anomalies-anything pertruding from the fetus's body
-Abnormal presentation-back labor
-Preterm/posterm labor
-Prolapsed umbilical cord-washes out ahead of fetus
-Failure to progress in labor-r/t 16>hrs. due to dilation and no effacement
True labor vs False labor: True labor-uterine contrations occur more frequent, increase in strength, and the cervix changes

False labor-No changes and UC fequency and strength do not increase

Start Studying!

Deck Info

Number of cards 22