intra partum

7/30/2019 Intra Partum

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INTRAPARTUMPROCESS OF LABOR AND DELIVERY

Presented by GROUP 3A

Andal, Jaybel Ann

Bolagao, Reymart B.

Cortez, Dyan M.

Eridao, Keyne Reenne

Herrera, Reggin Caryl V.


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INTRAPARTUM CARE

refers to the medical and nursing care

given to a pregnant woman and her

family during labor and delivery.

Extends from the beginning of

contractions that cause cervical

dilation to the first 1 to 4 hours afterdelivery of the newborn and placenta.


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FACTORSAFFECTING

LABORANDDELIVERY

5 Ps of Labor and Delivery

Passageway

Passenger

PowerPlacental Factors/Position

Psyche


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PASSAGEWAYrefers to the adequacy of

the pelvis and birth canal

allowing fetal descent; andfactors include:


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I. TYPESOFFEMALE

PELVISGynecoid typical female pelvis with

a rounded inlet.

Android normal male pelvis with aheart shaped inlet

Anthropoid is an apelike pelvis

with an oval inletPlatypelloid is a flat, female-type

pelvis with a transverse oval inlet


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II. STRUCTUREOF PELVISFalse pelvis vs. true pelvis

FALSE PELVIS -Superior half formed by theiliac. Offers landmark for pelvicmeasurements. Supports the growing fetusinto the true pelvis near the end of gestation

TRUE PELVIS -Inferior half formed by the

pubes in front, the iliac and the Ischia on thesides and the sacrum and coccyx behind.


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Engagement- refers to settling of the presentingpart of the fetus into the pelvis to be at the levelof the ischial spine, a midpoint of the pelvis,descent to this point means the pelvic inlet isproven adequate for birth.

Floating- a presenting part that is not engaged.Dipping- one that is descending but has not

reached the ischial spine.

Station- or degree of engagement; refers to therelationship of the presenting part of a fetus tothe level of the ischial spines.


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III. ADEQUATEDELIVERY

DIAMETER

c. Ability of the uterine segment to

distend, the cervix to dilate and the

vaginal canal and introitus to distend.

DILATATION-Enlargement of theexternal cervical os from 0 to 10cm. As

a result of uterine contractions and

additionally as a result of pressureon the presenting part.


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EFFACEMENT-Shortening and

thinning of cervical canal from0 to100%.

Primigravidaeffacementoccurs before dilatation

Multigravidasdilatation may

precede effacement


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PASSENGERThis refers to the fetus and its

ability to move through the

passageway.


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PASSENGER (CONT)

Fetal skull Size of the fetal head and capability of the head to

mold to the passageway. Molding- change in shape of fetal skull produced by

force of contraction pressing the

head against the not-yet dilated cervix Parents are

reassured that molding only lasts a day or two and

is not a permanent condition

No molding when fetus is breech.


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The fetal skull is the most important

part of the fetus because:

1. It is the largest part of the body

2. It is the least compressible of all parts

3. It is the most frequent presenting part


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PASSENGER (CONT..)

Fetal lie or presentation-

The part of the fetus that

enters the maternal pelvis first;the body part that will be bornfirst or contact the cervix first


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Cephalic = head first; ideal presentation for NSVDbecause the bones of the skull are capable of

molding so effectively to accommodate the cervix

and may actually aid in cervical dilation

Vertex head is sharply flexed, making the parietalbones the presenting parts

1. Face

2. Brow

3. Chin or mentum


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Breecheither buttocks or feet first;

difficult birth; can be delivered NSVD.Complete breech thighs are flexed on the abdomen and

legs are on thighs.

Frank breech thighs are flexed and legs are extended,resting on the anterior surface of the body. Footling

Doublelegs unflexed and extended; feet are presentingparts.

Single one leg flexed and extended; one foot is thepresenting part.

Shoulder presentation- presenting part can be one of the

shoulders(acromion process, an iliac crest, a hand an elbow;CS delivery)


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FETAL LIE

relationship between the long axis of the fetal body

and the long axis f the womans

body(cephalocaudal).

a. Horizontal (transverse)

b. Vertical (longitudinal)- cephalic or breech


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FETAL ATTITUDE

The relationship of fetal parts to

one another; degree of flexion a

fetus assumes during labor.


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FETAL ATTITUDE(CONT..)

GOOD ATTITUDE- if in complete flexion;

the spinal column is bowed forward, the

head is flexed forward so much that the chin

touches the sternum, the arms are flexedand folded on the chest, the thighs are

flexed onto the abdomen and the calves are

pressed against the posterior aspect of the

thighs.


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MODERATE ATTITUDE- if

chin is not touching the

chest but is in alert ormilitary position.


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POOR ATTITUDE- the

back is arched, the neck

is extended and a fetus is

in complete extension


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FETALPOSITION

The relationship of presenting part and the maternalpelvis which is divided into4 quadrants:

right anterior

right posterior

left anterior

left posterior

Four parts of the fetus have been chosen as point ofdirection

1.Occiput -= in vertex presentation2.Chin (mentum) in face presentations

3.Sacrum breech presentations

4.Scapula (acromion) in shoulder presentations


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Possible fetal positions:

LOA (left occipitoanterior)- most common fetal position(birthing is fast)

LOP (left occipitoposterior)- difficult delivery; more painful

LOT (left occipitotransverse)ROA (right occipitoanterior)-

second most frequent (birthing is fast)

ROP (right occipitoposterior)- difficult delivery, more painful

ROT (right occipitotransverse)

*Posterior positions may be more painful for the mother, because

the rotation of the fetal head puts pressure on the sacral

nerves causing sharp back pain.


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POWERrefers to the frequency,duration and strength of

uterine contractions tocause complete cervical

effacement and dilatation.


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3 PHASESOFUTERINECONTRACTIONS

crescendo/increment- intensity of the contractionincrease. This phase is longer than the other two

phases combined.

acme/apex-the height or peak of the contraction.

decrescendo/ decrement- intensity of thecontraction decreases


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Duration of contractions How Long

From the beginning of one contraction to the end of thesame contraction

Duration during early labor- 20-30 seconds.

Duration in late labor- 60-70 seconds.

Should never be longer than 60-70 seconds because anymuscle that is contracted does not have any blood supply

and so will jeopardize the fetus.


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Interval

From the end of one contraction to the beginningof the next contraction

Interval during early labor- 40-45 minutes

Interval in late labor- 60-70 seconds

It is an important aspect of contraction because it is during this relaxation period when the uterine

blood vessels refill themselves with blood to supply the

fetus with adequate oxygen


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Frequency How Often

From the beginning of one contraction to the

beginning of the next contraction.

Three to four contractions are timed to get a good

picture of the frequency.


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Intensity How Strong

The strength of contraction; may be mild, moderate,

strong or severe

Measured by the consistency of the fundus at the

acme of the contraction

When estimating intensity, check fundus at conclusi

on of contraction to determine whether it relaxes.

More strong: more pain


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PSYCHE

refers to theclientspsychological state, available

support systems, preparationfor childbirth, experiences and

coping strategies.


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PLACENTALFACTORS

refer to the site

of placentalinsertion.


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PREMONITORY/PRELIMINARY/

PRODROMALSIGNSOFLABOR

Lightening

is the descent of the fetus and uterus into the pelvic cavity2-3 weeks before the onset of labor.

Effects of lightening

Shooting pains down the legs because of pressureon the sciatic nerve

Increased lordosis as the fetus enters the pelvisand falls further forward

Increased amount of vaginal discharges

Resurgence of sign of pregnancy like urinary frequency,as the gravid uterus impinges on the bladder

Relief of abdominal tightness and diaphragmaticpressure


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Loss of weight - 2- 3 lbs is loss 2 days prior toonset of labor, probably due to loss of appetite

anddecrease in progesterone level that leads to

fluids excretion thus causing loss weight.

Progesterone is known to cause fluid retention


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Burst of energy or Increased tension and fatigue

Nesting behavior may occur right before the

onset of labor. Sudden burst of energy is due to

increase in epinephrine in response to the stress

brought about by the approaching delivery.

Pregnant woman should be caution not to use thisenergy to carry out household chores because it ismeant to prepare the body for the labor.


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Braxton Hicks contraction

irregular intermittent contractions that have occurre

d throughout the pregnancy, become uncomfortable

and produce a drawing pain in the abdomen and

groin; painless uterine tightening Also knownas practice contraction.


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Cervical changes

include softening ripening describe as butter softand effacement of the cervix that will cause

expulsion of the mucous plug (bloody show).


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Rupture of amniotic membranes or the bag ofwater

may occur before the onset of labor.

Its rupture may be seen as a sudden gush,

or a scanty, slow seeping of amniotic fluid from the

vagina. It is important to remember that once

membranes (BOW) have ruptured; Therefore labor is

inevitable. Labor pains will set in within the next 24

hours. Since the integrity of the uterus has been destroyed,

infection can easily set in.

Thus, ASEPTIC TECHNIQUE

should be observed in doing perineal care. Doctors do

less of the IE and enemas no longer given.

Check for any umbilical cord compression and or cord

prolapsed especially in breech presentation)


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A WOMANSEEKINGADMISSION

CLAIMSTHATHER BOW HASRUPTURED.

FIRST NURSING ACTION

Put her to bed right away, then take the fetal heart tones. Sheshould be allowed to remain in the standing position orsitting position because if its true that BOW has ruptured, thepossibility of cord compression is high.

If a woman in labor says that she feels a loop of the cordcoming out of her vagina (cord prolapsed),

IMMEDIATE ACTION

Place her in trendelenberg position to reduce pressure on

the cord. REMEMBER: only 5 minutes of cord compression can already

lead to CNS damage or even death

Apply a warm saline saturated OS on the cord toprevent crying of the cord.


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Color should be noted

1. Normal: clear, almost colorless and contains

white specks of vernix caseosa.

2. Abnormal:

a. green staining amniotic fluid has been

contaminated with meconium which

signifies fetal distress if the fetus is in

a non-breech presentation.

b. yellow staining may mean blood

incompatibility.

c. Pink stain may indicate bleeding


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If labor does not occur within the next 24 hours, thewoman will have to be induced to go into labor byadministering intravenous drip of oxytocin (Pitocin).

Show

This is the blood-tinged mucus discharged from thevagina because of pressure of the descending fetal parton the cervical capillaries, causing their rupture.

Capillaryblood mixes with mucus when operculum isrelease that is why SHOW than a pinkish vaginal

discharge. Show should be distinguished from bright red vaginal

bleeding because the later is a danger sign during thisphase of pregnancy.


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ONSET OF LABOR

Labor normally begins whena fetus is sufficiently mature to

cope with extra uterine life, yet notto large to cause mechanical

difficulties with birth.


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Differentiate TRUE LABOR from a FALSE

LABOR.


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Contractions False labor True laborTiming Irregular, no increase in

frequency or durationRegular intervals which

gradually become

closely spacedChange with motion Stop and start at

irregular intervalsProgress is continuous

Location Abdomen Back, then travels to thefront

Intensity Weak and remains weak Intensifies with timeExternal changes None Mucus plug may

dislodge; membrane

rupture; bladder

pressure

Occurrence Happens when you aretired, especially in the

eveningsAnytime


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STAGESOF LABOR

First stage ( Stage of Dilatation) begins with the onset of regular contractions which

cause progressive cervical dilation

and effacement. It ends when the cervixincompletely effaced and dilated.

1.Latent phase - 1-4 cm

2.Active phase - 4-7 cm

3.Transitional phase - 7-10 cm Power/Forces at work: involuntary uterine contracts


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STAGEOF DILATATION (FIRST STAGE)

LATENT PHASE

early time in labor

Regular contraction

Cervical dilation 1 to 4 cm Intensity: mild to moderate

Uterine contractions occur Q15-30 minutes and

are 15-30seconds in duration and of mild intensity

Mother is talkative and eager to be in labor


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ACTIVE PHASE

Cervical dilation 4-7 cm

Uterine contractions occur Q3-

5 minutes and are 30-60seconds in duration

Contraction: moderate to strong, frequent, longer m

ore painful

Mother may experience feeling of helplessness and

becomes restless and anxious as contractions

intensifies

Woman fears losing control of herself


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TRANSITIONAL PHASE-

Cervical dilation 8-10 cm

Uterine contractions occur every 2-3 minutes andare 45-90seconds in duration and of strong

intensity Mother becomes tired, is restless and irritable

and feels out of control

Mood change

AMNIOTOMY (if not yet ruptured) Gaping (bulging) of vagina or anus or perineum

AMNIOTOMY is not done if the station isstill negative because this can lead to cordcompression

S S


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SECOND STAGE

( STAGE OF EXPULSION)

Begins with complete dilatation of thecervix and ends with delivery of the

newborn.

Duration may differ among primiparas(longer) and multiparas (shorter),but

this stage should be completed within

1 hour after complete dilatation.


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SECOND STAGE

( STAGE OF EXPULSION)

Power/Forces at work: INVOLUNTARY UTERINECONTRACTIONS; CONTRACTIONS OF THEDIAPHR

AGMATIC AND ABDOMINAL MUSCLES

1. Contractions are severe at 2-3 minute intervals, with a

duration of 50-90seconds2. Cervical dilation is complete

3. Progress of labor is measured by descent offetal head thru the birth canal(change in fetal station)

4. Uterine contractions occur every 2-3 minutes, lasting60-75 seconds, and the intensity is strong.

5. Increase in bloody show

6. Mother feels the urge to bear down


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The newborn exits the birth canal with the help from the followingcardinal movements, or mechanisms of labor

(D FIRE ERE)

DESCENT- fetus goes down the birth canal (preceded byengagement)

FLEXION- pressure on the pelvic floor causes the fetal chin tobind towards the chest

INTERNAL ROTATION from antero-postero to transverse thenAP to AP

EXTENTION as the head comes out, the back of the neckstops beneath the pubic arch. Thehead extends and theforehead, nose, mouth and chin appear

EXTERNAL ROTATION (also known as restitution) anteriorshoulder rotates externally to the AP position so that it is justbehind the symphysis pubis

EXPULSION the delivery of the rest of the body


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SECOND STAGE ( STAGE OF EXPULSION)

Episiotomy Prevent prolonged & severe stretching of the muscles

Natural anesthesia (synchronized with pushing of thewoman)

Done to facilitate delivery and avoid laceration of the

perineum Reduce duration of second stage

Enlarge outlet in breech presentations or forcep delivery

TYPES OF EPISIOTOMY

Median

Mediolateral

Application ofRitgens Maneuver is the best method fordelivery As soon as crowning is taking phase, coveranus with sterile towel to exert.

THIRD STAGE (PLACENTAL


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THIRD STAGE (PLACENTAL

EXPULSION)

Begins with the delivery of the babyand ends with the delivery of the

placenta.

Placental separation and expulsionoccur

Placental birth occur 5-30 minutes

after birth of baby.


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THIRD STAGE (PLACENTAL EXPULSION)

Placental Separation(Mechanisms)

SCHULTZE MECHANISM: center portion of

placenta separates first and

its shiny fetal surface emerges from the vagina.

SHINY AND GLISTENING.

DUNCAN MECHANISM: margin of placenta

separates, and the dull, red, rough maternal surface

emerges from the vagina. DIRTY, RAW, REDANDIRREGULAR WITH THE RIDGES OR

COTYLEDONS.


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Signs of Placental Separation

uterus becoming globular (calkins sign)

Fundus rising in abdomen

gushing of blood Lengthening of the cord


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Contractions of the uterus controls uterine bleeding and aids with placentalseparations and delivery. Generally, oxytocicdrugs (oxytocin 10-20units) are administered to help the uterus contract (after placenta out)

METHERGINE

PROMOTES UTERINE CONTACTION AND PREVENTS POSTPARTUMHEMORRHAGE

PRODUCE STRONG AND EFFECTIVE CONTRACTION ASSESS VITAL SIGNS (BP)

DO NOT ADIMINISTER IF BP IS 140/90 mmHg

LEADS TO HYPERTENSION

DISCONTINUE: MARKED VASOCONSTRICTION (COLDNESS,PALENESS, NUMBNESSOF THE FEET AND HAND); NOTIFY THEPHYSICIAN

OXYTOCIN

INCREASES UTERINE CONTRACTION

MINIMIZED UTERINE BLEEDING

INCREASES BLOOD PRESSURE (VASOCONSTRICTION)


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FOURTH STAGE ( RECOVERYAND BONDING)

From the delivery of the placenta until the

postpartum condition of the woman has become

stabilized (usually after 1 hour after delivery).

the period of time from 1-4 hours after delivery the

mother and newborn recover from the physicalprocess of birth

The maternal organs undergo initial readjustment to

the nonpregnant state

The newborn baby systems begins to adjust toextra uterine life and stabilize


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Monitoring the Blood Pressure

Blood Pressure should not be taken during a

contraction as it tends to INCREASE, because noblood supply goes to the placenta during

contraction. All the blood is in the periphery, whichexplains the increased BP during contraction BP

taking should be taken at least every half hour

during active labor. Whenever a woman complains

of a HEADACHE, remove the blood pressureapparatus from the arm right away (priority

intervention)


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NURSING MANAGEMENT

DURING LABOR

1.Physical Assessment.

General physical examination, Leopolds

maneuvers and/or internal examination are done.

2.Bath.

Bath is advisable if contractions are still tolerable or

are not too close to one another. Bathing will not

only ensure cleanliness but will

also provide comfort and relaxation.

3.Perineal Preparation.

Perineal flushing is done to prevent contamination

of the birth canal and reduce possibilities of

postpartum infection.


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NURSING MANAGEMENT

DURING LABOR

4. Ambulation. Unless contraindicated (by medications, intravenous

infusion or ruptured membranes), ambulation is advisedduring the latent phase of labor in order to help shortenthe first stage of labor.

5. Diet

.Solid or liquid foods are avoided for the followingreasons:

a)Digestion is delayed during labor.

b)A full stomach interferes with proper bearing down.c)Aspiration may occur during the reflex nausea andvomiting of the transition phase or when anesthesia isused.


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NURSING MANAGEMENT

DURING LABOR

6.Enema Administration. Enema is not a routine procedure for all women in labor but

maybe done for the following reasons:

a)A full bowel hinders labor progress; enema increases the spaceavailable for passage of the fetus and improves frequency andintensity of uterine contractions

b)Enema decreases the possibility of fetal contamination of theperineum during the second stage of labor.

c)A full bowel can add to the discomfort of the immediatepostpartumperiod.

Contraindications of enema:

a)Vaginal bleeding

b)Premature labor

c)Abnormal fetal presentation or position

d)Ruptured membranes

e)Crowning


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NURSING MANAGEMENT

DURING LABOR

Voiding.

The woman in labor should be encouraged to

empty her bladder every2-3 hours because:

a)full bladder retards fetal descent.

b)urinary stasis can lead to urinary

tract infection.

c)a full bowel may be traumatized during delivery.


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NURSING MANAGEMENT

DURING LABOR

8.Breathing Technique.

The woman in the 1st stage of labor should be

instructed not to push or bear down during contractions

because it will not only lead to maternal exhaustion but, more importantly, unnecessary bearing down can

lead to cervical edema because of the excessive

pounding of the fetal presenting part of the pelvic floor,

thus interfering with labor progress.

To minimize bearing, the patient should be advised

to do abdominal breathing during contractions.


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NURSING MANAGEMENT

DURING LABOR

9.Position. Encourage the woman in labor to assume Sims position

because:

a)It favors anterior rotation of the head.

b)It promotes relaxation between contractions. c)It prevents Supine Hypotensive Syndrome.

The inferior vena cava, the blood vessel which carriesunoxygenated blood back to the heart, lies just above

the spinal column. When a pregnant woman lies flat onher back, the inferior vena cava is caught between thegravid uterus and the spinal column, causing a drop inarterial blood pressure, which leads the woman tocomplain of dizziness.


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NURSING MANAGEMENT

DURING LABOR

Contractions.

Uterine contractions are monitored every hour

during the latent phase of labor and every 30

minutes during the active phase by spreading thefingers lightly over the fundus.

NURSING MANAGEMENT


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NURSING MANAGEMENT

DURING LABOR

Vital Signs Blood Pressure (BP) and Fetal Heart Rate (FHR)

are taken every hour during the latent phase andevery 30 minutes during the active phase.

Definitely, BP and FHR should never be takenduring a contraction.

During uterine contractions

No blood goes to the placenta. The blood is pooledto the peripheral blood vessels

which results in increased BP. Therefore, the bloodpressure should be taken in between contractionsand whenever the mother in labor complains ofa headache.

NURSING MANAGEMENT


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NURSING MANAGEMENT

DURING LABOR

Danger Signals.

The nurse must be aware of the following danger

signals during labor and delivery.

a)Signs of fetal distress

1. Tachycardia (FHR more than 180)

Bradycardia (FHR less than100)

2.Meconium-stained amniotic fluid in non-

breech presentation3.Fetal thrashing or hyperactivity

due to fetal struggling for more oxygen

NURSING MANAGEMENT


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NURSING MANAGEMENT

DURING LABOR

Signs of maternal distress

1. BP over 140/90, or a falling BP associated with

clinical signs of shock (pallor, restlessness or

apprehension, increased respiratory and pulse rates)

2. Bright red vaginal bleeding or hemorrhage(blood lossof more than 500 cc)

3. Abnormal abdominal contour

(may be due to uterine rupture orBandls pathological

ring, a condition wherein the musclesat the physiological retraction ring become very tense,

gripping the fetus causing possible fetal distress)

NURSING MANAGEMENT


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NURSING MANAGEMENT

DURING LABOR

Administration of Analgesics. Narcotics are the most commonly used analgesics,

specifically Demerol (meperidine hydrochloride).

Demerol acts to suppress the sensory portion of thecerebral cortex. A dose of 25-100 mg is given and ittakes effect within 20 min when the patient experiencesa sense of well being and euphoria.

Demerol, being also an antispasmodic, should not begiven very early in labor because it will retard laborprogress. It should not also be given when delivery isless than an hour away because it can cause respiratorydepression in the newborn. It is , therefore, preferablygiven when cervical dilatation is around 5-8 cm.

NURSING MANAGEMENT


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NURSING MANAGEMENT

DURING LABOR

Administration of Anesthetics.

Regional anesthesia is preferred over any other

form because it does not enter the maternal

circulation and therefore does not retard labor

contractions nor cause respiratory depression in thenewborn.

NURSING MANAGEMENT


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NURSING MANAGEMENT

DURING LABOR

Transfer of Patients.

A sure sign that the baby is about to be born is the

bulging of the perineum. In general, multiparas are

transported to the delivery room when cervicaldilatation is about 7-9 cm, while primiparas are

transferred to the delivery room at full dilatation with

perineal bulging when crowning is taking place.

NURSING MANAGEMENT


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NURSING MANAGEMENT

DURING DELIVERY

Positioning on the Delivery Table. When positioning the woman on lithotomy on the

delivery table, the legs should be put up slowly at thesame time on the stirrups in order to prevent trauma tothe uterine ligaments and backaches or leg cramps. The

same should be done when putting the legs down fromthe stirrups after delivery.

Bearing Down Technique.

At the beginning of a contraction, the woman is asked totake two short breaths, then to hold her breath and beardown at the peak of contraction. She should also be toldto use blow-blow breathing pattern to prevent pushingbetween contractions.

NURSING MANAGEMENT


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NURSING MANAGEMENT

DURING DELIVERY

Care of the Episiotomy Wound. Episiotomy, a perineal incision done to facilitate the birth

of the baby, is made by the doctor primarily to preventlacerations. No anesthesia is necessary duringepisiotomy b/c the pressure of the fetal presenting part

against the perineum is so intense that the nerveendings for painare momentarily deadened(natural anesthesia).

Breathing Technique.

As soon as the head crowns, the woman is instructednot to push any longer because it can cause rapidexpulsion of the fetus. Instead, she should be advised topant (rapid and shallow breathing).

NURSING MANAGEMENT


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NURSING MANAGEMENT

DURING DELIVERY

Ritgens Maneuver.a) Support the perineum during crowning by applying

pressure with the palm against the rectum. This will notonly prevent lacerations of the fourchette but will alsobring the fetal chin down the chest so that the smallestdiameter of the fetal head is the one presented at thebirth canal.

b) in order to prevent rapid expulsion of the fetus whichcould result not only in lacerations, abruptio placenta,and uterine inversion but also to shock because ofsudden decrease in intra abdominal pressure, the head

should be pressed gently while it slowly eases out.

Time of Delivery.

Take note of the time the baby is delivered.

NURSING MANAGEMENT


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NURSING MANAGEMENT

DURING DELIVERY

Handling of the Newborn. Immediately after delivery, the newborn should be held below

the level of the mothers vulva so that blood from the placentacan enter the infants body on the basis of gravity flow.

The newborn should be held with his head in a dependent

position to allow drainage of secretions. A newborn is never stimulated to cry unless he has been

drained of his secretions because he can aspirate thesesecretions into his lungs. The newborn shouldbe immediately wrapped in a clean diaper to keep him warmbecause chilling increases the bodys need for oxygen.

He should then be placed on his mothers abdomen so thatthe weight of the baby can help contract the uterus; a noncontracted uterus can lead to death due to hemorrhage

NURSING MANAGEMENT


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NURSING MANAGEMENT

DURING DELIVERY

Cutting of the cord.

Cutting of the cord is postponed until pulsations

have stopped because it is believed that 50-100

ml of blood is flowing from the placenta to the

newborn at this time. It is then clamped twice, an inch apart, and cut in

between.9.Initial Contact. Maternal-infant bonding

is initiated as soon as the mother has eye-to-eye

contact with her baby. The mother is informed of her babys sex and

helped to hold and inspect her baby if she wishes.


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NURSING DIAGNOSIS

Fear r/t uncertainty about the outcome of thebirth process

Acute Pain r/t uterine contraction, cervical

dilatation and fetal descent

Health seeking behaviors: Information about thefetal monitor r/t an expressed desire tounderstand equipment used

Readiness for enhanced family processes r/topportunity to incorporate newborn into thefamily


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Severe bradycardia- FHR less than 80 bpm

Persistent severe bradycardia- severe bradycardiathat persists for longer than 5 minutes

Accelerations-FHR increases than 15 bpm for morethan 15 seconds

Appear as smooth patterns on electronic fetalmonitoring is good indicators of fetal well-being

Triggered in the normal mature fetus by fetalbody motions, sounds stimulations of the fetal scalpand other stimuli Early decelerations are normaland common


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Deceleration pattern matches the contractionwith the most deceleration occurring at the peak

of the contraction FHR rarely goes below 100 bpm.

Cause: head compression during uterine

contraction

Late decelerations

Decrease in FHR from the baseline rate with a lag

time of greater than 20 seconds from the peak of

contraction

First appear at or after the peak of the uterine


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First appear at or after the peak of the uterine

contractions. The FHR improves only after the

contraction has stopped.

May be mild or severe based on how low the FHRgoes and how long it takes for the FHR to recover

Caused by reduced blood flow to the uterus and

placenta during contraction

Associated withuteroplacental insufficiency and is a consequence o

f hypoxia and metabolic abnormalities Variable

deceleration


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Common type of FHR deceleration in labor

Cause by umbilical cord compression

Significance depends on how low the heart ratedrops and how long the episode lasts

Classified severe if they last more than 60 seconds

or to a FHR of less than 90 bpm

NURSING MANAGEMENT


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NURSING MANAGEMENT

DURING DELIVERY

Interventions for late or variable decelerationslasting more than 60 seconds:

1.Reposition the patient

2.Administer oxygen by face mask

3.Discontinue oxytocin

4.IV fluids to increase maternal volume

5.Notify physician

6.Vaginal exam to check for prolapsed of cord7.Prepare for emergency caesarean section

TYPES OF CHILDBIRTH


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TYPES OF CHILDBIRTH

Vaginal delivery

A natural process that usually does not require

significant medical intervention

NSVD- normal spontaneous vaginal delivery

TYPES OF CHILDBIRTH


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TYPES OF CHILDBIRTH

Forceps delivery- vaginal delivery with theuse of obstetric forcep (an instrumentdesigned to extract thebabys head)

Indications

Uterine inertia or poor uterine contraction and the second stagehasgone pass two hours

Face presentation; OA in flat pelvis, OP position

Relative CPD

Cardiac and pulmonary disorders of the mother, maternal

exhaustion

Late deceleration pattern, excessive fetal movement, meconium stained in cephalic presentation

TYPES OF CHILDBIRTH


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TYPES OF CHILDBIRTH

Leboyer method

Postulated that moving from a warm, fluid-filled

intrauterine environment to noisy air filled, brightly lit

birth room creates a major shock for newborn

He proposed that birthing room should be darkened,kept pleasantly warm, soft music is played, infant is

gently handled, cord is cut late and placed immediately

into a warm water bath

Advantage: ideal for most birthing institution

Disadvantage: warm bath could reduce spontaneous

respiration and high level of acidosis;

late cutting of the cord causes excess blood viscosity in

newborn


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TYPES OF CHILDBIRTH

Hydrotherapy and Water Birth

Baby is born underwater and immediately brought

to the surface for a first breath

Advantage: reduce discomfort in labor

Disadvantage: Contamination of bath water with

feces expelled, Aspiration of bath water by fetus:

pneumonia, Maternal chilling, Uterine infections-

pushing efforts in 2nd stage of labor


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TYPES OF CHILDBIRTH

Caesarean birth Latin word caedore means to cut

Birth accomplished through abdominal incision intothe uterus, after 28 weeks AOG

Emergency procedure (under general anesthesia)or elective procedure (under spinal)

Indications :CPD, Placenta previa, Abruptionplacenta, Malpresentation or malposition,Preeclampsia/eclapmsia, Previous CS, Cervical

dystocia, Cancer of the cervixFetal distress, Cordprolapsed,

Other factors: poor obstetrical history, vaginoplasty,vesico-vaginal fistula


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TYPES OF CHILDBIRTH

Complications

Uterine rupture in subsequent pregnancy

Postop infection

Injury to urinary system

Injury to uterine vessels

Embolism


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TYPES OF CHILDBIRTH

Types of CAESAREAN DELIVERY

Classic caesarean section- Incision made vertically

through the abdominal skin and uterus

Advantage: incision is made high on the uterus to

avoid cutting the placenta and be used withplacenta previa

Disadvantage:

Leaves a wide skin scar

Scar could rupture during labor and not be able to

have a subsequent vaginal birth


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TYPES OF CHILDBIRTH

Low segment incision Lower segment transverse caesarean section (LSTCS)

Made horizontally across the abdomen over the cervix

Referred to as pfannesteil incision or bikini incision

Advantage: Less likely to rupture in subsequent labours

Less blood loss- easier to suture

Decrease postpartal infections

Less possibility of GI complications

Disadvantage:

Longer procedure

No assurance for small skin incision and small uterineincision.


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THEEND

intra partum

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