normal intrapartum
DESCRIPTION
Normal IntrapartumTRANSCRIPT
![Page 1: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/1.jpg)
LABOR
![Page 2: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/2.jpg)
![Page 3: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/3.jpg)
THEORIES ON THE ONSET OF LABOR
Progesterone - Estrogen Ratios
Oxytocin Stimulation
Prostaglandins
Fetal Cortisol level increase
Uterine Distention- cervical pressure
![Page 4: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/4.jpg)
Four P’s
P PASSAGE
P PASSENGER
P POWER
P PSYCHE
![Page 5: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/5.jpg)
PASSAGE (The Pelvis)
False Pelvis True Pelvis
Pelvic inletMid pelvisPelvic outlet
Dilatation and Effacement Stations
![Page 6: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/6.jpg)
Pelvis Types
Gynecoid - most common for NSVD
Android - increased use of forceps/vacuum
Anthropoid - common OP position
Platypelloid - common for C/S
![Page 7: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/7.jpg)
![Page 8: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/8.jpg)
![Page 9: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/9.jpg)
![Page 10: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/10.jpg)
![Page 11: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/11.jpg)
PASSENGER (The Fetus)
Fetal Head Fetal Attitude Fetal Lie Fetal Presentation Fetal Position
![Page 12: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/12.jpg)
![Page 13: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/13.jpg)
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)
![Page 14: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/14.jpg)
Passenger con’t…
Fetal presentation: part of fetus closest to cervix Crown of the head: occiput Chin: mentum Shoulder: scapula Breech: sacrum
![Page 15: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/15.jpg)
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
![Page 16: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/16.jpg)
![Page 17: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/17.jpg)
![Page 18: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/18.jpg)
![Page 19: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/19.jpg)
POWER(The Forces of Labor)
Primary Forces-Uterine Contractions Frequency Duration Intensity
Secondary Forces Abdominal muscles Perineal muscles Pelvic floor muscles
![Page 20: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/20.jpg)
![Page 21: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/21.jpg)
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
![Page 22: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/22.jpg)
SIGNS /SYMPTOMS OF LABOR
Backache
Nausea/Vomiting
Indigestion
Diarrhea
Cervical changes
Bloody Show
Rupture of membranes
Sudden burst of energy
![Page 23: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/23.jpg)
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)
![Page 24: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/24.jpg)
![Page 25: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/25.jpg)
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
![Page 26: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/26.jpg)
![Page 27: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/27.jpg)
CARDINAL FETAL MOVEMENTS
ENGAGEMENT
DESCENT
FLEXION
INTERNAL ROTATION
EXTENSION
RESTITUTION
EXTERNAL ROTATION
EXPULSION
![Page 28: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/28.jpg)
![Page 29: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/29.jpg)
Labor Analgesics Demerol, Stadol, Nubain
Maternal Side Effects:Respiratory DepressionNausea/VomitingDrowsiness, Dizziness
Fetal Side Effects:Respiratory DepressionLethargy
![Page 30: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/30.jpg)
Poor fetal heart tones Maternal respiratory depression Known allergy
Nursing Implications Monitor fetal and maternal response Administer narcan/ naloxone prn - Route,
dose
Contraindications
![Page 31: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/31.jpg)
Anesthesia for Labor
Regional Anesthesia Epidural Spinal Pudenal Local
![Page 32: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/32.jpg)
![Page 33: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/33.jpg)
General Anesthesia Advantages
Faster access Disadvantages
No support person Discomfort to mother
Anesthesia for Labor
![Page 34: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/34.jpg)
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
![Page 35: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/35.jpg)
Pitocin/Oxytocin
Uses To induce / augment labor To stimulate contractions after birth
![Page 36: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/36.jpg)
Contraindications
Prone to uterine rupture Cephalopelvic disproportion Malpresentation Presence of fetal distress Preterm infant
![Page 37: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/37.jpg)
Side Effects
Abruptio placenta Water intoxication Fetal hypoxia History of rapid labor and/or birth Uterine rupture
![Page 38: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/38.jpg)
Fetal Monitoring External Monitoring
Tocodynameter Ultrasound
Internal Monitoring IUPC FSE
![Page 39: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/39.jpg)
![Page 40: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/40.jpg)
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
![Page 41: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/41.jpg)
![Page 42: Normal Intrapartum](https://reader035.vdocuments.net/reader035/viewer/2022062223/563db9dc550346aa9aa09b1a/html5/thumbnails/42.jpg)