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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FETAL ATTITUDE(CONT..)
MODERATE ATTITUDE- if
chin is not touching the
chest but is in alert ormilitary position.
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FETAL ATTITUDE(CONT..)
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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PREMONITORY/PRELIMINARY/
PRODROMALSIGNSOFLABOR
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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PREMONITORY/PRELIMINARY/
PRODROMALSIGNSOFLABOR
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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PREMONITORY/PRELIMINARY/
PRODROMALSIGNSOFLABOR
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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PREMONITORY/PRELIMINARY/
PRODROMALSIGNSOFLABOR
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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PREMONITORY/PRELIMINARY/
PRODROMALSIGNSOFLABOR
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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STAGEOF DILATATION (FIRST STAGE)
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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STAGEOF DILATATION (FIRST STAGE)
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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THIRD STAGE (PLACENTAL EXPULSION)
Signs of Placental Separation
uterus becoming globular (calkins sign)
Fundus rising in abdomen
gushing of blood Lengthening of the cord
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THIRD STAGE (PLACENTAL EXPULSION)
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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THIRD STAGE (PLACENTAL EXPULSION)
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.
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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).
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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.
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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
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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
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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
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