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Intrapartum

Reproduction: Intrapartum

QuestionAnswer
Intrapartum Period starts at onset of contractions and extends to the first 1-4 hours after birth of the neonate and delivery of the placenta
Premonitory/Preliminary Signs of Labor -Cervical changes (cervical softening, possible cervical dilation) -Lightening -Increased energy level (nesting) -Braxton hicks contractions
True Signs of Labor -Bloody show -Spontaneous rupture of membranes, painful contractions, effacement and dilation
Critical Factors Affecting Labor and Birth -Powers (contractions) -Passageway (birth canal: pelvis & soft tissues) -Passenger (fetus and placenta) -Psychological response (mom's emotional state)
Additional Factors Affecting the Labor Process -Philosophy (low-tech, high-touch) -Partners (support caregivers) -Patience (natural timing) -Patient preparation (childbirth knowledge base) -Pain control (comfort measures)
Factors Determining Fetal Presentation ALPPPS -Attitude -Lie -Presentation -Presenting part -Position -Station
Attitude -Flexion: normal attitude (head flexed down with chin to chest) -Extension: abnormal attitude (head extended back)
Lie Relationship of fetal spine to maternal spine -Longitudinal: normal lie, both spines are parallel -Transverse: both spines form cross, c-section required -Oblique: the fetal spine is at angel to the bony inlet and no palpable fetal part is presenting
Presentation -Cephalic (head): vertex, brow, face (mentum), sinciput -Breech (butt): Frank, cull/complete, footling, kneeling, incomplete -Shoulder: all transverse lies are considered shoulder
Presenting Part The term used describe which part of the baby will lead the way out of the birth canal -Head -Shoulder -Side -Foot -Abdomen
Position Used to describe baby position in relation to mom -Right or Left -Presenting part -Anterior or posterior
Landmarks -Occiput: back of the head (most common presenting part) -Scapula -Sacrum -Mentum: chin
Most common position - Left occiput anterior (LOA)
Station How far down the baby is in the birth canal in relation to mom's ischial spine -Ischial spine is 0 -Negative #s mean baby is farther inside (-1, -2) -Positive #s means baby is closer to delivery (+!, +2) -Station +4 known as crowning
Engagement When the presenting part of the fetus passes into the pelvis to the point where, in cephalic presentation, the fetal head is at the ischial spine (0 station)
Descent When the head passes the ischial spine and moves into the pelvic inlet
Internal Rotation Consist of a turning of the head in such a manner that the occiput gradually moves toward the symphysis pubis anteriorly
External Rotation (Restitution) Corresponds to the rotation of the fetal body and serves to bring its bisacromial diameter into the relation with the AP diameter
First Stage of Labor -Cervical dilation (ends at 10 cm) -Longest of all stages -Three phases: latent phase, active phase, transition phase
Second Stage of Labor -Cervix is dilated to 10 cm -Ends with delivery of the fetus
Third Stage of Labor -Starts immediately after baby is born -Placental separation -Ends with placental expulsion
Fourth Stage of Labor -Begins after delivery of placenta -1 to 4 hours following delivery -Monitor for hemorrhage, bladder distention, and venous thrombosis
Physiological Responses to Labor -^ heart rate, cardiac output, BP -^WBC count -^RR and O2 consumption -Decrease gastric motility, gastric emptying -Muscle aches/cramps -^BMR -Decrease blood glucose levels
Variable Deceleration An abrupt visual decrease in the FHR by at least 15 bpm that lasts >15 seconds <2 mins and not associated to contractions -Cord Compression
Early Deceleration Gradual visual decrease from and return of the FHR to baseline associated with a uterine contraction that matches the contraction -Head Compression
Accelerations Abrupt visual increase in the FHR; Represents adequate fetal oxygenation -Okay!
Late Decelerations Gradual visual decrease from and return to baseline associate with uterine contraction, but lowest point of the deceleration occurs after the peak of contraction -Placental insufficiency
Created by: NikkiLeigh83
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