Normal Intrapartum

  • View
    14

  • Download
    0

Embed Size (px)

DESCRIPTION

Normal Intrapartum

Text of Normal Intrapartum

  • LABOR

  • THEORIES ON THE ONSET OF LABOR

    Progesterone - Estrogen Ratios Oxytocin Stimulation

    Prostaglandins

    Fetal Cortisol level increase

    Uterine Distention- cervical pressure

  • Four Ps

    P PASSAGE

    PPASSENGER

    PPOWER

    PPSYCHE

  • PASSAGE (The Pelvis)

    False PelvisTrue Pelvis Pelvic inlet Mid pelvis Pelvic outlet Dilatation and EffacementStations

  • Pelvis Types

    Gynecoid - most common for NSVD

    Android - increased use of forceps/vacuum

    Anthropoid - common OP position

    Platypelloid - common for C/S

  • PASSENGER (The Fetus)

    Fetal HeadFetal AttitudeFetal LieFetal PresentationFetal Position

  • PassengerFetal attitude: relationship of fetal parts to maternal uterus and pelvisFlexion (ideal)Extension: labor will be more difficultLie: relationship of fetal spine to maternal spineLongitudinal (cephalic or breech)Transverse (c-sec)

  • Passenger cont

    Fetal presentation: part of fetus closest to cervixCrown of the head: occiputChin: mentumShoulder: scapulaBreech: sacrum

  • Passenger contdFetal position: relationship of presenting part to the four quadrants of maternal pelvis; right/left, anterior/posterior quadrantsFirst letter: mothers right or left (R, L)Second letter: fetal presenting part (O, S, M, Sc)Third letter: mothers anterior, posterior, or transverse (A,P,T)

    ****ideal position: ROA or LOA

  • POWER(The Forces of Labor)

    Primary Forces-Uterine ContractionsFrequencyDurationIntensity Secondary Forces Abdominal musclesPerineal musclesPelvic floor muscles

  • PSYCHE(The Patients Psychological State)

    PSYCHE

    Motivation for the pregnancyChildbirth EducationSense of Mastery, Self esteemPositive Relationship with MateMaintaining ControlSupport System during LaborNot Being Alone during LaborTrust in Medical Personnel

  • SIGNS /SYMPTOMS OF LABORBackache

    Nausea/Vomiting

    Indigestion

    Diarrhea Cervical changes

    Bloody Show

    Rupture of membranes

    Sudden burst of energy

  • 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)

  • Stages of LaborSecond 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

  • CARDINAL FETAL MOVEMENTSENGAGEMENT

    DESCENT

    FLEXION

    INTERNAL ROTATION

    EXTENSION

    RESTITUTION

    EXTERNAL ROTATION

    EXPULSION

  • Labor AnalgesicsDemerol, Stadol, Nubain Maternal Side Effects: Respiratory Depression Nausea/Vomiting Drowsiness, Dizziness Fetal Side Effects: Respiratory Depression Lethargy

  • Poor fetal heart tonesMaternal respiratory depressionKnown allergy Nursing ImplicationsMonitor fetal and maternal responseAdminister narcan/ naloxone prn - Route, dose Contraindications

  • Anesthesia for Labor

    Regional AnesthesiaEpiduralSpinalPudenalLocal

  • General AnesthesiaAdvantages Faster accessDisadvantagesNo support personDiscomfort to motherAnesthesia for Labor

  • Nursing ResponsibilitiesFor EpiduralsBolusBaseline vital signs and lab work availableEnsure client has an empty bladderPosition the patientOngoing monitoring of mother and babyFor General As aboveCricoid pressure

  • Pitocin/Oxytocin

    UsesTo induce / augment laborTo stimulate contractions after birth

  • Contraindications

    Prone to uterine ruptureCephalopelvic disproportionMalpresentationPresence of fetal distressPreterm infant

  • Side Effects

    Abruptio placentaWater intoxicationFetal hypoxiaHistory of rapid labor and/or birthUterine rupture

  • Fetal MonitoringExternal MonitoringTocodynameterUltrasoundInternal MonitoringIUPCFSE

  • Fetal MonitoringBaselineTachycardia >160 bpmBradycardia
  • *When head is at 0 station, the head is referred to as engaged.*Passenger: consists of fetus and placenta *Vertex: is when head is flexed*ROA: right occiput anterior or left occip ant.*