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INTRAPARTUM
Submitted by:
Josue, Reinier Hannah F.
Joven, Ernesto Steven Domingo U.
Jugo, Kate Guillan A.
Jurado, Carmella Expectacione P.
Lavadia, Dorothy Rose D.
Legaspi, Andrea Ceejay E.
Lerma, Maria-Jayne B.
Libunao, Camille Grace B.
Licas, Lexin Louie T.
Ligon, Charles Justine P.
Guevarra, Suina Mari
4 NUR-5
Submitted to:
Ma’am Cecilia Buenaflor
on
November 22, 2018
COMPONENTS OF THE BIRTH PROCESS
4 P’s OF LABOR
1. POWER
Uterine contractions (Involuntary)
During the first stage of labor (onset to full cervical dilation) uterine contractions are the
primary force that moves the fetus through the pelvis.
Maternal Pushing Efforts (Voluntary)
During the second stage of labor (full cervical dilation to birth of the baby), uterine
contractions continue to propel the fetus through the pelvis. In addition, the woman feels
an urge to push and bear down as the fetus distends her vagina and puts pressure on her
rectum. The woman her voluntary pushing efforts to the force of uterine contractions in
the second-stage labor.
CASE:
-Contractions and additional efforts helps for pushing. Contractions need to be strong enough to
dilate the cervix and aid the baby in his decent. They need to be at regular intervals, moving
closer together and increasing in strength throughout labor.
-Uterine contractions may be infrequent, hypotonic, or uncoordinated such that they are unable
to dilate the cervix.
-Maternal exhaustion that can result in ineffective maternal expulsive efforts in the second stage.
-Ineffective maternal pushing effort
2. PASSAGE
The birth passage consists of the maternal pelvis and soft tissues
The bony pelvis is usually more important to the outcome of labor than the soft tissues
because the bones and joints do not readily yield to the forces of labor.
The linea terminalis (pelvic brim) divides the bony pelvis into:
False pelvis (top) – provides support for the internal organs and the upper part of the
body
True pelvis (bottom)
-Inlet (upper pelvic opening) – T (13.5 cm); AP (11.5 cm or <)
-Midpelvis (pelvic cavity) – narrowest part; T (10.5 cm); AP (12 cm)
-Outlet (lower pelvic opening) – T (11 cm); AP (9.5-11 cm); PS (11 cm); functions like a
curved cylinder with different dimensions at different levels.
CASE:
-Possible prominent ischial spines or a narrow pubic arch that may impede progressive descent
of the fetus.
-Cephalopelvic disproportion - disparity between the pelvic architecture or size and the fetal
head that precludes vaginal delivery.
-Failure of engagement
3. PASSENGER
The passenger is the fetus, membranes, placenta, blood and amniotic fluid
Fetal Head (Transverse Diameter):
Biparietal – 9.5 cm
Bitemporal – 8 cm
Bimastoid – 7 cm
Occipitofrontal – 12 cm
Occipitomental – 13.5 cm
Suboccipitobregmatic – 9.5 cm
Submentobregmatic – 9.5 cm
Suboccipitomental – 13.5 cm
Variations in the Passenger:
Fetal Lie – longitudinal (96%), transverse (3%), oblique (1%)
Fetal Attitude – flexion; “C shaped”
Fetal Presentation:
- Cephalic – vertex, military, brow and face
- Breech – full, footling and frank
- Shoulder
Fetal Position:
- 1st letter – Right (R) or Left (L)
- 2nd letter – Occiput (O), Mentum (M), Sacrum (S) or Scapula (SC)
- 3rd letter – Anterior (A, Posterior (P) or Transverse
CASE:
-Large for Gestational Age baby
-Fetal malpresentation or malposition.
-The baby needs to be positioned properly to make it through the pelvis.
-The optimal position for birth is Occiput Anterior (OA).
4. PSYCHE
A woman’s psychological response to labor and birth are influences by:
Anxiety – Maternal catecholamines are secreted in response to anxiety and fear can
inhibit uterine contractility and placental blood flow
Culture and Expectations – A woman’s culture affects her values, expectations for and
responses to birth and the practices surrounding it.
Life experiences – Childbirth is a physical and emotional experience. The woman’s past
experiences with childbirth, pain, personal success and failure will influence her
expectations for this birth
Support – It includes physical comfort measures, providing information, advocacy, praise
and reassurance, presence and the maintenance of a calm and comfortable environment.
CASE:
-The mother might possible is afraid, tense, stressed out, angry, feels unsafe or unsupported
during birth.
-A good emotional state helps mom to: (1) cope with the pain effectively; (2) tune in to her body;
(3) guide her to her baby’s needs and allows the other 3 P’s to sync up effectively.
- It is diagnosed when there has been no change in cervical dilation for at least 2 hours.
- Stage 1 (Dilation) Active phase arrest
o Cervix is dilated to >6cm
o Prolonged/protracted if cervical dilation is <1.2cm/hour (primipara) or
1.5cm/hour (multipara)
o Arrest if no cervical change in > 4 hours with adequate contractions or > 6 hours
with inadequate contractions
Treatment
- Amniotomy: it is a procedure performed to release fluid from the amniotic sac to induce
labor during childbirth.
- Oxytocin: Increases contraction strength and frequency; administer until contractions
deemed adequate by frequency, intensity and duration measures
o If mother does not respond to oxytocin Cesarean Section
- Morphine: if hypertonic contractions
Contracted Pelvis
- A contracted pelvis may be defined as one in which there is alteration in the size and
shape of the pelvis of sufficient degree so as to alter the normal mechanism of labor in
an average size baby.
SCIENTIFIC
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATIO
RATIONALE
N
Objective: Risk for Dystocia refers After This will be helpful in After
maternal to difficult labor administration identifying possible causes, administration
injury related which is usually of nursing needed diagnostic studies, of nursing
VS as follows: to mechanical due to uterine interventions, Review the history of and appropriate interventions,
obstruction to dysfunction, the client will labor, onset, and interventions. the client
fetal descent fetal manifest: duration. manifested:
malpresentation
-HR: 110-
or abnormality
120/min A rigid or unripe cervix will
or pelvic
-cervix dilation not dilate, impending fetal -cervix dilation
-RR: 24/min abnormality.
at least 1.2 descent/labor progress. at least 1.2
cm/hr for Note the condition of Development of amnionitis cm/hr for
-T: 38 degrees
primipara, 1.5 cervix. Monitor for signs is directly related to length primipara, 1.5
celcius
cm/hr for of amnionitis. Note of labor, so that delivery cm/hr for
multipara in elevated temperature or should occur within 24 hr multipara in
active phase, WBC; odor and color of after rupture of membranes. active phase,
(+) ruptured bag with fetal vaginal discharge. with fetal
of water descent at least descent at least
1 cm/hr for 1 cm/hr for
Excess maternal exhaustion
primipara, 2 primipara, 2
contributes to secondary
(+) thinly stained cm/hr for cm/hr for
dysfunction, or may be the
meconium multipara. Evaluate the current level multipara.
result of prolonged
discharge/vagina of fatigue, as well as labor/false labor.
activity and rest prior to
onset of labor.
For *E* CS These indicators of labor
delivery progress may identify a
contributing cause of
Note effacement, fetal prolonged labor.
station, and fetal
presentation.