Intrapartum (Pre) Labor and Delivery Process

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dsherman
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119786
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Intrapartum (Pre) Labor and Delivery Process
Updated:
2011-11-30 14:35:29
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Pre Labor Delivery Process
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Intrapartum (Pre)Labor and Delivery Process
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  1. Physiologic changes preceding labor (permonitory signs)
    • Backache: a constant low, dull backache, caused by pelvic muscle relaxation
    • Weight losss: a 0.5 to 1kg (1 to 3 lbs) Lightening: more prominate in primigravida (first baby)
    • Contractions: begin with irregular uterine contractions (Braxton Hicks) that eventually progress in strength and regularity
    • Bloody show: brownish or blood-tinged mucus discharge caused by expulsion of the cervical mucus plug resulting from the oset of cervical dilation and effacement
    • Energy burst: sometimes called the nesting response
    • Gastrointestinal changes: less common include nausea, vomiting, and indigestion
    • Rupture of membranes: spontaneous rupture of membranes can initiate labor or can occur anytime during labor, most commonly during the transition phase
  2. Lightening
    • *fetal head descends into true pelvis about 14 days fefor labor
    • *feeling that the fetus has dropped
    • *easier breathing, but more pressure on bladder, resulting in urinary frequency *more pronounced in patient's who are primigravida (first baby)
  3. Rupture of membranes (Intrapartum)
    • *Labor usually occurs within 24 hrs.
    • *prolonged period befor delivery greater than 24 hrs increases the risk for infection
    • *Immediately following the rupture of membranes, a nures should assess the FHR for abrupt decelerations, which would indicate fetal distress and also rule out umbilical cord prolaps
  4. Assessment of amniotic fluid (completed once the membranes have ruptured)
    • Color should be pale to straw yellow
    • odor should not be foul
    • clarity should appear watery and clear
    • volume is between 500-1,00 ML

    Nitrazine paper should be used by a nurse to test fluid to comfirm that it is amniotic fluid

  5. Nitrazine test
    • test the pH of the amniotic fluid
    • *Deep blue (6.5-7.5 pH) indicates fluid that is alkaline
    • *if the fluid remains yellow, this indicates slight acicity because the fluid is urine
  6. The five "P's" that affect and define the labor and birth process
    • Passegner
    • Passageway
    • Powers
    • Position
    • Psychologic response
  7. Passenger
    • the fetus and placenta
    • *the size of the fetal head, fetal presentation, lie, position and attitude affect the ability of the fetus to navigate the birth canal
    • *the placenta is considered a passenger because it must also pass through the birth canal
    • *Lie: relationship of the maternal longitudinal axis (spine) to the fetal longitudinal axis (spine)
    • *Transverse- horizontal and will not
    • accomidate vaginal birth (the sholder
    • is the presenting part and may require
    • C-section)
    • *Parallel or longitudinal-parallel to
    • maternal long axis, either a cephalic
    • or breech presentation and will
    • accomidate vaginal birth (breech may
    • require C-section)
    • Attitude- relationship of fetal body parts to one another
    • *fetal flexion- chin flexed to chest,
    • extremities flexed into torso
    • *fetal extension- chin extended away
    • from chest, extremities extended
    • *Presentation
    • *fetal postion
    • *station
  8. Passageway
    Cervix must dilate and efface in response to contractions and fetal descent
  9. Powers
    uterine contreactions cause effacement and dilation of the cervix and decent of the fetus. Involentary urge to push and voluntary bearing down in the second stage of labor helps in the expulsion of the fetus
  10. Position
    • *The patient should engage in frequent postion changes during labor to increase comfort, relieve fatigue, and promote circulatio.
    • *Position the second stage is determined by maternal preference, physician preference, and the condition of the mother and the fetus
    • *Gravity can aid in the fetal decent in upright, sitting, kneeling, and squatting positions
  11. Psychological Response
    maternal stress, tension, and anxiety can produce physiological changes that impair the progress of labor
  12. Leopold maneuvers
    abdominal palpation of the number of fetuses, the fetal presenting part, lie, attitude, descent, and the probable location where fetal heart tones may be best ausculated on the woman's abdomen
  13. External electronic monitoring (tocotransducer)
    • seperate transducer applied to the maternal abdomen over the fundus that measures uterine activity
    • *displays uterine contraction patterns
    • *easily applied by the nurse, but must be repositioned with maternal movement of assure proper placement
  14. External fetal monitoring (EFM)
    transducer applied to the abdomen of the patient to assess FHR patterns during labor and birth
  15. Laboratory test during pre labor and dilivery
    • Urinalysis-clean catch urine samples obtained to ascertain maternal:
    • *hydration status via specific gravity
    • *nutritional status via keytones
    • *proteinuria, which is indicative of pregnancy-induced hypertention
    • *urinary tract infection via bacterial count
    • *Beta-strep culture to check for streptococcus B-hemolytic, Gorup B

    • Blood test:
    • Hct level
    • ABO blood typing and Rh factor if not previously done
  16. Patient education during pre labor and dilivery process
    provide the patient and the patients support with ongoing education regarding the labor and delivery process and procedures

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