Intrapartum Processes

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  1. Period of pregnancy that begins with onset of regular uterine contractions lasting until delivery of fetus and the placenta
    Intrapartum Period
  2. Uterine Contractions that lead to effacement and dilation of the cervix
    Labor (Parturition)
  3. Hollow muscular organ located in the female pelvis between the bladder and rectum
  4. Produce the eggs that travel through fallopian tubes
  5. Main function of the uterus
    nourishment of the developing fetus prior to birth
  6. Upper/Back portion of the uterus
  7. Part of the cervix that dilates first
    External os
  8. Part of the cervix that we use to measure dilation during labor
    Internal Os
  9. "Trigger of Labor" that releases with uterine muscles stretching, used in synthetic form to induce labor
    • Prostaglandin Hormone 
    • (Maternal Factor)
  10. "Trigger of Labor" that releases from the pituitary, stimulating UCs when cervical pressure occurs after nerve plexus stimulation
    • Oxytocin Hormone
    • (Maternal Factor)
  11. Oxytocin is released from the _____
  12. "Trigger of Labor" that increases stimulation of uterine response
    • Estrogen Hormone
    • (Maternal Factors)
  13. "Trigger of Labor" that decreases during labor (withdraws the "quieting" uterine)
    • Progesterone Hormone
    • (maternal factor)
  14. Maternal "Triggers of Labor"
    • Prostaglandin
    • Oxytocin
    • Estrogen
    • Progesterone
  15. Fetal "Triggers of Labor"
    • Placenta Aging
    • Prostaglandin Hormone
    • Fetal Cortisol
  16. "Trigger of Labor" leading to deterioration and triggers Uterine Contractions
    Placental Aging
  17. Trigger of Labor synthesized by fetal membranes and uterine decidua (lining) that stimulate UCs and breaks water
    Prostaglandin Hormone
  18. Trigger of Labor produced by the fetal adrenals that elevate and act on placenta...reduces progesterone and increases prostaglandin to stimulate uterine contractions
    Fetal Cortisol
  19. A "later miscarriage" is usually due to:
    fetus or uterus problems
  20. Early miscarriages are usually due to:
    deficient progesterone levels (within the first 13 weeks)
  21. Estrogen and Progesterone are _____ related
  22. Progesterone should stay ____ throughout the 1st trimester; during labor it ______ as estrogen ______
    Constant;  Decreases;  Increases
  23. When "stripping of the membrane" occurs, it stimulates:
  24. The intiation of labor is thought to be a complex interplay between the ______, ____, and _____
    Mother Fetus and Placenta
  25. It is thought that the fetus may coordinate myometrial activity through its influence on:
    • Placental Steroid Hormone Production
    • Mechanical Distention of the Uterus
    • Secretion of Neurohypophysial hormones and other stiumlators of prostaglandin synthesis via the activation of the fetal HPA axis
  26. The initiation of normal term parturition is the result of:
    an intricate interplay between the maternal, fetal, and placental endocrine, paracrine and autocrine systems...It involves complex positive and negative feedback systems, up and down regulation of cellular receptor sites, and dynamic chemical messenger systems...A cascade of events culminates in eventual maturation of the fetus and maternal uterine tissues and subsequent initiation of the labor process
  27. Image Upload
    Labor Initiation (Onset)
  28. 5 Ps of Labor
    • Powers
    • Passage
    • Passenger
    • Psyche
    • Position
  29. "P" relating to the contractions (involuntary) and pushing/"bearing down" (voluntary -> the cue)
  30. Involuntary Powers
    Uterine Contractions
  31. Uterine muscle where contractions and shortening of the cervix occur during the 1st stage of labor
  32. Voluntary Powers
    Pusing/Bearing Down
  33. Voluntary Powers occurs at _____ and combines with UCs to deliver the fetus and placenta
    10cm (full cervical dilation)
  34. Stretch receptors are activated which leads to ______ release; enhanced when contracting abdominal muscles and pushing downward
  35. Reflex that causes the urge to push after fetal presenting part stretches the pelvic floor muscles with full cervical dilation
    Ferguson Reflex
  36. Types of Pushing:
    • Spontaneous Pushing
    • Delayed Pushing
    • Directed Pushing
    • Valsalva Maneuver pushing (holding breath and bearing down)
    • Open Glottis Pushing (yelling and bearing down)
  37. 2 Uterine Segments:
    Upper segment (fundus)-- 2/3 of uterus, allows contractions that push fetus down

    Lower segment-- 1/3 of uterus, composes the cervix, allows for cervical effacement (thinning) and dilation (opening)
  38. Contractions are usually:
    Rhythmic and Intermittent (every 1-3 min)
  39. 3 phases of contraction:
    Increment, Acme, Resting
  40. Contractions will be felt in the ____ first
  41. Every contraction causes ______ml blood from uteroplacental unit transport back into the maternal circulation...This can be very forceful on the body bc mom will have 1 1/2 more times CO to sustain the pregnancy
    500 ml
  42. External Uterine Monitor used to measure UCs: measures frequency, duration and resting tone
    Tocodynameter (Toco)

    • *continuous or intermittent monitoring
    • *cannot measure intensity or uterine pressure (you will have to palpate the uterus to feel how the contractions are)
  43. "Buildup" phase or ascending part of the UC
    Increment Phase
  44. The increment phase of UC starts at ____ and extends _____
    Fundus; Across Uterus
  45. Phase of UC at the peak of intensity (also the shortest part of the contraction)
  46. "Relaxation" phase or descending part of the UC
    Decrement Phase
  47. 3 Descriptors of Contractions
    • Frequency
    • Duration
    • Intensity
  48. From the beginning of one contraction to the beginning of the next contraction is referred to as:
  49. From the beginning of one contraction to the end of the same contraction is referred to as:
  50. A contraction described as Mild, Moderate or Strong is referring to the ____ of the contraction (Strength of the Contraction)
  51. Each large block on the contraction monitor is how long
    1 min/60 sec
  52. Each tiny block inside the big block of the contraction monitor is how long
    10 seconds
  53. Frequency is measured in _____ whereas Duration is measured in _____
    Minutes, Seconds
  54. Cervical Changes that occur in labor:
    • Dilation - enlargement or opening
    • Effacement - shortening or thinning
  55. Full dilation is considered:
    • 10 cm
    • (measures from 0-10)
  56. Effacement is measured on a _____ is a subjective measurement
  57. Image Upload
    Cervical Effacement and Dilation visual
  58. 3 cm dilated is considered to be:
    Early Phase
  59. "P" that refers to The anatomical pelvic structure (ileum, ischium, pubis, sacrum and coccyx)
  60. Shallow upper section of the pelvis
    false pelvis
  61. Lower section of the pelvis that consists of 3 planes: pelvic inlet, midpelvis, and pelvic outlet
    True Pelvis
  62. Soft tissues of the cervix and pelvic floor muscles:
    Vagina, Vaginal introitus (opening)
  63. Stages of labor that make up the "1st P" (power)
    Dilation, Effacement, Contractions
  64. Assessment of the soft tissues of cervix and pelvic floor muscles are examined by:
    manual vaginal exam
  65. What hormones soften the pelvic cartilage and increase elasticity of ligaments, allowing fetal head passage
    Estrogen and Relaxin
  66. We are always assessing to see how close the baby is to the _______
    ischial spine
  67. Usually we can tell around how many weeks to see if the mother's body is responding to pelvic changes enough to deliver baby
    13 weeks
  68. Image Upload
    Pelvic Anatomy
  69. Types of Female Pelvis
    • Gynecoid
    • Android
    • Anthropoid
    • Platypeloid
  70. We want the baby to be in ______ position when delivering
    OA- occipital anterior
  71. Ideal shape of pelvis, with round to slightly oval shape; best chances for normal vaginal delivery
  72. Most common type of pelvis in >50% of women
  73. Typical male pelvic shape, triangular inlet, prominent ischial spines, more angulated pubic arch
  74. A woman with Android shape pelvis is at risk for developing baby in _____ position which puts the baby at risk for bruising bc the nose will hit the pelvic bone
    • OP -- occipital posterior
    • (<30% of women)
  75. Widest shaped pelvis (widest transverse diameter is less than the anteroposterior diameter)... 20% of women (often results in OP position as well)
  76. Flat inlet pelvis with shortened obstetrical diameter...least common type (3% of women)...responsible for a lot of C-sections
  77. Image Upload
    • Female Pelvis Types
    • Gynecoid- most common
    • Android- male
  78. "P" referring to the fetus and its relationship to the pelvis (passageway).
  79. Accounts for largest portion of fetus
  80. Largest transverse measurement and indicator of head size
    Biparietal diameter
  81. Useful to identify the head positioning during vaginal exam
    Cranial suture
  82. Fetopelvic Relationships we need to be aware of
    • Fetal Lie
    • Fetal Attitude
    • Fetal Presentation
    • Presenting Part
    • Fetal Positioning
    • Fetal Station
    • Engagement
  83. Fetal Skull consists of:
    2 parietal bones, 2 temporal bones, Frontal bone and Occipital Bone
  84. Cranial sutures consist of:
    • Lambdoid suture
    • Posterior Fontanel 
    • Sagital Suture
    • Coronal Suture
    • Anterior Fontanel
    • Frontal Suture
  85. Image Upload
    Fetal Skull
  86. Image Upload
    Cranial Sutures
  87. Image Upload
    The widest part of the baby's head is typically 9.5 cm...this is why you MUST be 10 cm dilated
  88. Relationship between the pelvic ischial spines to the fetal presenting part
    • Fetal Station
    • (assists in assessing for fetal descent into the pelvis)
  89. Scoring for Fetal Station
    • -3 = high in pelvis, mom not in labor
    • 0 = narrowest diameter even with the ischial spines
    • 3+ = crowning/delivery
  90. Image Upload
    Fetal Station
  91. Fetal skull ability to change shape to accomodate through pelvis, membranous space between bones and fontanels allows overlapping to occur
  92. Image Upload
    Determining Fetal Position
  93. 3 main fetal presentations
    • Cephalic/Vertex - head first
    • Breech - butt first
    • Shoulder/Transverse - shoulder first
  94. Presentation of baby that occuurs in 96% of pregnancies:
    • Cephalic/Vertex
    • (most common)
  95. Presentation of baby that occurs in 3% of births
  96. Presentation of baby that occurs in only 1% of births
  97. Presentation is determined by:
    presenting part entering the pelvic inlet
  98. specific fetal structure lying closest to cervix
    Presenting part
  99. When the provider tries to move the baby from breech position before doing a c-section (40% of the time)
  100. Major risk for babies presenting with shoulder
    Cord prolapse
  101. Image Upload
    Abnormal presentation of baby
  102. Complete flexion of thighs and legs over only anterior body is considered to be:
    Complete Breech
  103. Complete flexion of thighs and legs is considered to be:
    Frank Breech
  104. Most common type of abnormal presentation is:
    Breech (most likely results in CSection)
  105. Extension of 1 or both thighs and legs is considered
    Footling Breech
  106. Image Upload
    Breech positions
  107. Vertical Lie...Fetal long axis is parallel to maternal long axis
    Longitudinal lie
  108. Horizontal lie...fetal long axis is at right angles to the maternal long axis; fetus CANNOT deliver like this
    Transverse lie
  109. Types of Fetal Attitude
    Flexion and Extension
  110. Allows for the smallest diameters of the fetal head to descend through pelvis "chin to chest"
    Flexion (OA)
  111. partial or complete; larger diameters of the baby's head are presenting; fetus cannot deliver in this position
    • Extension
    • (OP)
  112. Relation of the denominator or reference point to the maternal pelvis
    Fetal Positioning
  113. Fetal Positions are designated by:
    • "Fetal Compass Rose"
    • 1st letter = left or right of maternal pelvis
    • 2nd letter= specific presenting part
    • 3rd letter = relationship of presenting fetal part to maternal pelvis
  114. Image Upload
    • Fetal Compass Rose
    • 1st letter = L or R side of mom
    • 2nd letter= Specific presenting part
    • 3rd letter = relationship of presenting part to maternal pelvis
  115. "P" referring to the response of the woman during labor...maternal satisfaction and experience
  116. Factors influencing woman's coping ability:
    Culture, Expectations, Strong Support System, Type of labor support
  117. Psyche of the mother during labor include:
    • Maternal Satisfaction and experience
    • Childbirth prep (physical, mental, sense of safety)
    • Coordination of collaborative goals (mother and healthcare birth plan)

  118. Avoid cultural stereotypes and use/note ____ instead
    Cultural and Religious preferences
  119. Expectations of childbirth are related to:
    How a woman views her own childbirth experience evolving (natural vs epidural use)
  120. Unrealistic expectations increase:
    anxiety, decreased self-worth, not an "ideal" birth
  121. Support role of a nurse during labor:
    Emotional, Informational, Comfort and Advocacy
  122. ____ may perform quiet birthing
  123. Cultures in which father may not be present in the room during birth, or may not be allowed to touch the woman once blood leakage occurs:
    Orthodox Jewish, Muslim
  124. Cultures that promote women circumcision:
    African and Middle Eastern Cultures
  125. ____ has an effect on both anatomical and physiological adaptations in labor
    Maternal position
  126. Ambulation facilitates _______
    Labor Progression and Fetal Descent
  127. Frequent position changes in labor are associated with:
    reduced fatigue, increased comfort, improved maternal and fetal circulation
  128. most used birthing position in the US
  129. Position that can increase pelvic outlet and align the fetus with pelvic inlet
    Upright position
  130. Premonitory Signs of Labor
    • Lightening
    • Braxton Hicks Contractions
    • Cervical Changes
    • Surge in Energy
    • Gastrointestinal Changes
    • Backache
    • Bloody Show
  131. Fetal descent into the true pelvis, can breathe easier
  132. False Labor,  Irregular uterine contractions NOT causing cervical change
    Braxton Hicks contractions
  133. If pt has Braxton Hicks Contractions, advise pt to
    Get up and walk around, if they go away it is not a true contraction
  134. Cervical changes that occur right before labor
    Cervical Softening/ "ripening" occurs
  135. Many women that have babies in OP position will have
    Back Labor
  136. Urge to put household in order
    surge in energy - nesting
  137. Due to gastrointestinal changes, women may experience a ____lb loss, some may experience n/v, indegestion, and diarrhea
    1-3 pound
  138. Regular UC's intervals increasing in frequency, duration, and intensity
    True Labor
  139. "Irregular" UC's resulting in slight or no cervical change (called Braxton-Hicks UC's), Pain remains in fundus and resolves with activity change, hydration or bloody show, bag of waters in tact
    False Labor
  140. 4 Stages of Labor
    • 1st- onset of labor
    • 2nd- Expulsive phase
    • 3rd- Placenta Delivery
    • 4th- Immediate Postpartum
  141. Phases of the 1st stage of labor
    • Latent/Early Phase: 0-3 cms (up to 4)
    • Active phase: 4-7 cms
    • Transition Phase: 8-10 cms
  142. Phase of labor: 0-3cms dilated
    Early/Latent Phase (1st stage)
  143. Phase of labor: 4-7 cms dilated
    Active Phase (1st stage of labor)
  144. Phase of labor: 8-10 cms dilated
    Transition phase
  145. Longest Stage of Labor
    1st stage- onset (8-12 hours)
  146. First stage of labor starts and ends with:
    Onset of labor and complete cervical dilation
  147. Stage of labor that begins with full cervical dilation (10cms) and ends with Delivery of the Fetus
    2nd Stage (Expulsive Phase)
  148. Stage of Labor that begins with the delivery of the fetus and ends at the delivery of the placenta
    3rd Stage (Placental Delivery)
  149. Stage of labor that begins after delivery of placenta and completed 4 hours after delivery
    4th Stage (Immediate Postpartum Period)
  150. Dilation and Effacement for the Early/Latent Phase of Labor (Stage 1)
    0-3 cms dilated, 0-40% effacement
  151. Average length of the Latent/Early phase for primiparous moms:
    9-19 hours
  152. Average length of the Latent/Early phase for multiparous moms:
    6-14 hours
  153. Contractions during the latent/early phase are usually:
    Mild intensity, Irregular, 5-15 min, lasting 10-30 seconds
  154. Physical Findings during the Latent/Early Phase of Labor (stage 1)
    Mild, irregular UCs about 5-15 min apart lasting 10-30 seconds

    Amniotic memranes intact

    "Cramping" feeling and backache

    Sleep, Activity, Hydrate, Eat light
  155. Emotional Assessment Findings during Latent/Early Phase
    Talkative, excited, confident, "centering thoughts on self", anxious

    May not recognize in labor

    May not be admitted yet- ambulate to evaluate if true labor
  156. Shortest phase of labor for multiparous mom:
    Active phase (1st stage of labor)
  157. Dilation and Effacement for Active Phase during Labor (1st stage)
    4-7cm, 40-80% effacement
  158. Primiparous average length of Active Phase:
    5 hours, or dilates .5cm/hour
  159. Multiparous average length for Active Phase during Labor (1st stage)
    2-3 hours, or 1.2 cm/hour
  160. Physical assessment findings duing active phase of 1st stage of labor:
    Moderate UC's, every 3-5 min, lasting 30-45 sec

    Amniotic membranes intact or ruptured

    Increasing back and abdominal pain, restless and labored breathing
  161. Emotional Assessment findings during active phase labor (1st stage)
    • Fearful, Inwardly focused
    • Working on breathing hard with UCs
    • May request pain meds
    • Desires support..."not sure if I can do this"
  162. Dilation and Effacement for Transition Phase of labor (1st stage)
    8-10 cm dilated, 100% effacement
  163. Primiparous average length for Transitional Phase:
    2 hours
  164. Multiparous average length during transition phase:
    1-2 hours
  165. Physical Assessment findings during transition phase:
    Severe UCs, every 1-2 minutes, lasting 40-60 sec

    Ruptured membranes

    Backache/pelvic pressure
  166. Emotional assessment during transition phase:
    • Exhaustion, inability to concentrate, "overwhelmed"
    • N/V, indigestion
    • Trembling or legcramps, panicky and diaphoretic
    • Backaches/Rectal pressure
    • Increased bloody show
  167. Dilation and Effacement of the Expulsive Phase (2nd stage of labor)
    10 cms dilated, 100% effacement
  168. Primiparous average length during expulsive phase:
    1-2 hourse
  169. Multiparous average length of expulsive phase (2nd stage of labor)
    < 1 hour
  170. Physical assessment findings during expulsive phase:
    less painful intensity of UCs, urge to push, every 1-2 min, lasting 50-90sec

    Ruptured membranes

    Bearing Down reflex (Ferguson's Reflex)

    Bloody show heavier

    Perineum flattens and rectum with vagina bulge
  171. Emotional Assessment findings during expulsive phase
    Exhaustion, burst of energy at end, need to "refocus", may rest between contractions
  172. Cardinal Movements of Labor
    • Engagement
    • Descent
    • Flexion
    • Internal Rotation
    • Extension
    • External Rotation
    • Expulsion
  173. Which cardinal movement of labor: fetal head greatest in diameter passes through pelvic inlet
  174. Which cardinal movement of labor: Fetal movement through birth canal during 1st and 2nd labor stages
  175. Which cardinal movement of labor: Fetal chin moves toward chest, results in smallest fetal diameter to maternal pelvis...occurs early labor
  176. Which cardinal movement of labor: Fetal head rotation aligns the long axis of fetal head with the maternal long axis of the pelvis (2nd stage)
    Internal Rotation
  177. Internal rotation occurs in which labor stage?
    2nd stage
  178. Which cardinal movement of labor: facilitated by pelvic floor resistance causing presenting fetal part to "PIVOT" underneath pubic bone to result in fetal head delivery
  179. Extension occurs in which stage of labor
    2nd stage
  180. Which cardinal movement of labor: Fetal head sagittal sutures rotate into a transverse diameter, fetal shoulders align in the anterioposterior diameter, fetal head sagittal sutures maintains alignment with fetal trunk as pelvic navigation occurs
    External rotation (restitution then shoulder rotation)
  181. Which cardinal movement of labor: shoulders and remainder of body are delivered after the fetal head
  182. Stage of labor that starts the "Recovery"
    3rd Stage: Placenta Delivery
  183. Phase average length of the Placenta Delivery
    1-20 minutes
  184. Physical assessment findings relating to placenta delivery phase
    • Mild-Mod cramping, placental separation signs (uterus rises, globular shaped, bloody gush, umbilical cord lengthens, increased cramping)
    • Perineal or vaginal edema possible
  185. Emotional assessment during the 3rd stage of labor (placental delivery)
    • Happy, exhausted
    • Sense of relief
    • Annoyed with post procedures (ie: stitch repair)
    • Postpartum shakes/chills
  186. Placental Delivery Separation Signs
    Uterus becomes globular shaped and rises in the abdomen

    Sudden gush of blood from vagina

    Lengthening of umbilical cord from vagina
  187. Maternal side of placenta expelling first
    "Dirty Duncan"- duncan mechanism
  188. Fetal side of placenta expelling first:
    Shiny Schultze- mechanism
  189. Controlled cord traction:
    manual delivery of placenta

    • ONLY do if she is on ergometrine or oxytocine
    • Pull toward her umbilicus as soon as her abdomen feels hard
  190. Phase length of Immediate Postpartum (4th labor stage)
    2-4 hours after delivery or maternal stability achieved
  191. Physical Assessment findings during Immediate Post Partum phase (4th stage of labor)
    Moderate to severe uterine cramping if multiparous (after birth pains)

    Less painful UCs

    Mod-Heavy vaginal lochia (frequent fundal checks needed)

    Perineal or Vaginal Edema possible

    Repair of perineal or vaginal vault lacerations possible if present
  192. Postpartum Hemorrhage is defined as any amount of blood greater than
    >500ml (no more than 1 pad an hour)
  193. Emotional Assessment during immediate postpartum
    • Mother at greatest risk for hemorrhage
    • Happy, maybe exhausted
    • Hungry or Thirsty
    • Postpartum Shakes/Chills
  194. Fetal Pulmonary Adaptations during labor:
    • Changes to stimulate breathing at delivery
    • UCs and vaginal squeezing assist with clearing fetal lung fluid
  195. Fetal Cardiovascular Adaptations during labor:
    • FHR reacts quickly to labor events
    • Maternal position
    • Prolonged UCs
    • Maternal hypotension
    • Umbilical blood flow disruption
  196. When decreased or depleted, the fetus has difficulty adapting to already present decreased ox situations normally occurring like a uterine contraction during labor
    Placental circulation O2 reserves
  197. Fetal Hypoxia releases ____ and ____ that increases the FHR and fetal BP and may deplete reserves causing decompensation
    Epinephrine and Norepinephrine
  198. When the maternal O2 decreases, the blood flow is deferred to _____ to compensate
    Vital Fetal Organs
  199. Maternal Adaptation during Labor
    CO increases (10-15% 1st stage, 30% 2nd stage...increases in systolic BP by 10- first stage, increase in systolic BP by 30 in second)

    ***BP assessment is most accurate in between UCs

    Increased risk for hyperventilation

    Decreased motility and absorption

    Increase Risk for N/V

    Decreased urinary sensation= full bladder may inhibit fetal descent

    WBC increased in labor (14,000 to 16,000 due to labor workload demands)

    Elevated clotting factors = prevent postpartum hemorrhage, increases DVT risk
  200. Cardiovascular System changes in MOM during labor:
    • CO increases (10-15% 1st stage, 30% 2nd)
    • Systolic BP increase (10 in 1st, 30 in 2nd)

    *BP most accurate in between UCs
  201. Respiratory System changes in MOM during labor:
    Increased Risk for Hyperventilation
  202. Gastrointestinal Changes in MOM during labor:
    • Decreased motility and absorption
    • Increase risk for N/V
  203. Urinary System changes in MOM during labor
    Decreased urinary sensation-- full bladder may inhibit fetal descent
  204. Hematopoietic System changes in MOM during labor:
    WBC increased in labor = 14,000 - 16,000 due to labor workload demands

    Elevated clotting factors = prevention of postpartum hemorrhage, increased risk for DVT
  205. Federal regulation enacted to ensure treatment for all pregnant women in active labor; regardless of the ability to pay
    EMTALA (Emergency Medical Treatment and Active Labor Act)
  206. Specific admission criteria for EMTALA
    Cervical dilation 3-4cms


    Ruptured fetal membranes/amniotic fluid
Card Set:
Intrapartum Processes
2014-10-06 21:22:35
Intrapartum Processes

Intrapartum Processes
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