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B.

INTRAPARTUM

INTRAPARTUM CARE

refers to the medical and nursing care given to a pregnant woman and her family during labor

and delivery

Extends from the beginning of contractions that cause cervical dilation to the first 1 to 4 hours

after delivery of the newborn and placenta.

1.Factors affecting labor and delivery

a.Passageway – refers to the adequacy of the pelvis and birth canal allowing fetal

descent; factors include:

i.Types of female pelvis (INSERT PICTURE)

A.Gynecoid – typical female pelvis with a rounded inlet

B.Android – normal male pelvis with a heart shaped inlet

C.Anthropoid – is an “apelike” pelvis with an oval inlet

D.Platypelloid – is a flat, female-type pelvis with a transverse oval inlet

ii.Structure of Pelvis

A.False pelvis vs. true pelvis

FALSE PELVIS - Superior half formed by the ilia. Offers landmark for

pelvic measurements. Supports the growing fetus into the true pelvis

near the end of gestation

TRUE PELVIS - Inferior half formed by the pubes in front, the ilia and

the ischia on the sides and the sacrum and coccyx behind.

iii.Adequate delivery diameter

A.Pelvic Inlet diameter

Inlet – entrance way to the true pelvis. Its Transverse diameter is

wider than its anteroposteror diameter. Also known as pelvic brim.

B.Pelvic Outlet diameter
Outlet – inferior portion of the pelvis, bounded on the back by thecoccyx, on the sides by the ischial tuberosities
and in front by theinferior aspect of the symphysis pubis and the pubic arch. Its

anteroposterior diameter is wider than its transverse diameter.
*Engagement- refers to settling of the presenting part of the fetus intothe pelvis to be at the level of the ischial
spine, a midpoint of the pelvis.

- descent to this point means the pelvic inlet is proven adequate for

birth

- “Floating”- a presenting part that is not engaged.

.“Dipping”.plus stations (+1 to +4)= presenting part below ischial spine.station 0= presenting part engaged . i. refers to the relationship of the presenting part of a fetus to the level of the ischial spines .minus stations (-1 to -4)= presenting part above ischial spine.station -4= presenting part is floating . o DILATATION  Enargement of the external cervical os from 0 to 10 cm As a result of uterine contractions and additionally as a result of pressure on the presenting part o EFFACEMENT  Shortening and thinning of cervical canal from 0 to 100%  Primigravida – effacement occurs before dilatation  Mutligravidas – dilatation may precede effacement b.or degree of engagement. measurement in cm . . Passenger This refers to the fetus and its ability to move through the passageway. measurement in cm .one that is descending but has not reached the ischial spine *Station.Ability of the uterine segment to distend. the cervix to dilate and the vaginal canal and introitus to distend. Fetal skull • Size of the fetal head and capability of the head to mold to the passageway.station +4= presenting part is at outlet or it is crowning (theencirclement of the largest diameter of the fetal head by the vulvar ring) C.

the body part that will be born first or contact the cervix first A.Chin or mentum B. one foot is the . making the parietal bones the presenting parts b. can be delivered NSVDa. ideal presentation for NSVD because the bones of the skull are capable of molding so effectively to accommodate the cervix and may actually aid in cervical dilation a. feet are presenting parts ii. Face c. Footling i.change in shape of fetal skull produced by force ofcontraction pressing the head against the not-yet dilated cervix  Parents are reassured that molding only lasts a day or two and is not a permanent condition  No molding when fetus is breech.Breech – either buttocks or feet first.Complete breech – thighs are flexed on the abdomen and legs are on thighs b.Double – legs unflexed and extended.Cephalic =head first. resting on the anterior surface of the body c. Brow d.Single – one leg flexed and extended.Vertex – head is sharply flexed. • The fetal skull is the most important part of the fetus because: o It is the largest part of the body o It is the least compressible of all parts o It is the most frequent presenting part Fetal lie orpresentation The part of the fetus that enters the maternal pelvis first.Frank breech – thighs are flexed and legs are extended. difficult birth.o Molding.

intra + partus.postpartal care. Horizontal (transverse) b. duration. If the amniotic sac has broken. a hand or an elbow. The cervical effacement and dilation and the station of the presenting part of the fetus are determined periodically by vaginal examination. and strength. Fetal Attitude The relationship of fetal parts to one another. emergency childbirth. and variations are noted in relation to the timing and intensity of contractions. protein.Vertical (longitudinal). birth care of a pregnant woman from the onset of labor to the completion of the fourth stage of labor with the expulsion of the placenta.relationship between the long axis of the fetal body and the long axis f the woman’s body (cephalocaudal) a. using careful aseptic technique. .presenting part can be one of the shoulders (acromion process. newborn intrapartal care. The position. an iliac crest. and quantity of the amniotic fluid are noted. producing a bloody discharge called "bloody show. Urine is measured regularly through labor and may be tested for levels of ketones. degree of flexion a fetus assumes during labor Etymology: L." A physical examination of the mother is performed. and presentation of the fetus are ascertained by abdominal palpation. Fetal Lie. The fetal heart rate is counted.cephalic or breech iv.presenting part iii. and glucose to determine specific gravity. method The signs and symptoms of true labor are observed. attitude. character. the color. A microhematocrit is often done. CS delivery) iii.Shoulder presentation. See also antepartal care. C. Uterine contractions increase in frequency. Pressure of the presenting part of the fetus causes dilation and effacement of the cervix and contractions of the amniotic sac.