MATERNITY NURSING 5.

Enters the foramen ovale

6. Goes to the left atrium
7. Passes through left ventricle
8. Flows to ascending aorta to supply nourishment to the brain and
upper extremeties
9. Enters superior vena cava
10. Goes to right atrium
11. Enters the right ventricle
12. Enters pulmonary artery with some blood going to the lungs to
supply oxygen and nourishment
13. Flows to ductus arteriosus
14. Enters descending aorta ( some blood going to the lower
extremeties)
15. Enters hypogastric arteries
16. Goes back to the placenta

INTRAPARTUM CARE
Intrapartum period extends from the beginning of contractions that
cause cervical dilation to the first 1-4 hours after delivery of the
Special Structures in Fetal Circulation newborn and placenta.
1. Placenta – Where gas exchange takes place during fetal life LABOR AND DELIVERY
2. Umbilical Arteries – Carry unoxygenated blood from the fetus to LABOR - is a series of processes by which the product of
the placenta conception are expelled from the maternal body.
3. Umbilical Vein – Brings oxygenated blood coming from the DELIVERY-- is the actual event of birth.
placenta to the fetus
NURSING MANAGEMENT OF THE CLIENT
4. Foramen Ovale – Connects the left and right atrium. It pushes
PREPARING
blood from the right atrium to the left atrium so that blood can be
supplied to the brain, heart, and kidney
FOR LABOR

5. Ductus Venosus - Carry oxygenated blood from the umbilical Intrapartum nurse has actually has 3 clients:
vein to the inferior vena cava, bypassing the metal liver
3 clients that require constant monitoring:
6. Ductus Arteriosus - Carry oxygenated blood from the pulmonary  the mother,
artery to the aorta, bypassing fetal lungs.  the fetus,
 the family unit

STAGES OF LABOR

1ST STAGE OF LABOR:

1) LATENT: cervical dilatation 0-3cm, the longest phase
2) ACTIVE: cervical dilatation 4-8cm
3) TRANSITION: cervical dilatation 8-10cm (full dilatation)

1ST Stage of Labor ( latent phase )

 Contractions maybe irregular

 10-20 minutes apart
 Client experiences cramping, low back ache, bloody show
 Administering analgesics during this phase of labor is not
advisable.
 Latent phase averages 8-20 hours (primigravida) 5-14 hours
for multiparas

1st Stage of Labor ( active phase )

 -Begins when the cervix dilates to 3cm and lasts to 7 or 8 cm

 - Contractions are 3-5 minutes apart of moderate intensity and
lasts 30- 60 seconds
 - Clients experience growing discomforts
1. Oxygenated blood enters the umbilical vein from the placenta  - Membranes may rupture
2. Enters ductus venosus 1st Stage of Labor (transition phase )
3. Passes through inferior venacava
4. Enters the right atrium  8 to 10 cm to full dilatation
  Contraction occurs every 2-3 minutes, intense,60-90 seconds Longer intervals bet. contractions Shorter intervals bet.
in duration contractions
 Bloody show increases, client experiences extreme discomfort Discomfort in the lower abdomen Discomfort begins in back &
 May have a strong desire to push in this phase, even though & groin radiates to the abdomen
not fully dilated Activity such as walking either Activity such as walking,
has no effect or decreases increases contractions
2ND STAGE OF LABOR contraction
Disappear while sleeping Continue while sleeping
1) Stage of expulsion Sedation decreases or stops Sedation does not stop
2) From full cervical dilatation through birth of the baby contractions contractions
Bloody show usually not present Bloody show usually present
STAGE OF EXPULSION No appreciable change in the Progressive thinning &
cervix opening of the cervix
 Starts with full cervical dilatation and ends at the BIRTH OF
THE NEONATE
 Contractions are very intense, every 1-2 minutes and lasts 60- THERAPEUTIC NURSING MANAGEMENT (TRUE VS FALSE
90 seconds in duration LABOR)
 Involuntary contraction and pushing accomplish expulsion of
the fetus •Advise client to change her activity level to differentiate FL from
TL
3RD STAGE OF LABOR
•Provide adequate hydration to avoid “ false labor “
From the birth of the baby through the expulsion of the
placenta ( 5-30 MINUTES) •Reassure clients who are embarrassed about being admitted to the
hospital in “false labor” that is difficult to tell the difference
o stage of placental expulsion •= even nurses can misinterpret the signs of labor
o This stage end at the delivery of the PLACENTA
o 5 to 30 minutes average duration of this stage Therapeutic Nursing Management (stages of labor)
o Detachment of the placenta is indicated by the
during 1ST stage ( latent )
lengthening of the umbilical cord
Nurses may orient the client & family to labor and delivery as
4th STAGE OF LABOR
they monitor progress of labor
The first 4 hours after delivery When Active labor begins, pain control & client/fetal
o the stage of recovery monitoring are important
o Encompasses the first 4 hours after delivery Transition phase- nurse comforts clients and prepares for 2nd
o The client’s physiologic stability is restored stage
Client should be discouraged from pushing until she is fully
o Bonding activities are important in this stage
dilated
THEORIES OF CAUSES OF LABOR.
2ND stage
UTERINE STRETCH THEORY
The nurse assists in pushing as appropriate and prepares for the
•any hollow body organ will contract and empty its content when birth of the baby and the placenta
stretched to its fullest capacity
4TH STAGE
OXYTOCIN THEORY
The nurse monitors VS, fundal height and firmness, lochia, Urinary
•Oxytocin makes the uterine muscles contract output, and bonding activities

•the uterus becomes increasingly sensitive to oxytocin at about the Complications of Labor
37th week of pregnancy
•Infections
PROGESTERONE DEPRIVATION THEORY •Cord compression
•CPD (cephalopelvic disproportion )
• progesterone – relaxes the uterine muscles •Dystocia (difficult or obstructed labor)
•with decreased amounts, labor pains occur •Failure to progress
•Breech /shoulder presentation
PROSTAGLANDIN THEORY •Preterm labor and birth
•Post term dates
•initiation of labor is said to result from the release of arachidonic •Meconium passage prior to delivery
acid which forms prostaglandin (PGE2) – responsible for uterine •Hemorrhage
contractions •Retained placenta
THEORY OF AGING PLACENTA
FACTORS THAT AFFECT LABOR AND DELIVERY
• because of the decreased blood supply, the uterus contracts (5Ps)

COMPARISON OF TRUE AND FALSE LABOR I. PASSAGEWAY

FALSE LABOR
Irregular contractions
Decrease in frequency & intensity
- refers to the adequacy of the pelvis and birth canal in allowing
TRUE LABOR
fetal descent.
Regular contractions
Progressive frequency &
AFFECTED BY THE FOLLOWING FACTORS:
intensity
Pelvic measurements
a. Diagonal conjugate
- from lower border of symphysis pubis to sacral
promontory
- should be 12.5-13 cm; may be obtained vaginal
examination

b. Obstetric conjugate
- shortest distance between inner surface of symphysis
pubis and sacral promontory; measured by subtracting
1.5-2 cm (thickness of symphysis) from the diagonal
conjugate
- usually 11 cm
- most important pelvic measurement
c. True conjugate or conjugate vera
- measured from upper margin of symphysis pubis to
sacral promontory; should be at least 11 cm.
- maybe obtained by x-ray or UTZ
d. Tuber-ischial diameter/ Intertuberous diameter
- measures the outlet between the inner borders of ischial
tuberosities, should be at least 8-9 cm.
- estimated on pelvic exam

• Ability of the uterine segment to distend, the cervix to dilate and

the vaginal canal and introitus to distend
•Type of pelvis (gynecoid, anthropoid, android, or platypelloid)
•Structure of pelvis ( false vs true pelvis )

METHOD OF OBTAINING DIAGONAL CONJUGATE

DIAMETER

INLET OF NORMAL FEMALE PELVIS SHOWING

TRANSVERSE AND ANTERIOR-POSTERIOR DIAMETER

TYPES OF PELVIC SHAPES

ANDROID
- Narrow, heart-shaped - Male type pelvis
ANTROPOID
- Narrow, oval shaped; AP diameter is equal to or greater than the
transverse diameter
- resembles ape pelvis
GYNECOID
-Classic female pelvis
-Wide and round in all directions
PLATYPELLOID
- Flattened, oval, transverse shape
- Broad pelvis with shortened AP diameter
II. PASSENGER
- refers to the fetus and its ability to move through the passageway.
AFFECTED BY THE FOLLOWING FACTORS:
1.Size of the fetal head and capability of molding to passageway.
2.FETAL ATTITUDE – the relationship of fetal parts to one
another
3.FETAL PRESENTATION – part of the fetus that enters the
maternal pelvis first.
a. CEPHALIC – vertex, face, brow
b. BREECH – frank, footling, complete
c. SHOULDER – transverse lie
NOTE: Lie (spine to spine) may be longitudinal (parallel),
transverse (right angles), oblique (slight angle off true transverse
lie).

PELVIC DIVISIONS
FALSE PELVIS
• Shallow upper basin of the pelvis
• Supports the enlarging uterus but not important obstetrically
LINEA TERMINALIS
• Plane dividing upper or false pelvis from lower or true pelvis
TRUE PELVIS
• Consists of the pelvic inlet, pelvic cavity, and pelvic outlet.
• Bony canal through which the infant pass.
• Measurements of true pelvis influence the conduct and progress
of labor and delivery.

TRUE vs FALSE PELVIS

Fetal Attitude
 Good flexion
 Moderate flexion
 Poor flexion
 Partial Extension

Poor Flexion/Complete Extension

Moderate Flexion

Full Flexion

FETAL PRESENTATIONS
 FRANK BREECH FULL/COMPLETE BREECH

FOOTLING BREECH SHOULDER BREECH

Face Military/Sinciput
II.PASSENGER
AFFECTED BY THE FOLLOWING FACTORS:

FETAL POSITION – the relationship of a particular

reference point of the presenting part and the
maternal pelvis described with a series of 3
letters.
FETAL REFERENCE POINT (PRESENTING PART)
Vertex` Brow
A. OCCIPUT (O)
B. SACRUM (S)
C. SCAPULA (Sc)
D. MENTUM (M)

MATERNAL REFERENCE POINT

1. SIDE OF MATERNAL PELVIS
A. Left (L) B. Right (R) C. Transverse (T)

2. PART OF THE MATERNAL PELVIS

A. Anterior (A) B. Posterior (P)

FETAL
POSITIONS

Breech PRESENTATIONS
Left sacral Anterior Right Occipital Posterior - refers to the site of placental insertion.
V. PSYCHE
- refers to the client’s psychological state, available
support systems, preparation for birth, experiences,
and coping strategies.

5Ps FACTORS AFFECTING LABOR AND DELIVERY

1) PASSAGEWAY
2) PASSENGER
3) POWER
Left 4) PLACENTAL FACTORS
5) PSCHE
Occipital Transverse Right
Occipital Transverse

Right Occi Anterior Left Occi posterior

Left Occipital Anterior

III. POWER
- refers to the frequency, duration, and strength of
uterine contractions to cause complete cervical
effacement and dilation.
IV. PLACENTAL FACTORS