METHODS TO DETERMINE FETAL POSITION, PRESENTATION, AND LIE:
• Leopold’s maneuvers – combined abdominal inspection and
palpation
• Vaginal Examination
• Auscultation of fetal heart tones
• Ultrasound
Powers of Labor
• Powers of labor – second important requirement for a
successful labor
- Force supplied by fundus, implemented by uterine
contractions (a natural process that causes cervical
dilation)
• Uterine contraction – primary power in labor
- Mark of effective uterine contraction: rhythmicity
and progressive lengthening and intensity
- HOW UTERINE CONTRACTION CAUSE PAIN: cervical
stretching during dilation
- PHASES:
1) Increment
2) Acme (Peak)
3) Decrement
• Duration – length of time a contraction lasts, increment to
decrement
• Frequency – time interval between beginning of one
contraction to beginning of next contraction
• Interval of Rest– time from end of one contraction to the start
of next contraction
• Intensity – the strength or a contraction at acne.
- MILD If uterine wall can be indented easily
- STRONG INTENSITY if cannot be indented
• RULES OF PALPATION OF UTERINE CONTRACTIONS:
- Use FINGERTIPS not the palmar surface
- Place fingertips LIGHTLY and not firmly
- Uterotubal junction – where pacemaker sites are
found
• Physiologic retraction ring – separation or differentiation of the
active, shorter but thicker upper uterine segment from the
lower segment
• Pathologic retraction ring or Bandl’s ring – danger sign that
signifies impending rupture of lower segment
• Effacement – shortening and thinning of cervical canal
- Primipara: effacement before dilation
- Multipara: dilation before effacement
• Dilatation – enlargement or widening of cervical canal
1 finger 1.25cm
2 fingers 3cm
3 fingers 4.5cm
4 fingers 5.5cm
5 fingers 7cm
6 fingers 8.5cm
7 fingers 9.5cm
Fully dilated 10cm
• Psyche – refers to psychological state or feelings that woman
bring into labor
STAGES OF LABOR:
1. First stage of labor begins when uterine contraction, frequency,
and intensity result in effacement and dilation of cervix.
- Completed when cervix reaches 10cm
2. The second stage involve descent of fetus and eventual
expulsion from vagina
3. The third stage involves delivery of placenta
4. Fourth stage – first 1-4 hrs after birth of placenta. Close
maternal observation needed.
PHASES OF FIRST STAGE OF LABOR:
1. Latent Phase – begins onset of regularly perceived uterine
contraction and ends when rapid dilation begins.
- 20 to 40s , 0 to 3cm, 6 hrs in nullipara, 4-5 in
multipara, 5-8mins, analgesia should NOT be given
- If phase is prolonged, cephalopelvic disproportion
occurs.
- Activity: Continue to walk
2. Active phase – 40 to 60s, 4-7cm, 3 hrs nullipra, 2 hrs multipara,
3-5mins
3. Transition – contractions reach peak, 60-90s, 8-10cm, 2-3mins
- Identified by slight slowing rate of cervical dilation
- Irresistible urge to push occurs
SECOND STAGE
- Full dilation and cervical effacement
- Perineum bulge and tense
- Anus everted and stool may expel
- Crowning – opening is slit like, oval, then circular
THIRD STAGE
- Begins birth of infant and ends with delivery of
placenta
- After birth, uterus can be palpated as firm round
mass
- After rest, organ assumes DISCOID SHAPE
- Two Phase:
▪ PLACENTAL SEPARATION
Signs are: Lengthening of umbilical cord,
Sudden gush of vaginal blood, change in
shape of uterus, firm contraction, and
appearance of placenta at vaginal
opening.
▪ PLACENTAL EXPULSION
Placenta is delivered by either: natural
bearing down of mother or Crede’s
Maneuver (gentle pressure on uterine
fundus)
PLACENTAL PRESENTATION
✓ Schultze – placenta separate first at center and tends to fold like
umbrella, appears shiny and glistening
✓ Duncan – raw, red, irregular
✓ Normal blood loss: 300-500ml
MATERNAL AND FETAL RESPONSES TO LABOR
PHYSIOLOGIC EFFECT ON WOMAN
• INCREASE – hemopoietic, respiration, temperature, neurologic
and sensory
• DECREASE – cardiac output, blood pressure, fluid balance,
urinary, muscuskeletal
PSYCHOLOGICAL EFFECT ON WOMAN
• Fatigue, Fear, Cultural influences
MATERNAL DANGER SIGNS
• Abnormal pulse, Inadequate or prolonged contraction,
pathologic retraction ring, Abnormal lower abdominal contour,
increasing apprehension
FETAL DANGER SIGNS
• High or Low Fetal Heart Rate, Meconium Staining, Hyperactivity,
Oxygen Saturation
COLOR OF AMNIOTIC FLUID
• Yellow stained – blood incompatibility
• Bilirubin stained – breakdown of RBC
• Green fluid – meconium stained
Get FHR every 30mins beginning of labor, 15mins active labor, and 5 mins
2nd stage of labor
VAGINAL EXAMINATION – necessary to determine extent of cervical
effacement and dilatation
PERINEAL SKIN PREP – systematic aseptic perineal prior to delivery