INTRAPARTUM

The Nursing Role in Caring for

the Family During Labor and
Birth
 LABOR

• Series of events by which uterine

contractions and abdominal pressure
expel the fetus and placenta from the
woman's body.
 NURSING PROCESS
OVERVIEW

Assessment
• Assessment of a woman in labor must be
done quickly yet thoroughly and gently.
• Assess how much discomfort a woman in
labor
• facial tenseness
• paleness of the face
• hands clenched in a fist
• rapid breathing o rapid pulse rate
Nursing Diagnosis
• Common nursing diagnoses used during,
labor include:
• Pain related to labor contractions
• Anxiety related to process of labor and birth
• Health-seeking behaviors related to
management of discomfort of labor
• Situational low self-esteem related to
inability to use prepared childbirth method
 THEORIES OF LABOR ONSET

• Uterine muscle stretching: prostaglandin

release
• Pressure on the cervix: release of
oxytocin
• Oxytocin stimulation: together with
prostaglandin to initiate contractions
• Change in the ratio of estrogen to
progesterone
 THEORIES OF LABOR
ONSET
• Placental age
• Rising fetal cortisol levels, which reduce
progesterone formation and increase
prostaglandin formation
• Fetal membrane production of
prostaglandin,which stimulates
contractions
• Seasonal and time influences
 SIGNS OF LABOR
• Preliminary Signs of labor
 Lightening
· Descent of the fetal presenting part into the pelvis
· occurs approximately 10 – 14 days before labor
begins
. relief from the diaphragmatic pressure .
. abdominal pressure increases
. shooting leg pains
. increased amounts of vaginal discharge
. urinary frequency from pressure on the bladder.
 Preliminary Signs of labor
• Increase in Level of Activity
· increase in activity is due to an
increase in epinephrine
• Braxton Hicks Contractions
· last week or days before labor begins,
extremely strong Braxton Hicks
contractions which may be interpret as
true labor contractions.
• Ripening of the Cervix
· Ripening of the cervix is an internal
sign seen only on pelvic examination.
· At term, cervix is described as "butter-
soft," and it tips forward.
 Signs of True Labor
• Uterine Contractions
· the initiation of effective, productive,
involuntary uterine contractions.
• Show
· As the cervix softens and ripens, the mucus
plug that filled the cervical canal during
pregnancy is expelled.
· The blood, mixed with mucus, takes on a
pink tinge and is referred to as "show" or
"bloody show."
 Signs of True Labor

• Rupture of the Membranes

· a sudden gush or scanty, slow seeping
of clear fluid from the vagina, .
• Two risks associated with ruptured
membranes
o intrauterine infection
o prolapse of the umbilical cord
 LABOR & DELIVERY
FOUR P’S OF LABOR
a. Power - the uterine contraction
b. Passenger – the fetus
c. Passageway – the maternal pelvis
d. Psyche – the mental and emotional aspect
of the woman
 LABOR & DELIVERY
POWER - Uterine Contractions
1. Frequency
- the beginning of one contraction to
the beginning of the next contraction
2. Interval
- pattern which increases in frequency
and duration
3. Duration
- the beginning of one contraction to
the end of the same contraction
4. Intensity
- strength of contraction, measured
through a monitor or through touch of a
fingertip on the fundus (mild, moderate or
strong)
PASSENGER - Fetus
1. Fetal Skull
2. Fontanels
3. Fetal Lie
4. Fetal Attitude
5. Presentation
6. Movement of Passenger upon birth or
descent
 COMPONENTS OF LABOR

Four integrated concepts:

(1) Woman's pelvis (the passage)
- adequate size and contour
(2) Passenger (the fetus)
- appropriate size and in an
advantageous position and presentation
(3) Powers of labor (uterine factors) are
adequate
(4) Woman's psyche
• Passage
·refers to the route the fetus must travel
from the uterus  cervix vagina 
external perineum.
· Because these organs are contained
inside the pelvis, the fetus must also
pass through the pelvic ring.
· the pelvis must be of adequate size.
• Two pelvic measurements are important to
determine the adequacy of the pelvic size:
- the diagonal conjugate (the anterior-
posterior diameter of the inlet)
- the transverse diameter of the outlet
• At the pelvic inlet, the anteroposterior
diameter is the narrowest diameter
• · At the outlet, the transverse diameter is the
narrowest diameter
 PASSAGES
• Functions of the Pelvis
1. provides protection to the organs
found within the pelvic cavity
2. provides attachment to muscles,
fascia, and ligaments
3. supports the uterus during pregnancy
4. serves as birth canal
• False pelvis – lies above the pelvic brim,
supports the increasing weight of the
enlarging pregnant uterus and directs
the presenting part into the true pelvis
below
• True pelvis – represents the bony limits
of the birth canal; adequacy of each
part; must be sufficient passage of the
fetus
 Types of Pelvis

1. Gynecoid – the normal female type

pelvis
- most ideal for childbirth
- the inlet is round shaped with
transverse diameter larger than antero-
posterior (AP) diameter
- found in 50% of women
2. Android - the male pelvis
- the AP diameter is wider than its
transverse diameter
- this pelvis presents the most difficulty
during childbirth
- found in 20% of women
- the fetal head has difficulty getting out of
this pelvis
3. Anthropoid - ape-like pelvis
- its inlet is oval shaped with AP
diameter wider than transverse
diameter
- this is the deepest type of pelvis and
found 25% of women
- Narrow transverse and wide AP does
not conform to the head of the baby
4. Platypelloid - the flat pelvis
- transverse diameter is wider than its
AP diameter
- the rarest type of pelvis and found in
only 5% of women
- Shallow AP diameter may not allow
the fetal head to rotate
 The POWERS of Labor
Characteristic of Uterine Contractions
1. Involuntary – not within the control of the
parturient
- Intermittent
- Involves discomfort – labor pains
Uterotropin – agents that prepares the uterus and
cervix for labor. They cause the uterus to
become irritable and the cervix to soften
Uterotonin - agents that cause uterine contraction
such as oxytocin and prostaglandin
 Phases of Uterine Contraction
1. Increment or Crescendo
- when contraction is starting and
intensity is building up, longest phase
2. Acme or Apex
- the peak of contraction
3. Decrement or Decrescendo
- when muscles start to relax
• Intensity - refers to strength of uterine
contractions
- mild contractions
- moderate contractions
- strong contractions
• Frequency – refers to the rate at which
contractions are occuring
- measured at the beginning of the
contraction to the beginning of the next
contraction
• Duration - refers to the length of the
contraction.
- measured from the beginning of contraction
to the end of the same contraction
• Interval - measured from the end of a
contraction to the beginning of the next
contraction
2. Secondary Forces
- this force is created by the
diaphragm, abdominal and thoracic
muscles.
- this group of muscles are effective
only in pushing the fetus out of the
uterus when the cervix is fully dilated
• Passenger
· The passenger is the fetus.
· The body part of a fetus that has the
widest diameter is the head,
· Whether a fetal skull can pass
depends on both its structure
 Fetus: THE PASSENGER
• The head of the fetus is the most important part
of its body
- largest part of the fetal body
- always the presenting part to its
measurements, structure, position and
presentation
- least compressible of all fetal parts so it has to
assume different positions as it passes through
the birth canal in order to present its smallest
diameter and encounter the least resistance
• Measurements of the Head
- fetal head is wider in its anteroposterior
(front to back) diameter than in its
transverse (side to side) diameter
• Fetal Lie
- refers to the relationship of the long axis
of the fetus to the long axis of the mother
Presentation & Presenting Part

Presenting part
- part of the fetal body that enters the
true pelvis first and which is also the first
part to come out during delivery
Presentation
- determined by fetal lie and attitude
1. Cephalic Presentation
Vertex Presentation – head is completely
flexed so that the chin touches the chest
Brow Presentation – moderate flexion of the
head
Sinciput Presentation – the head is partially
flexed and the anterior fontanelle is the
presenting part. Also called military
position.
Face Presentation – head is sharply
extended so that the occiput is in contact
with the back
- possible complication is damage to the
cervical cord
Chin Presentation – head is hyperextended
with the chin as the presenting part
2. Breech Presentation
- feet or buttocks of the fetus are the
presenting part
a. Complete Breech – feet and legs flexed on the
thighs and the thighs are flexed on the
abdomen
b. Frank Breech – hips flexed and legs extended,
the legs touching the abdomen with buttocks
as the presenting part. Most common type of
breech presentation
c. Footling Breech – one or both feet are the
presenting part
3. Shoulder Presentation
- the fetus is lying perpendicular to the
long axis of the mother and the shoulder
is the presenting part
Causes:
- relaxed abdominal walls due to grand
multiparity
- Pelvic contraction
- Placenta Previa
• FONTANELLE
· Significant membrane-covered spaces called the fontanelles
- The anterior fontanelle
- bregma
- lies at the junction of the coronal and sagittal
suture
- fontanelle diamond-shaped.
- The posterior fontanelle
- lies at the junction of the lambdoidal and
sagittal sutures
- parietal bones and the occipital bone >
triangular
- approximately 2 cm across its widest part.
 Position
• Relationship of the presenting part to a
specific quadrant of the woman's pelvis.
• Maternal pelvis is divided into four quadrants
according to the mother's right and left:
(1) right anterior
(2) left anterior
(3) right posterior
(4) left posterior.
 Position
• Four parts of the fetus have been chosen as
landmarks.
• Position is marked by an abbreviation of three
letters.
• The middle letter denotes the fetal landmark
• 0 for occiput
• M for mentum or chin
• S for sacrum
• A for acromion process
 Position
• The first letter denotes whether the landmark
is pointing to the mother's right (R) or left (L).
• The last letter denotes whether the landmark
points anteriorly (A), posteriorly (P), or
transversely (T).
• LOA is the most common fetal position and
right occipitoanterior (ROA) the second most
frequent position
 ATTITUDE

- Refers to the degree of flexion of the

fetal body, head and extremities or the
relationship of fetal parts to each other
• Attitude.
· Attitude describes the degree of flexion
the fetus assumes during labor or the
relation of the fetal parts to each other.
• · A fetus in good attitude is in complete
flexion:
- the spinal column is bowed forward
- head is flexed forward so much that the chin
touches the sternum
- arms are flexed and folded on the chest
- thighs are flexed onto the abdomen
- calves are pressed against the posterior
aspect of the thighs
Fetal Presentation and Position
Fetal Presentation and Position
• MODERATE FLEXION
• chin is not touching the
chest but is in an alert
• "military position"
• This position causes
the next-widest
anteroposterior
diameter, the occipital
frontal diameter, to
present to the birth
canal.
• PARTIAL EXTENSION
presents the "brow" of
the head to the birth
canal
• POOR FLEXION
• back is arched
• neck is extended
• complete extension -
presenting the
occipitomental
diameter of the head
to the birth canal
 Engagement.
• Engagement.
• refers to the
settling of the
presenting part of
the fetus far
enough into the
pelvis to be at the
level of the ischial
spines, a midpoint
of the pelvis.
 Engagement.

• A presenting part that is not engaged is

said to be "floating." ·
• One that is descending but has not yet
reached the iliac spines can be said to
be "dipping."
• The degree of engagement is assessed
by vaginal and cervical examination.
 Station.
• Refers to the relationship of the
presenting part of the fetus to the level of
the ischial spines
• Presenting part is at the level of the ischial
spines, it is at a o station (synonymous
with engagement).
• If the presenting part is above the spines
• the distance is measured and described
as minus stations
• range from 1 cm to 4 cm.
 Station.
• If the presenting part is below the ischial
spines
• the distance is stated as plus stations
• 1 cm to 4 cm
• At 3 or 4 station, the presenting part
is at the perineum and can be seen if
the vulva is separated (synonymous
with crowning).
 Fetal Lie.
• Relationship between the long (cephalocaudal) axis of
the fetal body and the long (cephalocaudal) axis of the
woman's body
• Whether the fetus is lying in a horizontal (transverse) or
a vertical (longitudinal) position.
• Approximately 99% of fetuses assume a longitudinal lie
(with their long axis parallel with the long axis of the
woman).
• Longitudinal lies are further classified
- cephalic - with the head as the first part to contact
the cervix
- breech
 Types of Fetal Presentation
• Cephalic Presentation.
- head is the body part that first contacts the
cervix.
- It is the most frequent type of presentation
- 95% of the time.
o The four types of cephalic presentation
• Vertex
• Brow
• Face
• Mentum
 Types of Fetal Presentation
• Breech Presentation.
• either the buttocks or feet are the first body parts to
contact the cervix.
• approximately 3% of births
• usually are difficult births, with the presenting point
influencing the degree of difficulty
o Three types of breech presentation
• Complete
• Frank
• Footling
 Types of Fetal Presentation
• Shoulder Presentation.
• In a transverse lie, the fetus is lying
horizontally in the pelvis so that its long
axis is perpendicular to that of the
mother.
• one of the shoulders (acromion
process), an iliac crest, a hand, or an
elbow
• Fewer than 1 % of fetuses lie
transversely.
• Shoulder Presentation
• Relaxed abdominal walls from grand
multiparity
• Another cause is pelvic contraction, in
which the horizontal space is greater than
the vertical space.
• Placenta previa (the placenta is located low
in the uterus, obscuring some of the vertical
space) may also limit the fetus' ability to
turn, resulting in a transverse lie.
• Infant is preterm and smaller than usual
 Position
• Relationship of the presenting part to a
specific quadrant of the woman's pelvis.
• Maternal pelvis is divided into four quadrants
according to the mother's right and left:
(1) right anterior
(2) left anterior
(3) right posterior
(4) left posterior.
 Position
• Four parts of the fetus have been chosen as
landmarks.
• Position is marked by an abbreviation of three
letters.
• The middle letter denotes the fetal landmark
• 0 for occiput
• M for mentum or chin
• S for sacrum
• A for acromion process
 Position
• The first letter denotes whether the landmark
is pointing to the mother's right (R) or left (L).
• The last letter denotes whether the landmark
points anteriorly (A), posteriorly (P), or
transversely (T).
• LOA is the most common fetal position and
right occipitoanterior (ROA) the second most
frequent position
Fetal Presentation
- L.O.A. – Left
occipitoanterior
Labor
- L.O.T. – Left
occipitotransverse
- L.O.P. – Left
occipitoposterior
- R.O.T. – Right
occipitoanterior
- R.O.T. – Right
occipitotransverse
- R.O.P. – Right
occipitoposterior
Mechanisms (Cardinal Movements)
of Labor

• Descent
• Flexion
• internal rotation
• Extension
• External rotation
• Expulsion
Labor
• Position changes of
the fetus
- Descent
- Flexion
- Internal rotation
- Extension
- External rotation
- Expulsion
 Descent.
• Downward movement of the fetal head to within
the pelvic inlet. (towards the pelvic floor) ; occurs
due to
• Uterine contractions
• Amniotic fluid pressure
• Abdominal muscle contractions
• Full descent: fetal head extrudes beyond the
dilated cervix and touches the posterior vaginal
floor.
• Descent occurs because of pressure on the fetus
by the uterine fundus.
• Full descent may be aided by abdominal muscle
contraction.
 Flexion
• As descent occurs, pressure from the
pelvic floor causes the fetal head to
bend forward onto the chest. ( cervical
flexion occurs)
• The smallest anteroposterior diameter
(the suboccipitobregmatic diameter) is
the one presented to the birth canal in
this flexed position.
 Internal Rotation.
• The head flexes as it touches the pelvic floor,
and the occiput rotates until it is superior, or
just below the symphysis pubis, bringing the
head into the best diameter for the outlet of
the pelvis (the anteroposterior diameter is now
in the anteroposterior plane of the pelvis).
• Movement brings the shoulders, coming next,
into the optimal position to enter the inlet or
puts the widest diameter of the shoulders (a
transverse one) in line with the wide
transverse diameter of the inlet.
 CROWNING

• Is said to occur when the widest

diameter of the fetal head successfully
negotiates through the narrowest part of
the maternal bony pelvis
• This is clinically evident when the head,
visible at the vulva, no longer retreats
between contractions
 Extension

• As the occiput is born, the back of the

neck stops beneath the pubic arch and
acts as a pivot for the rest of the head.
• The head thus extends, and the
foremost parts of the head, the face and
chin, are born.
• Extension of the head causes the
stretching of the perinium
 External Rotation & Restitution
• The head externally rotates to face the right or
left medial-thigh of the mother
• At the same time the shoulders are rotating
from a transverse position, to an anetrior-
posterior position
• This re-alignment of the shoulders with the
head is called restitutuion
• The anterior shoulder is delivered first,
assisted perhaps by downward flexion of the
infant's head.
 Expulsion

• Once the shoulders are delivered, the

rest of the baby is delivered easily and
smoothly because of its smatter size.
• This is expulsion and is the end of the
pelvic division of labor.
 Powers of Labor

• Uterine contractions
• a process that causes cervical dilatation
and then expulsion of the fetus from the
uterus.
• It is important for women to understand
they should not bear down with their
abdominal muscles until the cervix is fully
dilated. Doing so will impede the primary
force or could cause fetal and cervical
damage.
 Powers of Labor
• Primary forces – consists of involuntary
contractions of the uterine muscle fibers,
which are stimulated by a pacemaker
located in the upper uterine segment
Increment Acme Decrement
• Secondary powers consist of the voluntary
use of abdominal muscles during the 2nd
stage of labor to facilitate fetal descent and
delivery
 Powers of Labor

1. Frequency – time from the onset of one

contraction to the onset of the next
contraction
2. Intensity – strength of the contraction at
the acme, which can be palpated
3. Duration – length of the contraction
from the beginning of the increment to
the end of the decrement
 Cervical Changes
• Two changes that occur in the cervix:
• effacement (thinning)
• dilatation (enlargement)
• Effacement
• is shortening and thinning of the cervical canal.
• Normally : 1 to 2 cm long.
• In primiparas, effacement is accomplished before
dilatation begins.
• In multiparas, dilatation may proceed before
effacement is complete.
• Effacement must occur at the end of dilatation,
however, before the fetus can be safely pushed
through the cervical canal or cervical tearing may
result.
 Cervical Changes
• Dilatation
• enlargement of the cervical canal from an opening
a few millimeters wide to one large enough
(approximately 10 cm) to permit passage of the
fetus
• Dilatation occurs for two reasons.
- uterine contractions gradually increase the
diameter of the cervical canal lumen by pulling the
cervix up over the presenting part of the fetus.
- fluid-filled membranes press against the
cervix. If the membranes are intact, they push ahead
of the fetus and serve as an opening wedge.
 Psyche of Labor

• Represents the psychological component of

childbearing
• Excitement, fear/anxiety, perceived loss of
control are the common emotions during
the labor and birth process.
• Can be manifested physiologically
- elevation of BP, PR, RR
 Induction of Labor
Deliberate stimulation of uterine contraction prior
to labor

1. Medical
- Oxytocin (pitocin)
- Methergine
- Prostaglandin

2. Amniotomy
- Deliberate rupture of membranes
Nursing considerations
Continuous fetal monitoring
Monitor: maternal BP, PR and progress of labor
Discontinue oxytocin infussion if
1. There is fetal distress
2. Hypertonic contractions develop
3. Signs of complications are present (hemorrhage,
shock, abruptio placenta, amniotic fluid embolism)
Inform physician
 Obstetric Analgesia
Goal: to relieve pain and discomfort of labor
and delivery with the least effect on fetus

Routes:
1. Inhalation (methoxyflurane, nitrous oxide)
2. IV (sodium pentothal)
3. Regional (lidocaine, tetracanine, bupivacaine
- Lumbar epidural, caudal, subarachnoid
Nursing considerations
• Monitor maternal/fetal vital signs
• Monitor progress of labor
• Check for allergies
• Record drug used, time, amount, route,
site, client site
• Empty patient’s bladder
• Position client appropriatel
 Dystocia

Difficult or prolonged labor

Problem in any of the following

1. Passenger
2. Passage way
3. Powers
4. Placenta
5. Psychological response of the mother
Signs of fetal distress
• Slowing down of the fetal heart rate
• Meconium-stained amniotic fluid

Nursing intervention
• Monitor FHR
• Place patient on left side
• Prepare for emergency delivery
• Provide emotional support
 Electronic Fetal Monitoring

• Purpose: evaluate fetal condition and

tolerance of labor

• external/internal

• Heart rate
Pattern of Fetal Heart Rate Deceleration

1. Early deceleration

2. Late deceleration

3. Variable deceleration
Early deceleration
• Deceleration begins early in contraction
• Fall in heart rate stays within the normal
range
• Heart rate returns to baseline
• Due to compression of fetal head
against the cervix
• Not a dangerous pattern
• No intervention needed
Late Deceleration

Deceleration start late in contraction

Fall in heart rate > 20 bpm
Heart rate does not return to baseline
Due to uteroplacental insufficiency
Dangerous pattern
Change maternal position, administer O2, discontinue
oxytocin, prepare for immediate delivery if pattern is
consistent
Variable Deceleration

Onset not related to contractions

Abrupt and dramatic swings in heart rate; rapid return
to baseline
Due to compression of the umbilical cord
Not a dangerous pattern
Change maternal position, administer O2, discontinue
oxytocin infusion
If persistent, CS will be needed
 Obstetrical Procedure
Episiotomy

Incision made into the

perineum to enlarge
the opening
Prevents perineal
laceration
Types:
1. Midline (median)
2. Mediolateral
• Nursing considerations
- Apply ice packs for the 24 hours
- Hot sitz bath to promote healing
- Check for signs of bleeding/infection
- Instruct client about perineal hygiene
 Forcep Delivery

• Indication: to shorten • Nursing

second stage of labor considerations
- Fetal distress - Explain procedure
- Poor maternal effort - Reassure patient
- Medical condition - Monitor mother and
- Maternal fatigue fetus continuously
- Large infant - After delivery, check
mother and fetus for
injuries
 Vacuum Extraction

• Used to assist delivery of the fetal head

• Suction device applied to fetal head and
traction applied during contractions
• Nursing considerations
- Do not keep suction device longer than
25 minutes
- Continuous fetal monitoring
- Assess infant fro cerebral trauma
 Cesarian Section
Delivery of the fetus through an abdominal and uterine
incision
Indications:
- Fetal distress
- Abnormal presentation (breech, face, shoulder)
- CPD
- Placental abnormalities
- Multiple gestation
- Previous CS
- Arrest in labor
• Nursing considerations
- Obtain inform consent
- Explain procedure to the mother
- Monitor mother and fetus continuously
- Prep abdomen and pubic area
- Insert IV and catheter
- Pain relief
- Encourage turning, coughing and deep
breathing
- Monitor for signs of bleeding and infection
 Physiologic Changes

• Involution of the Uterus

• Return of the uterus to its nonpregnant
size
- 1 hour postpartum: fundus at the level of
the umbilicus
- Fundus decrease by 1cm per day
- Fundus no longer palpable by the 10th
day
Lochia
1. Lochia rubra – red; 1-3 days
2. Lochia serosa – pinkish-brown; 4-10 days
3. Lochia alba – yelowish-white; 11-21 days

Foul smelling lochia indicates infection

Menstrual flow resumes within 8 weeks in

nonbreastfeeding mothers, within 3-4 months in
breastfeeding mothers.
• Normal blood loss: 500cc (vaginal
delivery); 1 L (CS)

• Increased WBC count (up to 20,000)

• Fever may be present

• Colostrum secreted from 1-3 days

 Postpartum Discomfort Intervention
Perineal discomfort Ice packs (1st 24 hrs) warm
sitz bath (after 24hrs)
Episiotomy Analgesics spray
perineal care after voiding
Analgesics
Breast engorgement
breastfeed frequently
Ice packs between feedings
warm soaks before feedings
Encourage verbalization
Postparutum blues
• Cracked nipples Air dry nipples 1-20
minutes after feeding
rotate baby’s position
after feeding
Make sure baby is
latched on the areola
Do not use soap when
cleaning the breast
 Phase of Maternal Adjustmet
• 1. “Taking In”
- 1-2 days post partum
- Predominance of mother’s needs (sleep and
food)
- Help with daily activities as well as child care
- Listen to the mother’s experience during labor
and delivery
- Not the best time to do teaching about care of
the neonate
2. “Taking Hold”
- 3-10 days post partum
- Mother starts assuming the care of the
neonate
- Emotional lability may be present
- Best time to teach about baby care
- Reassure the mother that she can
perform the tasks of being a mother
3. “Letting Go”

- Fifth or sixth week postpartum

- New baby is included in new lifestyle
- Focus on entire family
- Mother may be overwhelmed by
demands on her time and energy
 Postpartum Complications

• Postpartum Hemorrhage

• Loss of more than 500 ml of blood

• Causes:
- Uterine atony
- Lacerations
- Retained placental fragments
• Nursing considerations
- Monitor vitals signs
- Monitor fundus
- IV fluids
- Administer medications
- Measure I and O
- Keep client warm
• Postpartum Infection

• Occurs within 10 days after birth

• Predisposing factors;
- Prolonged rupture of membranes
- Cesarean section
- Trauma
- Maternal anemia
- Retained placental fragments
• Clinical presentation
- Fever (100.4 F or 37.8 C) for 2
consecutive days
- Chills
- Abdominal or pelvic pain
- Foul-smelling vaginal discharge
- Dysuria
- Increased wbc count
• Management
- Antibiotics
- Warm sitz bath

• Nursing considerations:
- semi-Fowler’s or high Fowler’s position
- High-calorie, high protein diet
- Increase oral fluids (>3 L/day)
Mastitis

Infection of the breast

Usually bilateral
Staphylococcus aureus
Clinical presentation
- Redness and tenderness
- Fever and chills
- malaise
Breast abscess
• Management
- Antibiotics
- ice
• Nursing considerations
- Teach importance of hand washing
- Empty breast regularly
- Mother may continue breastfeeding