INTRAPARTUM 5 P's

effacement

(0-100%) thinning of cervix during labor, muscles of uterus shorten and exert longitudinal traction on cervix, turns from thick to paper thin; expressed in percentages, less than 50% will say still thick, once above 50% then will talk in percentages - occurs 1st in primagravida's -non-labor; will feel like the nose. Cytotec will help soften and thin cervix, will start to feel like an earlobe, then will feel like inside of cheek when fully softened -contractions longer here

breech presentation

(buttocks or feet first) complete: fetus's hips and knees flexed, thighs on abdomen, presenting part is buttocks frank: hips flexed, knees extended, butt presenting footling: hips and legs extended, one or both feet presenting

cephalic presentation

(head) vertex: head completely flexed onto presenting part and occiput is presenting part military: top of the head is presenting part brow: frontal bone/ brow is presenting part face: hyper-extending

Psyche

-somatic manifestations: elevated BP, increased HR and RR -mom may be excited or scared, help with mental support

3 main measurements

1st effacement 2nd dilation 3rd station

types of attitude:

Flexion: Chin flexed to chest, extremities flexed into torso. Best for delivery. Military: not exactly straight but not flexed

pelvic types:

Gynecoid: rounded heart and best for vaginal delivery Android: deep heart, male pelvis, difficult delivery Anthropoid: oval, ape-like Platypelloid: flat, oval inlet, outlet capacity inadequate, delay of progress

the five P's

Passenger (fetus and placenta) Passageway (birth canal) Powers (contractions) Position of mother and fetus Psychologic response ( maternal)

position abbreviations

R or L ( right or left) Presenting part O, S, M, SC ( occiput, shoulder, mentum, sacrum) A,P,L ( anterior, posterior, lateral/transverse) example: ROA- right occiput anterior

powers continued...( frequency, duration, intensity)

frequency: beginning of one contraction to beginning of next duration: from beginning to end of 1 contraction intensity: strength of the contraction, assessed by palpation *** measure intensity by laying hand on moms abdomen, chart intensity by palpation and nothing else ***

ballotable

head floats back up after descending, if tap head and it goes back up, it is NOT engaged

maternal position

labor positions: almost any but flat on back, change position every 15 minutes, lithotomy/semi or lateral recumbent/standing/squatting - frequent position changes; relieves fatigue and aids in comfort and circulation

types of lie

longitudinal: vertical, spines parallel, can be head first or breech transverse: rare, fetal spine at right angle, diagonal to mom, shoulder presents first, can't deliver vaginally oblique: turn baby to right angle, slightly better, can transition to longitudinal

fetal presentation

manner in which the fetus enters the pelvis

0 station=

at level of ischial spines

shoulder presentation

baby is in transverse position at delivery, must be turned, can't deliver vaginally

secondary powers

bearing down efforts, pushing aids in expulsion of fetus, compress uterus on all sides, prefer that mom is fully dilated before she starts to push

below ischial spines, above?

below= (+) #, less work above= (-) #, more work

3 main types

cephalic, breech, shoulder

anterior fontanelle

diamond shaped

engagement ( fetal presentation continued)

point at which the largest diameter of the presenting part of the fetus has passed through the maternal pelivis

primary powers

primary forces- uterine contractions, myometrium contracts in response to stimuli, move downward over uterus in waves, separated by short periods of rest; effacement, dilatation.

lie

relation of the spine of the fetus to the spine of the mom

fetal position

relationship of fetal landmark to maternal pelvis

station

relationship of presenting part of fetus to imaginary lines drawn between maternal ischial spines, measures degree of descent

attitude

relationship of the fetal parts to each other

passenger

the fetal skull 3 major parts: face, base, and vault

posterior fontanelle

triangle shaped

bony pelvis: true and false ?

true: lower, curved bony canal, includes inlet, cavity, and mid-pelvis during birth; must be adequate for normal fetal passage, coccyx movable to allow for engagement. false: upper portion of the inlet; plays no part in child birth, supports weight of large uterus, looks like pinball machine flaps.

Dilation

widening of the cervical opening ( 0-10cm) enlargement of cervical opening or canal; w/ each contraction the uterus elongates, causes straightening, of uterus, thrusts downward to lower segment, the longitudinal muscle fibers are pulled upward and over presenting part. measures in cm