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