Intrapartum care study notes

Pathophysiology,
etiology and direct
and indirect
causes in your
own words

Pathophysiology:

Both mother and baby begin to prepare for birth in the final weeks of pregnancy. The mother is instructed to call the health care provider and come into the birthing unit if any of the following occur. Rupture of membranes, regular, frequent uterine contractions (nulliparas, 5 minutes apart for one hour; multiparas, 6-8 minutes apart for 1 hour), any vaginal bleeding or decreased fetal movement. Family centered care is a model of care based on the philosophy that physical, sociocultural, spiritual, and economic needs of the family are combined and considered collectively when planning for the childbearing family.

Five factors are important in the process of labor and birth. 1)Birth passage - is the size of the maternal pelvis or diameters of the pelvic inlet, midpelvis, and outlet. The type of maternal pelvis, and the ability of the cervix to dilate and efface and ability of the vaginal canal and the external opening of the vagina to distend.

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2) The fetus-fetal head, fetal attitude, fetal lie, and fetal presentation. 3) Relationship between passage and fetusengagement of the fetal presenting part, station or location of fetal presenting part in the maternal pelvis in relation to the spine, and fetal position. 4) Physiologic forces of labor -frequency, duration, and intensity of uterine contractions as the fetus moves through the passage, and effectiveness of the maternal pushing effort.

5)Psychosocial considerations-mental and physical preparation for childbirth, socio-cultural values and beliefs, previous childbirth experience, support from significant other, and emotional status.

Labor usually begins between 30 and 42 weeks of gestation. Pro just her own relaxes the smooth muscle tissue, estrogen stimulates uterine muscle contractions, and connective tissue loosens to permit the softening, thinning, and eventual opening of the cervix. In true labor, with each contraction the muscles of the upper uterine segment shortening and exert a Longitudinal traction on the cervix, causing effacement in which is the drawing up of the internal OS and the cervical canal into the uterine sidewalls. The contractions of true labor produced progressive dilation and effacement of the cervix. They only occur regularly and increase in frequency, duration, and intensity. The discomfort of true labor contractions usually starts in the back and radiates around to the abdomen. The pain is not relieved by ambulation. The contractions of false labor do not produce progressive cervical effacement and dilation. They are you regular and do not increasing frequency, duration, and intensity. The discomfort may be relieved by ambulation, changing positions, drinking a large amount of water, or taking a warm shower.

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Pathophysiology,
etiology and direct
and indirect
causes in your
own words

The first stage begins with the onset of true labor and ends when the cervix is completely dilated at 10 cm. The second stage begins with complete dilation and ends with the birth of the newborn. The third stage begins with the birth of the newborn and ends with the delivery of the placenta. Some clinicians identify a fourth stage. This stage lasts 1 to 4 hours after delivery of the placenta, the uterus effectively contracts to control bleeding at the placental site. Maternal systemic response to labor. The mothers cardiovascular system is stressed both by the uterine contractions and by the pain, anxiety, and apprehension she experiences. During pregnancy the circulating blood volume increases by 50%. The increasing cardiac output peaks between the second and third trimester. Maternal position also affects cardiac output. In the supine position, cardiac output lowers heart rate increases and stroke volume decreases. When turned to a lateral side laying position cardiac output increases. As a result blood-pressure rises during uterine contractions. Oxygen demand and consumption increased at the onset of the labor because of the presence of uterine contractions. By the end of the first stage of labor most women develop a mild metabolic acidosis compensated by respiratory alkalosis. The changes in acid-base status that occur in labor quickly reversed in the fourth stage because of changes in the woman's respiratory rate.

During labor there is an increase in maternal renin level, plasma renin activity, and angiotensinogen level. These help control uteroplacental bloodflow during birth and the early postpartum period. Gastric mobility and absorption of solid food are reduced. Some narcotics also delayed gastric emptying. White blood cell count increases to 25,000 to 30,000 cells during labor and the early postpartum Period. The change in wbc's is mostly because of the increased neutrophils resulting from a physiologic response to stress. The increased WBC count makes it difficult to identify the presence of an infection. Maternal blood glucose levels decrease during labor because glucoses uses an energy source. Fetal response to labor. The mechanical and hemodynamic changes of normal labor have no adverse effect when the fetus is healthy. Heart rate deceleration can occur with intracranial pressure as the head pushes against the cervix. Bloodflow is decreased to the fetus at the peak of each contraction, leading to a slow decrease in pH status. The adequate exchange of nutrients and gases in the fetal capillaries depends in part on the fetal blood pressure. Fetal blood pressure is a protective mechanism for the normal fetus in the anoxic periods caused by the contracting uterus during labor. The fetus is able to experience sensations of light, sound, and touch beginning at approximately 37 or 38 weeks of gestation.

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Pathophysiology,
etiology and
direct and indirect
causes in your
own words

Sometimes procedures are necessary to maintain the safety of the woman and the fetus. The most common of these procedures are labor induction, episiotomy, cesarean birth, and vaginal birth following a previous cesarean birth. Labor induction is the stimulation of the uterine contractions before the spontaneous onset of labor, with or without ruptured fetal membranes, for the purpose of accomplishing birth.

Risk Factors: Other alterations may occur during the intrapartum period. These include precipitous birth (rapid progression of labor, with birthing occuring within 3 hours or less), abruption placentae (premature separation of a normally implanted placenta from the uterine wall. Considered to be a catastrophic event because of the severity of the resulting hemorrhage), placenta previa (implantation of the placenta day in the lower uterine segment rather than the upper portion, resulting in placental separation with dilation of the cervix), premature rupture of membranes (spontaneous rupture of the membranes before the onset of labor), preterm (Labor that occurs between 20 and 36 completed weeks of pregnancy) and postterm labor (A pregnancy that exceeds 42 weeks since the last menstrual period), hypertonic labor (ineffective uterine contractions of poor quality occurring in the latent phase of labor with increased resting tone of the myometrium and frequent contractions), hypotonic labor (usually developing in the active phase of labor, characterized by 4000g at birth, often associated with excessive maternal weight, maternal obesity, maternal diabetes, or prolonged gestation), nonreassuring fetal status (when the oxygen supply is insufficient to meet the physiologic needs of the fetus), prolapsed umbilical cord (The umbilical cord precedes the fetal presenting part, placing pressure on the cord and reducing or stopping bloodflow to and from the fetus), amniotic fluid embolism (The presence of a small tear in the amnion or chorion high in the uterus, an area of separation in the placenta, or cervical tear where a small amount of amniotic fluid may leak into the chorionic plate and enter the maternal system as an amniotic fluid embolism), cephalopelvic disproportion (occurs when the fetal head is too large to pass through any part of the birth passage, which can result in prolonged labor, uterine rupture, necrosis of maternal soft tissue, cord prolapse, excessive molding of the fetal head, or damage to the fetal skull and central nervous system), retained placenta (retention of the placenta beyond 30 minutes after birth, resulting in bleeding that may lead to shock), lacerations (tearing of the cervix or vagina. The highest risk is in young or nullipara woman, forceps assisted birth, or administration of an epidural),

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Pathophysiology,
etiology and
direct and
indirect causes
in your own
words

placenta accreta (The chorionic villa attached directly to the myometrium of the uterus.. The adherence itself maybe total, partial, or focal, depending on the amount of placental
involved), and perinatal loss (death of a fetus or infant from the time of conception through the end of the newborn period 28 days after delivery).

Interrelated
Concepts (3 or
more)

Comfort, Mobility, Family, and Sexuality

Prioritized
1. Risk for injury related to hyperstimulation of uterus caused Nursing
by induction of labor.!
Diagnoses (4 or
more in two or
2. Anxiety related to discomfort of labor and unknown labor
three part
outcomes as evidence by verbal communication.!
statements)!
3. Acute Pain related to uterine contractions as evidence by verbal complaints of pain.

4. Readiness for enhanced cognition related to the birth
process as evidence by verbalizing concerns to nurse.
Resource Links ! Grassley, J. S., & Sauls, D. J. (2012). Evaluation of the (2 or more)!
Supportive Needs of Adolescents during Childbirth
Intrapartum Nursing Intervention on Adolescents' Childbirth
Satisfaction and Breastfeeding Rates. JOGNN: Journal Of
Obstetric, Gynecologic & Neonatal Nursing, 41(1), 33-44. doi: 10.1111/j.1552-6909.2011.01310.x!

Mathew, D., Dougall, A., Konfortion, J., & Johnson, S. (2011). The Intrapartum Scorecard: Enhancing safety on the labour
ward. British Journal Of Midwifery, 19(9), 578-586.!