CARE OF MOTHER, CHILD, ADOLESCENT (WELL
CLIENTS)
o
OUTLET
Prelim Lesson 2: Intrapartum
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Discusses the period occurring
during labor and delivery. It
describes the process of
childbirth. Contractions of the
uterus and changes in the cervix
prepare a woman’s body to give
birth. Then the baby is born, and
the placenta follows
COMPONENTS OF LABOR
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A successful labor depends on
four integrated concepts
PASSAGE
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Woman’s pelvis is of adequate
size and contour
PASSENGER
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Fetus, is of appropriate size and
in an advantageous position and
presentation
POWERS
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Uterine factors are adequate
Strongly influenced by the
woman’s position during labor
PSYCHE
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Woman’s psychological outlook is
preserved so that afterward labor
can be viewed as a positive
experience
PASSAGE
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Refers to the route a fetus must
travel from the uterus to the
cervix and vagina to the external
perineum
DIAGONAL CONJUGATE
o Antero-posterior diameter
of the inlet
TRANSVERSE DIAMETER OUTLET
Different types of pelvis
o GYNECOID
▪ Female pelvis
▪ Inlet well-rounded
forward and backward
in a wide pubic arc
▪ Ideal for childbirth
o ANDROID
▪ Male pelvis
▪ Pubic arc forms an
acute angle making
the lower dimensions
of the pelvis
extremely narrow
▪ A fetus may have
difficulty exiting
from this type of
pelvis
o PLATYPELLOID
▪ Flattened pelvis
▪ Smoothly curved oval
inlet but the
anterior-posterior
diameter is shallow
▪ A fetal head might
not be able to rotate
too much of the
curves of the pelvic
cavity from this type
of pelvis
o ANTHROPOID
▪ Ape-like pelvis
▪ The transverse
diameter is narrow
and the anteriorposterior diameter of
the inlet is larger
than normal
▪ Does not accommodate
a fetal head as well
as a gynaecoid pelvis
PASSENGER
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Subdivisions of the true pelvis
o INLET
o MIDPELVIS
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Fetus
The body part of the fetus that
has the widest diameter is the
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head, the part which is least
likely to pass through the pelvic
ring
While a fetal skull can pass
depends on both its structure and
its alignment with the pelvis
Structure of the Fetal skull:
FONTANELLES
o Anterior Fontanelle
▪ BREGMA, lies at the
junction of the
coronal and sagittal
sutures,
▪ Diamond in shape and
closes when the
infant is 12 to 18
months of age
o Posterior Fontanelle
▪ Lies at the junction
of the lambdoid and
sagittal sutures
▪ Triangular in shape
and closes when an
infant is about 2
months of age
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MOLDING
o Change in the shape of a
fetal skull produced by the
force of uterine
contractions, pressing the
vertex of the head against
the not yet dilated cervix
o Commonly seen in infants
just after birth
o Parents can be reassured
that molding only last a
day or two and is not a
permanent condition
o No skull molding occurs
when a fetus is breeched
because the buttocks, not
the head, are presented
first
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2 other factors play a part in
whether a fetus is lined up in
the best position to be born:
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Fetal Presentation and Position
o ATTITUDE
▪ Describes the degree
of flexion a fetus
assumes during labor
or the relation of
fetal parts to each
other
▪ COMPLETE FLEXION
• A fetus in good
attitude is in
complete
flexion the
spinal column
is bowed
forward, the
head is flexed
forward, so
much that the
chin touches
the sternum,
arms are flexed
and folded on
the chest,
thigh flexed
unto the
abdomen, calves
pressed against
the posterior
aspect of the
thigh
• Advantage for
birth because
it helps the
fetus present
the smallest
anteriorposterior
diameter of the
skull to the
pelvis
▪ MODERATE FLEXION
• If the chin is
not touching
the chest but
it is in an
alert or
military
position
▪ PARTIAL/POOR
EXTENSION
• Presents the
brow of the
head of the
birth canal
▪ FULL/COMPLETE
EXTENSION
• Back is arched,
the neck is
extended,
presenting the
occipital
mental diameter
of the head to
the birth canal
or the face
presentation
o ENGAGEMENT
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o
Settling of the
presenting part of
the fetus far enough
into the pelvis, to
be at the level of
the ischial spine, to
the midpoint of the
pelvis
The degree of
engagement is
assessed by vaginal
and cervical
o
examination
A presenting part
that is not engaged
is said to be
floating
One that is
descending but is not
yet reached the
ischial spine is said
to be beating
STATION
▪ Relationship of a
presenting part of
the fetus to the
level of the ischial
spine
▪ When the presenting
fetal part is at the
level of the ischial
spine it is at a zero
station or synonymous
with engagement
▪ If the presenting
part is above the
spine the distance is
measured and
described as minor
stations which range
from -1cm to -4cm
▪ If the presenting
part is below the
ischial spine the
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distance is stated as
*plause?* station,
+1cm to +4cm
▪ At a +3/+4 station
the presenting part
is at the perineum
and can be seen if
the vulva is
separated, this is
now what we call
crowning
FETAL LIE
▪ Lie is the
relationship between
the lung cephalocaudal axis of the
fetal body and the
long cephalo-caudal
axis of a woman’s
body
▪ Whether the fetus is
lying in a horizontal
or transverse or a
vertical or
longitudinal position
▪ Approximately 99% of
the fetuses assume a
longitudinal lie
▪ Longitudinal lies are
further classified as
cephalic, which means
the head will be the
first part to contact
the cervix; breech,
buttocks as the first
position to contact
the cervix
Types of Fetal Presentation
Fetal presentation, denotes the
body part that will first contact
the cervix or be born first
This is determined by a
combination of fetal lie and the
degree of fetal flexion/attitude
o CEPHALIC
▪ Most frequent type of
presentation
▪ Occurring as often as
95%
▪ The fetal head is the
body part that will
first contact the
cervix
• VERTEX
o Ideal
presentin
g part
• BROW
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FACE
MENTUM
BREEACH
▪ Either the buttocks
or the feet are the
first body parts that
will contact the
cervix
▪ Can be a difficult
birth, with the
presenting point
influencing the
degree of difficulty
• COMPLETE
• FRANK
• FOOTLING
SHOULDER
▪ In a transverse lie a
fetus lies
horizontally in the
pelvis so that the
longest fetal access
is perpendicular to
that of a mother
▪ The presenting part
is usually one of the
shoulders or the
acromion process,
iliac crest, hand, or
an elbow
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TYPES OF FETAL POSITION
Position is the relationship of
the presenting part to a specific
quadrant of a woman’s pelvis
For convenience the maternal
pelvis is divided into four
quadrants according to the
mother’s right and left
Four quadrants of the maternal
pelvis:
o RIGHT ANTERIOR
o LEFT ANTERIOR
o RIGHT POSTERIOR
o LEFT POSTERIOR
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Types of Fetal Position
Landmarks to describe the
relationship of the presenting
part to one of the pelvic
quadrants:
o VERTEX POSITION: OCCIPUT
o FACE PRESENTATION:
CHIN/MENTUM
o BREECH PRESENTATION: SACRUM
o SHOULDER PRESENTATION:
SCAPULA/ACROMNION PROCESS
Positions indicated by
abbreviations of three letters:
o FIRST LETTER
▪ Defines whether the
landmark is pointing
to the mother’s right
or left
o MIDDLE LETTER
▪ Denotes the fetal
landmark
▪ O for Occiput, M for
Mentum/Chin, SA for
sacrum, and A for
acromion process
o LAST LETTER
▪ Defines whether the
landmark points
anteriorly,
posteriorly, or
transversely
▪ LEFT OCCIPUT ANTERIOR
(LOA)
• If the occiput
of the fetus
points to the
left anterior
quadrant in a
vertex position
• Most common
fetal position
▪ RIGHT OCCIPUT
ANTERIOR (ROA)
• Second most
frequent
position
Mechanisms of Labor (Cardinal
Movements of Labor)
The passage of the fetus through
the birth canal involves several
different position changes, to
keep the smallest diameter of the
fetal head always presenting to
the smallest diameter of the
pelvis, termed as CARDINAL
MOVEMENTS OF LABOR
o DESCENT
o FLEXION
o INTERNAL ROTATION
o EXTENSION
o EXTERNAL ROTATION
o
o
EXPULSION
DEFIREERE
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an opening a few
millimeters wide to
one large enough
Approximately 10cm to
permit passage of a
fetus
PSYCHE
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POWERS OF LABOR
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The second important requirements
for successful labor are
EFFECTIVE POWERS OF LABOR
Force supplied by the fundus of
the uterus, implemented by
uterine contractions
Natural process that causes
cervical dilatation and expulsion
of the fetus from the uterus
After full dilatation of the
cervix the primary power is
supplemented by the use of the
abdominal muscles
UTERINE CONTRACTIONS
o The mark of an effective
uterine contraction is
rhythmicity and progressive
lengthening and intensity
CERVICAL CHANGES
o Even more mark than the
changes in the body of the
uterus are 2 changes that
occur in the cervix
o EFFACEMENT
▪ Shortening and
thinning of the
cervical canal
▪ Normally the canal is
approximately 1cm-2cm
long
▪ The canal virtually
disappears because of
longitudinal
attraction from the
contracting uterine
fundus
o DILATATION
▪ Enlargement or
widening of the
cervical canal from
Woman’s psychological outlook
Refers to the psychological state
or feelings that a woman brings
into labor
For many women this is a feeling
of apprehension or fright for
almost everyone including a sense
of excitement or awe
Women who manage best in labor
typically are those who have a
strong sense of self-esteem and a
meaningful support person with
them
THEORIES OF LABOR ONSET
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Uterine stretching
Pressure on the cervix
Oxytocin stimulation
Change in the ratio of estrogen
to progesterone
Placental age
Rising fetal cortisol levels
Fetal membranes production of
prostaglandin
SIGNS OF LABOR
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PRELIMINARY SIGNS OF LABOR
SIGNS OF TRUE LABOR
MATERNAL AND FETAL RESPONSES TO LABOR
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PHYSIOLOGIC EFFECTS OF LABOR ON A
WOMAN
o Cardiovascular System
o Hemopoietic System
o Respiratory System
o Temperature Regulation
o Fluid Balance
o Urinary System
o Musculoskeletal System
o Gastrointestinal System
o Neurologic and Sensory
Responses
PSYCHOLOGICAL RESPONSES OF A
WOMAN TO A LABOR
o Fatigue
o Fear
o Cultural Influences
PHYSIOLOGIC EFFECTS OF LABOR TO A
FETUS
o Neurologic System
o Cardiovascular System
o Integumentary System
o Musculoskeletal System
o Respiratory System
STUDOCU THEORIES OF LABOR ONSET
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