Category Archives: The Intrapartum Care

Intrapartum Care

1.  The intrapartum period extends from the beginning of contractions that cause cervical dilation to the first 1 to 4 hours after delivery of the newborn and placenta.
2.  Intrapartum care refers to the medical and nursing care given to a pregnant woman and her family during labor and delivery.
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Intrapartum Care: Phenomena And Process Of Labor And Delivery

1.    Labor is the process by which the fetus and products of conception are expelled as the result of regular, progressive, frequent, strong uterine contractions.
2.    Theoretically labor is thought to result from:
a.    Progesterone deprivation
b.    Oxytocin stimulation
c.    Fatal endocrine control
d.    Uterine deciduas activation (release of a complex cascade of bioactive chemical agents into amniotic fluid)
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Intrapartum Care: First And Second Stages Of Labor

A.    Maternal Assessment
1.  A complete health history should include.
a. Name
b. Age
c. Physician
d. Weight
e. Allergies
f. Blood type and Rh factor
g. Previous medical conditions
h. Prenatal problems
i. Gravida and para status
j. Estimated date of delivery
k. Prenatal education
l. Method of newborn feeding
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Intrapartum Care: Third And Fourth Stages Of Labor

A.    Assessment during the third and fourth stages on the following:
1. Maternal physiologic adjustment, including vital signs, bladder uterine firmness uterine fundus, perineum, and amount and color of lochia.
2. Maternal emotional adjustment.
3. Newborn physiological adjustment, including respiratory effort and maintenance of body temperature.
4. Signs of parents-newborn attachment.
5. Mother’s and newborn’s breast-feeding attempts, if the mother is breast-feeding.
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Intrapartum Complications: Essential Concepts

A. Problems that can be anticipated because of maternal and fetal conditions or that can be stabilized and corrected without emergency intervention are increasingly managed in facilities designed to accommodate high-risk maternal and fetal clients. Read More »

Intrapartum Complications

1. Health History
a. Elicit a description of symptoms, including onset, duration, location and precipitating factors or events. Cardinal signs and symptoms may include:

- A sudden gush of fluid from the vagina
- Any copious vaginal bleeding
- Presence of uterine contractions with or without abdominal pain
- Decreased fetal movement
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Intrapartum Complications: Premature Rapture Of Membranes (Prom)

A. DESCRIPTION. PROM is rupture of chorion and amnion before the onset of labor. The gestational age of the fetus and estimates of viability affect management.
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Intrapartum Complications: Preterm Labor

A.DESCRIPTION. Preterm labor is labor that begins after 20 weeks gestation and before 37 weeks gestation.
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Intrapartum Complications: Vasa Previa

A.DESCRIPTION. Vasa previa is a rare development disorder made up of two separate disorders.
1. Velamentous insertion of the umbilical cord, in which the umbilical blood vessels course through amnion and chorion and meet to form the umbilical cord a distance from the placental surface. This places the fragile umbilical vessels at risk for tearing and hemorrhage.
2. The fragile unprotected umbilical vessels cross the internal os and are in front of the presenting fetal head, thus creating a vasa previa.
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Intrapartum Complications: Umbilical Cord Prolapse

1. Cord is descent of the umbilical cord into the vagina ahead of the fetal presenting part with resulting compression of the cord between the presenting part and the maternal pelvis.
2.Cord prolapsed is an emergency situation; immediate delivery will be attempted to save the fetus.
3. It occurs in 1 of 200 pregnancies
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Intrapartum Complications: Prolonged Pregnancy

1.A prolonged or postdate pregnancy is a pregnancy that extends beyond 42 weeks’ gestation.
2. The incidence of prolonged pregnancy is approximately 10%.
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Intrapartum Complications: Dysfunctional Labor

A.DESCRIPTION. Dysfunctional labor is difficult, painful, prolonged labor due to mechanical factors.
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Intrapartum Complications: Shoulder Dystocia

A.DESCRIPTION. In shoulder dystocia, the anterior shoulder of the baby is unable to pass under the maternal pubic arch. Read More »

Intrapartum Complications: Induction Of Labor


1. The deliberate initiation of labor before spontaneous contractions begin may be either mechanical (amniotomy [rupture of amniotic membranes]), physiologic (ambulation and nipple stimulation), or chemical (prostaglandins and oxytocin).
2.Artificial rupture of membranes (AROM) may be adequate stimulation to initiate contractions, or AROM may be done after oxytocin administration establishes effective contractions.
3. Induction and AROM are initiated when the cervix is soft, partially effaced, and slightly dilated, preferably when the fetal presenting part is engaged.
4. Oxytocin-induced labor must be done with careful, ongoing monitoring; oxytocin is a powerful drug. Hyperstimulation of the uterus may result is titanic contractions prolonged to more than 90 seconds, which could cause fetal compromise due to impaired uteroplacental perfusion, abruption placentae, laceration of the cervix, uterine rupture, or neonatal trauma.
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Intrapartum Complications: Uterine Rupture

1. Uterine rupture is tearing of the uterus, either complete (rupture extends through entire uterine wall and uterine contents spill into the abdominal cavity) or incomplete (rupture extends through endometrium and myometrium, but the peritoneum surrounding the uterus remains intact).
2. Small tears may be asymptomatic and may heal spontaneously, remaining undetected until the stress and strain or a subsequent labor.
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Intrapartum Complications: Placenta Accreta

A. DESCRIPTION. Placenta accrete is an uncommon condition in which the chorionic villi adhere to the myometrium. It can be exhibited as:

1. Placenta Accreta – the placental chorionic will adhere to the superficial layer of the uterine myometrium.
2. Placenta Increta – the placental chorionic will invade deeply into the uterine myometrium.
3. Placenta Pecreta – the placental chorionic will go through the uterine myometrium and often adhere to abdominal structures such as the bladder or intestine)

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Intrapartum Complications: Cesarian Birth

1.In this surgical procedure, the newborn is delivered through the abdomen from an incision made through the maternal abdomen and the uterine myometrium.
2. The surgery maybe preplanned (elective) or arise form an unanticipated problem.
3. Types of cesarean birth include the following:
a. Classical or vertical. A vertical midline incision is made in the skin and the body of the uterus, permitting easier access to the fetus. This is indicated in emergency situations, where there are abdominal adhesions for previous surgeries, or when the fetus is in transverse lie. Blood loss increased because large vessels of the myometrium are involved. Because the uterine musculature is weakened, there is greater possibility of rupture of the uterine scar subsequent pregnancies.
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Intrapartum Complications: Uterine Intervention

A.DESCRIPTION. The uterus turns completely or partially inside out; it occurs immediately following delivery of the placenta or in the immediate postpartum period.
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Intrapartum Complications: Early Postpartum Hemorrhage

1.Early postpartum hemorrhage is defined as blood loss of 500ml or more during the first 24 hours after delivery.
2. Postpartum hemorrhage is the leading cause of maternal death worldwide and common cause of excessive blood loss during the early postpartum period.
3. Approximately 5% of women experience some type of postdelivery hemorrhage.
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