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Intrapartum Assessment and

Interventions

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ObjectivesThe learner will be able to Define key terms Describe the four stages of labor and the related

nursing and medical care Demonstrate understanding of supportive care of the

laboring woman Identify the four Ps of labor Describe the mechanism of spontaneous vaginal

delivery and related nursing care

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Factors That May Trigger Labor

Maternal factors Fetal factors

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Management of Discomfort During Labor and Delivery

Pain may result due to the following factors Decreased blood supply to uterus Increased pressure and stretching of the pelvic

structures Cervical dilatation and stretching

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Factors Affecting Labor (4 Ps)

Powers (the contractions) Passage (the pelvis) Passenger (the fetus) Psyche (the response of woman)

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Labor Process

Premonitory signs of labor are Lightening Braxton-Hicks contractions Bloody show Spontaneous rupture of membranes

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Mechanism of Labor

Engagement Descent Flexion Internal rotation Extension External rotation Expulsion

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Labor

Labor is the process in which the fetus, placenta, and membranes are expelled spontaneously

Stages of labor Stage one Stage two Stage three Stage four

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First StageLatent phase Cervix 0 – 3 cm Contraction every 5 – 10 min, mild intensity,

lasting 30 – 45 sec Medical interventions Nursing actions

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First StageActive phase Average dilation 1.2 cm/hr depending on gravida Dilation progresses 4 – 7 cm, 40 – 80% effacement Fetal descent Intense contraction q 2 – 5 mins, lasting 40 – 60 sec Increase in pain Medical interventions Nursing actions

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First Stage

Transition phase Dilation from 8 – 10 cm, 100% effacement Contractions intense, q 1 – 2 min lasting 60 – 90 sec Feels exhausted Bloody show N/V, backache, diaphoresis, and trembling Medical interventions Nursing actions

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Second Stage Complete dilatation Sudden burst of energy Shorter duration with multips than primips Intense contraction every 2 min, lasting

60 – 90 sec Increase in bloody show Perineum flattens, with bulging rectum and vagina Medical interventions Nursing actions

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Third Stage of Labor

Occurs after delivery of infant Period involving separation and expulsion of

placenta/membranes Last 5 – 20 min Medical interventions Nursing actions

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Fourth Stage

This stage begins the postpartum period Ends 4 hr after delivery Mechanism of homeostasis occurs Medical intervention Nursing actions

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Management of Discomfort During Labor

Nonpharmacological management Pharmacological management Care of a woman before and after epidural

anesthesia

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Case Study Review

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Review QuestionsLatent phase of labor is indicated by

1. Cervix 0 – 3 cm dilated with contractions every 5 – 10 min, of mild intensity, lasting 30 – 45 sec

2. Cervix 0 – 4 cm dilated with contractions every 5 – 15 min, of mild intensity, lasting 30 – 45 sec

3. Cervix 0 – 2 cm dilated with contractions every 3 – 10 min, of mild intensity, lasting 45 – 60 sec

4. Cervix 0 – 3 cm dilated with contractions every 5 – 10 min, of strong intensity, lasting 30 – 60 sec

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1

Answer

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Active phase of labor is indicated by

1. Average dilation 1.2 cm/hr, dilation progresses 4 – 7 cm

2. Average dilation 1.2 cm/hr, dilation progresses 4 – 10 cm

3. Average dilation 2 cm/hr, dilation progresses 4 – 7 cm

4. Average dilation 1 cm/hr, dilation progresses 2 – 6 cm

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Answer

1

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Transition phase of labor is indicated by 1. Dilation from 8 to 10 cm, contractions intense,

q 1 – 2 min lasting 60 – 90 sec2. Dilation from 6 to 10 cm, contractions intense,

q 1 – 2 min lasting 60 – 90 sec3. Dilation from 7 to 10 cm, contractions intense,

q 2 – 4 min lasting 60 – 90 sec4. Dilation from 8 to 10 cm, contraction moderate,

q 1 – 2 minutes lasting 60 sec

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1

Answer