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2026:( updated) Intrapartum, Lecture notes of Medicine

Huston-Tillotson University (HTU)Medicine

Intrapartum FOR PASS EXPLAINED

Typology: Lecture notes

2025/2026

Available from 02/07/2026

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Premonitory signs of labor • Lightening
• Contractions (Braxton Hicks)
• Bloody Show
• Nesting
• Weight loss
• "Funny little backache"
• Flu like symptoms
True labor Contractions will produce changes in the cervix (effacement & dilation)
First stage of labor • onset of labor to complete dilation of the cervix
o Latent phase -ends with cervix 6 cm
o Active - 6-8cm
o Transition (if used) 8-10 cm
• Contractions last 30-60 seconds and are 5-20 minute apart
• Brown/pink mucous discharge
• Amniotic sac rupture
Second stage of labor • Complete dilation to birth
• Contrations last 45-60 seconds and are 2-5 minutes apart to 60-90 seconds 2-3
minutes apart
• Dilation up to 8-10 cm
• increasing pressure in back and rectum
Third stage of labor Birth to placental expulsion
Forth stage of labor Four hours following delivery of placenta (recovery)
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Premonitory signs of labor • • (^) Contractions (Braxton Hicks)Lightening

  • • Bloody ShowNesting
  • • Weight loss"Funny little backache"
  • Flu like symptoms True labor Contractions will produce changes in the cervix (effacement & dilation) First stage of labor • o Latent phase -ends with cervix 6 cm onset of labor to complete dilation of the cervix o Active - 6-8cmo Transition (if used) 8-10 cm
  • • Contractions last 30-60 seconds and are 5-20 minute apartBrown/pink mucous discharge
  • Amniotic sac rupture Second stage of labor • • Complete dilation to birthContrations last 45-60 seconds and are 2-5 minutes apart to 60-90 seconds 2- minutes apart • Dilation up to 8-10 cm
  • increasing pressure in back and rectum Third stage of labor Birth to placental expulsion Forth stage of labor Four hours following delivery of placenta (recovery)

Components of birthing process (5 P's) • • PowersPassage

  • • PassengerPresentation
  • Psyche Powers Power of uterine contractions & maternal pushing efforts Passage • • (^) The bony pelvis is more important to the outcome of labor, because the bonesMaternal pelvis and soft tissues and joints do not readily yield to the forces of labor. • Softening of the cartilage linking the pelvic bones increases as term approaches and the hormone relaxin increases Passenger Fetal head, bones, sutures, & fontanels Presentation position of fetus in maternal pelvis Psyche • • The state of the mother's psyche is a crucial aspect of childbirth.Marked anxiety, fear, or fatigue decreases a woman's ability to cope with labor pain. • Maternal catecholamines are secreted in response to anxiety or fear.
  • • They inhibit uterine contractility and placental blood flow.Relaxation augments the natural process of labor.

Cultural Values • labor and how she should interact with her newborn. A woman's culture gives her cues about how she should behave and react to

  • encounters provides a framework to assess and care for the woman and her Knowledge of the values and practices of cultural groups that the nurse family. Mechanisms of Labor • • DescentEngagement of the presenting part
  • • Flexion of the fetal headInternal rotation
  • • Extension of the fetal headExternal rotation
  • Expulsion of the fetal shoulders and body Normal Labor • • Consistent progression of uterine contractionsCervical dilation and effacement
  • • Fetal descentFetus is the more vulnerable of the maternal-fetal pair.

Normal fetal hear rate (FHR) 110-160 beats per minute

Electronic fetal monitoring Advantages • Supplies more data about the fetus and auscultation

  • • (^) Gradual trends in FHR and uterine activity are apparentProvides a permanent record that may be printed or stored electronically Limitations • Reduced mobility is the major limitation

External fetal monitoring • • Remote surveillanceUltrasound transducer

  • Secured on the mothers abdomen with a last straps- Less accurate than internal devices but are noninvasive and suitable for most women in labor • Toco transducer
  • A pressure sensitive area detects changes and abdominal contour to measureuterine activity

Early Decelerations • • Mirror images of contractionReturn to baseline fetal heart rate by end of contraction

  • • (^) Associated with fetal head compressionMaternal position changes usually have no effect on pattern
  • Not associated with fetal compromise Late Decelerations • • Begin after contraction begins (often near peak)Nadir occurs after peak of contraction
  • • May remain in normal range and not fall far from baselineReflect possible impaired placental exchange
  • • Occasional late decelerations accompanied by moderate variabilityRequires nursing intervention to improve placental blood flow and fetal oxygen supply Variable Decelerations • • Caused by reduced flow through umbilical cord (cord compression)Shape, duration, and degree of fall below baseline rate are variable
  • • Fall and rise in rate is abruptRequires nursing intervention

Significance of fetal heart rate pattern • • Category I: Normal (reassuring): Associated with fetal well-beingCategory II: Indeterminate (equivocal or ambiguous data): Describe patterns or elements of reassuring characteristics but also data that may be nonreassuring • Category III: Abnormal (nonreassuring): Favorable signs are absent

Responding to non reassuring fetal heart rate patterns • • Identify cause of patternIncrease placental perfusion

  • • Increase maternal blood oxygen saturationReduce cord compression