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Intrapartum, NUR 4545- Resurrection University, Best document for preparation, Verified And Correct Answers
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Intrapartum, NUR 4545- Resurrection University, Best document for preparation, Verified And Correct Answers

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  • May 10, 2021
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Intrapartum
Ricci Chapters 13 and 14; ATI Chapters 11-15

1. Discuss the signs/symptoms that may occur in the days or weeks preceding the initiation of labor: “promontory signs”.
 Cervical changes  cervical softening, cervical dilation with descent. Can occur 1 month to 1 hour before actual labor.
 Lightening  fetal’s presenting part begins to descend into the true pelvis (breathing is easier, ↓ reflux, ↑ pelvic pressure,
leg cramping, dependent edema, low back discomfort) – more likely to happen w/ the first baby.
 ↑ energy level  “nesting”, occurs 24-48 hours before onset of labor (due to ↑ in epinephrine release caused by ↓ in
progesterone).
 Bloody show  blood from ruptured cervical capillaries from the mucus plug that fills the cervical canal.
 Braxton hicks  contractions become stronger and more frequent. It is felt as a tightening or pulling sensation of the top of
the uterus – occurs primarily in the abdomen and groin and gradually spread downward before relaxing.
 Usually lasts as long as 30 seconds - 2 minutes. IF contractions last longer than 30 seconds and happens more than 4-6
times an hour, contact her PCP. WON’T SHOW CERVICAL CHANGE.
 ROM  labor will begin spontaneously within 24 hours after ROM. After ROM, there is a danger of cord prolapse if
engagement has not occurred so it’s important to see the HCP right away.
2. How do we discern “true” labor from “false” labor?
 True labor is progressive, regular in duration, and becomes stronger. CERVICAL CHANGE and fetus engaged in the pelvis.
 False labor is irregular contractions, does not become stronger or closer together, stops with rest, hydration and activity.
 If mom changes activity (going from resting to walking) and the contractions stop, it is FALSE labor.
 True labor produces dilation, effacement, engagement and descent (false labor does not produce any of these).
 Other events that occur just before true labor occurs:
 Lightening  Burst of energy can occur 24-48 hours before
 Vaginal discharge (“nesting”)
 Brown/blood tinged cervical mucus passes  Estrogen and progesterone levels fluctuate,
 Cervix gets ready by ripening, potentially causing a fluid shift and subsequent weight loss
dilating/effacing of 2.2-6.6 kg approximately 2-48 hours prior to
labor.
 Rupture of membranes “water breaking” (can be anywhere from 50-300 ml)
3. Discuss the five “P’s” that affect labor:
 (1) PASSAGEWAY (BIRTH CANAL) (students do NOT need to know the details about the bony pelvis; they should be familiar
with the four most common pelvic shapes)
 Consists of the maternal pelvis and soft tissues.
 Hormones relaxin and estrogen cause the connective tissues to become more relaxed and elastic and cause the joints to
become more flexible to prepare for childbirth.
 Effacement  thinning of the cervix to allow fetus to descend into the vagina. Along with dilation, think of it as similar
to pulling a turtleneck sweater over your head.
 (2) PASSENGER/PLACENTA – BABY!
 Cephalic/Head: size and presence of molding. Go back to
skull and sutures***
 Vertex  most common, head fully flexed down.
 Brow  head tipped back slightly, “eyebrows first”
 Face  head tipped back fully, full face first
 Reassure mom that the oblong shape is only
temporary.
 Attitude: relationship of fetal head position to maternal
spine (flexion or extension).
 Flexion  normal attitude, head flexed down with chin to chest. Thighs are flexed on the
abdomen, legs are flexed to the knees.
 Extension  abnormal attitude, less commonly seen, head extended back.
 Lie: relationship of fetal spine to maternal spine
 Longitudinal/vertical  normal lie, both spines parallel
 Transverse  abnormal lie; both spines form cross, c-section required.

1
Rev. Fall 2019

, Intrapartum
 Presentation: used to describe the way the baby is positioned while coming down the birth canal. Which part is leading
the way?What’s pointing towards mom’s vagina?
 Head (look above at cephalic/head. i.e. vertex, brow, face)
 Breech: butt; difficult because largest part is born last (skull) and might get “hung up”/stuck in the pelvis. Umbilical
cord may also become compressed because abdomen is born before the skull.
o Frank (A)  most common, hips flexed, knees extended
o Full/complete (B)  both knees bent, bottom of feet closest to birth canal, cross legged appearance
o Footling (C and D) when a foot presents first
 Others: shoulder, side, foot, abdomen, etc.
 Position: used to describe the position of the baby in
relation to mom’s pelvis. Described by THREE LETTERS.
 Must know landmark  occiput/occipital (most
common, back of the head) “O”, scapula/acromion
process “Sc”, sacrum/buttocks “S”, mentum/chin “M”.
 look at where landmark is in relation to mom’s spine
 right vs left; anterior vs posterior
 left occiput anterior is most common and where most babies naturally face… it allows the widest part of the baby’s
head to correspond with the widest part of mom’s pelvis.
o Example1 --- ROA  occiput is facing right side of pelvis and is towards the front of the pelvis
o Example 2 --- LOA  occiput is facing the left side of the pelvis and is anterior (towards the front)





Station: how far down the baby is in the birth canal in relation to mom’s ischial spine
 Mom’s ischial spine is the narrowest of her pelvis, so when the baby is there,
they are at 0 station
 Negative numbers mean the baby is farther inside/up (-1, -2, -3)
 Positive numbers mean the baby is farther out/closer to delivery (+1, +2, +3)
 Measured in cm

 Cardinal movements of labor: specific movements the baby does, in this specific order, to exit mom successfully.
 Engagement  where the presenting part descends through the pelvic inlet. May be called lightening or dropping.
Occurs approximately 2 weeks before delivery.
 Descent and flexion  process of presenting part (typically the head) going through mom’s pelvis, occur
simultaneously as a fluid movement.
o Baby flexes head down
o Descent is measured by station, continuous process until delivery
o 0, negative or positive station.
 Internal rotation  baby rotates within the birth canal (baby’s face in line with mom’s rectum).
 Extension  baby’s head extends. Begins after crowning. Complete when chin is out of perineum.
 Restitution and external rotation  occur simultaneously as a fluid movement
o Baby re-aligning its head with body
 Expulsion  baby’s entire body is out.
 (3) POWERS: primary and secondary
 Primary = Uterine contractions (involuntary)
 Frequency  how often contractions occur and is measured from the beginning of one contraction to the
beginning of the next contraction.

2
Rev. Fall 2019

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