OB EXAM #3

ATI 11, 12, 13, 14

Intrapartal Period: From the beginning of contractions through delivery
of the newborn and placenta and the first 1-4 hours.

Intrapartal Care: Medical and nursing care given to pregnant woman
and family during labor and birth.
o The intrapartum nurse should collect assessment data on
maternal and fetal well-being during labor, the progress of
labor, and the psychosocial and cultural factors that affect labor.

Physiologic Changes Preceding Labor (premonitory signs)
Backache
o A constant low, dull backache, caused by pelvic muscle
relaxation
Weight loss
o A 0.5-1.4kg (1-3 lb) weight loss
Lightening
o Fetal head descends into true pelvis about 14 days before labor
o Feeling that the fetus has dropped
o Easier breathing; but more pressure on the bladder, resulting in
urinary frequency
o More pronounced in clients who are primigravida
Contractions
o Begin with irregular uterine contractions (Braxton Hicks) that
eventually progress in strength and regularity.
Bloody show
o Brownish or blood tinged mucus discharge caused by expulsion
of the cervical mucus plug resulting from the onset of cervical
dilation and effacement
Energy burst
o Sometimes called nesting response
Gastrointestinal changes
o Less common
o Include nausea, vomiting, and indigestion
Rupture of membranes
o Spontaneous rupture of membranes can initiate labor or can
occur anytime during labor, most commonly during the
transition phase.
o Labor usually occurs within 24 hour of the rupture of
membrane
o Prolonged rupture of membranes greater than 24 hour before
delivery of fetus and may lead to infection.
o Immediately following the rupture of membranes, a nurse
should assess the FHR for abrupt decelerations, which are
indicative of fetal distress to rule out umbilical cord prolapse.
Assessment of amniotic fluids (completed when membranes rupture)
o Should be watery, clear, and pale to straw yellow in color
o Odor should not be foul
o Volume is between 500 and 1,200 mL
o Nitrazine paper should be used by a nurse to confirm that
amniotic fluid is present
Amniotic fluid is alkaline. Nitrazine paper should be
deep blue, indicating a pH of 6.5-7.5.
Urine is slightly acidic. Nitrazine paper remains yellow.



The 5 P Factors That Affect & Define The Labor & Birth Process
1. Passenger
= Consists of the fetus and the placenta.
The placenta can be considered a passenger because it also must
pass through the canal.
Factors affecting the ability of fetus to navigate birth canal:
o The size of the fetal head
o Fetal presentation: the part of the fetus that is entering the
pelvic inlet first.
It can be the back of the head (occiput), chin
(mentum), shoulder (scapula), or breech (sacrum
or feet)
o Lie attitude
Lie: the relationship of the maternal longitudinal
axis
o Position