INTRAPARTAL CARE

fetus and placenta from the

Acme uterus

- A phase of contraction when the - Normally begins within 37-42

contraction is at its strongest weeks

- Primipara: 14-16 hours

- Multipara: 6-8 hours

Trial Labor

- An attempt labor to determine

whether labor will progress
normally

- Permitting labor to continue

long enough to determine if
vaginal birth (normal) appears
Decrement
to be possible (usually 2-3
hours)
- A phase of contraction when the
contraction intensity decreases
- Done to assess whether a
woman who underwent to
Increment
caesarean section is possible to
deliver through normal
- A phase of contraction in which
spontaneous vaginal delivery in
it increases
her present pregnancy
Duration
- Done if a woman has a
borderline or just adequate inlet
- Length of contraction
measurement and the fetal lie
and position are good
- Time the contraction has
started to the time it ended
- Considered a successful trial of
labor when the post-caesarean
Frequency
pregnancy terminates in a
vaginal delivery without causing
- Refers to how close together
a scar or rupture and a live
the contractions are
fetus is born.
- From beginning of one
- A failed trial of labor is when
contraction to the beginning of
vaginal delivery is arrested or
the next
scar ruptures and an emergency
caesarean section is required
- Occurrence
Amniotomy
- T2 – T1
- Artificial rupture of membrane
Intensity
to hasten labor
- Refers to strength of contraction
- Done if the amniotic sac does
not ruptures spontaneously
Labor
- Performed to allow the fetal
- Series of events by which
height to contact the cervix
uterine contractions and
directly which will possible
abdominal pressure expel a
increase the efficiency of
 INTRAPARTAL CARE
contractions and therefore medications like oxytocin to
increases the speed of labor induce or initiate labor

- Can be performed using a Augmentation of labor

amniohook and hemostat (like a
Kelly straight) - Assisting labor that has
spontaneously started but is not
effective

- Uses oxytocin or amniotomy to

strengthen labor contractions

- The labor has started already

however the contractions are
hypotonic or too weak or
infrequent to be effective that’s
- Disadvantage: puts the fetus
why we use oxytocin to
momentarily at risk for cord
enhance the uterine contraction
prolapse. If a loop of cord
escapes into the vagina with the
Dysfunctional labor
fluid, it is only important to
perform amniotomy if the fetal
- Sluggishness of contractions or
height is well-applied to the
that the force of labor is less
cervix
than usual
- Always measure the Fetal heart
- Sudden rest of contractions
Rate immediately after the
rupture of membrane (to
- In this circumstance,
determine for presence of cord
augmentation of labor may be
prolapse)
performed to improve uterine
contractions
- Cord prolapse and compression
can cause deceleration or a
Dystocia
decrease in the fetal heart rate
of the baby
- Difficult labor; painful labor
Induction of Labor
- Example: Shoulder dystocia –
wide fetal shoulders cannot
- Labor is started artificially
pass through the outlet of the
pelvis
- It is necessary to initiate labor
before the spontaneous
- Cause: cephalopelvic
occurrence because the fetus is
disproportion
in danger or because the labor
does not occur spontaneously
Episiotomy
and the fetus appears to be at
term
- Surgical incision made at the
opening of the vagina during
- Done through mechanically
childbirth to aid a difficult
opening your cervix through
delivery and prevent rupture of
amniotomy or using a
tissues
medication to start the
contractions like the use of
- Prevent tearing
oxytocin or Pitocin
TYPES OF EPISIOTOMY
- Labor has not started yet so we
use mechanical methods or
1. Medio-lateral - more bleeding
 INTRAPARTAL CARE
2. Median/Midline - prone to infection

Eutocia PREVIOUS NOTES

- Normal childbirth characterized 1. Progesterone Deprivation Theory

by uterine contractions that
result in progressive cervical - Increased in estrogen in
dilatation and fetal descent relation to progesterone
→ interpreted as
THEORIES OF LABOR progesterone
withdrawal
Normally begins within 37-42 weeks of
pregnancy when a fetus is sufficiently 2. Uterine Stretch Theory
mature to adapt to extrauterine life yet not
too large to cause mechanical difficulty with - Uterine muscle
birth. stretches from the
increasing size of the
Factors are known to be responsible for fetus → release of
initiation of spontaneous labor although prostaglandins
much is still unknown. Factors such as
withdrawal of progesterone known as the 3. Oxytocin Theory
pregnancy hormone and increase in
prostaglandins and other complex - Fetus presses on the
biochemical markers have shown to be at cervix → stimulates
work. A number of theories a combination release of oxytocin from
of factors originating from both the woman the posterior pituitary
and the fetus have been proposed to
explain why progesterone withdrawal. - Oxytocin

Some of the theories include: 4. Estrogen Theory

5. Placental Degeneration
● The uterine muscle stretches from
the increasing size of the fetus, - Placenta reaches a set
which results in the release of age → triggers
prostaglandins. contraction
● The fetus presses on the cervix ,
which stimulates the release of 6. Fetal Endocrine Control Theory
oxytocin from the posterior pituitary (Adrenal Theory)
● Oxytocin stimulation works together
with prostaglandins to initiate - Rising fetal cortisol
contractions. levels → reduce
● Changes in the ratio of estrogen progesterone formation
occurs, increasing estrogen in → increase
relation to progesterone, which is prostaglandin formation
interpreted as progesterone
withdrawal 7. Prostaglandin Theory
● The placenta reaches a set age
which triggers contractions - Fetal membrane begins
● Rising of fetal cortisol levels reduce to produce
progesterone formation and prostaglandin →
increase prostaglandin formation stimulates contraction
● The fetal membrane begins to
produce prostaglandins, which
stimulates contractions
 INTRAPARTAL CARE
PRELIMINARY/ PREMONITORY SIGNS
OF LABOR
● Lightening
● Increase in energy
● Slight loss of weight
● Back ache
● Braxton Hick’s contraction
● Ripening of cervix
Lightening
- Descent of the fetal presenting
part to the pelvis
- Occurs approximately 10-14
days before labor begins
- Fetal descent changes the
woman’s abdominal contour and
this gives the woman relief from
diaphragmatic pressure and
shortness of breath
- In relation to this lightening, the
woman may experience
shooting leg pain from the
increased pressure of sciatic
nerve, increased amount of
vaginal discharge and urinary
frequency
Increase in energy
- In contrast to the feeling of
chronic fatigue that she has
been feeling for the previous
months, this increase in activity
is related to a boost in
epinephrine which is initiated by
a decrease in progesterone
production by the placenta
- Decreased progesterone
production by the placenta
which leads to
- boost of epinephrine release
- Increased energy
Slight Loss of Weight
- Progesterone level falls →
bodily fluid is more easily
excreted (increase in urine
production) – weight loss
between 1-3 lbs
Backache
- Labor contraction begins at the
back
Braxton Hick’s Contraction
- False labor uterine contractions
- In the last weeks or days before
labor begins, a woman usually
notices extremely strong
Braxton Hick’s contractions
- A woman having her first child
may have a difficulty
distinguishing Braxton Hick’s
contraction and true labor
contractions that she may come
to the labor unit of a hospital or
birthing center believing that
she is in labor. This is
discouraging for the woman
when this happens
- Assure woman that
misinterpreting labor signals is
common
- Remind her that if contractions
became strong enough to be
mistaken for true labor, true
labor is not far away.
Ripening of cervix
- An internal sign seen only on
pelvic examination
- Throughout pregnancy, the
cervix feels softer than usual to
palpation which is similar to the
consistency of an earlobe =
Goodell Sign
- At term, the cervix becomes
softer (butter soft)
 INTRAPARTAL CARE
- An internal announcement that presenting to the birth canal
labor is very close at hand at less than its narrowest
diameter
TRUE LABOR FALSE LABOR
2. PASSENGER
● The fetus
● Head of the fetus is the
Begin irregularly but - begins and remains
body part which has the
become regular and irregular
widest diameter
predictable
● Fontanelle spaces compress
- felt first
during birth to aid in
- felt first in lower abdominally and
molding of the fetal head
back and sweep remain confined to
around to the the abdomen and
➢ MOLDING
abdomen in wave groin
○ Overlapping of skull bones
along the suture lines
- continue no matter - often disappear
○ Causes a change in the
what the woman’s with ambulation or
shape of the fetal skull that
level of activity sleep
facilitates passage through
the rigid pelvis
- increases in - do not increase in
duration, frequency duration, frequency
and intensity or intensity

- achieve cervical - do not achieve

dilation cervical dilation

- mild, tolerable pain

COMPONENTS OF LABOR NURSING INTERVENTION:

● Passage ● Assure the parents that it
- A woman’s pelvis will only last a day or two
and will not be a permanent
● Passenger condition.
- The fetus ○ No skull molding
will happen when
● Power the fetus is in
- Uterine factors breech
(contractions) presentation.

● Psyche ❖ Fetal Attitude

- A woman’s psychological ➢ Degree of flexion a fetus
state assumes during labor or the
relation of the fetal parts to
1. PASSAGE each other
● Refers to the route a fetus ■ Good attitude
must travel from the uterus (complete flexion)
through the cervix and ■ Moderate flexion
vagina to the external ■ Poor flexion
perineum ■ Full extension
● In most instances, if a
disproportion between the
fetus and the pelvis occurs,
the pelvis is the structure at
fault. If the fetus is the
cause of the disproportion,
it is often because it is
 INTRAPARTAL CARE
and the long axis of a
woman’s body
➢ Position of the baby
■ Horizontal
(transverse)
■ Vertical
(longitudinal)
● Cephalic
● Breech
❖ Presentation
➢ Body part that will first
1. Good Attitude (Complete Flexion) contact the cervix or be
a. Spinal column is bowed born first
forward, head is flexed ➢ Determined by the
forward so much that the combination of fetal lie and
chin touches the sternum degree of fetal flexion
b. Arms are flexed and folded (attitude)
on the chest
c. Thighs are flexed unto the 1. Cephalic - Head
abdomen a. Vertex, brow, face, mentum
d. Calves are pressed against b. Most frequent type of
the posterior aspect of the presentation
thighs c. Vertex - ideal presenting
part because skull bones
● Advantageous for birth because it are capable of effectively
helps a fetus present the smallest molding to accommodate
anteroposterior diameter of the skull the cervix
to the pelvis d. Area of the skull that
● It puts the whole body into an ovoid contacts the cervix often
shape occupying the smallest space becomes edematous —
possible results to caputs
sacsidonium (cone shaped
2. Moderate Flexion head of the baby
a. Chin is not touching the 2. Breech
chest but is in an alert or a. Buttocks/ feet
military position b. Can cause a difficult birth
b. Does not usually interfere c. Three types
with labor however later i. Complete - both of
mechanisms of labor baby’s knees are
(descent & flexion) will bent; his feet and
force the fetal head to fully bottom are closest
flex to the birth canal
ii. Frank - baby’s legs
3. Partial Extension are folded flat up
a. Presents the “brow” of the against his head;
head to the birth canal bottom is closest to
the birth canal
4. Complete Extension iii. Footling - one or
a. Back is arched and neck is both feet are the
extended (face presenting parts
presentation) during delivery
b. Face is presented to the
birth canal

❖ Fetal Lie
➢ Relationship between the
long axis of the fetal body
 INTRAPARTAL CARE
3. Shoulder
a. One of the shoulder, iliac
crest, a hand or an elbow
b. Fetus lies horizontally in the
pelvis
c. Contour of the mother’s
abdomen at term may
appear fuller side to side
rather than top to bottom
d. In cephalic/breech
presentation, fetus lies
longitudinally or vertically
with respect to the position
of the mother’s pelvis
❖ Fetal Position
➢ Relationship of the
presenting part to a specific
quadrant and side of a
woman’s pelvis
➢ Examples:
■ ROA - right
occipitoanterior
■ LOA - left
occipitoanterior is
the most common
fetal position
■ ROA is the 2nd
most frequent fetal
position
➢ Important because it can
influence both the process
and efficiency of labor
➢ Fetus is born fastest in ROA
or LOA position
➢ Labor can be extended if
position is posterior (LOP,
ROP) and may be more
painful for a woman
because the rotation of the
fetal head puts pressure on
the sacral nerves
NURSING INTERVENTION:
● Place woman in Sims position on
the same side of the fetal spine or
use hands and knees position (to
encourage rotation from
occipitoposterior to occipitoanterior)
❖ Engagement
➢ Settling of the presenting
part of a fetus far enough
into the pelvis that it rests
at the level of the ischial
spines, the midpoint of the
pelvis
➢ In primipara,
nonengagement of the fetal
head at the beginning of
labor suggests that a
possible complication such
as an abnormal
presentation or position,
abnormality of the fetal
head, or cephalopelvic
disproportion exists
➢ In multipara, engagement
may or may not be present
at the beginning of labor
➢ If patient is primipara,
assess the engagement of
the presenting part at the
beginning of labor
➢ In a multipara patient, if
presenting part is not yet
engaged at the beginning of
labor, it is still considered
normal
➢ Degree of engagement is
established by a cervical
and vaginal examination
➢ During documentation
■ Engaged —
presenting part
already rests at the
level of the ischial
spine
■ Floating —
presenting part is
not engaged
 INTRAPARTAL CARE
■ Dipping — ✔ External rotation
presenting part is
✔ Expulsion
descending but has
not yet reached the
ischial spine -if you wonder why engagement is not included in this
mechanism of labor, previously it is part of the
❖ Station
➢ Related to the passenger mechanism.
-in the new update it starts with descent, why?
Because engagement is already part of descent.

STATION
1. Descent
✔ refers to the relationship of the
-downward movement of the biparietal
presenting part of the fetus to the level
diameter of the fetal head within the pelvic
of ischial spines
inlet.
✔ When the presenting part is at the level
-full descent occurs when the fetal head
of the ischial spine, it is at 0 station
protrudes beyond the dilated cervix and
(synonymous with the engagement)
touches the posterior vaginal floor this
because we mentioned earlier that the fetus has
engaged or is already engaged. When the
occurs because of the pressure on the fetus
presenting parts already rests on the ischial by the uterine fundus.
spine, so again when the presenting part is
already at the level of ischial spine it is
2. Flexion
considered as station 0 but if the presenting part
is above the ischial spine, the distance is
-as descent is completed and fetal head touches the
measured and described as minus stations or the pelvic floor, the head bends forward onto the
negative ones which ranges from -1 to -4. On the chest, causing the smallest anteroposterior
other hand, when the level is below the ischial
diameter to present to the birth canal.
spines the distance is stated as plus stations.
Take note that when we are talking about +3 or -aided by abdominal muscle contraction
+4 stations. The presenting part is at the during pushing
perineum and can be seen if the vulva is
separated
3. Internal rotation
-as the head flexes at the end of descent this is how
Mechanisms (Cardinal Movements) of
internal rotation works, the occiput rotates so
Labor
the head is brought into the best
-Effective passage of a fetus through the birth canal,
relationship to the outlet of the pelvis.
involves not only position and presentation but also a
number of different position changes. In order to keep
the smallest diameter of the fetal head always -this movement brings the shoulders into
presenting to the smallest diameter of the pelvis, these
the optimal position to enter the inlet or
position changes are term as Cardinal movements of
puts the widest diameter of the shoulders in
labor which includes

✔ Descent line with the wide transverse diameter of

✔ Flexion the inlet.

✔ Internal rotation
✔ Extension 4. Extension
 INTRAPARTAL CARE
-the head extends and the foremost parts of
the head, the face and chin, are born
5. External rotation
-almost immediately after the head of the
infant is born, the head rotates a final time
back to the diagonal or transverse position
of the early part of labor.
-anterior shoulder is born first
-this brings the after coming shoulders into
an anteroposterior position which is the best
for entering the outlet.
6. Expulsion
-Once the shoulders are born, the rest of
the baby is born easily and smoothly
because of its smaller size
-it is the end of the pelvic division of labor
3. Powers of Labor
✔ force supplied by the fundus of the
uterus and implemented by uterine
contractions
↓
Cervical dilation
↓
Expulsion of the fetus from the uterus
-after full dilation of the cervix, the primary
power is supplemented by the use of
secondary power source
✔ Secondary power source: abdominal
muscles
-it is important for women to understand
they should not bear done with their
muscles to push until the cervix is fully
dilated. Doing so, impedes the primary force
and could cause fetal and cervical damage
✔ 3 phases of contraction:
1. Increment- when the intensity of
the contraction increases.
2. Acme- when the contraction is at
its strongest
3. Decrement- when the intensity
decreases
-why is it important differentiate these 3?
During delivery, we will encourage woman to push only
during the acme of contraction
✔ As labor contractions progress and
become regular and strong, the uterus
gradually differentiates itself into 2
distinct functioning areas: an upper
portion (thickens) and a lower
segment (becomes thin-walled, supple
and passive)
-the upper portion is the active segment,
because the fundus is the source of
contraction
-lower segment is the passive one, because
there is no contraction in this part of the
uterus and it only serves as passageway for
the fetus.
-In order for the fetus to pass through the
uterine segment successfully, effacement
and dilation has to take place.
● Effacement
-shortening and thinning of the cervical
canal
-in primiparas, effacement is achieved
before dilation begins. Meaning, the
thinning of the cervix has to take place first
 INTRAPARTAL CARE
before it widens but in mulitipara, dilation contractions and ends with rapid
may proceed before effacement is complete. cervical dilation begins
✔ Duration of contraction:
● Dilation 20-40 seconds
-enlargement or widening of the cervical ✔ Cervical effacement occurs and
canal cervix dilates minimally
-the cervix opens from an opening of few
mm to one large enough (10cm) to permit Nursing interventions:
passage of a fetus ● Encourage woman to continue to walk
● Make preparations for birth such as
Psyche or woman’s psychological state doing last minute packing for her stay
✔ Psychological outlook at the hospital or birthing center
-refers to the psychological state or feelings ● Preparing older children for her
a woman brings into labor departure and the upcoming birth
-a woman who manages best in labor ● Giving instructions to the person who
typically are those who have a strong sense will take care of them while she is away
of self-esteem and a meaningful support ● The woman could begin alternative
person is with them. But women without methods of pain relief such as
adequate support can have a labor so aromatherapy, distraction, or
frightening and stressful that they can acupressure.
develop symptoms of post-traumatic stress -why? Because in this phase even if the contractions
disorder. The women should need a positive are not frequent or the contractions are not that strong
it still causes discomfort for the woman. So you need to
mind and people who will support you
look into nursing interventions to relieve the pain of the
during birth. patient like deep breathing exercises, guided imagery,
positional changes and so on.

Stages of Labor
-labor is traditionally divided into three ● Encourage the woman to continue to

stages be active and to use

non-pharmacotherapeutic measures

⮚ 1st Stage she finds effective.

-begins with the initiation of true labor

contractions and ends when the cervix is 2. Active phase

fully dilated ✔ Cervical dilation occurs more

-takes about 12 hours to complete rapidly

-it is divided into 3 segments: ✔ Duration of contraction: 40-60

1. Latent phase seconds

-begins on the onset of the ✔ Occurrence of contraction is every

regularly perceived uterine 3-5 mins

 INTRAPARTAL CARE
Nursing interventions: ● Demonstrate breathing and relaxation
● Encourage woman to be active methods
participants in labor by keeping active
● Assuming position that is most ⮚ 2nd Stage (Fetal stage)
comfortable for them during this time, -denotes the time of full dilatation until the
except flat on their back infant is born.
● Perform back rubs, specially that the -time span from full cervical dilation and
occurrence of the contraction right now effacement to birth of the infant (fetal
is more frequent stage)
3. Transition phase -woman may experience momentary nausea
✔ Contractions occur: every 2-3 and vomiting because pressure is no longer
minutes exerted in her stomach as the fetus
✔ Duration of contraction: 60-70 descends into the pelvis.
seconds -the woman pushes with such force that she
✔ A maximum cervical dilation of perspires and the blood vessels in her neck
8-10 cm occurs becomes distended.
✔ By the end of this phase, both
full dilation and complete Possible nursing interventions:
cervical effacement have ● Coaching the expectant mother
occurred. ● Wipe the perspiration of the
✔ A new sensation, the irresistible patient
urge to push usually begins
-may experience intense discomfort The fetus begins descent and as the fetal head touches
the internal perineum to begin internal rotation, her
accompanied by nausea and vomiting
perineum begins to bulge and appears tense. The anus
-may experience a feeling of loss of may become inverted and still may be expelled. As the
control, anxiety, panic, and irritability fetal head pushes against the vaginal introitus this
opens and the fetal scalp appears at the opening of the
vagina and enlarges from the size of a dime to a
Nursing Diagnosis and related
quarter then a half dollar.
Interventions:
a) Anxiety related to stress of labor -crowning happens
● Offer support -at this stage, the baby is delivered
● Respect and support the support
person The delivery of baby is not as easy as that,
● Support a woman’s pain management the health care provider who will facilitate
needs the delivery of the baby needs to perform:
● Orient client to staff, environment and
procedure ● Ritgen’s maneuver
● Encourage client to verbalize feelings
 INTRAPARTAL CARE
-pressing forward of the fetal chin while the ⮚ 3rd Stage
other hand is pressed downward on the -placental stage
occiput -from the time the infant is born until the
-this is the maneuver that the health care delivery of the placenta
provider has to apply in order to facilitate -begins with the birth of the infant and ends
the delivery of the baby. with the delivery of the placenta
-2 separate phases are involved:
1. Placental separation
-lengthening of the umbilical cord
-sudden gush of vaginal blood
-the placenta is visible at the vaginal
opening
-the uterus contracts and feels firm
again
● during childbirth, pressure should
2. Placental expulsion
never be applied on the fundus of
-once the placenta detached it is ready
the uterus because uterine rupture
to be delivered
could occur
● Check for Nuchal cord
Mechanism of placental expulsion
-loop of cord encircling on the neck
or presentation of placenta upon
-why? Because this may cause asphyxia or
delivery:
absence of oxygen in the body of the baby.
❖ Schultze presentation
-placenta separates first at the center and
✔ A child is only considered born when
lastly at its edges
the whole body is already born (time
-it tends to fold on itself like an umbrella
should be noted and recorded)
and presents at the vaginal opening with
✔ Delayed umbilical cord cutting
the fetal surface evident
(physiologic clamping) until pulsation
-placenta appears shiny and glistening from
ceases and maintaining the infant at
the fetal membrane
uterine level allows as much as 100 mL
more of blood to pass from the
placenta into the fetus.
✔ After clamping and cutting of the cord,
thw vessel of the cord are then counted
after clamping and cutting.
-it is important to assess the number of of
cord vessels in order to determine a possible ❖ Duncan presentation

genetic abnormality on the baby -if the placenta separates first at its edges
and slides along the uterine surface and
 INTRAPARTAL CARE
presents at the vagina with the maternal
surface evident
-looks raw, red, and irregular with the ridges
or the cotyledons that separate blood
spaces.
Non-intact placenta

-it is important to make sure that there is no retained

-placental delivery up to 30 mins following
childbirth is considered normal
-during normal spontaneous vaginal delivery
-Blood loss for NSVD: 300-500mL
placenta in the uterus because if there are retained
placental fragments attached on the wall of the uterus,
the uterus could not contract properly which may lead
to bleeding

-bleeding occurs as the placenta separates -After the placenta inspection, if the

-placenta delivers by either the mother’s uterus has not contracted firmly on

natural-bearing down effort or by applying its own, the primary care provider will

gentle pressure on the contracted uterine massage the fundus to urge it to contract

fundus (Crede ‘s maneuver) -Oxytocin (Pitocin) may be prescribed to

-pressure should never be applied to a be administered IM or IV to also help

uterus in a noncontracted state because contraction

doing docould cause the uterus to evert
(turn inside out) accompanied by massive
hemorrhage and that is very fatal for the
-in the real clinical setting, you are not allowed to
administrate the medication without the supervision of
your teacher and as students, you are not allowed to
administer medication intravenously.

patient as it may lead to hypovolamic shock -If excessive bleeding with poor uterine

-even when the placenta is not removed contraction remains, an injection of

spontaneously, it could be removed carboprost tromethamine (Hemabate) or

manually methylergonovine maleate (Methergine)

is another solution to increase contraction

Nursing responsibility after the delivery of and to guard against hemorrhage

placenta:
1. Check for the intactness of the In this intervention, you need to

placenta remember: CHECK THE BLOOD

Intact placenta PRESSURE BEFORE ADMINISTERING

THE MEDICATION
 INTRAPARTAL CARE
-because this medication can cause vasoconstriction
and thereby increases the blood pressure of the patient
-if the patient is hypertensive before giving the
medicatio, it can further increase the blood pressure of
the patient

-After birth, the uterus can be palpated as

firm round mass just below the level of
umbilicus
-Do perineal inspection check for tears, with
this you need to assess for the degree of perineal
laceration.

Classification of Perineal Lacerations: Nursing Interventions:

Classification Description of ✔ Note of the time the placenta was out

Involvement ✔ check for intactness of placenta

First degree Vaginal mucous ✔ Check for bleeding

membrane and skin of ✔ Anticipate for the administration of

the perineum to the medications to promote uterine
fourchette contraction. Check BP first!
Second degree Vagina, perineal skin, ✔ Assess the degree of perineal laceration
fascia, leveatoe ani
muscle, and perineal
⮚ 4th Stage (Placental stage)
body
-the 1st 4 hours after birth of the placenta
Third degree Entire perineum,
-emphasize the importance of close
extending to reach the
external sphincter of maternal observation needed at this time

the rectum -high risk for hemorrhage

Fourth degree Entire perineum, rectal

sphincter, and some of Nursing interventions:
the mucuos ✔ Obtaining vital signs every 15 min for
membrane of the the first hour
mucus ✔ Wash the perineum and apply perineal
pad
✔ Palpate a woman’s fundus for size,
consistency, and position
✔ Observe the amount and characteristics
of lochia each time you record vital
signs