CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)

(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

FETAL HEAD
Module 5: Labor and
• Largest part of the baby; it has found effect on the
Delivery birthing process.
• Bones of the skull are joined by membranous sutures,
LABOR which allow for overlapping or “molding” of cranial
bones during birth process.
Series of events by which uterine contractions and • Anterior and posterior fontanels are the points of
abdominal pressure expel the fetus and placenta from intersection for the sutures and are important
the woman’s body. landmarks.
• FONTANELS - are used as landmarks for internal
INHIATION OF LABOR: examinations during labor to determine position of
fetus.
• ANTERIOR FONTANEL – diamond shape and formed
by the intersection of 4 structures (2 coronal, frontal,
and sagittal).
• POSTERIOR FONTANEL – triangular shape formed by
the intersection of 3 structure (1 sagittal and 2
lambdoid).

FETAL SHOULDERS

➢ May be manipulated during the delivery to allow

passage of one shoulder at a time.
➢ It is important because of their width, but they
usually flex and adapt the pelvis.

DELIVERY
DIAMETERS OF THE FETAL SKULL
Actual event of birth.

FOUR FACTORS OF LABOR (4P’s)

A.) PASSENGER (4P’s)

➢ The size, presentation, and position of the fetus.

➢ The fetus plus the membranes and placenta.

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

2. SUBOCCIPITO FRONTAL – 10 cm from below the

occipital protuberance to the center of the frontal
suture.

3. OCCOPITO FRONTAL – 11.5 cm – bridge of the nose

to the occipital prominence.
4. MENTOVERTICAL or OCCIPITO MENTAL – 13.5 cm –
measured from the chin to the posterior fontanelle.
(The widest AP diameter).

5. SUBMENTO VERTICAL – 11.5 cm – from the point

MOLDING – when structures and fontanels allow the 6.
bones to move slightly, changing the shape of the fetal
head so that is can adapt to the size and shape of the
pelvis.
where the chin joins the neck to the highest point on
the vertex.
SUBMENTO BREGMATIC – 9.5 cm – from the point
where the chin joins the neck to the center of the
bregma.

DELIVERY PRESENTATIONS

PRESENTATION - That part of the fetus which enter the

pelvis in the birth process.

TYPES OF PRESENTATION:
1. Cephalic / Vertex
2. Breech
3. Shoulder
4. Compound

1.) VERTEX REPRESENTATION

• When the head is well flexed, the

2 TRANSVERSE DIAMETERS: subocciptobregmatic diameter and the biparietal
diameter present.
1. BIPARIETAL DIAMETER – 9.5 cm between 2 parietal • When the head in not flexed but erect, the
eminences. presenting diameters are occipito frontal, and the
2. BITEMPORAL DIAMETER – 8.2 cm between the furthest biparietal. (95%)
points of the coronal suture of the temples.
• CEPHALLIC – more favorable than others.
AP or LONGITUDINAL DIAMETERS: • Fetal head is largest single fetal part.
• During the labor the fatal head can gradually
1. SUBOCCIPITO BREGMATIC – 9.5 cm from the inferior change shape to adapt size.
aspect of the occiput to the center of the anterior • Fetal head is smooth, round, and hard, making
fontanelle. it an effective part to dilate the cervix, which is
also round.

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

• VERTEX – most common cephalic presentation.

• Fetal head is fully flexed.
• Most favorable for normal progress of labor –
because the smallest suboccipitobregmatic
diameter is presenting.
3.) SHOULDER
• Presenting part is the SCAPULA.
• Baby is in horizontal or transverse lie.
• Cesarean birth indicated.
• The shoulder presentation is a transverse lie and
accounts for fewer than 1% of births, usually
premature.

LIE

• Relaxation of the long axis of the fetus to the long

axis of the mother.
• LONGITUDINAL LIE is normal.

2.) BREECH

• Buttocks or lower extremities present first.

• Occurs when the fetal buttocks or feet enter the
pelvis first.

3 VARIATIONS OF BREECH:

1. FRANK BREECH – thighs flexed, legs extended on

anterior body surface, buttocks presenting.

2. FULL or COMPLETE BREECH – thighs and legs flexed,

buttocks and feet (baby is squatting position).
• Reversal of usual cephalic representation.
• Head, knees, and hips are flexed, but the
buttocks are presenting.

3. FOOTLING BREECH – one or both feet are presenting.

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

ATTITUDE

➢ This refers to the posturing of the joints and relation

of fetal parts to one another.
➢ The normal fetal attitude when labor begins is with
all joints in flexion.

POSITION

• Relationship of reference point on fetal presenting

part to maternal bony pelvis.
• Describes the location of a fixed reference point on
the presenting part in relation to the 4 quadrants.
• Fetal position is not fixed but rather changes during
labor as the fetus moves downward and adapts to
the pelvic contours.

• MATERNAL BONY PELVIS is divided into 4 quadrants.

(Right and left anterior; right and left posterior).
LEOPOLD’S MANEUVER
Most common positions are:

ROA ROP a. FIRST MANEUVER

(right occiput anterior)
LOA
(left occiput anterior)
(right occiput posterior)
LOP
(left occiput posterior)
• Facing the head part, palpate for fetal part
found in the fundus (hard, smooth ballotable in
the fundus means BREECH)
• Moving the breech also moves the fetal trunk.
• The head is harder, with round, uniform shape.
• The head can move w/o the entire trunk
moving.

b. SECOND MANEUVER
• Palpate sides of the uterus to determine location
of fetal back.

c. THIRD MANEUVER
• grasp lower portion of the abdomen just above
the symphysis pubis to determine the degree of
engagement.

d. FOURTH MANEUVER
• Facing the feet part. Cross fingers downward on
both sides of the uterus above the inguinal
ligaments to determine attitude.

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

• DIAGONAL CONJUGATE – from lower border of

symphysis pubis to sacral promontory. (12.5 – 13
cm).

• OBSTETRIC CONJUGATE – from inner surface of

symphysis pubis, slightly below upper border to
sacral promontory.

• (Estimated subtracting 1.5 – 2 cm to diagonal

conjugate).

• CAVITY – space bet, the inlet and outlet. Approx

12 cm diameter.

• OUTLET – inferior portion of the pelvis.

MEASUREMENTS:
• ANTEROPOSTERIOR – 13 cm – from the lower
border of the symphysis pubis to the
B.) PASSAGEWAY (4P’s) sacrococcygeal joint.
• OBLIQUE – 12 cm – from obturator foramen to
the sacrospinous ligament.
➢ Shape and measurement of maternal pelvis and
• TRANSVERESE – 11 cm – line between the two-
distensibility of the birth canal.
ischial spines.
➢ Refers to the route the fetus must travel from the
• INTERTUBEROUS DIAMETER – 8 cm – outlet
uterus through the pelvis.
between the inner borders of the ischial
tuberosities.
STRUCTURES
TYPES OF PELVIS
2 INNOMINATE BONES:
a. GYNECOID – the true female pelvis.
a. ILEUM – Upper extended part.
b. PLATYPELLOID – wide but flat, kidney-shaped brim.
b. ISCHIUM / ISCHIA – under part.
c. ANTHROPOID – oval in shape. Transverse diameter is
ISCHIAL SPINES – are important landmark.
narrow, A-P is longer. Ape pelvis.
c. SYMPHYSIS PUBIS – front part.
d. ANDROID – heart shape, male pelvis.

2 DIVISIONS OF THE PELVIS

a. FALSE PELVIS – Situated above the pelvis brim and

formed by the ileum.
Fxn: Supports the growing uterus during the
pregnancy and direct the fetus into the true pelvis
near end off gestation.

b. TRUE PELVIS – inferior half formed by the pubis in front,

the ileum and the ischium on the sides and the
sacrum and the coccyx behind.
3 parts: Pelvic Inlet, Pelvic Outlet, and Pelvic Cavity.

• PELVIC INLET / PELVIC BRIM – entrance to the true

pelvis.

MEASUREMENTS:
• TRUE CONJUGATE – from the upper margin of
symphysis pubis to sacral promontory. (11 cm)

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

PELVIC MEASUREMENTS

Two pelvic measurements are important to determine • ENGAGEMENT

the adequacy of the pelvic size: • fetal presenting part enters true pelvis (inlet).
• may occur 2 weeks before labor in Primipara.
1. Diagonal conjugate (AP diameter of the inlet). • Usually occurs at the beginning of labor for
2. Transverse diameter of the outlet. Multipara.

• STATION
• OBTETRIC CONJUGATE
• From the inner surface of symphysis pubis, slightly
below upper border, to sacral promontory, it is
the most important pelvic measurement.
• Can be estimated by subtracting 1.5 – 2 cm
from diagonal conjugate.
• INTERTUBEROUS DIAMETER
• Measures the outlet between the inner borders
of the ischial tuberosities.
• Should be at least 8 cm.
• Measurement of how far the presenting part has
descended into the pelvis.
• Referent is ischial spines, palpated through
lateral vaginal walls.
When presenting part is:
• At ischial spines, station is “0”.
• Above ischial spines, station is negative number.
• Below ischial spines, stations is positive number.
• “High” or “Floating” terms used to denote
unengaged presenting part.

• TRUE CONJUGATE
• From the upper margin of symphysis pubis to
sacral promontory.
• Should be at least 11 cm.
• Maybe obtained by x-ray or ultrasound.

• DIAGONAL CONJUGATE
• From lower border of the symphysis pubis to
sacral promontory.
• Should be 12.5 – 13 cm.
• May be obtained by vaginal examination.

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

• SOFT TISSUE (CERVIX & VAGINA)

• Stretches and dilates under the force of
contractions to accommodate the passage of
the fetus.

C.) POWERS (4P’s)

• Forces of labor, acting in concert, to expel fetus and

placenta.

MAJOR FORCES ARE: PHASES OF CONTRACTION

a. FREQUENCY
o timed from the beginning of one
contraction to the beginning of the a. INCREMENT – When the intensity of the contraction
next. increases.
b. ACME – when the contraction is at its strongest.
b. REGULARITY c. DECREMENT – when the intensity decreases.
o discernible pattern
o better established as pregnancy INTENSITY OF CONTRACTIONS
progress.

c. INTENSITY a. MILD – the uterus is contracting but does not

o strength of contraction. become more than minimally tense.
o May be determined by the b. MODERATE – the uterus feels firm.
“despressability” of the uterus during a c. STRONG – contraction is so intense, the uterus feels
contraction. as hard as a wooden board at the peak of
o Describe as mild, moderate, or strong. contraction.

d. DURATION VOLUNTARY BEARINGG DOWN EFFORTS

o Length of contraction.
o Contraction lasting more than 90
seconds without a subsequent period
of uterine relaxation may have severe
implications for the fetus and should be
reported.
1. After full dilation of the cervix, the mother can use
her abdominal muscles to help expel fetus.
2. These efforts are similar to those for defecation, but
the mother is pushing out the fetus from the birth
canal.
3. Contraction of levator ani muscles.

D.) PSYCHE (4P’s)

It is the crucial part of the childbirth. Marked anxiety,

fear, or fatigue decreases a woman’s ability to cope
with pain in labor.

• A woman who is relax, aware and participating in

the birth process usually has shorter, less intense
labor.
• A woman who is fearful has high levels of adrenaline
which slows uterine contractions.

PHYSIOLOGIC CHANGES PRECEDING LABOR

• LIGHTENING (engagement)
• “dropping”.
• Occurs up to 2 weeks before labor in Primipara.
• At the beginning of labor for Multipara.
• A premonitory sign.

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

regular and predictable

• BRAXTON HICK’S CONTRACTIONS in a matter of hours.
• May become more noticeable. Generally confined to the First felt in the lower back
• May play part in ripening of cervix. abdomen. and sweep arounds to
• Irregular mild contractions which occur the abdomen in a girdle
throughout pregnancy increase in frequency like fashion.
and are sometimes painful. No increase in duration Increase in duration,
frequency and intensity. frequency and intensity.
• EASIER RESPIRATIONS – from decreased pressure on Intervals remain long. Intervals remain short.
diaphragm. Often disappears if the Continue no matter what
woman ambulates the woman’s level of
• FREQUENT URINATION – from increased pressure on relieved by walking. activity is not relieved by
bladder. walking.
Absent cervical changes. Accompanied by
• RESTLESSNESS – poor sleeping patterns. “Nesting cervical effacement and
behaviors”. dilation (most important
difference).
THEORIES OF LABOR Absent / brownish. Show: present: pink
tinged.
Decrease number of Does not stop by
• PROSTAGLANDIN THEORY contractions by sedation. sedation.
• Initiation of labor is said to result from the release
of arachidonic acids produces by steroid action
on lipid precursors.
• Arachidonic acid is said an increase STAGES OF LABOR
prostaglandin synthesis which is turn causes
uterine contractions.

• OXYTOCIN THEORY
• Release of oxytocin from the posterior pituitary
glands causes contraction of the smooth
muscles.
• E.g., Uterine muscles will necessarily contract
and empty.

• UTERINE STRETCH THEORY

• Release of oxytocin from the posterior pituitary.

• PLACENTAL DEGENERATION THEORY

• Because of decreased blood supply and
functional capacity, the uterus starts to
contract.

• PROGESTERONE DEPRIVATION THEORY

• Decreased amount of progesterone initiates • STAGE 1
uterine motility. • From onset of labor until full dilation of cervix.
• Latent phase: 0-4cm
• Active phase: 4-8 cm
• Transition phase: 8-10 cm

• SATGE 2
• From full dilation of cervix to birth of baby.
FALSE vs. TRUE LABOR • STAGE 3
• From birth of baby to expulsion of placenta.

FALSE LABOR TRUE LABOR • STAGE 4

Remain irregular May be slightly irregular • Time after birth (usually 1-2 hours) of immediate
at first but become recovery.

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

• Power of forces at work: involuntary uterine

CERVICAL CHANGES IN FIRST STAGE LABOR: contractions.

• EFFACEMENT
• Shortening and thinning of cervix.
PHASES OF LABOR
• In Primipara, effacement is usually well
advanced before dilatation begins. LATENT ACTIVE TRANSITION
• In Multipara, effacement, and dilation progress (0-3 cm) (4-7 cm) (8-10 cm)
together. Cervical Cervical Cervical
dilatation 1-3 dilatation 4-7 dilatation 8-10
cm. is minimal cm. cm.
because
effacement is
occurring only
Contractions Rapid increase. Duration 60-90
are short during seconds
20-40 seconds Duration 40-60
and occur seconds. Frequency 2-3
regularly. minutes
Frequency 3-5
Frequency 5-10 minutes. Average-
minutes apart 40 min primi
(during which Duration 3 hr, 2 20 min multi
woman may hr
seek admission
to the hospital)
Mild, feel like Increasing Mood od the
cramps, back intensity of woman
pain, pressure contractions. suddenly
changes and
the nature of
the
contractions
intensify.
• DILATATION Mother is Mother fears Feeling of losing
• Enlargement or widening of the cervical os and excited, losing control of control, anxiety,
canal. euphoric, some herself. panic, irritability,
• Full dilatation is considered 10 cm. degree of does not want
apprehension to be touched.
still with ability to
DURATION OF LABOR communicate Profuse
takes up 6-12 perspiration,
a. Depends on hour first stage. distention of
• Regular, progressive uterine contraction. neck veins.
• Progressive effacement and dilatation of cervix.
• Progressive descent of presenting part. Nausea and
vomiting – a
b. Average length of Normal Labor: reflex reaction

uncontrollable
urge to push.

a.) FIRST STAGE (Stage of Dilatation)

STAGES OF DILATATION
• Begins with true labor contractions and ends with
complete dilatation of the cervix.

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

• LATENT • Nitrazine paper turns blue in the presence of alkaline

• Early time in labor.
• Cervical dilatation is minimal because
effacement is occurring.
• Cervix dilates 0-4 cm.
• Contractions are of shorts duration and are
occurring regularly 5-10 minutes apart hence
admission can be done.
• The woman in this stage is excited with some
degree of apprehension but still with the ability
to communicate.
Assessment:
• Contractions: frequency, intensity, duration.
• Membranes: intact or ruptured, color of fluid.
• BLOODY SHOW – mixture of thick mucus and
pink or dark brown blood, may occur as the
cervix begins to soften, dilate, and efface
slightly.
• Time of onset, cervical changes, time on last
ingestion of food.
• ACTIVE or ACCELERATED
• Cervical dilatation reaches 4-8 cm.
• Rapid increase in duration, frequency and
intensity of contraction.
• Woman fears losing herself.
amniotic fluid (nitrazine positive).
• Vaginal secretions are nitrazine negative (yellow)
because of their acidity.
• Pooling of amniotic fluid in the vaginal vault is a
reliable sign.
NURSING CARE IN LATENT PHASE
• V – voiding – encourage to void q 2-3 hours – full
bladder inhibits contractions.
• A – ambulation
• B – bath
• B – breathing – chest breathing
• E – elimination / enema
NURSING CARE IN ACTIVE PHASE
• M – Medications – have meds ready (early halt labor
/ late neo. Resp dep.)
• A – Assessment (Vital signs, cervical dilation and
effacement, fetal monitor, etc.)
• D – Dry lips – oral care (ointment) dry linens.
• A – Abdominal breathing
• A – Anticipate physical needs

• TRANSITION PERIOD
• 8-10 cm cervical dilatation occurs.
NURSING CARE IN TRANSITION PHASE
• The mood of the woman suddenly changes and
the nature of contractions intensify. • T – Tired
• I – Inform of progress.
• R – Restless support her breathing technique
➢ If the cervix is intact, this period is marked by a • E – Encourage and praise
sudden gush of amniotic fluid as the fetus is pushed • D – Discomforts – sacral pressure
into the birth canal. Shows become prominent.
➢ AMNIOTIC FLUID - clear, slightly yellowish liquid that
surrounds the unborn baby during the pregnancy. POSITIONS IN LABOR
➢ There is an uncontrollable urge to push with
contractions (a sign that the second stage of labor
is very near).
➢ Duration of contraction – 60-70 seconds.
➢ Interval – 30-90 seconds.

STATUS OF MEMBRANES POSITIONS IN DELIVERY

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

• Mediated by afferent fibers of posterior roots of

S2-S4 nerves.
• Somatic, localized, sharp, definite and constant.

PHARMACOLOGIC METHODS

• REGIONAL ANESTHESIA
• Provide pain relief with injected anesthetic
agents at sensory nerve pathways.
• Spinal block, epidural, paracervical, pudendal
block and local infiltration.
• Adverse Reactions: Maternal hypotension,
DANGER SIGNALS OF LABOR allergic reaction, respiratory paralysis.

• FETAL DANGER SIGNS

• High or low fetal heart rate
o Normal – 120-160 bpm
o Above 160 – fetal tachycardia
o Below 120 – fetal bradycardia
• Meconium staining
• Hyperactivity
• Fetal acidosis – pH below 7.2

• MATERNAL DANGER SIGNS

• Rising or falling blood pressure.
• Abnormal pulse
• Inadequate or prolonged contractions
• Pathologic retractions rings
• Abnormal lower abdominal contour.
• Increasing apprehension
ANESTHESIA FOR LABOR AND DELIVERY
• During the first stage
• Arise fr, the uterus and adnexae during
contractions.
• Mediated by T10 -L1 spinal segments.
• Pain intensity – strength of contractions and
uterine pressure
• Dull, diffuse, periodic and build to peaks.
b.) SECOND STAGE (Stage of Expulsion)
• Begins with the complete dilation and ends with the
delivery of the infant.
• Primi – 80 minutes.
• Multi – 30 minutes.
• Power / forces at work: involuntary uterine
contractions of the diaphragmatic and abdominal
muscles.
SIGNS OF IMPENDING DELIVERY:
• Bulging perineum and appears tense
• Anus may appear everted, stool may be
expelled.
• Vaginal introitus opens.
• Fetal scalp visible – CROWNING.

• During the Second stage

• Distention from the birth canal, vulva, and
perineum.

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

Mechanisms of Labor / Fetal position

Changes: (ED FIRE ERE)

• ENGAGEMENT – the head is fixed in the pelvis.

• DESCENT – fetus goes down in the birth canal.
• FLEXION – fetal chin bends toward the chest.
• INTERNAL ROTATION – from AP to transverse the
AP to AP.
• EXTEMSION – the head extends, the forehead,
nose, mouth, and chin appear.
• EXTERNAL ROTATION – restitution.
• EXPULSION – delivery of the rest of the body.

c.) THIRD STAGE (Placenta Stage)

• Begins with the delivery of the baby and ends with

the delivery of the placenta.
• Primi – 10 minutes.
• Multi – 10 minutes.

• Avoid tugging at the cord as it can cause uterine

inversion.
• Just watch for the signs of placental separation.
• Perform BRANT ANDREW MANEUVER.
• Take note of the time of placental delivery – it should
be delivererd within 20 minutes after the baby.
Otherwise, refer stat to the M.D.
• Inspect for completen ess of cotyledons – retained
placental fragmenrs cause severe cleeding and
possible death.
• Palpate the uterus – To determine the degreee of
contraction. Massage gently, ICE CAP is also
allowed.
• Medical Management: OXYTOCIN – it is injected IV
postplacental delivery to maintain uterine
contraction.

DUQUE, CHRISTINE D.
 CARE OF THE MOTHER AND CHILD, ADOLESCENT (WELL CLIENT)
(MATERNAL)
NUR 1208 – NCM 107 │ 2ND YEAR │ 2ND SEMESTER
FAR EASTERN UNIVERSITY – IHSN

• Place flat on the bed.

SIGNS OF PLACENTAL SEPARATION:

• CALKIN’S SIGN – the uterus becomes round and
firm, rising up to the level of the umbilicus.
(Earliest sign)
• Sudden gush of the blood from the vagina.
• Lengthening of the cord.

TYPES OF PLACENTA DELIVERY:

• SCHULTZ – the placenta separates first at the
center and presents the shiny fetal surface.
(Most common – 80%).
• DUNCAN – placenta separates first at the
margin presents the maternal side. (20%).
d.) FOURTH STAGE (Recovery Stage)

• The first 2 hours postpartum is the most crucial stage

of the mother due to unstable vital signs.

ASSESSMENT:
• FUNDUS – should be checked q 15 mins for 1
hour and q 30 mins for the next 4 hours.
• LOCHIA – should be moderate in amount.
• BLADDER – full bladder is evidenced by the
shifting of the uterus to the right.
• PERINEUM – normally tender, discolored and
edematous. It should be cleaned with intact
sutures.
• BP & HR – should be monitored. Closely: 15
minutes during the 1 hr, q 30 mins for the next 2
hours.
• ROOMING – in concept – the mother and the
baby stays in the same room in the hospitals to
promote the bonding at the same time
encourage breastfeeding.
• Fundal firmness, position.
• Lochia – color, amount
• The endometrial surface is sloughed off as
LOCHIA, in three stages:
a. LOCHIA RUBRA – dark red color, days 1-3
after delivery; consists of blood and cellular
• EPISIORRHAPHY
debris from decidua.
• Repair of the episiotomy or lacerations.
b. LOCHIA SEROSA – pinkish brown, days 4-10;
• Vaginal pack is sometimes iserted to prevent
mostly serum, some blood, tissue debris.
bleeding.
c. LOCHIA ALBA – yellowish white, days 11-21;
• Remove pack 24-28 hours.
most leukocytes, with decidua, epithelial
• Make the pt. comfortable by doing perineal
cells, mucus.
care and applying clean sanitary napkins.

DUQUE, CHRISTINE D.