EINC, INTRAPARTUM, MATERNAL AND FETAL RESPONSES TO LABOR, AND POSTPARTUM CARE

Essential intrapartum and newborn care EINC

A package of evidence-based practiced recommended by DOH and WHO.

It is the standard of care in all births by skilled attendants in all government and private settings.

1. Immediate and thorough drying

2. Early skin-to-skin contact

3. Properly timed clamping and cutting of cord after 1-3 minutes

4. Non-separation of the newborn from the mother for early breastfeeding initiation and rooming-in

4 Main interventions of EINC

Appearance

Pulse

Grimace

Activity

Respiration

Meaning of APGAR?

After 1 minute

When should you take the first APGAR score of the baby?

Oxytocin 10IU IM deltoid/ lateral thigh

What should you inject to the mother after birth to stimulate uterine contractions, reduce postpartum bleeding, and support lactation?

1-3 minutes (after cord pulsations have stopped)

When should you clamp and cut the cord?

2 and 5cm away from the abdomen

At what centimeters should you clamp the cord?

3000g - 4000g

Normal weight of a newborn

Erythromycin

What ointment should you use to provide eye care to the newborn?

Vitamin K

It is injected into the baby to prevent blood coagulation.

Administration of vaccines (Vitamin K, Hepa-B, BCG, Erythomycin)

What is an essential care given within 90minutes to hours of birth?

between 18-22 inches (45cm-55cm)

Normal height range of newborns

33-35cm

Normal head circumference of newborns

31-33cm

Normal chest and abdomen circumference of newborns

Newborn screening

Simple procedure to determine if the newborn infant has a heritable congenital

metabolic disorder that may lead to serious physical health complications, mental

retardation, and even death if left undetected and untreated.

24-48hrs after birth

When is it best to obtain specimen for newborn screening?

Congenital hypothyroidism

The lack of production of the thyroxine

Congenital adrenal hyperplasia

Inborn defect in the biosynthesis of adrenal cortisol, leads to severe sodium loss, dehydration.

Phenylketonuria

An inborn error of metabolism, the lack of liver enzyme phenylalanine hydroxylase, needed to break down the amino acid phenylalanine to tyrosine and pigment melanin.

Galactosemia

Deficiency in galactokinase, inability to convert galactose and galactosuria. If left untreated, may lead to mental retardation, cataracts, and even death.

• Kangaroo hold

• Cradle hold

• Shoulder hold

• Football hold

• Transfer hold

Types of infant hold

1. Passage

2. Passenger

3. Powers of labor

4. Psyche

4Ps of Labor

The fetus

Passenger is known as?

• It has the widest diameter in the head

Attitude

The degree of flexion a fetus assumes during labor or the relation of the fetal parts to each other.

Lie

The relationship between the cephalocaudal axis of the fetal body and the cephalocaudal axis of the mother’s body, describes whether the fetus is lying in a horizontal or vertical position.

Fetal presentation

Denotes the body part that will first contact the cervix or be born first and is determined by the combination of fetal lie and the degree of fetal flexion.

Breech position

A fetal position that can cause difficulty in birth

• Ripening of the cervix

• Rupture of the bag of water

• Progressive fetal descent

3 premonitory signs of labor

True: regular and progressive

False: Irregular and non-progressive

How to identify if labor is false or true with mother’s contractions?

True: Lumbo-sacral radiating to the front; increasing intensity

False: Abdominal

How to identify if labor is false or true with mother’s discomfort?

True: Dilated

False: No dilation

How to identify if labor is false or true with mother’s cervix opening?

True: Intensifies contractions

False: No effect on contraction

How to identify if labor is false or true with mother’s walking and enema?

True: present and increasing

False: Absent

How to identify if labor is false or true with mother’s show?

Dilation

• progressive widening of the cervical os

  • described as the opening or widening

Effacement

The thinning and obliteration of the cervical canal, expressed in percentage

100% effacement

A fully effaced cervix where the cervix canal becomes paper-thin or already absent

Labor

A local process that involves the abdomen and reproductive organs, its intensity is so great that almost all body systems are affected by it.

Increases to 40-50%

Cardiac output during labor

15mmHg/contraction

BP rise due to pain response during labor

300-500ml

Average blood loss during labor

100% during 2nd stage of labor

Total oxygen need during labor?

Diaphoresis

It occurs with accompanying evaporation to cool and limit excessive warming.

every 2hrs

Advice the mother to void every?

2cm

The secretion of relaxin causes cartilage to be flexible, allowing the pelvis to open in how many centimeters for fetal passage?

Dick-read method

Management of pain by preventing fear from occurring. Based from this idea, fear leads to tension, and tension increases pain.

Promotes understanding labor, staying relaxed, and removing fear to reduce discomfort

Kitzinger (Psychosexual method)

• Developed by Sheila Kitzinger

  • A technique that focuses on staying calm and working with the body’s natural rhythm instead of resisting contractions.

Bradley (Partner-coached method)

In this pain management, the partner plays an active role during pregnancy.

• Muscle toning exercises and limits food that contain preservatives, animal fat, or high sodium content.

• Abdominal breathing

  • Walk

Lamaze Philosophy

a technique that teaches women to cope with labor pain through education, relaxation, and active participation

Cleansing Breath

A woman breathes in deeply and then exhales deeply.

Consciously controlled breathing

Breathing patterns at specific rates, provides distraction as well as prevents the diaphragm from descending fully and putting pressure on the expanding uterus.

Effleurage

Light abdominal massage, done with enough pressure to avoid tickling.

5bpm

How much does FHR increase during a contraction?

Fetal hypoxia

The increase in BP caused by increased intracranial pressure and keeps circulation from falling below normal for the duration of contraction.

Head compression

The principal cause for v-dip contractions to occur?

Uteroplacental insufficiency

The principle cause of U dip contractions to occur?

Partogram

Tool used to record a woman’s progress in labor.

• VS

• FHR

• Cervical dilation

• Descent of fetal head

• Urine test

  • drugs administered

Intrauterine hemorrhage

Hypotension during the 2nd stage of labor may signify?

140/90 mmHg

Normal BP of laboring woman during 2nd stage?

Hemorrhage

100bpm during labor is unusual and should be reported as it may be an indication of?

Bandl’s ring

An indentation across a woman’s abdomen, where the upper and lower segments of the uterus join, may be a sign of extreme uterine stress.

Possible fetal distress

Less than 110bpm in FHR is a sign of?

• High/low FHR

• Meconium staining

• Hyperactivity

• Low oxygen saturation

4 signs of fetal danger

Meconium staining

A green color in the amniotic fluid, a fetal danger sign which may indicate loss of rectal sphincter control and hypoxia

For child

Meaning of Latin word ‘puer’

To bring forth

Meaning of Latin word ‘parere”

Puerperium

The 6-week period after childbirth

Involution of the uterus and vagina

Retrogressive changes during puerperium

Production of milk for lactation, restoration of the normal menstrual cycle, beginning of parental role

Progressive changes during puerperium

Autolysis

Reduction in both cell size and weight of the uterus.

Lochia

Vaginal discharge that occurs after giving birth.

• the uterus sheds extra blood, mucus, and tissue built up during pregnancy

Rubra - Fusca - Serosa - Flava - Alba

Sequence of Lochia

Lochia rubra

Identify the Lochia

• Red

• Mainly blood, tissue debris, decidua

• Occurs 1st - 3rd day

Lochia Fusca

identify the Lochia

• Brownish

• Increasing hemolysis, less blood; serous

  • Occurs 3rd - 7th day

Lochia Serosa

identify the Lochia

• Serous

• Leukocytes, decidual cells, cervical mucus

• 7th - 14th day

Lochia flava

identify the Lochia

• Yellowish

• Mainly leukocytes, bacteria, detritus

  • 2nd - 3rd week

Lochia alba

identify the Lochia

• Grayish

• Decline of weekly flow; endometrial epithelializing; clear mucous secretion of uterine glands

• 3rd - 4th week

Slit like/ stellate (star-shaped)

Shape of cervix after birth

Hemorrhoids

Distended rectal veins

Striae gravidarum

Stretch marks on a birthing mother’s abdomen

Chloasma

dark pigment on the face and neck

19lb (8.6kg)

Total weight loss after birth

Engorgement

Increased vascular activity

Mastitis

An infection of the breast during lactation