Terms in this set (31)
What are the 5 P's of Labor?
Passage (the pelvis & maternal soft parts)
Powers (uterine contractions)
Psyche (maternal psychological status)
What are the 3 components of the Passenger (Fetus)?
Discuss the fetal head. What are the 4 major landmarks? What and where are the 4 sutures? What and where are the 2 Fontanelles?
Discuss the passage
Related to the internal dimensions of mom's pelvis in relation to the baby's head. Differences in mom and dad can affect the clearance between baby's head and the mom's pelvis.
Discuss the differences in pelvic architecture.
Pelvis come in different shapes and sizes and this can affect the ease in which the baby's head comes out of the pelvis. (Don't memorize chart above just be familiar)
What is pelvimetry?
An estimation of the pelvic diameter through either manual exam (With Hands) or prior with an Xray.
Discuss Leopold's Maneuvers
Used to evaluate where the babies' position is (Head down or breach & OA/OP) as well as how big the baby is. Also used to determine the flexion of the head.
1. Find the fundus by walking the hands up the sides of belly
2. Find head by squeezing (Head is mobile)
3. Find the back (It's Hard)
4. Determine if head has dropped into pelvis. (??)
What is the purpose of measuring fundal height?
Determines the gestational age of the baby.
Discuss Lie of the baby
Lie is the position of the baby's spine in relation to the mothers. There are 3 types of lies.
1. Longitudinal (Straight up Vertically)
2. Transverse (Across)
3. Oblique (At Angle)
What are some nursing interventions for mom's with baby in the OP position?
Have mom's get on hands on knees.
Discuss Fetal Attitude
Fetal Attitude: refers to the relationship of the fetal parts to one another
Flexion, extension, military, brow
Discuss Fetal Presentation
Fetal Presentation: The part of the fetal body that enters (or presents to) the maternal pelvis
Vertex (head), Breech (butt), Face (Mentum)
Discuss the fetopelvic relationships
Fetal Position: refers to the relationship of an assigned area of the presenting part (often called the fetal denominator) to the maternal pelvis
If vertex presentation = occiput
If breech presentation = sacrum
If face presentation = mentum (chin)
Three initials are used to represent presentation, lie & position; e.g. ROT means the baby is in a transverse (T) lie with the occiput (O) towards the mother's right (R) side!
Discuss the passage!
Consists of 2 pieces, the cervical change and the station!
(Cervical Changes Include)
Dilatation: 0-10 centimeters
Effacement: 0 - 100%
Also location and consistency of cervix are described as
(Station Includes) (See Pic Look at Right Side)
From -5cm to +5cm with 0 station = presenting part is even with the ischial spines; typically -3 or -2 station to +2 are common measurements
Discuss dilatation and effacement of cervix
(Dilation and Effacement)
*These are relative measurements
A. Closed/Not Effaced
B. 1cm/10% effaced
C. 4cm/70% effaced
D. 8cm/90% effaced
Discuss the 7 Cardinal movements
1. Engagement - presenting part enters pelvis
3. Flexion - allows the smallest diameter to present
4. Internal Rotation
5. Extension - as the vertex passes under the pubic symphysis
6. External Rotation - after the head delivers
7. Restitution - Rotation of the shoulders and lining up of the shoulders after the head rotates
Discuss contractions. What are we interested in knowing?
(Contractions, we want to know)
1. How often are they occurring
2. How long do they last
3. How far apart are they
Discuss the stages of labor
1. First Stage (under the powers of the uterus alone)
*Early (Latent) Phase (0-4 cm)
*Active Phase (4-7cm)
*Transition (7-10cm) - Hard time for Mom & She may feel the urge to push but can't bc cervix not completely dilated. Give coaching here.
2. Second Stage (maternal powers join in)
*Passive Phase (the "NAP", often no urge to push)
*Active Phase (pushing, maternal urge to bear down) - Gravity helps here so standing or related positions are helpful. On back takes the longest to get baby out.
*Transition Phase (crowning)
3. Third Stage - Placental Delivery. It's sheers off from the wall of the uterus bc of a change in the uterine shape. Active management is common to prevent hemorrhage. Oxytocin may be given IM to encourage placental birth.
4 .Fourth Stage (immediate postpartum)
What should be done regarding blood loss following birth? What is one cause of hemorrhaging?
Measure the amount of blood loss.
500 ml to 600 ml is ok
Beyond this is hemorrhage & must be treated
Placenta not completely birthed
Discuss how we Assess fetal well being
1. Intermittent auscultation (IA)
FHR: Doppler (ultrasound) or fetoscope
UC: Manual palpation of contractions
2. Electronic fetal monitoring (EFM)
FHR: Transducer (ultrasound)
UC: Tocodynamometer (does not measure pressure)
*Internal EFM (Used if can't get a good external reading, baby has passed meconium, or is otherwise in distress)
FHR: Fetal Scalp Electrode (FSE) - Attaches to baby's head
UC: Internal Uterine Pressure Cather (IUPC)
What are the important factors for fetal oxygenation? What interventions are taken to maximize fetal oxygenation? What is done if fetal oxygenation is compromised?
(MOST IMPORTANT FACTORS AFFECTING FETAL OXYGENATION)
1. UTERINE Blood Flow
2. UMBILICAL BLOOD FLOW
(Maximizing Fetal Oxygenation)
(Management of compromised fetal oxygenation)
turning off Pitocin
possibly operative delivery.
What are we looking for on the strip?
1. Uterine contractions.
2. Baseline fetal heart rate.
3. Baseline variability.
4. Presence of accelerations.
5. Periodic or episodic decelerations.
6. Changes or trends of FHR patterns over time.
*Remember VEAL CHOP
Discuss baseline & Variability of Fetal HR
Mean FHR rounded to 5 bpm during a 10 minute window; must be > 2 minutes of identifiable baseline in 10 minutes
Normal baseline range is 110 to 160 bpm
Absent: Amplitude range undetectable
Minimal: 5 bpm
Moderate: 6-25 bpm
Marked: > 25 bpm
Discuss Accelerations. When does a new baseline occur?
Abrupt increase in FHR from onset to peak in < 30 seconds
15 bpm and last seconds
*If it lasts minutes - it is a change in baseline.
Discuss early, late, and variable decelerations.
Etiology: Head compression
Usually symmetrical, gradual decrease and return of FHR associated with contraction of 30 seconds. Mirrors contraction.
Etiology: Utero-placental insufficiency
Usually symmetrical, gradual decrease in FHR from onset of deceleration to nadir of FHR of 30 seconds. The nadir of the deceleration is after the peak of the contraction and the recovery is after the contraction ends.
Etiology: Compression of the umbilical cord
Abrupt decrease in FHR to nadir in < 30 seconds; if associated w/contractions onset, depth and duration vary.
*Remember VEAL CHOP
Examine the strip and think about VEAL CHOP
What are nursing interventions that would be applied during various decelerations?
1. Understand etiology
2. For nearly all non-normal patterns:
*Change maternal position, give oxygen at 8-10 L/min
*Increase IV fluids
3. Other Interventions
*Assess vital signs
*consider internal monitoring
*vaginal exam(check for cord, rapid descent of head, excessive show)