Chapters 9, 10, 11, & 12 Flashcards
asynclitism
oblique presentation of the fetal head at the superior strait of the pelvis; the pelvic planes and those of the fetal head are not parallel.
attitude
relationship of fetal parts to each other in the uterus (e.g., all parts flexed or all parts flexed except neck extended.)
biparietal diameter
Largest transverse diameter of the fetal head; measured between parietal bones.
approx. 9.25 cm at term
bloody show
vaginal discharge that originates in the cervix and consists of blood and mucous; increases as the cervix dilates during labor.
dilation
stretching of the external os from an opening a few millimeters in size to an opening large enough to allow the passage of the fetus
effacement
Thinning and shortening or obliteration of the cervix that occurs during late pregnancy or labor or both
engagement
in obstetrics, the entrance of the fetal presenting part into the superior pelvic strait and the beginning of the descent through the pelvic canal; usually the lowest part of the presenting part is at or below the level of ischial spines
Ferguson reflex
reflex contractions (urge to push) of the uterus after stimulation of the cervix when the presenting part of the fetus reaches the perineal floor. Caused by endogenous oxytocin
fontanels
broad areas, or soft spots, consisting of a strong band of connective tissue contiguous with cranial bones and located at the junctions of the bones.
lie
relationship existing between the long axis of the fetus and the long axis of the mother; in longitudinal lie, the fetus is lying lengthwise or vertically, whereas in a transverse lie, the fetus is lying crosswise or horizontally in the uterus.
lightening
sensation of decreased abdominal distention produced by uterine descent into the pelvic cavity as the fetal presenting part settles into the pelvis; usually occurs 2 weeks before the onset of labor in nulliparas
molding
overlapping of cranial bones or shaping of the fetal head to accommodate and conform to the bony and soft parts of the mother’s birth canal during labor
position
relationship of a reference point on the presenting part of the fetus, such as the occiput, sacrum, chin, or scapula, to its location in the front, back, of sides of the maternal pelvis
presentation
the part of the fetus that lies closest to the internal os of the cervix
station
relationship of the presenting fetal part to an imaginary line drawn between the ischial spines of the pelvis
suboccipitobregmatic diameter
smallest anterior-posterior diameter of the fetal head; follows a line drawn from the middle of the anterior fontanel to the undersurface of the occipital bone.
9.5 cm
valsalva maneuver
forced expiratory effort against a closed airway, such as holding one’s breath and tightening the abdominal muscles. (e.g., pushing during the second stage of labor)
vertex
crown, or top, of the head.
The 5 P’s
Passenger (fetus & placenta) Passageway (birth canal) Powers (contractions) Position of the mother Psychologic response.
The way the passenger moves through the birth canal is determined by
the size of the fetal head, fetal presentation, fetal lie, fetal attitude, and fetal position.
How many bones comprise the fetal skull
6 - 2 parietal, 2 temporal, frontal and occipital.
How many sutures and their names
4 - sagittal, lambdoidal, coronal, and frontal
The two most important fontanels
anterior and posterior
Anterior fontanel facts
diamond shaped, larger than the posterior, and lies at the junction of the sagittal, coronal, and frontal sutures.
closed by 18 months
Posterior fontanel facts
Triangular shaped, lies at the junction of the sutures of the two parietal bones.
closes 6 - 8 weeks after birth
Purpose of sutures and fontanels
to make the skull flexible to accommodate the infant brain, and to allow for flexibility for passage through the birth canal
Molding of the newborns head returns to normal…
within 3 days.
The 3 main presentations are…
Cephalic (head first) - 96%
Breech (buttocks or feet first) - 3%
Shoulder - 1%
Presenting part in each presentation is usually
cephalic - occiput
breech - sacrum
shoulder - scapula
Normal fetal attitude
Called general flexion
Back of the fetus is rounded so that the chin is flexed on the chest, the thighs are flexed on the abdomen, and the legs are flexed at the knees. The arms are crossed over the thorax and the umbilical cord lies between the arms and the legs.
The smallest and most critical anteroposterior diameters is the…
suboccipitobregmatic diameter
9.5 cm at term
Position documentation
3 letter abbreviation.
1st letter - location of the presenting part in the right (R) or left (L) side of the mother’s pelvis
2nd letter - the specific presenting part (O- occiput, S- sacrum, M- mentum and Sc- scapula.
3rd letter - location of presenting part in relation to the maternal pelvis (A- anterior, P- posterior, T- transverse)
SVE
Sterile vag exam
Four basic types of pelvises
Gynecoid (the classic female pelvis)
Android (resembling the male pelvis)
Anthropoid (resembling the pelvis of anthropoid ape)
Platyepaloid (flat pelvis)
Which pelvis type is the most common
Gynecoid, present in 50% of all women
True/False: Mixed types of pelvises are more common than pure
True
Primary Powers
Involuntary uterine contractions that signal the beginning of labor. They are responsible for effacement and dilation of cervix and descent of the fetus.
Secondary Powers
The voluntary bearing down efforts of the mother after the cervix has dilated. They augment the force of the involuntary contractions.
Normal cervix size
2-3 cm long, 1 cm thick
effacement & dilation
1st pregnancy vs subsequent
effacement usually is progressed in 1st pregnancy before dilation occurs. In subsequent pregnancies they can occur at the same time.
Other phenomena in the days preceding labor
- loss of 0.5 to 1.5 kg in weight, caused by water loss resulting from electrolyte shifts produced by changes in estrogen & progesterone levels.
- a surge of energy
- lightening
- return of urinary frequency
- backache
- stronger braxton hicks contractions
- increased vaginal mucous or bloody show
- possible rupture of membranes.
how many stages of labor?
4
first stage of labor
onset of regular uterine contractions to full dilation of cervix. In a first pregnancy this can take 20 hours or longer, in multipara it can occur in less than an hour.
Divided further into 3 phases: latent, active and transition.
second stage of labor
lasts from the time the cervix is fully dilated to the birth of the fetus.
Average of 20 minutes in multiparous women and 50 minutes in nulliparas.
Asians longer second stage, Hispanic and African-American women shorter when compared to Caucasian women.
Divided into 3 phases.
first phase
2nd stage of labor
begins approximately the time of complete dilation of the uterus, when the contractions are weak, and the mother has no urge to push, is resting, or is exerting only small bearing-down efforts with contractions.
second phase
2nd stage of labor
period when contractions resume, the woman is making strong bearing-down efforts, and the fetal station is advancing.
third phase
2nd stage of labor
a period lasting from crowning until the birth
third stage of labor
last from the birth of the fetus until the placenta is delivered.
May be as short as 3-5 minutes, and up to 30 minutes is considered within normal limits.
When does the placenta typically separate
during the 3rd or 4th strong uterine contraction after the infant has been born. It is then delivered on the next contraction.
fourth stage of labor
lasts approximately 2 hours after the delivery of the placenta. The period of recovery when homeostasis is reestablished.
VERY IMPORTANT to observe for BLEEDING in this phase
7 cardinal movements
engagement descent flexion internal rotation extension external rotation (restitution) expulsion
Descent
the progress of the presenting part through the pelvis.
Descent depends on what 4 forces
- pressure exerted by the amniotic fluid
- direct pressure exerted by the contracting fundus on the fetus
- force of the contraction of the maternal diaphragm and abdominal muscles in the 2nd stage of labor
- extension and straightening of the fetal body.
When does the fetus’s head usually flex?
As soon as the head meets resistance from the cervix, pelvic wall, or pelvic floor, it normally flexes, bringing the chin closer to the fetal chest
restitution
the external rotation of the head after it is born
FHR
average at term is 140 beats/min
range 110 - 160 beats/min.
Earlier in gestation the FHR is higher than normal with an average of 160 beats/min at 20 weeks.
Factors affecting fetal circulation
- maternal position
- uterine contractions
- blood pressure
- umbilical cord blood flow.
What certain changes stimulate the chemoreceptors in the aorta and carotid bodies to prepare the fetus for initiating respiration after birth?
- fetal lung fluid is cleared from the air passages during labor and vaginal birth
- fetal oxygen pressure (PO2) decreases
- Arterial carbon dioxide pressure (PCO2) increases
- Arterial pH decreases
- Bicarbonate level decreases
- Fetal respiratory movements decrease during labor.
Maternal physiologic changes during labor
- Cardiac output increases 10-15% in the first stage, 30-50% in the second stage.
- HR increases slightly in the 1st and 2nd stages
- SBP increases during uterine contractions in 1st stage; SBP & DBP increase during contractions in second
stage.
-WBC count increases - Resp rate increases
-Temp may be slightly elevated - proteinuria may occur
- gastric motility and absorption of solid food is decreased; N/V may occur during transition to second-stage labor.
- blood glucose level decreases.
Maternal endocrine changes during labor
labor may be triggered by decreasing levels of progesterone and increasing levels of estrogen, prostaglandins, and oxytocin.
Normal volume of amniotic fluid
500 - 1200 mL
tests for presence of amniotic fluid
Nitrazine paper - will turn blue if positive
Amni-sure
Fern test
latent phase
first stage of labor
4 - 6 hours long
0-3 cm dilated
irregular contractions
active phase
first stage of labor
2-3 hours
4-7 cm
more regular, strong contractions
transition phase
first stage of labor
20-40 minutes
8-10 cm
strong to very strong contractions q 2-3 mins
analgesia
absence of pain without loss of consciousness
anesthesia
partial or complete absence of sensation with or without loss of consciousness
counterpressure
pressure applied to the sacral area of the back during uterine contractions
effleurage
gentle stroking used in massage, usually on the abdomen
epidural block
type of regional anesthesia produced by injection of local anesthetic alone or in combination with a narcotic analgestic into the epidural (peridural) space
epidural blood patch
a patch formed by a few mililiters of the mother’s blood occluding a tear in the dura mater around the spinal cord that occurs during induction of spinal or epidural block; its purpose is to relieve headache associated with leakage of spinal fluid
gate-control theory of pain
pain theory used to explain the neurophysiologic mechanism underlying the perception of pain; the capacity of nerve pathways to transmit pain is reduced or completely blocked by using distraction techniques.
local perineal infiltration anesthesia
process by which a local anesthetic medication is deposited within the tissue to anesthetize a limited region of the body.
neonatal narcosis
central nervous system depression in the newborn caused by an opioid (narcotic); may be signaled by respiratory depression, hypotonia, lethargy, and delay in temperature regulation.
opioid (narcotic) agonist analgesics
medications that relieve pain by activating opioid receptors
e.g., hydromorphone, meperidine (demerol), fentanyl
opioid (narcotic) agonist-antagonist
medications that combine agonist activity (activates or stimulates a receptor to perform a function) and antagonist activity (blocks a receptor or medication designed to activate a receptor) to relieve pain without causing significant maternal or fetal or newborn respiratory depression.
e.g., butorphanol (stadol), nalbuphine (nubain)
opioid (narcotic) antagonists
medications used to reverse the central nervous system depressant effects of an opioid, especially respiratory depression.
e.g., narcan
pudendal nerve block
injection of a local anesthetic at the pudendal nerve root to produce numbness of the genital and perianal region
spinal anesthesia (block)
regional anesthesia induced by injection of a local anesthetic agent into the subarachnoid space at the level of the third, fourth, or 5th lumbar interspace
systemic analgesia
pain relief induced when an analgesic is administered parenterally (e.g., subcut, IM, or IV) and crosses the blood-brain barrier to provide central analgesia effects.
two origins of labor pain
visceral and somatic
pain impulses during the 1st stage of labor are transmitted by..
the T1 - T12 spinal nerve segment and accessory lower thoracic and upper lumbar sympathetic nerves. These nerves originate in the uterine body and cervix
examples of visceral pain
pain from cervical changes, distention of the lower uterine segment, stretching of cervical tissue as it dilates, and pressure on adjacent structures and nerves
referred pain occurs when…
the pain originates in the uterus and radiates to the abdominal wall, lumbosacral area of the back, iliac crests, gluteal area, thighs and lower back.
During the second stage of labor the woman has which kind of pain?
somatic pain, which is often describes as inteanse, sharp, buring and is well localized.
pain impulses during the second stage of labor are transmitted by…
the pudendal nerve through S2 to S4 spinal nerve segments and the parasympathetic system
Pain experienced during the 3rd stage of labor and the early postpartum pains are…
uterine, similar to the pain experienced early in the first stage of labor
The meaning of pain and the expressions associated are learned from….
interactions within the primary social group
Women with a history of _______ may experience increased pain during childbirth as a result of higher ____ level
dysmennorrhea; prostaglandin
other physical factors of pain
fatigue, the interval and duration of contractions, fetal position, rapidity of fetal descent and maternal position.
most potent endorphins
beta-endorphins
cleansing breath
relaxed breath in through nose and out mouth. Used at the beginning and end of each contraction
slow paced breathing
6-8 breaths/min
IN-2-3-4/OUT-2-3-4/IN-2-3-4/OUT-2-3-4
modified-paced breathing
32-40 breaths/min
IN-OUT/IN-OUT no more than 2xs normal breathing rate
patterned-paced or pant-blow breathing
same rate as modified
enhances concentration
3:1 patterned breathing (IN-OUT/IN-OUT/IN-OUT/IN-BLOW repeat through contraction)
4:1 pattern same as 3:1 but with one extra IN-OUT cycle.
Pharmacologic control of first stage of labor
- systemic analgesia
- opioid agonist analgesics
- opioid agonist-antagonist analgesics
- epidural (block) analgesia
- combines spinal-epidural (CSE) analgesia
- nitrous oxide
Pharmacologic control of second stage of labor
- nerve block analgesia and anesthesia
- local infiltration anesthesia
- pudendal block
- spinal anesthesia
- epidural analgesia
- CSE analgesia
- nitrous oxide
Pharmacologic control of vaginal birth
- local infiltration anesthesia
- pudendal block
- epiduaral
- spinal
- CSE analgesia
- nitrous oxide
Pharmacologic control of cesarean birth
- spinal
- epidural
- general anesthesia
When should opioid angonist analgesics be given in relation to birth?
Ideally, birth should occur less than 1 hour or more than 4 hours after administration so that neonatal CNS depression resulting from the opioid is minimized.
Signs of potential complications
Maternal opioid abstinence syndrome (opioid/narcotic withdrawal)
- yawning, rhinorrhea, sweating, lacrimation(tearing), mydriasis(dilation of pupils)
- anorexia
- irritability, restlessness, generalized anxiety
- tremor
- chills and hot flashes
- piloerection (goose bumps)
- violent sneezing
- weakness, fatigue, and drowsiness
- nausea and vomiting
- diarrhea, abdominal cramps
- bone and muscle pain, muscle spasm, kicking movements
many local anesthetic agents are chemically related to…
cocaine and end with the suffix -caine.
signs and symptoms of maternal hypotension with decreased placental perfusion
- maternal hypotension (20% decrease from preblock baseline level or <100 mm Hg systolic)
- fetal bradycardia
- absent or minimal FHR variability
Interventions for maternal hypotension with decreased placental perfusion
- turn the woman to lateral position or place pillow or wedge under hip to deflect uterus.
- maintain IV infusion at rate specified, or increase as needed administration per hospital protocol.
- administer oxygen by facemask at 10-12 L/min or per protocol
- elevate the woman’s legs.
- notify primary health care provider, anesthesiologist, or nurse anesthetist.
- asminister IV vasopressor (e.g., ephedrine 5-10 mg or phenylephrine 50-100 mcg) per protocol if previous measures are ineffective
- remain with the woman and continue to monitor maternal blood pressure and FHR every 5 minutes until her condition is stable or per primary health care provider’s order.
headache after spinal or epidural is called
postdural puncture headache
conservative treatment for a PDPH
oral analgesics and caffeine or theophylline.
caffeine or theophylline cause constriction of cerbral blood vessels and may provide symptomatic relief
The most reliable, and beneficial relief measure of PDPH
an autologous epidural blood patch
side effects of epidural and spinal anesthesia
- hypotension
- local anesthetic toxicity
- high or total spinal anesthesia
- fever
- urinary retention
- pruritus
- limited movement
- longer second stage labor
- increased use of oxytocin
- increased likelihood of forceps- or vacuum-assisted birth.
contraindications to epidural blocks
- active or anticipated serious maternal hemorrhage
- coagulopathy
- infection at the injection site
- increase intracranial pressure caused by a mass lesion
- some types of maternal cardiac conditions
acceleration
increase in fetal heart rate usually interpreted as a reassuring sign.
amnioinfusion
infusion of normal saline or lactated Ringer’s solution through an intrauterine catheter into the uterine cavity in an attempt to increase the fluid around the umbilical cord and prevent compression during uterine contractions.
baseline fetal heart rate
Average FHT during a 10 minute period that excluded periodic and episodic changes and periods of marked variability; normal FHR baseline is 110-160 beats/min.
Baseline differs by more than 25 beats/min.
bradycardia
baseline FHR below 110 beats/min and lasting for 10 minutes or longer
deceleration
slowing of FHR attributed to a parasympathetic response and described in relation to uterine contractions. Types of decelerations include: early, late, prolonged, & variable
early deceleration
A visually apparent gradual decrease of FHR before the peak of a contraction and return to baseline as the contraction ends; caused by fetal head compression.
late deceleration
a visually apparent gradual decrease of FHR, with the lowest point of the deceleration occurring after the peak of the contraction and returning to baseline after the contraction ends; caused by uteroplacental insufficiency.
prolonged deceleration
a visually apparent decrease (may be gradual or abrupt) in FHR of at least 15 beats/min below the baseline and lasting more than 2 minutes but less than 10 minutes
Variable deceleration
A visually apparent abrupt decrease in FHR below the baseline occuring any time during the uterine contracting phase; caused by compression of the umbilical cord.
electronic fetal monitoring (EFM)
Electronic surveillance of FHR by external and internal methods
episodic changes
Changes from baseline patterns in the FHR that are not associated with uterine contractions
hypoxemia
reduction in arterial oxygen pressure resulting in metabolic acidosis by forcing anaerobic glycolysis, pulmonary vasoconstriction, and direct cellular damage.
hypoxia
insufficient availability of oxygen to meet the metabolic needs of body tissue
intermittent auscultation
listening to fetal heart sounds at periodic intervals using nonelectronic or ultrasound devices placed on the maternal abdomen
periodic changes
changes from baseline of FHR that occur with uterine contractions
tachycardia
baseline FHR about 160 beats/min and lasting longer than 10 minutes
tachysystole
more than 5 uterine contractions in 10 minutes, averaged over a 30-minute window
tocolysis
inhibition of uterine contractions through administration of medications; used as an adjunct to other interventions in the management of fetal compromise related to increased uterine activity
uteroplacental insufficiency
decline in placental function (exchanging of gases, nutrients, and wastes) leading to fetal hypoxia and acidosis; evidenced by late FHR decelerations in response to uterine contractions.
variability
Normal irregularity of fetal cardiac rhythm or fluctuations from the baseline FHR of two cycles or more
In the US, what percentage of women wear EFM during labor
85%
frequency
contraction
contraction frequency overall generally ranges from 2-5 per 10 minutes during labor, with lower frequencies seen in the first stage of labor and higher frequencies (up to 5 contractions in 10 minutes) seen during the second stage of labor.
duration
contractions
contraction duration remains fairly stable throughout the first and second stages, ranging from 45-80 seconds, not generally exceeding 90 seconds.
intensity (peak less resting tone)
contractions
intensity of uterine contractions generally range from 25-50mmHg in the first stage of labor and may rise to over 80 mmHg in second stage. Contractions palpated as “mild” would likely peak at less than 50 mmHgif measured internally, whereas contractions palpated as “moderate” or greater would likely peak at 50 mmHg or greater if measured internally.
resting tone
Average resting tone during labor is 5-10 mmHg; if using palpation, should palpate as “soft” (i.e., easily indented, no palpable resistance)
Montevideo units (MVUs)
Ranges from 100-250 MCUs in the first stage, may rise to 300-400 in the second stage. contration intensities of 40 mmHg or more and MVUs of 80-120 are generally sufficient to initiate spontaneous labor.
Abnormal FHR patterns
- Absent baseline FHR variability
- Recurrent late decelerations
- Recurrent variable decelerations
- Bradycardia
- Sinusoidal FHR patten
The average pressure during a contraction (IUPC)
50 - 85 mm Hg
Reading the strip
counting squares
each small square represents 10 seconds; each larger box of 6 small squares is 1 minute. Paper moves through at 3cm/min
How is baseline documented
As a single number, rather than a range.
4 types of variability
Absent, minimal, moderate, marked
absent or minimal variability is classified as
abnormal or indeterminate
possible causes of absent or minimal variability
fetal hypoxemia, metabolic acidemia, congenital anomalies, pre-existing neurologic injury, CNS depressant medications, and/or general anesthetics. Minimal variability can also occur with tachycardia, extreme prematurity or when the fetus is in a sleep state
Moderate variability is classified as
normal
The significance of marked variability is…
unknown.
Possible causes of tachycardia
- early fetal hypoxemia
- fetal cardiac arrhythmias
- maternal fever
- infection
- parasympatholytic drugs
- B-sympathomimetic drugs
- maternal hyperthyroidism
- fetal anemia
- drugs (caffeine, cocaine, methamphetamines)
Possible causes of bradycardia
- atrioventricular dissociation
- structural defects
- viral infections
- medications
- fetal heart failure
- maternal hypoglycemia
- maternal hypothermia
causes of accelerations
- spontaneous fetal movement
- vaginal examination
- electrode application
- scalp stimulation
- reaction to external sounds
- breech presentation
- occiput posterior presentation
- uterine contractions
- fundal pressure
- abdominal palpation
causes of early decelerations
head compression resulting from the following:
- uterine contractions
- vaginal examination
- fundal pressure
- placement of internal mode of monitoring.
causes of late decelerations
uteroplacental insufficiency caused by the following:
- uterine tachysystole
- maternal supine hypotension
- epidural or spinal anesthesia
- placenta previa
- abruptio placentae
- hypertensive disorders
- postmaturity
- intrauterine growth restriction
- diabetes mellitus
- intraamniotic infection
nursing interventions for late decelerations
The usual priority is as follows:
- Change maternal position (lateral)
- Correct maternal hypotension by elevating legs
- Increase rate of maintenance IV solution.
- Palpate uterus to assess for tachysystole
- discontinue oxytocin if infusing
- Administer oxygen at 8-10L/min by nonrebreather facemask
- Notify physician or nurse-midwife
- consider internal monitoring for a more accurate fetal and uterine assessment
- Assist with birth (cesarean or vaginal assisted) if pattern cannot be corrected.
causes of variable decelerations
Umbilical cord compression caused by the following:
- maternal position with cord between fetus and maternal pelvis.
- cord around fetal neck, arm, leg, or other body part
- short cord
- knot in cord
- prolapsed cord
nursing interventions for variable decelerations
The usual priority is as follows:
- Change maternal position (side to side, knee chest)
- Discontinue oxytocin if infusing
- Administer oxygen at 8 - 10 L/min by nonrebreather facemask
- Notify physician or nurse-midwife
- Assist with vaginal or speculum examination to assess for cord prolapse
- Assist with amnioinfusion if ordered
- Assist with birth (vaginal assisted or cesarean) if pattern cannot be corrected.
cause of prolonged decelerations
disruption in oxygen supply.
- prolonged cord compression
- profound uteroplacental insufficiency
- sustained head compression
5 essential components of the fetal heart rate tracing that must be evaluated regularly
baseline rate, baseline variability, accelerations, decelerations, and changes or trends over time.
Basic Interventions for management of Abnormal FHR
- administer oxygen by nonrebreather facemask at a rate of 10 L/min
- assist the woman to a side-lying (lateral) position
- Increase maternal blood volume by increasing the rate of the primary IV infusion
Interventions for Maternal hypotension
- increase the rate of the primary IV infusion
- change to lateral or Trendelenburg positioning.
- Administer ephedrine or phenylephrine if other measures are unsuccessful in increasing blood pressures.
Interventions for Uterine tachysystole
- Reduce or discontinue the dose of any uterine stimulants in use (e.g., oxytocin)
- Administer a uterine relaxant (tocolytic) e.g., terbutaline
Interventions for Abnormal FHR tracing during the second stage of labor
- Use open glottis pushing
- use fewer pushing efforts during each contraction
- make individual pushing efforts shorter.
- push only with every other or every third contraction
- push only with a perceived urge to push ( in patients with regional anesthesia.)
pH
cord blood
Artery: 7.2 - 7.3
Vein: 7.3 - 7.4
PCO2
cord blood
Artery: 45 - 55
Vein: 35 - 45
PO2
cord blood
Artery: 15 - 25
Vein: 25 - 35
Base deficit (cord blood
<12 in both artery and vein
Respiratory acidemia
pH: <12 mmol/L
Metabolic acidemia
pH: or = 12 mmol/L
Mixed acidemia
pH: or = 12 mmol/L
oligohydramnios
abnormally small amount of amniotic fluid
anhydramnios
no amniotic fluid
amniotomy
Artificial rupture of membranes, using a plastic Amnihook or a surgical clamp
fern test
appearance of a fern-like pattern found on microscopic examination of certain fluids such as amniotic fluid
Nitrazine test
evaluation of body fluids using a test swab to determine the fluid’s pH; urine exhibiting an acidic result and amniotic fluid exhibiting an alkaline result.
Somalia
cultural considerations
Because Somalis in general do not like to show any sign of weakness, women are extremely stoic during childbirth
Japan
cultural considerations
Natural childbirth methods practiced; may labor silently; may eat during labor; father may be present
China
cultural considerations
Stoic response to pain; fathers not usually present; side-lying position preferred for labor and birth because this position is thought to reduce infant trauma
India
cultural considerations
Natural childbirth methods preferred; father is not usually present; female relatives are usually present
Iran
cultural considerations
Father’s not present; female support and female caregivers preferred
Mexico
cultural considerations
May be stoic about discomfort until second stage, then may request pain relief; fathers and female relatives may be present
Laos
cultural considerations
May use squatting position for birth; fathers may or may not be present; female attendants preferred.
Signs of potential complications of labor
- intrauterine pressure of > or = to 80 mmHg (determined by intrauterine pressure catheter monitoring) or resting tone of > or = 20 mmHg
- Contractions lasting > or = 90 seconds
- More than 5 contractions in a 10 min period
- relaxation between contractions lasting or = 38C
- foul-smelling vaginal discharge
- continuous bright or dark-red vaginal bleeding
nuchal cord
Encircling of fetal neck by one or more loops of umbilical cord
Ritgen maneuver
technique used to control the birth of the head; upward pressure from the coccygeal region to extend the head during the actual birth
