Intrapartum/ Labor Flashcards
Leopold maneuvers
Noninvasive way to assess a fetus’s position, presentation, & engagement in the uterus
performed by gently touching the abdomen
Leopold’s maneuvers
Head feels like
Hard, round, bump
Leopold’s Maneuvers
Breach or buttocks feels like
Soft & squishy → does not move independently of the trunk
Leopold’s maneuver
What are the small knobby things?
Hands, elbows, knees, feet
Leopold’s maneuver
The back feels like
Smooth, long, firm surface
Where should fetal monitor be placed?
On the back
Assessing uterine contractions
Feels like tip of nose → mild
Feels like tip of chin → moderate
Feels like forehead → strong
Non-pharmacological pain relief in labor
Position changes
Counter pressure
Project calm positive energy
Could also try:
→ hydrotherapy; relaxation; walking; acupressure; aromatherapy; music
Stages of labor
First stage, latent phase
First stage, active phase
Second stage
Third stage
First stage, latent phase
Cervical dilation → 0-5 cm, effacement 0-50%
Contractions are uncomfortable but bearable
Patient usually copes well
May be talkative & excited
Longest phase → may take 12 hrs or more in primigravidas
As the nurse what could be helpful to provide in first stage, latent phase?
distraction, encourage ambulation, educate on normal labor
First stage, active phase
Cervix dilation → 6-10 cm, progressive effacement to 100%
Contractions are moderate to strong immediately, get closer together
Patient needs to focus in order to cope (no talking)
At ~ 8 cm, patient may be overwhelmed
Ends with complete cervical dilation & effacement
Second stage of labor
Begins when cervical dilation is complete
Ends with the birth of the baby
“Laboring down” → wait for spontaneous urge, especially with epidurals/ primips
Contractions become stronger, longer, closer together
Fetal descent through the vagina (contractions/pushing)
Cardinal movements → fetus rotates to align with the pelvis
What is important to watch in the second stage of labor?
WATCH THE FETAL HEART PATTERNS – this stage is challenging to the fetus
Third stage of labor
Begins with delivery of newborn & ends with expulsion of the placenta
Delayed cord clamping is beneficial to the baby
Active management – oxytocin, gentle traction on the cord, tell mother to push
Passive management – let it deliver on its own
What are some signs that the placenta is about to deliver?
- Change in uterine shape (globular)
- Sudden gush of bright red blood
- Sudden lengthening of cord
Prolonged third stage of labor increases ____ ____
maternal bleeding
SBAR example question:
The nurse is caring for Olivia Jones, who has just experienced an eclamptic seizure in labor and delivery. After stabilizing the patient, the nurse calls the provider to give SBAR. Which statement reflects an effective description of the situation (“S”) when giving I-SBAR to the provider?
A. “I need you to come to room 12 as quickly as possible”
B. “This is Kathy, I’m call about Olivia Jones in Room 12”
C. “Olivia is postictal, Oriented x 2, the BP was 156/88. Fetal Heart tones are 150 with minimal variability”
D. “Olivia just had an eclamptic seizure”
D. “Olivia just had an eclamptic seizure”
First priority when looking at variables on fetal heart monitor?
ALWAYS turn the patient first → variables are cord compression
After patient is turned what could be the next action performed?
Give fluids → increase BF through umbilical cord
At very end of day → can recommend amnioinfusion
Early decelerations
Mirror the contraction
→ decel starts at beginning of contraction, reaches nadir at the peak of contraction, & recovers at end of contraction
What do early decelerations indicate?
Head compression → not always a bad thing
i.e if mom is 7-8 cm means she is making progress
Variable decelerations
Vary in shape & timing but always has abrupt descent
→ does not happen with the contraction
What do variable decelerations indicate?
Cord compression
