L&D, Fetal Monitoring Flashcards
what are some critical factors in labor?
- birth passage
- fetus (passenger)
- relationship b/w the passage and fetus (proportion)
- physiologic forces of labor (powers)
- psychological factors (psyche of mother)
vertex presentation
occiput presentation; crown of head is presenting first; fetal head is completely flexed and chin is to chest
most common and this is what we want to see!
cephalic presentation
head is partially flexed
brow presentation
baby’s head is beginning to lift up and the brow/forehead is the presenting parts
facial presentation
fetal head hyperextended, babies can come out w/ very bruised faces
fetal sutures
membranous spaces between cranial bones
fetal fontanels
intersections of cranial sutures; molding
anterior (diamond shape), posterior (triangle shape)
what is the purpose of sutures and fontanels?
during vaginal delivery process, sutures can override themselves to make the head a little smaller for the birthing process
as a developing human child and the brain grows, these allow the skull to grow with it
engagement in presenting part to pelvis
largest diameter of the presenting part passes through the pelvic inlet (BPD; biparietal diameter)
station in presenting part to pelvis
relationship of the presenting part to the ischial spine
ex: - 5 = high up; + 5 = baby’s ready to come out; 0 = at ischial spine
how do we confirm spontaneous ROM?
ferning & nitrazine/amnio indicator
ferning
obtain fluid, put on slide, dry, and look at microscope = looks like fern plant
nitrazine/amnio indicator
exposed to amniotic fluid = turns dark blue/black color = positive ROM, ruling out urine or other vaginal secretions
what is the key to true labor?
progressive dilation and effacement
what is pitocin?
chemically manufactured oxytocin which is used to augment or induce labor
what does pitocin do?
promotes increased uterine tone following delivery = to prevent some bleeding as well
first stage of labor
0-10 cm dilated
3 phases
second stage of labor
10 cm dilated –> deliver of baby
- pushing, counting w/ pushes
- nullipara: lasts 2 hrs
- multipara: lasts 15 min
third stage of labor
expulsion and delivery of placenta
fourth stage of labor
first few hours (1-4 hrs) postpartum
- prime time for breast feeding and bonding
- drop in BP, increase in pulse d/t blood loss
- firm fundus and should be measured
- hypotonic bladder
phases within the first stage of labor
- early/latent phase
- active phase
- transition phase
first stage of labor: early/latent phase
- starts with onset of contractions (mild)
- able to cope w/ pain
- excited!
first stage of labor: active phase
- contractions intensify
- anxiety increases
- 4-7 cm and fetal decent (coming down)
first stage of labor: transition phase
- increasing force and intensity of contractions
- significant anxiety
- dilation slows and decent increases
nullipara: lasts < 3 hrs
multipara: lasts < 1 hr
cardinal movements of labor
- descent
- flexion
- internal rotation
- extension
- restitution
- external rotation
- expulsion
pro of perineal laceration
tissue tears where it’s weakest
con of perineal laceration
may be difficult to repair if it’s jagged, may extend to 4th degree laceration (where tissue b/w vagina and rectal area tears completely), labia, or urethra
how can we prevent a perineal laceration?
perineal massage (scooping tissue to stretch it out to allow for deliver)/mineral oil
what is an episiotomy?
lengthening the vaginal opening to allow for delivery by cutting the tissue
pro of an episiotomy
controlled (don’t risk tearing into rectum, urethra, or labia), repair is cleaner
may have less chance for infection
con of episiotomy
may be unnecessary
what is a retained placenta?
placenta that hadn’t been delivered within 30 minutes following delivery of baby
pain management in labor
- relaxation techniques
- narcotics
- epidural
- spinal
how can nurses be supportive in pain management for a woman in labor?
- massage or counter pressure (using tennis balls into back, use of light touch)
- breathing
- meditation
- focal point
- sip and chips
- hygiene
what is the most concerning possible side effect of an epidural?
hypotension
monitor every 2-3 min then every 15 during epidural
criteria for epidural
- pt PLT count must be at least 100,000
- fluid bolus must be given to decrease change of drop in BP
- monitor BP
why is hypotension concerning when given an epidural?
this affects the fetus because there’s less pressure perfusing to the placenta = fetal HR to bottom out = fetus gets less O2 during this time
how do we position a patient with an epidural?
- left lateral tilt, pressure of pregnancy off abdominal aorta
- frequent repositioning to avoid pressure –> epidural works w/ gravity
- straight cath q2
contraindications for epidurals
- PLT < 100,000
- coagulation disorders/hemorrhage
- severe spinal abnormalities = makes placement difficult
- infection or septic
- uncooperative pt
common indications of a c-section
- prior c/s
- breech presentation
- failure to progress
- fetal distress
- placental complications
nursing care following c-section
- encourage mom to breast feed in recovery room w/in 1hr
- continue to provide emotional support
what orders do we expect following c-seciton?
- pitocin to ensure uterus remains firm
- DVT prophylaxis (ambulate 4 hrs post op)
- advance diet
- pain management
external fetal monitor
toco & EFM on monthers abdomen
toco
looks for uterine muscle tone, cx strength placed on fundus
only tells us duration of cx
EFM
place over where baby’s heart would be, graphical representation of cardiac movement
what is a drawback of external fetal monitoring?
inability to precisely determine how strong cx is
if mother moves or baby moves = may not have accurate reading
methods of internal fetal monitoring
scalp electrode and IUPC
scalp electrode
small spiral placed into layer of skin on baby’s scalp
reassurance for accurate HR
IUPC (internal uterine pressure catheter)
- determine intensity of uterine cx
- mmHg muscle tone of uterus is doing
- resting tone in b/w cx as well as during cx –> how effective cx’s are
indications of internal fetal monitoring
- when not getting a good reading w/ external
- baby must be vertex
what’s a major drawback of internal fetal monitoring?
risk for infection
what are the risks of using internal fetal monitoring?
- AROM
- uterine perforation –> going through uterus
- baby may have small mark on scalp
how can we accurately determine if a fetus is tachycardic or bradycardic?
HR must last > 10 min
what does variability indicate?
fetal wellbeing, it’s the interaction b/w sympathetic and parasympathetic
nursing interventions for non-reassuring variability
- give mom something to wake baby up
- acoustical stimulator (buzzer) –> lil apparatus on belly to startle baby
accelerations in FHR
elevation > 15 bpm lasting at least 15 seconds; indicates fetal wellbeing
early decelerations in FHR
- “mirror” cx
- d/t head compression
nursing interventions for early decels
- vaginal exam, check mom
- perhaps progressing and moving along
- potentially change positions
late decelerations in FHR
- start at peak of cx and then resume to baseline
- non-reassuring!!
- indicates placental insufficiency
what are we most concerned about with late decels?
most concerned about the brain, hypoxia
nursing interventions for late decels
“5 turns”
1. turn pt on left side
2. turn fluids on
3. turn pitocin off
4. turn O2 on
5. turn call light on (for additional assistance!)
variable decelerations in FHR
- can happen whenever
- d/t cord compression
nursing interventions for variable decels
- sometimes it’s positional
- move so there’s not as much pressure
- continue to monitor
prolonged decelerations
decel is > 15 bpm and > 2min but < 10 min
