Week 2- Fetal Assessment In Labor Flashcards
Reassuring fetal heart rate patterns
Range 110-160 No periodic changes Moderate baseline variability Presence of accelerations Absence of decelerations
Fetal oxygen can decrease by
Maternal hypertension Hypotension Hypovolemia Fetal circulation Reduction of O2 in maternal blood Umbilical cord compression Reduction in blood flow in placenta
Moderate Variability
6-25 bpm
Marked Variability
> 25 BPM
Minimal Variability
0-5 BPM
Acceleration
Up 15 beats for 15 seconds
Tachycardia
> 160 BPM
Bradycardia
<110 BPM
Nonreassuring FHR
Baseline tachy or Brady
Absent or minimal variability
Variable or late decelerations
Prolonged decelerations
Ultrasound Transducer
Electronic fetal heart rate monitor
Tocotransducer
Electronic uterine contraction monitoring
Spiral Electrode
Internal monitoring
Electronic fetal heart rate monitoring
Baseline Fetal Heart Rate
Baseline is an average over 10 min
Periodic changes = contraction
Episodic changes = no contractions
Periods of marked variability
Variability
Baby’s response and ability to adapt
Early Deceleration
During the contraction
Poor O2 perfusion
-Head compression-
Late Deceleration
Heart rate declines after a contraction
Uteroplacental insufficiency
Not enough O2 to recover
Variable Decelerations
Umbilical cord compression
Prolonged Deceleration
Fetal heart rate below baseline of 15 beats per minute and lasting more than 2 minutes
5 essentials for FHR tracing
Baseline rate Baseline variability Accelerations Decelerations Changes or trends over time
5 factors that affect labor
Passenger Passageway Powers Position Psychological
Passenger
Fetus and placenta
A few minutes apart
Passageway
Birth canal
Powers
Contractions
Uterus
Position
Position of mother
Squatting is the best
Psychological
Mother needs to be cooperative
Breathing and relaxing techniques
Fetal Head
Largest part
BPD measures the head
Presentation
Head up or head down
Vertex
Head up
IDEAL!
Breech
Butt first
Cord Prolapse
Cord falls between baby legs
Very dangerous
Fetal Position
Put 2 fingers up vagina
Feel how dilated the mother is
Feel the head/butt
ROA and LOA
Best positions
Right and left anterior
Transverse Position
Hard for birth
Posterior Position
Harder for the mother
More painful
-4/-5
Can feel the head
Long way to go
+2/3
Ready for delivery
+5
Crowing and out
“In labor”
Regular contractions
Dilation
Cervix during labor
About 1hr per cm
10-12 hr for 1st pregnancy
Multiple pregnancies= much faster
Fundus
Where the contractions start
Effacement
Thinning 2cm thick at first 10% long way to go 80% really thin 100% paper thin
Position during Labor
Squatting is most powerful
No squatting with epidural
Change position between contractions
Try not to lay all the way down
Epidural Caution
Too early = stop contractions
Too late = baby will be limp
Give around 5/6 cm dilated
First stage of Labor
Onset of dilation
To 10cm
Most variable
Second stage of Labor
Full dilation to birth
Within one hour (hopefully)
Third stage of labor
Birth until placenta is delivered
Within minutes
Fourth stage of labor
2 hours after delivery of the placenta
Engagement
Head is in the pelvis
Descent
Goes a little farther down
Flexion
Baby brings head in and compresses itself
Internal rotation
Baby moves towards the mom
Extension
Stretches out completely
Restitution
Turns head
External rotation
Expulsion
Baby comes out!
Coroamitilis
Bag of water has ruptured prematurely
Lots of bacteria
Onset of labor
Week 39/40
Preceding labor
About 2 weeks before baby is dropping
-5 in pelvis, better breathing but more pressure
Bloody Show
Mostly mucus
NOT a sign of labor
