OB Exam 3: Labor

What is

• fetal presentation

• fetal attitude/flexion

• fetal station

• fetal presentation:

  • part of baby that enters pelvis first

    • Cephalic, Breech, or shoulder

• fetal attitude/flexion:

  • how baby holds body

    • chin tucked to chest, arms/legs flexed

• fetal station:

  • how far baby’s moved down in pelvis (-5 to +5

    • 0 station= head @ ischial spines

    • positive numbers= baby moving toward birth

Whats the 7 mechanisms of labor:

1. engagement

• head enters pelvis

2. descent

• head through pelvis

3. flexion

• infant chin to chest

4. internal rotation

• head turns to fit pelvis

5. extension

• infant chin up

6. external rotation (restitution)

• realignment and shoulders

7. expulsion

• baby delivered

*EDFIREEE

Stage 1 of Labor

• 2 stages

• Early stage: onset of regular contractions till cervix is @ 4 cm

• Active stage: cervix 5-10 cm

Stage 2 of Labor:

• 2 phases

1. Latent: delayed pushing, laboring down, passive descent till full dilation with urge to push (Fergusons Reflex)

2. Active: pushing (descent) till baby BORN

Stage 3 and Stage 4 of labor:

Stage 3: Placenta delivered

Stage 4: begins w/ placental delivery and includes @ least first 2hrs after birth

Determine the fetal positions:

Whats the desired diameter of the fetal head through pelvis?

• 9.5 cm: when baby tucks head→ suboccipitobregmatic

  • if not tucked = 13.5 cm (baaad)

4 Categories of FHR variability:

• variability= how much beat to beat fluctuation is there

1. absent 0

2. minimal 1-5 bpm

3. moderate 6-25bpm (normal!!)

4. marked >26 bpm

What are Early Decelerations?

• cause?

gradual drop in FHR during contractions (GOOD)

• mirrors contractions—goes down after peak and recovers before contractions end

• cause: head compression (NORMAL)

What are Late Decelerations?

• cause?

• FHR drops after contractions end

  • cause: placental insufficiency!! (BAD: baby not getting enough O2)

What are Variable decelerations?

• cause?

sudden DROP in FHR (looks like U,V,W)

• caused by umbilical cord compression→ change position!!

Prolonged decelerations

• causes (5)

• Drop in FHR > 15 bpm below baseline

• Duration: 2-10 mins

1. maternal HTN

2. rapid cervical dilation

3. anesthesia

4. uterine tachysystole (too many contractions)

5. mom position compressing blood vessels

acronym for decelerations:

veal chop mine

• Variable deceleration = Cord compression → Move pt (left side; hands and knees)

• Early deceleration = Head compression→ Identify labor progression

• Acceleration = OKAY!!→ Nothing

• Late deceleration = Placental insufficiency→ Emergent delivery!

How do nurses assess uterine contractions (5) and rupture of membrane (4)?

uterine contractions

1. frequency: how often

2. duration: how long

3. intensity: strength

4. TOCOdynamometer

5. palpitation

rupture of membrane (aka water breaks)

1. color of fluid

2. odor

3. amount

4. time of rupture

Whats priority after membrane ruptures??

Assess FHR!!!

• rules out cord prolapse or abrupt deceleration caused by cord prolapse

What tests are needed if fetal membranes ruptured? (3)

1. Nitrazine test (pH test)

• if paper turns blue= water broke

2. Fern Test

• vaginal fluid under microscope

  • fern pattern/frost = water broke

3. AmniSure ROM Test (Immunoassay testing)

• vaginal swab checks for protein found in amniotic fluid

How to perform Leopold Maneuver: (4)

1. Is fundus hard or soft?

• soft=butt (good)

2. Find fetal back

• place monitor here

3. Squeeze fingers together above pelvis.

• if no→ head is engaged or reached mid point of pelvis

4. Is head flexed?

• chin tucked =good

What factors affect the progression of labor? (5 P’s)

1. Passenger: baby

2. Passageway: pelvis

3. Powers: contractions

4. Position of laboring women

5. Psyche: moms emotional state

Primary vs secondary powers of labor:

Primary: body doing active labor

1. Involuntary uterine contractions (laboring down)

2. effacement/dilation

3. Ferguson reflex (urge to push)

Secondary: adding to the process

1. Voluntary pushing efforts by mom (bearing down)

2. Valsalva maneuver (holds breath and push)

What interventions for Non-Reassuring FHR patterns? (4)

1. lay on left side 1st

2. STOP PITOCIN!!! (oxytocin)

3. IV fluids

4. amnioinfusion: especially useful if meconium stained/ low fluid

• infusing LR or NS into amnio sac through intrauterine catheter

Caput Succedaneum and Cephalohematoma

Caput Succedaneum:

• swelling of babys head during birth (normal)

Cephalohematoma:

• bleeding bulge on ½ of head

Category I FHR: (4)

1. Normal w/ early decelerations (baby getting enough O2)

2. baseline 110-160 bpm

3. moderate variability (6-25 bpm fluctuations)

4. no late decelerations

Category II FHR: (4)

1. Intermediate (not normal but not dangerous yet)

2. minimal variability

3. brady/tachy-cardic

4. variable decelerations

Category III FHR:(4)

1. abnormal (baby may not be getting enough O2)

2. recurrent LATE decelerations (placental insufficiency- no O2 to baby)

3. recurrent Variable decelerations (cord compression)

4. bradycardia

• needs immediate delivery!