ch. 19: caring for the laboring client

sterile vaginal exam (SVE)

exam performed to determine baseline and establish true labor/ cervical change, not performed on preterm babies, recorded as 3 different numbers

dilation of cervix

what does the 1st number on an SVE indicate?

effacement

what does the 2nd number on an SVE indicate?

station

what does the 3rd number on an SVE indicate?

• occur regularly and become stronger, longer, and closer

• more intense with walking

• felt in lower back and radiate to lower abdomen

• continue despite comfort measures

4 components of true labor contractions

1st stage of labor

the longest stage of labor, lasts from start of regular uterine contractions to full dilation of cervix, has latent (1-4cm) and active phase (4-8cm)

active phase

part of 1st labor stage where dilation and descent occur faster, lasts 3-6 hours

Leopold maneuvers

abdominal palpation to determine fetal positioning

initial dose of 5 million U IVPB then 2.5 million U q4h until baby is born

what is the dosing regimen of penicillin G for GBS positive pts?

q15min during labor, q5min when pushing

how often should VS be taken during labor and pushing for low-risk clients?

2nd stage of labor

stage of labor that begins with full dilation of cervix (10cm) and ends with baby being born, the “pushing” stage, can last 20 min to 2 hr

Ferguson reflex

the urge to bear down due to oxytocin release from pressure on cervix

open glottis pushing

type of pushing where patient does NOT hold their breath while pushing, is found to be the best method

crowning

when you see most of the fetal head coming out

Ritgen maneuver

applying upward pressure from coccyx region to help reduce risk of perineal tears

1st degree laceration

perineal laceration that extends through skin and vaginal mucous membrane but not underlying fascia and muscle

2nd degree laceration

perineal laceration that extends through fascia and muscles of perineal body bit not anal sphincter

3rd degree laceration

perineal laceration that involves external anal sphincter

4th degree laceration

perineal laceration that extends completely through rectal mucosa, disrupting external and internal anal sphincters

3rd stage of labor

stage of labor where placenta is delivered, usually expelled within 10-15 minutes, problematic if >30min

signs of placental separation

sudden gush of dark blood, apparent lengthening of cord, uterus has globular shape, rise of fundus, vaginal fullness

bolus of pitocin to prevent hemorrhage

what is given after placenta is delivered and why?

4th stage of labor

recovery period, lasts until patient is stable in immediate postpartum period