labor and fetal monitoring

1st stage pain

type: visceral

why it hurts: cervical changes, uterine distention/ischemia

what it feels like: diffuse lower abdominal cramps; may refer to back, hips, thighs

2nd stage pain

type: somatic

why it hurts: perineal/pelvic-floor stretching

what it feels like: sharp, burning, localized

3rd stage pain

type: -

why it hurts: uterine contractions during placental delivery

what it feels like: similar to first stage pain

morphine, fentanyl (opioid agonists)

• assess RR

• sedation

• BP

• FHR before/after

• placental transfer → neonatal resp depression risk

butorphoanol/stadol; nalbuphine/nubain (mixed agonist-antagonists)

may precipitate withdrawal with dependence

opioid antagonist (naloxone)

reverses opioid related resp dep

most important immediately after edpidural/

maternal bp

intermittent auscultation

periodic FHR checks; doppler is most common device listed

external ultrasound transducer

FHR; place over fetal back

external TOCO

contraction timing; cannot accurately measure intensity

internal scalp electrode

more direct FHR; invasive, requires ruptured membranes

IUpressure catheter

contraction pressure and resting tone; enables montevideo units

baseline FHR - absent/minimal

(0BPM) and (<5BPM)

• abnormal or indeterminate

• fetal hypoxemia or metabolic acidemia

• 
  

baseline FHR - moderate

(6-25BPM)

normal

baseline FHR - marked

(>25BPM)

• unclear significance

• fetal anemia, sepsis, etc.

sinusoidal

a true sinusoidal FHR pattern is category III, not normal variability

IV opioids can cause a transient pseudo-sinusoidal appearance

IV analgesia

systemic and sedates baby

epidural is high risk for :

hypotension

• dec placental perfusion

• ineffective breathing pattern

nursing actions before epidural placement

• VS and fetal monitoring prior to administration

• assess fluid balance

• give IVF bolus 15-30 min before to dec hypotension

nursing actions after epidural placement

• assess VS Q5min for 15 min

• woman may/may not feel contractions, needs to be instructed when to push

nitrous oxide

quick half life

pt controlled: only the client can hold the mask. start when a contraction begins

fetal oxygen supply can dec due to

• reduction of BF through maternal vessels as a result of HTN and hypotension

• reduction of oxygen content in maternal blood as result of hemorrhage or severe anemia

• alterations in fetal circ w compression of umbilical cord

• reduction in BF to intervillous space in placenta

uterine tachysystole

more than 5 contractions in 10 mins, averaged over a 30 min window

variable deceleration

cord compression

early deceleration

head compression

acceleration

okay!

late deceleration

placental insufficiency

early decels

FHR goes down at the same time as a contraction and comes up/recovers after the contraction is over

NOT related to fetal oxygenation

causes:

• uterine contractions/compression of fetal head

nursing care: check patients dilation/effacement

late decels

FHR begins after the contraction starts, lowest point is AFTER the peak of the contraction, does not return to baseline until after contraction ends

*related to fetal hypoxemia

causes:

• reduced oxygen delivery to fetus during contraction

nursing care:

• stop pit

• side lying

• administer 10 O2 by nonrebreather

nursing management of abnormal patterns

• assist the client to the side-lying position

• inc maternal BV by inc the rate of the primary IV infusion

• administer O2 10L/min x 15-30min

• if there are any meds running to induce labor, turn off

• notify physician

fetal tachycardia is most common during which of the following situations/conditions?

maternal fever