Week 3: Labor & Birth Part II

What is labor?

Process of moving the fetus, placenta, and membranes our of the uterus and through the birth canal

What are the major signs preceding labor?

Lightning, backaches, contractions, Braxton Hicks

Bloody show

What is lightning/dropping?

Presenting part of fetus gradually descends into true pelvis

less pressure below ribcage -> easier breathing

Urinary frequency

ROM

rupture of membranes

SROM

spontaneous rupture of membranes

AROM

Artificial rupture of membrane; more common

PROM

prelabor rupture of membrane

PPROM

Preterm, pre-labor rupture of membrane (

What factors are onset of labor caused by?

Myometrial irritability

Changes in maternal uterus, cervix and pituitary gland

Hormones (estrogen, oxytocin)

What are the four stages of labor?

First stage (0-10cm)

Second stage (10cm to birth)

Third stage (birth to placenta)

Fourth stage (1-4 hours postpartum)

What makes up the first stage of labor?

Latent phase

Active phase

What is the latent phase of labor?

Begins with onset of regular contractions

Cervix will slowly start to dilate (0-5cm)

Woman excited, burst of energy

What is the active phase of labor?

Contractions intensify; anxiety increases

Cervix quickly dilates from 6-10cm

Increased bloody show, ROM, desire to push

When does the second stage of labor begin?

When the cervix is completely dilated

What happens during the second stage of labor?

longer, frequent, intense contractions

Descent of presenting part through pelvis and expulsion of fetus

What is crowning?

fetal head is encircled by the external opening of the vagina

What is the third stage of labor?

Placenta delivery

caused by contractions and decreased uterine sign

What is the fourth stage of labor?

1-4 hours after birth; greatest concern as a nurse

Upon assessing what are the norming findings of the fundus?

firm, midline, at/below level of umbilicus

What are the abnormal findings of the fundus?

feels boggy, soft

displaced to the right

During labor, what should the nurse constantly be assessing?

Vitals, pain, anxiety

fluid status

Cervix status

Fetal status (presentation, position, FHR)

What is tachysystole?

more than 5 contractions in 10 minutes

What are the advantages of intermittent auscultation and palpation?

Fetus mobility, ability for mom to change position, more natural environment

What are the disadvantages of intermittent auscultation and palpation?

1-1 nursing care

Uterine activity and FHR are minimally assessed

What is an ultrasound transducer?

Device secured on abdomen with elastic straps

Less accurate than internal devices, but are non-invasive

Placed by LLQ/LUQ

What is a tocodynamometer?

A pressure-sensitive area detects changes in abdominal contour to measure uterine activity

Placed by fundus

What is the main advantage of using internal fetal monitoring?

Accuracy!

Fetal scalp electrode

detects electrical signals from fetal heart via the baby's scalp

Intrauterine Pressure Catheter (IUPC)

Catheter measuring intrauterine pressure, contraction strength, duration, frequency, and resting tone

What is considered fetal tachycardia?

Baseline FHR > 160 for 10 min or more

What are the maternal causes of fetal tachycardia?

fever, dehydration, anxiety, medications, maternal hyperthyroidism, SVT

What are the fetal causes of fetal tachycardia?

Fetal hypoxia, infection, anemia, prematurity

What is considered fetal bradycardia?

Baseline FHR < 110 for 10 min or more

What are the major causes of fetal bradycardia?

Vagal nerve stimulation

Anesthesia

Maternal hypotension

Umbilical cord compression

Accidental monitoring of maternal pulse

What is baseline variability?

fluctuations in the baseline FHR that are irregular in amplitude and frequency

reliable indicator of fetal heart and neurologic function

Periodic fetal heart rate changes

Associated with contractions

Episodic fetal heart rate changes

Not associated with contractions

Accelerations

abrupt increase from baseline FHR

15x15

indicate intact nervous system and well-being

Decelerations

abrupt/gradual decrease from baseline FHR

timing related to contractions

Early decelerations

healthy fetus compensating

uniform, bowl shaped

onset correlates with onset of contractions

Variable decelerations

"V" or "W" shape

may occur with or without contractions

What are the major causes of variable decelerations?

cord compression

prolapsed cord

knot cort

Late decelerations

fetal distress

uniform shape, duration proportional to duration of contraction

What are prolonged decelerations in fetal heart rate (FHR)?

Abrupt FHR decreases of at least 15 bpm from baseline.

How long do prolonged decelerations last?

Longer than 2 minutes but less than 10 minutes.

What is the significance of prolonged decelerations?

They can be fatal; cord compression, cord spasm, tachysystole

What are the physiologic goals with altered decelerations?

Maximize oxygen/uterine oxygenation

Maximize placental blood flow

Maximize umbilicus cord blood circulation

What nursing interventions should be done with altered decelerations?

Discontinue pitocin

Change maternal position

Increase IV fluids

Notify provider

Category I FHR pattern

normal; no intervention required

Category II FHR pattern

Continue evaluation; consider entire clinical circumstance

Category III FHR pattern

Predictive of abnormal fetal acid-base status

NEEDS INTERVENTION

When is a cord blood analysis taken?

Abnormal FHR pattern

MSF

Depressed infant at birth