Labor and Birth & Fetal Monitorying & Intrapartum Emergencies

Which factors make up the five Ps of labor?

• Passenger

• Passageway

• Powers

• Position

• Psychological response

In the five Ps, what does the passenger include?

Fetus and Placenta

Premature placental detachment is an emergency during labor.

True

What had structure forms the bony passageway for birth?

Pelvis

What soft tissue may become edematous and bruised during pushing?

Perineum

Match each type of placenta previa with its description.

Marginal = Placental edge extends slightly to opening

Partial = Placenta partially covers the cervix

Complete = Placenta completely covers the entrance

What delivery method is recommended when placenta previa causes heavy bleeding?

C-section

Which statements describe the powers of labor?

Contractions are involuntary, cause effacement, causes dilation, and pushing is voluntary.

How is contraction frequency measured?

Beginning to beginning

How is contraction duration measured?

Beginning to end

Which maternal factor includes movement and maternal positioning?

Position

Which factors are part of the psychological response of labor?

Anxiety, culture, and support.

Match labor pattern with its characteristic.

True labor = Regular contractions with progressive cervical change

False labor = irregular contractions without progressive cervical change

Which findings indicate true labor?

Regular pattern, strong and closer contractions, continues with activity, cervical effacement and dilation

Which findings are characteristic of false labor?

Irregular pattern, may stop with rest, may stop with hydration, and no progressive cervical change.

Match each fetal presentation with its description.

Cephalic = head first

Breech = feet or buttocks first

Shoulder = Scapula present first

Which fetal presentation is generally an indication for cesarean birth?

Breech

Match each fetal lie with its description.

Longitudinal = Fetus is parallel with the mother’s long axis

Transverse = Fetus lies sideways across uterus

Oblique = Fetus lies diagonally to the mother

Which fetal attitude presents the smallest head diameter?

General flexion

What is the most optimal fetal alignment for birth?

Cephalic longitudinal flexed

Match each part of a fetal position designation with its meaning.

First letter = maternal right or left

Middle letter = Fetal reference point

Third letter = Anterior, posterior, or transverse

An anterior fetal position is generally favored for vaginal birth

True

Why is a posterior fetal position often associated with longer labor and more pain?

Baby looks upward

What bony landmark is used to determine fetal station?

Ischial spine

Match each station description with its location relative to the ischial spines

Negative station = Above the ischial spines

Station 0 = At the ischial spines

Positive station = Below the ischial spines

What fetal event usually corresponds with station 0?

Engagement

Which findings indicate readiness for pushing?

10 cm dilation, 100% effacement, +2 or +3 station

Place the cardinal movements of labor in order.

1. Engagement

2. Descent

3. Flexion

4. Internal rotation

5. Extension

6. Restitution and external rotation

7. Expulsion

During which cardinal movement does the fetal head align with the maternal tailbone?

Internal rotation

What event marks the end of the first stage of labor?

Complete dilation

At what cervical dilation does active labor begin?

6 cm

Onset of labor to approximately 6 cm

Latent phase

Approximately 6 to 10 cm with stronger contractions

Active phase

Which are appropriate nursing interventions during the first stage of labor?

Monitor maternal and fetal status

Promote movement

Encourage bladder emptying

Explain comfort measures

Ensure privacy and choices

What marks the beginning of the second stage of labor?

Complete dilation

Which assessments are important during the second stage of labor?

FHR

Contractions

Fetal descent and rotation

Maternal fatigue

What event marks the end of second stage of labor?

Birth of newborn

Which findings indicate placental separation?

Sudden gush of blood

Lengthening cord

Firm globular uterus that rises (placental separation)

Excessive cod traction should be applied before placental separation

False

What is the primary postpartum risk during the fourth stage of labor?

Postpartum hemorrhage

Whcih findings should be assessed during the fourth stage of labor?

• Fundal tone and position

• Lochia and blood loss

• Vital signs

• Bladder

• Perineum

What is the priority response to a boggy fundus with heavy bleeding?

Massage the fundus

Which information should be documented after rupture ofo membranes?

• Time

• Amount

• Odor

• Color

What should be assessed first after rupture of membranes?

FHR

Which findings are concerning after rupture of membranes?

• Green or brown fluid

• Foul odor

• Maternal fever

• Uterine tenderness

• Fetal tachycardia

Match each nonpharmacologic comfort measures with its use

Sacral counterpressure = Firm pressure to the lower back, hips, or sacrum

Effleurage = Light abdominal stroking

Hydrotherapy = Water based comfort measure

Pant blow breathing = Useful during transition

During which dilation range is quick pant-blow breathing most useful?

8-10 cm

Concerns with systemic opioid analgesia during labor

• Maternal sedation

• Maternal/Newborn respiratory depression

• Increased aspiration risk

When is systemic analgesia most effective during labor?

Early active labor

T or F: Opioids administered during labor cross the placenta

True

Match each regional anesthesia technique with its medication location:

Epidural = Epidural space

Spinal = subarachnoid space

Combined spinal-epidural = Spinal onset with continued epidural dosing

Side effects of epidural anesthesia:

• Itching

• Urinary retention

• N/V

• Delayed respiratory depression

What is a common complication of spinal anesthesia caused by CSF leakage?

Post-dural puncture headache

What are priority actions for maternal hypotension after regional anesthesia?

• Position side-lying

• Increase IV fluids as prescribed

• Assess FHR

• Notify provider or anesthesia

How often should respiratory status be assessed after epidural-related respiratory depression?

Every hour for 24 hours

Which medication may be administered for opioid related respiratory depression?

Naloxone

Which finding suggest an epidural hematoma?

• Severe insertion-site pain

• Unexplained sensory loss

• Unexplained motor loss

Place order of fetal monitoring interpretation sequence in order:

1. Uterine activity

2. Baseline rate

3. Variability

4. Accelerations

5. Decelerations

6. Overall category

What defines uterine tachysystole?

More than 5 contractions in 10 minutes

What are appropriate interventions for tachysystole?

• Stop oxytocin

• Reposition laterally

• Assess maternal and fetal status

• Increase IV fluid as ordered

• Notify provider

What is the exptected baseline FHR range?

110-160 bpm

What degree of FHR variability is ideal?

Moderate variability

What is baseline FHR indicates bradycardia?

Less than 110 bpm

What baseline FHR indicates tachycardia?

More than 160 bpm

Which findngs are abnormal FHR variability patterns?

Absent, Minimal, and Marked

How long must a consistent FHR persist to establish a prolonged baseline?

3 minutes

How long must a consistent FHR persist to establish a new baseline?

10 minutes

What causes early decerlerations?

Fetal head compression

How are early decelerations timed relative to contractions?

They mirror contractions

T or F: Early decelerations are usually benign and require only monitorying

True

What causes late decelerations?

Uteroplacental insufficiency

When does a late deceleration begin relative to the contraction?

After the contraction begins

which conditions can contribute to late decelerations?

• Maternal hypotension

• Placental abruption

• Hypertensive disorders

• Epidural anesthesia

What causes variable decelerations?

Umbilical cord compression

What shape typically characterizes a variable deceleration?

Sharp V shape

Within what time may a variable deceleration appear?

30 seconds

T or F: Variable decelerations may or may not correlate with contractions

True

Which interventions are appropriate for variable decelerations?

• Reposition the pt

• Stop oxytocin

• Assess for cord prolapse

• Notify provider

What should the nurse assess after rupture of membranes when variable decelerations occur?

Cord prolapse

What is a prolonged deceleration by duration?

More than 2 min.

What is the upper duration limit for a prolonged deceleration?

Less than 10 minutes

Which findings define a Category 1 tracing?

• Baseline 110-160 bpm

• Moderate variability

• No late or variable decelerations

What does Category 1 indicate about fetal acid-base status?

Normal acid-base balance

T or F: Accelerations may be present or absent in a Category 1 tracing.

True

What does Category 2 indicate?

Intermediate status

Which findings can be included in a Category 2 tracing?

• Minimal or Marked variability

• Prolonged or recurrent late deceleration

What does Category 3 indicate?

Abnormal fetal status

Which findings can make a tracing Category 3?

• Absent variability with recurrent late decelerations

• Absent variability with recurrent variable decelerations

• Absent variability with bradycardia

• Sinusoidal pattern

What may a sinusoidal FHR pattern indicate?

Fetal anemia

What is the tachysystole threshold?

More than 5 contractions

Over what time is tachysystole overaged?

30 min.

Why is uterine tachysystole concerning?

• Reduced placental blood flow

• Reduced fetal recovery time

• Fetal oxygen compromise

• Risk of uterine rupture

When tachysystole occurs during oxytocin infusion, what is the priority sequence of nursing response?

1. Stop or decrease oxytocin

2. Position laterally

3. Increase IV fluids

4. Give tocolytic as ordered

5. Monitor FHR

6. Notify provider

What is the normal contraction frequency range?

2-5 per 10 minutes

What is the expected contraction duration during labor?

45-80 seconds

What is the average resting uterine tone?

10 mmHg

What does MVU measure?

Summed uterine pressure

How are MVUs calculated from an internal monitor?

Peak pressure - Resting tone = MVU

What MVU value is considered necessary for adequate active-phase labor?

200 MVUs

Which actions are appropriate when concerning FHR patterns occur with oxytocin use?

• Stop oxytocin

• Position on left side

• Increase IV fluids

• Continue FHR monitoring