Fetal Monitoring and Labor & Birth (Week 6 OB)

5 Ps of Labor

• passenger

• passageway

• power

• position

• psyche

Passenger

Fetal lie (how the fetus is laying)

• Longitudinal Lie (vertical)

• Transverse Lie (horizontal)

• Oblique Lie (diagonal)

Fetal Presentation

• Cephalic (head)

• Breech (butt and cervix will want to dilate when it gets to neck and c-section)

• Mentum (chin and will need C-section)

• Transverse (shoulder and C -section)

Fetal Attitude

• Flexion (chin tucked and we want this)

• Extension

Fetal Position

• Occiput is back of head

• we want anterior occiput for easy delivery (back of head facing out in pelvis)

• can still give birth for posterior occiput

Passageway

Components

• pelvis

• cervix

• floor muscles

• vagina

baby makes vagina bigger with each birth

Three principles

• balance (want everything equal

• gravity

• movement

Powers

• contraction frequency/duration/strength

• contractions gets cervix to dilate

How cervix changes

• old coke bottle during preg

• turns into jar when it gets closer to labor

• Effacement

Station

• where top of baby head is compared to pelvis

• -4 to 4

• -4 is farther up and 4 is farther down

Effacement

Thining of cervix

0%-100%

Cardinal Movements

• Engagement – Baby’s head enters the top of the pelvis.

• Descent – Baby moves down further into the pelvis.

• Flexion – Baby’s chin tucks to the chest, making the head smaller to fit.

• Internal Rotation – Baby’s head turns to line up with the birth canal.

• Extension – Baby’s head tilts back as it passes under the pubic bone.

• External Rotation (Restitution) – Baby’s head turns to the side so shoulders can fit.

• Expulsion – Baby’s shoulders and body are delivered.

Position

anything other than laying down during labor

• forward leaning

• squatting

• hands and knees

Psyche

nurses role is to reassure/comfort/ask what would feel better/educate

First stage of labor

when your cervix opens (dilates) and thins (effaces) to prepare for birth

• latent is 0-5 cm

• active is 6-10 cm

Second stage of labor

pushing and birth

• natural pushing relies on the mother's urge to push

• coached pushing is care providers directing the timing and manner of pushing efforts

• crowning is head appears and home stretch

• perineal care

Third stage of labor

placenta delivery

• passive management is when placental comes out naturally

• active management is when you pull on cord so it can come out

Forth stage of labor

after birth and recovery

• monitor BP and HR

• repair of stitches

• golden hour

• fundal checks

• check bladder

• Lochia = bleeding and bright red

Artificial ROM (amniotomy)

• more pressure so it INDUCES LABOR and more oxytocin released so more contractions

• go in with hook to rupture (cord comes out)

Considerations

• is baby low down enough

• risk for infection

• monitor baby baselines

Intermittent vs Continuous

• no problems

• problem

• epidural

External vs Internal

• outside

• gives an idea

• slightly dilated and ruptured

• tracks when HR starts and ends

• risk for infection

Leopold’s Maneuver

to determine the fetal position by palpation

• Identifies best area for placement of the external monitors (put on baby back)

Station/effacement/cm

• a way to describe labor

Fetal Heart Rate interpretations

• 110-160 is baseline

• Variability

• Accelerations

• Decel

• Artifact

Variability

• How much the fetal heart rate fluctuates from the baseline

• Moderate variability: (6-25 bpm) is a sign of a healthy fetus. WE WANT THIS

• Minimal variability: (≤ 5 bpm) or absent variability (undetectable) can be concerning potentially indicating hypoxia or other problems

Accelerations

• Temporary, short increases in the FHR compared to the baseline

• Abrupt: less than 30 seconds increase from the baseline

• 15 acel by 15 sec is term

• 10 by 10 sec is preterm

Decelerations

Temporary decreases in the FHR

Nadir is lowest point of FHR

• Early deceleration: gradual decrease and return to baseline with uterine contractions, nadir is at same time as peak

• Late deceleration: gradual decrease and return to baseline with uterine contraction; nadir is occurs after the peak of the contraction

• Variable deceleration: abrupt decrease in FHR below baseline; 15 bpm below baseline for a minimum of 15 seconds but less than 2 minutes

• Prolonged deceleration: decrease in FHR below baseline with a minimum depth of 15 bpm and a duration of 2 minutes or greater but less than 10 minutes

Artifact

errors that lead to an inaccurate or misleading representation of the fetus's heart rate

Fetal Resuscitation

1. Reposition client (right or left side or hands and knees)

2. Increase fluid (bolus)

3. Apply Oxygen at 10L if client has low pulse ox

Category 1

 Baseline 110-160

 Moderate Variability

 Accelerations: present or absent

 Early Decelerations: present or absent

 Variable or Late Decelerations: absent

Category 2 – contain ANY of the following

 Baseline: Bradycardia or Tachycardia

 Variability: Minimal/ Marked

 Absent WITHOUT recurrent variable or late decelerations

 Decelerations

 Prolonged

 Variable

 Late

Category 3

 Absent variability WITH

Recurrent variable decelerations

Recurrent late decelerations

Bradycardia

 Sinusoidal pattern