Labor and Delivery Notes

Fetal Monitoring Overview

  • Types of Fetal Monitoring:
    • External (non-invasive)
    • Uses ultrasound transducers secured to the mother's abdomen.
    • Measures fetal heart rate (FHR) and uterine activity (via tocotransducer).
    • Less accurate than internal devices but suitable for most women in labor.
    • Internal (invasive)
    • Requires ruptured membranes and cervical dilation of ~2 cm.
    • Includes fetal scalp electrode (FSE) and intrauterine pressure catheter (IUPC) for accurate monitoring of FHR and uterine contractions.

Monitoring Fetal Heart Rate (FHR)

  • Baseline FHR:
    • Normal range: 110-160 bpm.
    • Tachycardia: FHR > 160 bpm.
    • Bradycardia: FHR < 110 bpm.
  • Variability: Reflects an intact central nervous system. Categories:
    • Minimal: undetectable to 5 bpm.
    • Moderate: 6-25 bpm.
    • Marked: > 25 bpm.
  • Accelerations: Temporary increases in FHR (at least 15 bpm for 15 seconds), indicating fetal well-being.

Decelerations

  • Types:
    • Early Decelerations:
    • Mirror contractions, benign, caused by head compression.
    • Returns to baseline by end of contraction.
    • Late Decelerations:
    • Occur after peak contraction, associated with poor oxygen transfer, require nursing interventions.
    • Variable Decelerations:
    • Caused by cord compression, have variable shapes and durations, may need interventions.

Stages of Labor

  1. Stage 1: Cervical dilation from 0-10 cm.
    • Phase 1 (Latent): 0-3 cm
    • Phase 2 (Active): 4-7 cm
    • Phase 3 (Transition): 8-10 cm
  2. Stage 2: Complete dilation to delivery of baby.
  3. Stage 3: Delivery of the placenta.
  4. Stage 4: Observational phase for 1 hour post-delivery.

Nursing Interventions for Decelerations

  • Late Decelerations:
    1. Discontinue oxytocin infusion.
    2. Position the mother on her side.
    3. Administer oxygen.
    4. Monitor uterine activity and call for physician assistance as needed.
  • Variable Decelerations: Assess for umbilical cord compression and consider interventions during pushing.

Cervical Assessment

  • Effacement and Dilation:
    • Monitor cervical changes to assess labor progress.
    • Signs of labor include regular contractions, cervical dilation, and effacement.

Induction and Augmentation of Labor

  • Oxytocin Use:
    • Indicated for inducing or augmenting labor, requires continuous monitoring for adverse effects.
  • Cervical Ripening Agents: Used to prepare the cervix prior to labor induction.