Intrapartum Knowledge Checks
What response should be elicited when performing fetal scalp stimulation? What does this tell you about fetal oxygenation?
Acceleration of FHR - confirms fetal oxygenation and normal fetal acid-base balance at time of acceleration
How can the nurse reduce a laboring woman's anxiety or fear?
Accurate information and a focus on the normal aspects of childbirth Avoid using the words "client" or "patient" (use given name), empower birthing partner (helps improve confidence in competency to give birth)
When hydrotherapy is used during labor, why are these cautions required? Adequate maternal hydration and control of water temperature.
Adequate maternal hydration - offset diuresis (can reduce placental perfusion if plasma level is low) Control of water temperature - prevent hyperthermia or hypothermia (could raise mother's metabolic rate, which would increase oxygen and glucose consumption)
What FHR characteristics (when auscultated) are normal?
110-160 bpm, regular rhythm, accelerations, absence of decelerations
Which umbilical cord vessel(s) carry(ies) deoxygenated blood back from the fetus to the placenta?
2 umbilical arteries carry deoxygenated blood from fetus to placenta
What is the preferred order of resuscitation for the newborn who has respiratory depression? Does naloxone have any use in an adult?
Airway management then Narcan
Why is it important to avoid advancing to more complex breathing techniques sooner than needed?
Although more effective for pain, they are more tiring Advancing too quickly can cause fatigue
What are some nursing actions to encourage relaxation during labor?
Arranging for environmental comfort, maintaining woman's general comfort, reducing factors that cause anxiety and fear, using relaxation techniques
How can the nurse incorporate the couple's cultural practices into intrapartum care?
Asking about specific practices, obtaining a fluent interpreter
What is the purpose of umbilical cord blood gas sampling? Which umbilical cord vessels reflect oxygenated and deoxygenated blood?
Assess level of oxygenation and fetal acid-base after delivery when category II or III pattern is observed Umbilical vein blood is oxygenated (from placenta to fetus) Umbilical arteries blood is deoxygenated (from fetus to placenta)
What are the nursing considerations for a woman with PPROM?
Assess vital signs and FHR, teach mother to avoid inserting anything into vagina, avoid breast stimulation, maintain activity restrictions, note any uterine contractions or foul odor to vaginal discharge, observe fetal kick sounds, take temperature 4 times a day
How does the gate-control theory of pain relate to nonpharmacological methods of pain control?
Assumes that a gaiting mechanism in the dorsal horn of the spinal cord controls transmission of painful impulses to brain Pain impulses transmitted through small fibers Tactile sensations transmitted more quickly through large fibers - these interfere with (or "close the gate") to transmission of pain impulses Impulses from brain can also impede pain transmission
Why is observing the FHR important before, during, and after ECV?
Before - identify abnormal patterns that would preclude procedure, establish baseline (Doppler or real-time ultrasound) During - detect cord compression After - detect cord compression
Why is the FHR assessed before and after the membranes rupture?
Before - to identify if fetus has normal rate and pattern, establish baseline After - identify patterns that suggest umbilical cord compression and other problems
What are the similarities in the uses of vacuum extractors and forceps? What are the differences? Do limits exist for the number of attempts with these instruments?
Both used to provide traction to assist mother in rotation and expulsion of fetal head Forceps - deliver aftercoming head of fetus in breech position; may cause fetal injury (facial bruising, nerve injury) Vacuum extractor - can only be used with cephalic presentation, may create artificial caput (chignon); no more than 3 pop-offs should be done, should not be followed with forceps attempts
What changes occur in the maternal cardiovascular, respiratory, gastrointestinal, urinary, and hematopoietic systems during labor?
Cardiovascular - slight increase in blood pressure and slight decrease in pulse rate as each contraction temporarily stops blood flow to the uterus; supine hypotension may occur because the uterus compresses the inferior vena cava and reduces blood flow to the heart Respiratory - depth and rate of respirations increase Gastrointestinal - gastric motility is reduced (which can result in nausea and vomiting) Urinary - the sensation of a full bladder is reduced Hematopoietic - leukocyte counts are increased (20,000-30,000/ cubic mm), levels of clotting factors are elevated
How do changes in the following maternal body systems affect pharmacologic pain management? Cardiovascular, respiratory, gastrointestinal, and nervous systems.
Cardiovascular - wedge under hips to offset aortocaval compression Respiratory - tilt table during surgery to reduce compression, general anesthesia causes greater fall in oxygenation Gastrointestinal - reduced peristalsis and tone of sphincter at junction of esophagus and stomach can lead to regurgitation and aspiration Nervous - epidural or subarachnoid blocks
Which category is interpreted as being predictive of abnormal fetal acid-base status?
Category III FHR
What four sources of pain are present in most labors?
Cervical dilation, uterine ischemia, pressure and pulling on pelvic structures, distention of vagina and perineum
How does the pain of childbirth differ from other kinds of pain?
Childbirth pain is part of a normal process, woman has time to prepare for it, it is self-limited and intermittent, and ends with birth of baby
What data are collected to determine the current status of a woman's labor?
Contraction pattern (frequency, duration, intensity), status of amniotic membranes (ruptured, intact), cervical exam (dilation, effacement, fetal station)
How do labor contractions cause the cervix to efface and dilate? How do they cause fetal descent?
Contractions pull the cervix upward over the fetus and amniotic sac while pushing the fetus and amniotic sac downward against the cervix. The muscles fibers of the upper uterus become shorter to maintain these forces between contractions. In addition, the uterus changes shape and becomes more elongated and narrow to maintain pressure of the fetus and amniotic sac against the cervix.
How can maternal position changes favor rotation of the fetus from the OT or OP position to the OA position?
Convex surface of rounded fetal back rotates towards convex surface of anterior uterus Squatting position increases pelvic diameter and straightens pelvic curve to facilitate fetal rotation and descent
What psychosocial factors influence a woman's experience with labor pain?
Culture, anxiety, fear, previous experiences, preparation for childbirth, mother's support system
What high technology method is primarily used in the United States to assess FHR and uterine activity (UA)?
Electronic fetal monitor (EFM) for FHR and UA Intermittent auscultation for FHR Palpation of uterine contractions for UA
How can drugs taken by the expectant mother affect the fetus?
Decrease FHR variability (direct) Maternal hypotension that reduces placental blood flow and fetal oxygen supply (indirect)
What precautions are taken to enhance the safety of oxytocin administration for the woman and fetus?
Dilution of oxytocin in isotonic solution Piggybacking oxytocin solution into port of primary IV line nearest venipuncture site Starting oxytocin infusion slowly Increasing rate of infusion gradually Monitoring uterine contraction and FHR
Why should the nurse monitor the laboring woman's bladder frequently?
Distention can occupy available room in pelvis, impeding labor progress and fetal descent; potential source for discomfort
Describe the differences among early, late, and variable decelerations.
Early - visually apparent, symmetric, gradual decrease and return of FHR to baseline; deceleration onset, nadir, and recovery coincide with beginning, peak, and end of contraction; onset of deceleration to nadir >/= 30 seconds; represent vagal response during head compression; benign, not associated with interruption of fetal oxygenation Late - visually apparent, symmetric, gradual decrease and return of FHR to baseline; occur when onset of deceleration to nadir >/= 30 seconds, nadir occurs after peak of contraction; can indicate transient fetal hypoxia in presence of FHR variability; more concerning when recurrent and associated with tachycardia and loss of variability; if left uncorrected, hypoxic stress will lead to acidemia and neonatal depression Variable - visually apparent, abrupt decrease from onset to nadir of deceleration, onset to nadir < 30 seconds, decrease at least 15 bpm below baseline (deceleration lasts at least 15 seconds, no longer than 2 minutes from onset to return to baseline); deceleration shape, depth, duration, and time in relation to contractions may vary; suggestive of interruption of oxygenation at level of umbilical where cord vessels may be compressed; not associated with significant hypoxia or acidosis (as long as they are intermittent and accompanied by normal baseline rate and variability); if cord compression is recurrent or prolonged, interruption in fetal oxygenation can progress to hypoxemia, hypoxia, metabolic acidosis, and final metabolic acidemia
Why should the nurse add a urinary catheter to the instrument table if a forceps-assisted or vacuum extractor-assisted birth is expected?
Eliminate a full bladder to increase available room in pelvis; emptying bladder reduces risk of bladder injury
Why is it important to identify preterm labor early?
Enables management that may delay birth to allow further maturation or permit transfer to facility equipped to care for preterm infant Corticosteroids may be given between 24 to 34 weeks gestation to accelerate maturation of lungs
What observations suggest that the woman may need additional help with pain management during labor?
Expressing ineffectiveness of nonpharmacological measures, showing muscle tension during and between contractions, tense facial expression, expressing inability to tolerate pain
What newborn injury is suggested by an asymmetric facial appearance when the infant cries?
Facial nerve injury (usually temporary and can occur with use of forceps)
How can induction of labor with oxytocin contribute to postpartum hemorrhage?
Fatigued uterus cannot contract properly to compress bleeding vessels at placenta site (uterine atony)
What maternal and fetal signs are associated with chorioamnionitis?
Fetal tachycardia (often the first sign), elevated maternal temperature, amniotic fluid with foul or strong odor or cloudy/yellowish appearance
How do maternal behaviors change during each phase of first-stage labor and the second stage?
First stage (latent phase) - sociable, excited, anxious First stage (active phase) - less sociable, inwardly focused First stage (transitional phase) - irritable, temporarily loses control Second stage - concentrates energy towards pushing, interacts little with others, regains a feeling of control and active participation in the birth
Define frequency, duration, intensity, resting tone, and relaxation time.
Frequency - time (minutes) from onset of contraction to onset of next contraction; uterine activity as number of contractions in a 10 minute window Duration - time (seconds) from onset of contraction to end of contraction Intensity - strength of contraction at peak (mild, moderate, strong/firm) Resting tone - amount of pressure in uterus at rest Relaxation time - amount of time from end of contraction to beginning of next contraction (soft or relaxed)
Describe the significance of each of the following types of amniotic fluid. Greenish, cloudy, yellowish, and foul-smelling.
Greenish - meconium-stained; transient fetal hypoxia, postterm gestation, placental insufficiency Cloudy - choriamnionitis Yellowish - choriamnionitis Foul-smelling - choriamnioitis
What observations suggest that a woman is going to give birth very soon? What should the nurse do in that case?
Grunting, bearing down, sitting on one buttock, urgently signifying that baby is about to be born Nurse should abbreviate initial assessment and collect other information after birth
What complications may occur if the uterus does not contract firmly and remain contracted after the placenta is expelled?
Hemorrhage
How might maternal hypotension or hypertension affect the fetus?
Hypotension - reduces blood flow to placenta (reduces fetal oxygenation) Hypertension - vasospasm that can reduce exchange of oxygen, nutrients, and waste in placenta Both can result in fetal hypoxia and acidosis
A woman has a vacuum extractor-assisted birth with a medium episiotomy. What nursing interventions can make her more comfortable?
Immediate use of cold for first 12 hours reduces pain, edema, and hematoma formation Observe for continuous bright red bleeding (suggests vaginal wall laceration) Warmth after at least 12 hours of cold promotes resolution of edema and hematomas
How does an IV bolus of fluids benefit fetal oxygenation?
Improves maternal cardiac output, which improves uteroplacental perfusion, resulting in improved fetal oxygenation
What are some signs and symptoms that a woman might experience before labor begins?
Increased strength and frequency of Braxton-Hicks contractions, lightening, increased vaginal mucus, bloody show, an energy spurt, and a small weight loss
How does the normal process of vaginal birth benefit the newborn after birth?
Increasing absorption of fetal lung fluid
What are typical characteristics of contractions during each phase of first-stage labor and second-stage labor?
Increasing frequency, duration, and intensity First stage (latent) - 5 minutes apart, 30-40 seconds First stage (active) - 2-5 minutes apart, 60-90 seconds First stage (transition) - 1.5-2 minutes apart, 60-90 seconds Second stage - 2-3 minutes apart, 40-60 seconds
What are the three divisions of the true pelvis?
Inlet, midpelvis, and outlet
What are the advantages and limitations of each fetal monitoring method?
Intermittent auscultation - promotes laboring woman's mobility and creates more natural environment; assessment is intermittent (significant events may not be detected, changes in FHR cannot be determined, intolerance of touch during contractions, contractions cannot be assessed objectively) Continuous electronic fetal monitoring - provides more data, expected by parents, can assist nurse to observe more than one woman (devote more time to coaching woman and partner); reduced maternal mobility, equipment adjustment, technical atmosphere External transducers (ultrasound/tocotransducer) - FHR may be doubled or halved with fetal bradycardia or tachycardia, maternal heart rate may be recorded as fetal data, obese/preterm/multifetal gestations difficult to monitor, does not accurately assess contraction intensity or uterine resting tone Internal monitors - not affected by maternal position changes, accurate; require cervical dilation, ruptured fetal membrane can cause trauma and infection
How does labor dystocia differ from tachysystole?
Labor dystocia - occurs during active phase of first stage labor, uterine contractions become weaker, shorter, and less frequent, not painful because contractions decrease (woman may become tired) Tachysystole - spontaneous or induced, excessive uterine activity, more than 5 contractions in 10 minutes (averaged over 30 minutes) Contractions lasting 2 minutes or longer, with less than 1 minute resting time between, failure of uterus to return to resting tone between contractions, or intraamniotic pressure above 25 mmHg may be of concern Contractions may be uncoordinated and erratic in frequency, duration, and intensity Mother becomes very tired due to constant discomfort
How can each of the following physical factors influence the pain a woman experiences during childbirth? Labor intensity, cervical readiness, fetal position, maternal pelvis, and fatigue.
Labor intensity - short and intense may be more painful because dilation, effacement, and descent occur rapidly Cervical readiness - longer and more uncomfortable labor if cervix does not efface or dilate easily Fetal position - abnormal position may cause longer labor (back pain especially noticeable if fetus is in occiput posterior position) Maternal pelvis - abnormal fetal presentations of positions, longer labor if because fetus doesn't fit Fatigue - reduces pain tolerance and ability to use coping skills
How may oxytocin administration differ if labor is being augmented rather than induced?
Labor may be augmented if it stops or contractions become ineffective Woman whose labor is augmented with oxytocin usually needs less of the drug than the woman whose labor is being induced because uterus is more sensitive to effects
What is the usual therapeutic management of PROM if the woman is at or near term? What if the gestation is preterm?
Labor may be induced (consider risk for infection and preterm complications)
Is there a valid reason why a woman should push as soon as her cervix is completely dilated? Why, or why not?
Lengthy pushing in the second stage causes more fatigue, more operative births, nonreassuring FHR patterns, does not significantly shorten second stage Strenuous directed pushing increases risk for structural and neurogenic injury to woman's pelvic floor Closed glottis pushing delivers less blood to placenta (possibly resulting in fetal hypoxia and nonreassuring FHR patterns)
Why is the low transverse uterine incision preferred for cesarean birth?
Less likely to rupture during another pregnancy
What four classifications of drugs may be used to stop preterm labor contractions?
Magnesium sulfate, calcium channel blockers, prostaglandin synthesis inhibitors, beta adrenergics
What is the major adverse effect of the epidural block or SAB? How can the fetus be affected? How may this effect be reduced?
Maternal hypotension - may result in reduced placental blood flow (compromising fetal oxygen supply) Bladder distention, prolonged second stage of labor, postdural puncture headache IV fluids before block reduces this effect
What are the major adverse effects of general anesthesia? What measures reduce the risks?
Maternal regurgitation with aspiration Reduce risk by limiting intake to clear fluids, giving drugs to increase gastric pH, giving drugs to reduce gastric secretions or speed emptying of stomach, using cricoid pressure to block esophagus while endotracheal tube is being inserted Reduce risk in infant by delaying general anesthesia and keeping anesthesia level as light as possible until umbilical cord is cut
List the corrective measures that may be considered to correct a category II or II FHR pattern.
Maternal repositioning, IV fluids, oxygen, reducing uterine activity, correcting maternal hypotension, amnioinfusion, modifying second-stage pushing efforts
What are three assessment priorities when a woman comes to the intrapartum unit?
Maternal vital signs, FHR and patterns, progress of labor
What is the relationship of infection to PROM?
May be both a cause and result of PROM
Why are frequent vaginal examinations undesirable during labor?
May cause infections
Why is it important to know about a woman's intake of drugs, botanical medicines, legal substances, and illegal drugs?
May interact with one another - interactions may be harmful to woman and/or fetus Knowledge of drugs allows safest choices in pain relief methods
What three descriptive terms are used to characterize UA with palpation?
Mild (easily indented) moderate (slightly indented), firm/strong (unable to indent)
What are the signs of excessive uterine activity?
More than 5 contractions in 10 minutes, increased resting tone of uterus, relaxation time of less than 60 seconds between contractions in first stage labor (45-50 seconds in second stage labor)
What are common side effects of epidural or intrathecal opioid analgesics, and how are these managed?
Nausea, vomiting, itching, delayed respiratory depression (up to 24 hours) Management - promethazine for nausea and vomiting, diphenhydramine and Narcan for itching, pulse oximetry and respiration monitoring
What is the primary adverse effect of opioid administration? How can this effect be reduced?
Neonatal respiratory depression Reduced by giving narcotic in small, frequent IV doses at beginning of contraction Narcan can be given to reverse respiratory depression along with bag/mask ventilation
If the fetus is in the face presentation, why is using the occiput to determine position within the pelvis not possible?
Not accessible to the examiner's fingers during vaginal examination
Using traditional thought based on Friedman's curve, what is the dilation and fetal descent rate expected for a nulliparous woman during the active phase of labor? For the parous woman? How has new data effected this belief?
Nullipara - cervix dilates 1.2 cm per hour, fetal descent 1 cm per hour Parous - cervix dilates 1.5 cm per hour, fetal descent 2 cm per hour Zhang et al - labor may take over 6 hours to progress from 4 to 5 cm, over 3 hours to progress from 5 to 6 cm Nulliparas and multiparas progress at a similar pace up to 6 cm; allowing labor to continue for a longer period before 6 cm may reduce rate of cesarean deliveries
What are potential obstacles that may be encountered during the "C" part of the ABCD approach? Describe measures to overcome these obstacles.
Operating room and equipment availability, availability of staff, considerations regarding mother (consent, anesthesia, labs, blood, catheter, abdominal prep, speedy transfer), considerations for fetus (how many, gestational age and weight, presentation and position, anomalies), labor monitoring considerations (adequate data) Measures to overcome obstacles - preparing OR, notifying staff, reviewing mother's medical record (consents, labs, prenatal data), verify patient's IV status, insert urinary catheter, prep abdomen
Describe maternal blood flow to the uterus and placenta.
Originates primarily in uterine arteries and iliac and ovarian arteries Maternal arterial blood pressure maintains oxygen/nutrient-rich blood flow to uterus and placenta Blood enters intervillous space of placenta via spiral arteries, then allows for exchange of substances without mixing maternal and fetal blood Maternal blood carrying away carbon dioxide and fetal waste drains from intervillous spaces through endometrial veins, then returns to maternal circulation for elimination
How does PROM differ from PPROM?
PROM - occurs before true labor begins, may occur at any gestational age PPROM - occurs before 37 weeks gestation, may be accompanied by contractions; more likely to be associated with preterm labor and birth
What are two major advantages of using regional pain management techniques during childbirth?
Pain relief, remain alert
What are two factors that may affect tocodynamometry accuracy?
Position of the toco on maternal fundus and amount of maternal adipose tissue between toco and uterus and maternal position
How can contractions stimulated with drugs such as oxytocin or misoprostol increase the risk for uterine rupture?
Potentially more powerful than natural contractions May cause pressure in uterus to exceed uterine wall's ability to withstand that pressure
What is the significance of FHR accelerations?
Predictive of adequate oxygenation and fetal pH that rules out acidemia
What should a woman who expects a cesarean birth be taught about the operating room? The recovery room or the PACU?
Preoperative procedures (skin prep, catheter insertion), personnel and their functions, narrow table, safety strap, positioning measures, whether partner/support person can come in, regional anesthetic (awake, pulling and pressure, but no pain), general anesthetic, use of oxygen, pulse oximeter, blood pressure cuff, checking fundus, incision, lochia, and pain
Why should the UA be monitored after ECV?
Procedure may cause uterine irritability or possible placental abruption
What are important nursing considerations for each kind of intrapartum emergency? Prolapsed umbilical cord, uterine rupture, uterine inversion, and amniotic fluid embolism.
Prolapsed umbilical cord - relieve pressure on cord to restore adequate blood flow Uterine rupture - attempt prevention by cautious intrapartum use of uterine stimulants, close monitoring of uterine contractions Uterine inversion - avoid pressure on poorly contracted fundus after birth, assess for and correct shock Amniotic fluid embolism - provide cardiorespiratory support and hemodynamic monitoring, observe for coagulation deficits
What are three risks associated with amniotomy?
Prolapsed umbilical cord, infection, placental abruption
What is the priority nursing care for a woman in prolonged labor?
Promoting comfort, energy conservation, position changes, assessments for related complications (infection)
For each fetal position listed, describe the fetal landmark. Where is this landmark located in relation to the mother's pelvis? ROP? OA? RSA? LMA?
ROP - occiput (vertex presentation) located in right posterior quadrant OA - occiput (presentation just before birth) located in anterior pelvis (not directed right or left) RSA - sacrum (breech presentation) located in the right anterior pelvis LMA - mentum/chin (face presentation) located in the left anterior pelvis
What is the immediate management of prolapse of the umbilical cord?
Reduce compression, restore normal blood flow by elevating presenting part while giving mother oxygen to maximize blood oxygen concentration; summon help to expedite delivery (probably cesarean)
What are three risks to the fetus or neonate when pregnancy lasts longer than 42 weeks?
Reduced placental function, umbilical cord compression before birth Meconium aspiration after birth
Why is psychological support during labor important for effective physiologic function?
Reduces stress that could consume energy that uterus needs, inhibit uterine contractions reduce placental blood supply, impair woman's pushing efforts, increase woman's pain experience
What is the purpose of a cleansing breath?
Release tension, increase oxygen intake to combat miometrial hypoxia, clean woman's mind to focus on relaxing through contractions, signal labor partner that contraction has begun
How might each of these cutaneous stimulation techniques be used to aid relaxation during labor? Self-massage, massage by others, counterpressure, and warmth or cold.
Self-massage - effleurage, rubbing hands together, patting or banging hands on rail Massage by others - relax tense muscles, aids relaxation Counterpressure - reduce back pain Accupressure - directed pressure for pain management Warmth - shower, tub bath, whirlpool Cold - feels better to laboring women
Why would the nurse defer asking a woman about a history of domestic violence?
Several others may be present (sensitive information) and unaware of history; confidentiality, safety, accuracy
What are the primary complications of a uterine inversion? How are they managed?
Shock and hemorrhage Manage with rapid IV fluids and blood replacement (2 IV lines), drug that relaxes uterus given to allow uterine replacement to proper positions, general anesthesia may be needed Oxytocin given after uterus is returned to proper position Hemodynamic monitoring to ensure stabilization
Why is watching the perineum as a woman pushes important?
Shortly before birth, perineum bulges and fetal head becomes visible as mother pushes (birth can occur suddenly)
What kinds of fetal injury may occur with maternal trauma during pregnancy?
Skull fracture, intracranial hemorrhage related to maternal injuries such as pelvic fracture, penetrating wounds, blunt trauma; placental abruption, disruption of placental flow because of maternal hemorrhage or shock
What general measures can make the woman more comfortable during labor? How can the nurse support the woman's labor partner?
Soft, dim lighting, comfortable temperature, cleanliness, mouth care, observations for full bladder, positions for comfort, warm bath or shower Respect couple's wishes about partner involvement, provide support that partner cannot, consider needs for food and rest
What four signs may indicate that the placenta has separated?
Spherical uterine shape, uterus rising upward in the abdomen, protrusion of umbilical cord, gush of blood
How does preparation for the birth of multiple infants (vaginal or cesarean) differ from preparation for a single infant's birth?
Staff must be prepared for care of multiple infants (duplicate staff and equipment should be ready)
Describe the ABCD management approach used in fetal monitoring.
Standard approach to FHR management A - assess oxygen pathway, identify cause of FHR changes (maternal and fetal) B - begin corrective measures C - clear obstacles to delivery D - determine delivery plan
How can excessive pain adversely affect a laboring woman and her fetus?
Stress response (diverting blood from uterus, compromising fetal oxygenation), maternal acid-base imbalance, fetal acidosis Increase length of labor, lessen joy of childbirth (lasting psychological effects)
What position should the woman avoid during labor? Why? What should you do if the woman must be in this position temporarily?
Supine - causes woman's uterus to compress aorta and inferior vena cava (reduces blood flow to placenta) Use a small pillow or folded blanket under one hip o shift uterus to maintain blood flow
What signs may indicate a nonreassuring fetal response to oxytocin stimulation?
Tachycardia, bradycardia, decreased variability, pathologic (late, variable, or prolonged) decelerations
What differences in effacement are expected in the parous woman compared with the woman who has not previously given birth?
The cervix of the nullipara effaces more before it dilates. The cervix of the multipara is usually thicker.
Why is the vertex presentation best during birth?
The fetal head is fully flexed forward, this allows the smallest diameter of the fetal head to enter the pelvis and more effectively dilates the cervix
Why does the fetus enter the pelvis with the sagittal suture aligned with the transverse diameter of the woman's pelvic inlet?
The transverse diameter of the pelvic inlet is slightly larger than the inlet's anteroposterior diameter The anteroposterior diameter of the fetal head (in line with the sagittal suture) is slightly larger than the transverse diameter
Why does the fetal head turn during labor until the sagittal suture aligns with the anteroposterior diameter of the mother's pelvic outlet?
The woman's pelvic outlet is usually slightly larger in its anteroposterior diameter than its transverse diameter The fetal head turns in the mechanism of internal rotation so that the sagittal suture aligns with the anteroposterior diameter as the fetus descends
What is the purpose of giving corticosteroids to a woman who is in preterm labor at 27 weeks of gestation? Why is it important the birth be delayed at least 24 hours?
To accelerate maturation of fetal lungs Greatest benefit occurs if drugs are in mother's system for at least 24 hours
Why is cesarean birth usually the delivery method of choice for infants in breech presentation?
To avoid major complications associated with breech birth (slow labor, risk for umbilical cord prolapse, risks associated with cord compression before head is born)
What are the maternal and fetal risks when labor is unusually short?
Trauma (uterine rupture, cervical lacerations, hematomas) Fetal risks - trauma (intracranial hemorrhage, nerve damage, hypoxia)
What are the differences between true and false labor? Which difference is the most significant?
True labor is characterized by contractions that progressively become more frequent, last longer, and are more intense Discomfort of true labor begins in the lower back and sweeps to the lower abdomen (abdominal or groin discomfort in false labor) Progressive effacement and dilation of the cervix occur (*most significant difference from false labor*)
Which EFM sensor uses heart motion to measure FHR?
Ultrasound transducer/external fetal monitor and Doppler (for fetal heart motion for FHR) Fetoscope/Pinard stethoscope (fetal heart sounds) Internal fetal scalp electrode (measures, processes, and records R to R intervals of fetal QRS complexes
Which grid on the paper tracing or computer monitor is used to record FHR and UA data?
Upper grid for FHR Lower grid for UA
What are the two powers of labor?
Uterine contractions (first stage) Uterine contractions and pushing (second stage)
Why are intermittent rather than sustained uterine contractions important?
Uterine contractions temporarily decrease blood flow to the placenta; if contractions were sustained, the fetus could not receive freshly oxygenated blood and nutrients or dispose of waste products through the placenta
What symptoms of preterm labor should be taught to women at risk?
Vague - uterine contractions that may be painless, fetus "balling-up," menstrual-like cramps, backache, pelvic pressure, increased vaginal discharge, abdominal cramps, thigh pain, sense of "feeling bad"
How should the nurse modify recovery room care of the mother who had a cesarean birth from that of the mother who had a vaginal delivery?
Vital signs, fundus and lochia assessments for both Additional care - oxygen saturation, respiratory status (turning, coughing, deep breathing), I & Os, observation of incision, pain management Anesthesia related care - level of consciousness, return of movement and sensation
What communication skills can the nurse use to establish a therapeutic relationship when the woman and her family enter the hospital or birth center?
Warmth, concern, friendliness Determine woman's and family's expectations, convey confidence, assign primary nurse, respect cultural values Nonjudgemental attitude