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Nursing actions (intraprocedure)
- *assess maternal vital signs per agency protocol
- *check maternal temperature every 1 to 2 hous if membranes are ruptured
- *assess FHR to determine fetal-well being
- *assess uterine labor contraction characteristics
- *insert a solid, sterile, water-filled intrauterine pressure catherter inside the uterus to measure intreuterine pressure (displays uterine contraction pattens on monitor)
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Assessing fetal heart rate
- *Electric fetal monitoring
- *spiral electrode that is applied to fetus scalp (cervical dialtion and membrane rupture must have occured before electode can be palced)
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Assessing uterine labor contraction characteristics
- *palpation (place hand over the fundus to assess contraction, intensity, frequency, and duration)
- *use of the external or internal monitoring
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Water-intrauterine catherter
- *Displays uterine contraction patterns on monitor
- *requires the membranes to be ruputred
- Dispalys the
- frequency: established from the beginning of one contraction to the beginning of the next
- duration:time between the beginning of a contraction to the end of the same contraction
- intensity:strength of the contraction at its peak described as mild, moderate, or strong
- resting tone of uterine contractions:tone of the uterine musxle in between contractions
- Prolonged duration or too frequent contractions without sufficient time for uterine relaxation in between can reduce blood flow to the plecenta causing fetal hypoxia and decreased FHR
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Vaginal examination
- performed digitally by the physician or qualified nurse to assess for
- *cervical dilaion (stretching of cervical os adequate to allow fetal passage)
- *descent of the fetus through the birth canal as measured by fetal station in centimeters
- *fetal position, presenting part, and lie
- *Membranes intact or ruptured
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Characteristics of true vs false labor (Braxton Hicks Contractions)
- True labor leads to cervical dilation and effacement
- True labor:
- *contractions:
- may begin irregularly, but become regular in frequency
- stronger, last longer, and are more frequent
- felt in lower back, radiating to abdomen
- walking can increase contraction intensity
- continue dispite comfort measures
- *Cervix (assessed by vaginal exam)
- progressive change in dilation and effacement
- moves to anterior position
- bloody show
- *Fetus
- presenting part engages in pelvis
- False Labor:
- *Contractions:
- painless, irregular frequency, and intermittent
- decrease in frequency, duration, and intensity with walking or position changes
- felt in lower back or abdomen above umbilicus
- often stop with sleep or comfort measures such as oral hydration or emptying of the bladder
- *Cervix:
- no significant change in dilation or effacement
- often remains in posterior position
- no significant bloody show
- *Fetus
- presentin part is not engaged in pelvis
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Mechanisms of labor
the adaption of the fetus as it makes progression through the birth canal during the birthin process
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Engagement
- Occurs when the presenting part
- usuallly bipartietal (largest) diameter of the fetal head passes the pelvic inlet at the level of the ischial spine
*referred to as station 0
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Descent
- The progress of the presenting part (preferably the occiput) through the pelvis
- measured by station during vaginal examination, as either
- *negitive (#) station measured in centimeters if superior to station 0 and not yet engaged)
- *positive (#) station measured in centimeters if inferior to station 0
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Flexation
When fetal head meets resistance of the cervix, pelvic wall, or pelvic floor. The head flexes bringing the chin close to the chest, presenting a smaller diameter to pass through the pelvis
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Internal Rotation
The fetal occiput ideally rotates to a lateral anterior position as it progresses from the ischial spines to the lower pelvis in a corkscrew motion to pass through the pelvis
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Extension
The fetal occiput passes under the symphysis pubis and then the head is deflected anteriorly and is born by extension of the chin away from the fetal chest
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Restitution and external rotation
After head is born, it rotates to the position it occupied as it entered the pulvic inlet (restitution) in allignment with the fetal body and completes a quarter turn to face transverse as the anterior shoulder passes under the symphysis
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Expulsion
after birth of the head and shoulders the trunk of the neonate is born by flexing it toward the symphysis pubis
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