Fetal assessment during labor

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dsherman
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120135
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Fetal assessment during labor
Updated:
2011-12-01 18:01:29
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Fetal assessment during labor
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Fetal assessment during labor
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  1. Leopold maneuvers
    • performing external palpations of the maternal uterus through the abdominal wall to determint
    • *number of fetuses
    • *presenting part
    • *fetal attitude
    • *fetal lie
    • *degree of fetal decent into the pelvis
    • *expected location of the point of maximal impulse (PMI)

    • Prepare the client:
    • *have her empty her bladder
    • *supine position with a pillow under her head and have her flex her knees slightly
    • *place a wedge under her right hip to displace the uterus to the left and prevent supine hypotension/vena cava syndrome
  2. Point of maximal impulse (PMI)
    • PMI is the optimal location where the fetal heart tones are ausculated the lowdest on the woman's abdmon
    • *best heard directly over the fetal back
    • *in vertex presentation, PMI is either in the right- or left lower quadrant or below the maternal umbilicus
    • *in breech presentation, PMI is either in the right- or left upper quadrant above the maternal umbilicus
  3. During labor, uterine contractions compress the uteroplacental arteries resulting in;
    temporarily stopping maternal blood flow into the uterus and intervillous spaces of the placents thus decreasing fetal circulation and oxygenation

    circulation to the uterus and placenta resumes during uterine relaxation between contractions

    • Monitoring guidlines: (Intermittent ausculation or continuous electronic fetal monitoring)
    • Low-risk
    • *during latent phase, every 60 min
    • *during active phase, every 30 min
    • *during second stage, every 15 min
    • High-risk
    • *during latent phase, every 30 min
    • *during active phase, every 15 min
    • *during second stage, every 5 min
  4. Guidelines for intermittent ausculation following routine procedures
    • *rupture of membranes, either spontaneously or artificially
    • *proceding and subsequent to ambulation
    • *prior to and following administration of or a chage in mediction anesthesia
    • *at peak action of anesthesia
    • *following vaginal exam
    • *following expulsion of enema
    • *after urinary catheterization
    • *in the event of abnormal or excessive uterine contractions
  5. Normal reassuring FHR
    110 to 160/min with increases and decreasis from baseline
  6. Preparing the patient/Nursing actions- intermittent ausculation or continuous electronic fetal monitoring
    • 1) perform leopold maneuvers to determine point of maximum impulse (PMI)
    • 2) auscultate at PMI using listening device
    • 3) palpate the patients abdomen at uterine fundus to assess uterine activity
    • 4) count FHR for 30 to 60 seconds to determine baseline rate
    • 5) Auscultate FHR during contraction and for 30 seconds following the completion of the contraction

    • Ongoing:
    • identify any nonreassuring FHR patterns and notify the physician

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