NURS 3334 Lecture Notes - Lecture 15: Leading Edge, Umbilical Cord Prolapse, Occipital Bone

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Intrapartum Maternal Assessment and Care During Labor
Focused Admission Assessment
Woman’s reason for coming to hospital/birth center
Fetal heart rate
o Baseline 110-160bpm
Contractions
o Time of onset
o Frequency
o Duration
Maternal vital signs
o Looking for elevated BP or temp
Maternal Interview
o Name of support person
o Name of MD
o GTPAL (vaginal or c/s deliveries)
o Status of membranes (Time of rupture and color)
o Presence of bloody show
o EDD
o Problems during pregnancy (diabetes, bleeding, PTL)
o Allergies
Database Admission Assessment
Prenatal record
o Age
o Height/weight
o Baseline VS
o Recent Labs/ Results of diagnostic screening tests:
Venereal disease testing (VDRL or RPR for syphilis)
H/H, Blood type/ Rh
Status r/t Hep B, GBS, HIV, Rubella
Interview
o Birth plans
o Infant feeding choice/pediatrician/circumcision
o Chronic diseases, past surgeries, and pregnancy history
o Recent illnesses and treatments including STD’s
o Medications (prescription & over the counter)
o Tobacco/alcohol/illicit drugs
o Potential or history of domestic violence
Physical Assessment
Vaginal exam usually done by MD or CNM
o Done to rule out imminent birth
Tests for Rupture of Membranes
Leopold’s Maneuver’s
Fetal assessment
o Gone to reassure of fetal well-being
Contraction assessment
General maternal systems assessment
Common Procedures Before or During Labor
Amnioinfusion
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o Warm NS or LR infused into uterus to decrease severe variables d/t cord compression or
dilute thick meconium. Strict FHR and Cxt monitoring for uterine distension
External cephalic version
o After 37 weeks to turn breech presentation to vertex. Using ultrasound for guidance,
IV, FHR monitoring, anesthesia aware.
o Criteria for external version and contraindications for external version page 622 of
book.
Vaginal Delivery after cesarean birth (VBAC)
o Necessary documentation of low segment transverse prior. Contraindications: LGA,
malpresentation, CPD, prior vertical incision or not documented incision
Bishop Score
o Used to determine maternal readiness to labor check cervix to see if it is favorable
for labor induction
o Looks at dilation, effacement, consistency, position and station of presenting parts
scores like Apgar and biophysical. ACOG recommendation: over 39 weeks, multip at
least 8, nullip at least 10
o This is out of possible score of 15
Vaginal Exam
Assess
o Status of membranes
o Presenting part
o Cervical effacement, dilation, and station
Use sterile gloves and soluble gel (unless checking for ROM)
o Use index and middle finger
Tests for Rupture of Membranes
Nitrazine pH Test
o + Nitrazine pH test is (alkaline) pH 6.5-7.5
Fern Test
o + Test is crystalline fern under microscopic examination
Assessment in Labor
Fetal heart rate/ contractions
Rupture of membranes
Vaginal exams
Maternal vital signs
Intake/output
Pain assessment
Support person
Leopold’s Maneuvers
Maneuvers 1-3 stand beside woman
1st maneuver:
o Palpate uterine fundus
2nd maneuver:
o One hand steady, palpate on other side of fetus / then rpt. with opposite side
3rd maneuver:
o Palpate suprapubic area
4th maneuver: Face feet
o Slide hands down either side of fetus
Placement of EFM PMI (Point of Maximal Intensity)
Location of FHR in relation to the more commonly seen fetal positions
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Document Summary

Database admission assessment: prenatal record, age, height/weight, baseline vs, recent labs/ results of diagnostic screening tests, venereal disease testing (vdrl or rpr for syphilis, h/h, blood type/ rh, status r/t hep b, gbs, hiv, rubella. Interview: birth plans, infant feeding choice/pediatrician/circumcision, chronic diseases, past surgeries, and pregnancy history, recent illnesses and treatments (cid:523)including std"s(cid:524, medications (prescription & over the counter, tobacco/alcohol/illicit drugs, potential or history of domestic violence. Physical assessment: done to rule out imminent birth, vaginal exam usually done by md or cnm, leopold"s maneuver"s, tests for rupture of membranes, fetal assessment, gone to reassure of fetal well-being, contraction assessment, general maternal systems assessment. Common procedures before or during labor: amnioinfusion, warm ns or lr infused into uterus to decrease severe variables d/t cord compression or, external cephalic version dilute thick meconium. Strict fhr and cxt monitoring for uterine distension: after 37 weeks to turn breech presentation to vertex.

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