#3 passenger - fetus, membranes, and placenta (continued)
Give this one a try later!
,◦Presentation -Part of fetus that enters pelvis FIRST
◦Station-descent past ischial spines
◦Position- LOA ROP...
◦Is it engaged or ballotable
◦Bouncing up and down is not engaged
The fetal part that first enters the pelvis is termed presenting part.
Falls into 3 categories—cephalic, breech, transverse (shoulder)
Cephalic most common, other presentations may prolong labor or cause
other problems and more likely to have
C-section
Usual head flexed into chest (smallest diameter) ovoid occiput presents
vertex presentation
Vertex or an occiput presentation most favorable for vaginal delivery
Military = head is in a neutral position, neither flexed nor extended
Brow = head partially extended. Largest diameter
Face = head hyper-extended (largest diameter)
Fetal position describes the location of a fixed reference on the presenting
part in relation to the four quadrants of the maternal pelvis
The 4 quadrants are the right and left anterior and the right and left
posterior.
Abbreviations are used to describe the relationship (LOA-occiput in left
anterior quadrant of mom's pelvis)
First letter: R or L mother's pelvic side. If neither to R or L, the letter is
omitted
Middle letter: refers to the fixed fetal reference point which varies with the
presentation
O (occiput) is used in the vertex presentation
M (mentum or chin) is the reference point in a face presentation
S (sacrum) is used for breech presentations
F (fronto or brow) presentation
SC (scapula or shoulder) presentation
Final letter: location of presenting point in relation to maternal pelvis
A= anterior
P = posterior
T = transverse (neither A or P)
, Engagement—widest diameter of fetal presenting part (usually the head)
has passed through the pelvic inlet and entered the pelvic cavity.
Presumed to have happened when the presenting part reaches maternal
ischial spines (0 station)
Level of ischial spines is zero station. Other stations are described with
numbers representing the approximate number of centimeters above
(negative) or below (positive) the ischial spines. As fetus descends statin
changes from higher negative numbers (-3, -2, -1)to zero to higher positive
numbers (+1, +2, +3) POSITIVE= PUSH
Engagement often takes place before onset of labor in nulliparous. In
parous and some nullips does not occur until labor begins.
positioning
Give this one a try later!
•Change positions often
A specific maternal position may help reduce discomfort and assist the
labor process. Encourage woman to assume any position she finds
comfortable other than supine and change positions frequently. Movement
and frequent position changes decrease pain, improve maternal-fetal
circulation, improve strength and effectiveness of contractions, decrease
the length of labor, facilitate fetal descent, and decrease perineal trauma
and episiotomies. "Back labor"—is common when the back of the fetal head
puts pressure on the woman's sacral promontory (OP position)—hands and
knees, leaning over birthing ball—encourages fetus to move away from
sacral promontory.
SHOW COUNTERPRESSURE
Change positions often
nitrous oxide
, Give this one a try later!
—"laughing gas" see with dental procedures
1.Colorless, almost odorless, tasteless gas
2.Mechanism not well understood—stimulate endorphins and give euphoric
effect
3.Rapid onset—30-60 seconds
4.Quick clearance—prevent accumulation in tissues
5.Remain awake, alert, have sensory and mother functioning, remain
ambulatory
6.Does not alter uterine activity
7.50% oxygen 50% nitrous
8.Can change to another form of pain management if not satisfied with
nitrous—used in early labor
9.N/V (5- 36%); vertigo (39%)
10.Crosses placenta—quickly eliminated-no CNS or resp. depression
11.Less costly, self administered, others can't hold the mask, is pain free
-patient controls it, reversal is oxygen
Amniotomy (Artificial Rupture of Membranes)
Give this one a try later!
◦Baseline FHR
◦Monitor following procedure
◦Characteristics of fluid
◦Monitor temp every 2-4 hours
◦RISK—CORD PROLAPSE
◦Presenting part not engaged
◦Breech
◦Polyhydramnios
Prolapse—Do not try to replace cord—trauma, decrease blood flow thru
cord, can cause umbilical artery spasm.
May see sudden onset of persistent variable decelerations or prolonged
bradycardia.
Give this one a try later!
,◦Presentation -Part of fetus that enters pelvis FIRST
◦Station-descent past ischial spines
◦Position- LOA ROP...
◦Is it engaged or ballotable
◦Bouncing up and down is not engaged
The fetal part that first enters the pelvis is termed presenting part.
Falls into 3 categories—cephalic, breech, transverse (shoulder)
Cephalic most common, other presentations may prolong labor or cause
other problems and more likely to have
C-section
Usual head flexed into chest (smallest diameter) ovoid occiput presents
vertex presentation
Vertex or an occiput presentation most favorable for vaginal delivery
Military = head is in a neutral position, neither flexed nor extended
Brow = head partially extended. Largest diameter
Face = head hyper-extended (largest diameter)
Fetal position describes the location of a fixed reference on the presenting
part in relation to the four quadrants of the maternal pelvis
The 4 quadrants are the right and left anterior and the right and left
posterior.
Abbreviations are used to describe the relationship (LOA-occiput in left
anterior quadrant of mom's pelvis)
First letter: R or L mother's pelvic side. If neither to R or L, the letter is
omitted
Middle letter: refers to the fixed fetal reference point which varies with the
presentation
O (occiput) is used in the vertex presentation
M (mentum or chin) is the reference point in a face presentation
S (sacrum) is used for breech presentations
F (fronto or brow) presentation
SC (scapula or shoulder) presentation
Final letter: location of presenting point in relation to maternal pelvis
A= anterior
P = posterior
T = transverse (neither A or P)
, Engagement—widest diameter of fetal presenting part (usually the head)
has passed through the pelvic inlet and entered the pelvic cavity.
Presumed to have happened when the presenting part reaches maternal
ischial spines (0 station)
Level of ischial spines is zero station. Other stations are described with
numbers representing the approximate number of centimeters above
(negative) or below (positive) the ischial spines. As fetus descends statin
changes from higher negative numbers (-3, -2, -1)to zero to higher positive
numbers (+1, +2, +3) POSITIVE= PUSH
Engagement often takes place before onset of labor in nulliparous. In
parous and some nullips does not occur until labor begins.
positioning
Give this one a try later!
•Change positions often
A specific maternal position may help reduce discomfort and assist the
labor process. Encourage woman to assume any position she finds
comfortable other than supine and change positions frequently. Movement
and frequent position changes decrease pain, improve maternal-fetal
circulation, improve strength and effectiveness of contractions, decrease
the length of labor, facilitate fetal descent, and decrease perineal trauma
and episiotomies. "Back labor"—is common when the back of the fetal head
puts pressure on the woman's sacral promontory (OP position)—hands and
knees, leaning over birthing ball—encourages fetus to move away from
sacral promontory.
SHOW COUNTERPRESSURE
Change positions often
nitrous oxide
, Give this one a try later!
—"laughing gas" see with dental procedures
1.Colorless, almost odorless, tasteless gas
2.Mechanism not well understood—stimulate endorphins and give euphoric
effect
3.Rapid onset—30-60 seconds
4.Quick clearance—prevent accumulation in tissues
5.Remain awake, alert, have sensory and mother functioning, remain
ambulatory
6.Does not alter uterine activity
7.50% oxygen 50% nitrous
8.Can change to another form of pain management if not satisfied with
nitrous—used in early labor
9.N/V (5- 36%); vertigo (39%)
10.Crosses placenta—quickly eliminated-no CNS or resp. depression
11.Less costly, self administered, others can't hold the mask, is pain free
-patient controls it, reversal is oxygen
Amniotomy (Artificial Rupture of Membranes)
Give this one a try later!
◦Baseline FHR
◦Monitor following procedure
◦Characteristics of fluid
◦Monitor temp every 2-4 hours
◦RISK—CORD PROLAPSE
◦Presenting part not engaged
◦Breech
◦Polyhydramnios
Prolapse—Do not try to replace cord—trauma, decrease blood flow thru
cord, can cause umbilical artery spasm.
May see sudden onset of persistent variable decelerations or prolonged
bradycardia.
