1
OB Exam 2 Intrapartum
Chapter 14–
Nursing Management during Labor and Birth
Susset H. Alcover
Key Terms Related to Fetal Heart Rate
• Accelerations
• Baseline fetal heart rate
• Baseline variability
• Deceleration
• Electronic fetal monitoring
• Periodic baseline changes
Nursing Management of Laboring Women
• Assessment
• Comfort measures
• Emotional support
• Information and instruction
• Advocacy
• Support for the partner
Maternal Assessment During Labor and Birth
• Maternal status (vital signs, pain, prenatal record
review)§ Vaginal examination
¨ The recommendation is to do digital vaginal
examinations at intervals of 4 hr. for routine
assessment and identification of a delay in active labor
¨ Prepare the woman by informing her about the procedure
o Cervical dilation and effacementà key
assessment of vaginal examination, subjective
¨ The width of the cervical opening determines
dilation and the length of the cervix assesses
effacement
¨ The information yielded by this examination serves as a basis for
determining the stage of labor the woman is in
o Fetal descent (station) and presentation
¨ If progressive fetal descent does not occur, a disproportion between the
maternal pelvis and the fetus might exist and needs to be investigated
o Membrane status
¨ To determine the integrity of the membranes
¨ If intact, it will be felt as a soft bulge that is more prominent during a
contraction
¨ If ruptured, the woman may report a sudden gush of fluid but it may also
occur as a slow trickle of fluid
§ Rupture of membranes
¨ When rupture, the priority focus is assessing the FHR first to identify a
deceleration, which may indicate cord compression secondary to cord prolapse
¨ If rupture when admitted to the hospital, ask when it happened
, 2
¨ Prolonged rupture of membranes increase the risk of infection because of
ascending vaginal
organisms for the mother and fetus
¨ Be alert for s/s of intrauterine infection: maternal fever, fetal and maternal tachycardia, foul
odor of vaginal discharge and an increase in WBC count
, 3
OB Exam 2 Intrapartum Susset H. Alcover
¨ Confirm rupture of membrane by taking a sample of fluid from the vagina
via a Nitrazine tallow dye swab to determine the fluid’s p H à turns blue
¨ False positive can occur, especially when woman is experiencing a large
amount of bloody show, because blood is alkaline
¨ If it remains yellow to olive greenà the membranes are most likely to
be intact¨ If test is inconclusive, a fern test is done
§ Uterine contractions (see Figure
14.2)¨ Primary power of labor
¨ Uterine contractions increase intrauterine pressure, causing tension on the cervix
what leads to cervical dilation and thinning, which eventually forces the fetus
through the birth canal
¨ To palpate for contraction intensity, place the pads of your fingers on the fundus
and describe how it feels:
o Forehead– strong
o Nose– mild
o Chin– moderate
¨ Second method is electronic monitoring either external or internal
¨ The external fetal monitor is sometimes used to estimate the intensity of uterine
contractions– not an accurate assessment tool
§ Leopold’s maneuvers (see Nursing Procedure 14.1)
¨ Method for determining the presentation, position, and lie of the fetus using
four specific steps
¨ Involves inspection and palpation of the maternal abdomen as a screening
assessment for malpresentation– longitudinal lie is expected
¨ Each maneuver answers a question:
o Maneuver 1: what fetal part is located at the fundus?
o Maneuver 2: on which maternal side is the fetal back located?
o Maneuver 3: what is the presenting part?
o Maneuver 4: is the fetal head flexed and engaged in the pelvis?
¨ Note: If the hands move together easily, the fetal head is not descended into the
woman’s pelvis inlet
If the hands do not move together and stop because of resistance, the fetal head
is engaged into the woman’s pelvic inlet
Leopold’s Maneuver (SATA question on the exam or picture) - For determining fetal position
and presentation
1.
Leopold’s maneuvers for determining fetal position and presentation.
B, Second maneuver: Moving the hands on the pelvis, palpate the abdomen with gentle
OB Exam 2 Intrapartum
Chapter 14–
Nursing Management during Labor and Birth
Susset H. Alcover
Key Terms Related to Fetal Heart Rate
• Accelerations
• Baseline fetal heart rate
• Baseline variability
• Deceleration
• Electronic fetal monitoring
• Periodic baseline changes
Nursing Management of Laboring Women
• Assessment
• Comfort measures
• Emotional support
• Information and instruction
• Advocacy
• Support for the partner
Maternal Assessment During Labor and Birth
• Maternal status (vital signs, pain, prenatal record
review)§ Vaginal examination
¨ The recommendation is to do digital vaginal
examinations at intervals of 4 hr. for routine
assessment and identification of a delay in active labor
¨ Prepare the woman by informing her about the procedure
o Cervical dilation and effacementà key
assessment of vaginal examination, subjective
¨ The width of the cervical opening determines
dilation and the length of the cervix assesses
effacement
¨ The information yielded by this examination serves as a basis for
determining the stage of labor the woman is in
o Fetal descent (station) and presentation
¨ If progressive fetal descent does not occur, a disproportion between the
maternal pelvis and the fetus might exist and needs to be investigated
o Membrane status
¨ To determine the integrity of the membranes
¨ If intact, it will be felt as a soft bulge that is more prominent during a
contraction
¨ If ruptured, the woman may report a sudden gush of fluid but it may also
occur as a slow trickle of fluid
§ Rupture of membranes
¨ When rupture, the priority focus is assessing the FHR first to identify a
deceleration, which may indicate cord compression secondary to cord prolapse
¨ If rupture when admitted to the hospital, ask when it happened
, 2
¨ Prolonged rupture of membranes increase the risk of infection because of
ascending vaginal
organisms for the mother and fetus
¨ Be alert for s/s of intrauterine infection: maternal fever, fetal and maternal tachycardia, foul
odor of vaginal discharge and an increase in WBC count
, 3
OB Exam 2 Intrapartum Susset H. Alcover
¨ Confirm rupture of membrane by taking a sample of fluid from the vagina
via a Nitrazine tallow dye swab to determine the fluid’s p H à turns blue
¨ False positive can occur, especially when woman is experiencing a large
amount of bloody show, because blood is alkaline
¨ If it remains yellow to olive greenà the membranes are most likely to
be intact¨ If test is inconclusive, a fern test is done
§ Uterine contractions (see Figure
14.2)¨ Primary power of labor
¨ Uterine contractions increase intrauterine pressure, causing tension on the cervix
what leads to cervical dilation and thinning, which eventually forces the fetus
through the birth canal
¨ To palpate for contraction intensity, place the pads of your fingers on the fundus
and describe how it feels:
o Forehead– strong
o Nose– mild
o Chin– moderate
¨ Second method is electronic monitoring either external or internal
¨ The external fetal monitor is sometimes used to estimate the intensity of uterine
contractions– not an accurate assessment tool
§ Leopold’s maneuvers (see Nursing Procedure 14.1)
¨ Method for determining the presentation, position, and lie of the fetus using
four specific steps
¨ Involves inspection and palpation of the maternal abdomen as a screening
assessment for malpresentation– longitudinal lie is expected
¨ Each maneuver answers a question:
o Maneuver 1: what fetal part is located at the fundus?
o Maneuver 2: on which maternal side is the fetal back located?
o Maneuver 3: what is the presenting part?
o Maneuver 4: is the fetal head flexed and engaged in the pelvis?
¨ Note: If the hands move together easily, the fetal head is not descended into the
woman’s pelvis inlet
If the hands do not move together and stop because of resistance, the fetal head
is engaged into the woman’s pelvic inlet
Leopold’s Maneuver (SATA question on the exam or picture) - For determining fetal position
and presentation
1.
Leopold’s maneuvers for determining fetal position and presentation.
B, Second maneuver: Moving the hands on the pelvis, palpate the abdomen with gentle
