11/19/23, 9:32 AM CH 14 - Summary Maternity and Pediatric Nursing
OB#Exam#2#Intrapartum## ##############################Susset#H.#Alcover#
#
Chapter(14(–(Nursing(Management(during(Labor(and(Birth(
#
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# effacement# à# 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##
¨ 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##
about:blank 1/13
, 11/19/23, 9:32 AM CH 14 - Summary Maternity and Pediatric Nursing
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#pH#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#green#à#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#but#deep#pressure.#The#
about:blank 2/13
OB#Exam#2#Intrapartum## ##############################Susset#H.#Alcover#
#
Chapter(14(–(Nursing(Management(during(Labor(and(Birth(
#
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# effacement# à# 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##
¨ 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##
about:blank 1/13
, 11/19/23, 9:32 AM CH 14 - Summary Maternity and Pediatric Nursing
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#pH#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#green#à#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#but#deep#pressure.#The#
about:blank 2/13
