Labor and Delivery
Term
Dilatation
Definition
The diameter of the opening of the cervix in labor
measured during a vaginal examination.
Measurement parameters
0 10 cm
Effacement
The thinning out of the cervix that usually occurs
along with dilation shortly before delivery.
0 100%
Station
The location of the presenting part in relation to the
mothers ischial spines.
-4 +4
Stage
1st stage
Latent phase
Active phase
Transition phase
2nd stage
3rd stage
4th stage
Definition
The cervix dilates and effaces to allow the baby to move into the
birth canal. The longest stage.
Cervix is 0-3cm dilated, 60% effaced and the baby is -3 to -1 station.
Contractions are every 5-10 minutes and 30 seconds in duration
Cervix is 4-7cm dilated, 90% effaced and the baby is +1 to +2 station
Contractions are stronger last 45-60 seconds and occur every 2-5
minutes.
Cervix is 8-10cm dilated, 100% effaced and the baby is +3 to +4
station. Contractions may overlap occurring every 30 seconds to 2
minutes and last 60-90 seconds. Hardest phase.
Delivery of the baby. Contractions occur every 2-3 minutes and last
60-90 seconds.
Delivery of the placenta. Mild contractions for 5-20 minutes. Uterus
remains in a contracted state to prevent hemorrhage.
Recovery stage. Shakes or chills may occur from stage 3 or epidural.
Electronic fetal monitoring:
Type of monitor
(both uterine and
fetal)
External
Ultrasound
transducer
Tocotransducer
Internal
Fetal spiral
electrode (FSE)
What it monitors
Where it is placed
Continuous or intermittent fetal
heart rate monitoring
On the mothers abdomen where the
babys back is facing
Frequency and length of uterine
contractions
Fetal heart rate by reading fetal
ECG
Top of the fundus
Frequency, length and intensity of
Intrauterine
pressure catheter uterine contractions
(IUPC)
Requires ruptured membranes and
cervical dilation. Is a fine wire placed
under skin of presenting part
Inside uterus next to fetus to the
fundus.
FHR terminology:
Term
Baseline FHR rate:
Definition
The mean FHR during a 10 minute period rounded to the
nearest 5 bpm. Excludes accelerations and decelerations.
Normal baseline
110-160 bpm
FHR tachycardia
>160 for at least 10 minutes
FHR bradycardia
<110 bpm for at least 10 minutes
Baseline variability:
Absent
The most important predictor of adequate fetal oxygenation.
Shows as a visible irregular fluctuations in FHR above and
below the baseline FHR.
Undetectable variations above or below the baseline.
Minimal
Detectable variations but at or below 5 bpm
Moderate
Variation in FHR 6-25 bpm above and below the baseline
Marked
Variation in FHR >25 bpm above or below the baseline
Accelerations:
Abrupt increase of FHR above baseline where the onset to peak
is <30 sec
Parameters for > 32 wks
> 15 bpm for > 15 sec from beginning to end of increase
Parameters for < 32 wks
> 10 bpm for > 10 sec
Decelerations:
Transitory decrease in FHR
below baseline can be abrupt or
gradual
Gradual, symmetric decrease in
FHR that mirrors contractions
and is benign
Primary Cause
Variable
Abrupt decrease in FHR > bpm
lasting > 15 sec but <2 min
Cord Compression
Late
Gradual, symmetric decrease in
FHR associated with
contractions where the onset
begins after the contraction
begins and onset to nadir is > 30
sec
Uteroplacental insufficiency
such as tachysystole,
maternal hypotension, and
abruption.
Early
Head compression or Vagal
nerve stimulation
Prolonged
Gradual or abrupt FHR
decrease of > 15 bpm that lasts
> 2 min but <10 min
Any mechanism that causes
profound change in fetal
oxygen
Newborn
Measurement
Weight
Average
5 lbs, 8 oz. 8 lbs. 13 oz. At high altitudes the average weight of a
newborn is 5-6 oz, less than newborns born at sealevel.
Length
18-22 inches
Head circumference
(OFC):
size of body. 13-14 inches
Vital Sign
Pulse
Normal parameters
110 - 160
Why is it recommended to auscultate the
newborn heart rate for 1 full minute?
Because its variable, speeding up and
slowing down with sleeping or crying. Full
minute allows for an accurate assessment.
Is an irregular heart rate normal or abnormal?
Why?
Can be normal. Most murmurs come from
the closing of the ductus arteriosus or
foramen ovalae.
Respirations
30 60 per minute
Describe normal respirations in the newborn.
Irregular rhythm called periodic breathing
where the baby pauses for 15-20 sec.
Are they regular?
No. Diaphragmatic breathers have abdomen
and chest rise together. Nose breathers need
to be sure to keep airway free from
obstruction.
Axillary 36.5-37.2 C or 97.7 99.0 F
Temperature
Thermoregulation after birth is imperative.
List 3 nursing interventions in preventing heat loss in the birthing room/delivery room.
1) Skin to skin contact
2) Warm blankets
3) Increase room temperature
Normal physical exam variations:
Finding
Vernix caseosa
Definition
White cheese like substance on newborn skin that protects and
lubricates skin in utero.
Acrocyanosis
Blue hands and feet due to poor circulation
Milia
Exposed sebaceous glands that will go away without treatment in about
a month or so.
Slate gray spots
(Mongolian)
Macular areas of blue-grey pigment usually found on dorsal areas. More
common in dark skinned races and will usually fade by age 2.
Nevi or storkbites
Benign birthmarks on nape of neck or on eyelids/nose that will usually
fade by age 2
Erythema toxicum
Also known as the Newborn Rash that peaks around 24-48 hours and
is seen as an eruption of lesions surrounding the hair follicles. Can move
around the body and disappears spontaneously. No known cause or
treatment.
Keratin containing cysts often found on the gums and palate. Has no
clinical significance, are hard to the touch and usually disappear within
a few weeks.
Collections of blood between the cranium and periosteal membrane that
does not cross suture lines, does not increase in size with crying, appears
on day 1 or 2 and disappears in 2-3 weeks.
Collection of fluid, swelling of the scalp that does cross suture lines, is
present at birth or shortly after and reabsorbed in 12 hours to a few
days after birth.
Epstein pearls
Cephalohematoma
Caput Succedaneum
Concerning physical exam findings:
Finding
Respiratory distress
(List four signs)
Cause, signs or significance
1) Retractions
2) See-saw breathing
3) Nasal flaring
4) Grunting or singing
Heart murmur
Usually associated with the incomplete closure of the foramen ovale or
ductus arteriosis
Central cyanosis
Bluish discoloration of the skin, mucus membranes and tongue that is
associated systemic arterial oxygen desaturation
Tuft of hair at base of
spine
Associated with spina bifida occulta which is the mildest form of spina
bifida. Its a neural tube defect resulting in a small separation or gab in
one or more vertebrae. Usually doesnt involve spinal nerves.
Pulmonary air leak starts with the rupture of an over distended alveolus
which may be due to air trapping or uneven distribution. The air has
escaped the lung into the extra-alveolar spaces.
Unequal movement of
chest
Postpartum
Component
Breasts
How and what do you assess
General appearance of breast tissue
and nipples. LATCH assessment.
Palpation of breast tissue. Size,
shape, firmness, redness and
symmetry
Normal findings in the first 3 days
Smooth, even pigmentation, one
may appear larger. Nipples are
supple, pigmented and intact.
Breast tissue is soft, filling, full or
engorged upon palpitation.
Uterus
Fundus is it firm or boggy? Make a
C shape with hand and push up on
lower fundus. Fundal height and is it
midline or deviated? Height in
relation to umbilicus
Auscultate abdomen and bowel
movements
Firm with day 1 being at the
umbilicus descending 1cm/day
Bowel
Bladder
Legs
Palpate while palpating the fundus
and assess last void
Homans sign, edema and clonus.
Palpate, flex calf at 90 angle and
manipulate foot in dorsiflexion
movement
Episiotomy/perinuem REEDA when shes lying on her side
and upper cheek raised
Problem
Breast engorgement
Constipation
Perineal pain
Full bladder
Bowel sounds present in all 4
quadrants with normal bowel
movement by the 2nd or 3rd day
after birth.
Bladder should not be distended
or palpable. Should void within 12
hours post-partum or requires
straight cath.
No pain with palpation, negative
Homans, slight amount of edema
and 2+ reflexes without clonus
Often swollen and bruised, no
redness, edema, ecchymosis, or
discharge; edges well
approximated. No hemorrhoids
present, if they are they should be
small and nontender.
Nursing interventions (include prevention)
Prevent by nursing early and often, dont skip feedings and allow the
baby to finish the first breast before offering the other side. Can apply
warm compresses to breast and hand express or pump. Ice packs for 1015 minutes after feeding. Put a chilled cabbage leaf in tight fitting bra for
1-2 hours or until the leaf becomes limp or wilted. Analgesics PRN.
Increase fluids, fiber, ambulation or stool softeners. Encourage reestablishing regular bowel habits
Ice for the first 12 hours then heat in a sitz bath, ibuprofen for pain and
swelling, squirt bottle to keep area clean, donut not fully inflated for
pain, Americaine, Nupercainal, Tucks, Narcotics, and help mom
ambulate to assess mobility, reduce risk of falling and prevent trauma to
the perineum
Catheterization, running water in the sink, or relax with deep breaths.
Encourage voiding soon after giving birth.
Antepartum
Type of assessment
Biophysical profile
(BPP)
Definition
Assessment of fetal reflex activities
controlled by the CNS and sensitive to
fetal hypoxia
Reasons may be used
High risk pregnancies after 32
weeks. Ultrasounds and NST
combined for scoring.
Non-stress test
(NST)
Non-invasive test of fetal well-being
with electronic monitoring of FHR for
20-40 minutes.
The baby isnt moving as frequently
as usual, overdue, or high risk
pregnancy.
Criteria for a
reactive NST
Biophysical profile
Component
At least 2 FHR accelerations in 20
minutes.
Normal (2 points)
1 breathing episode within 30 minutes
Abnormal (0 points)
No breathing episodes within 30
minutes
1 or more episodes of active
extension/flexion of limbs etc.
Slow extension/flexion of limbs,
partially open fetal hand, etc.
2 or more movements within 30 minutes
Less than 2 movements within 30
minutes
1 or more adequate pockets of fluid
Either no pockets or inadequate
pockets of fluid
Breathing
Tone
Fetal movement
Amniotic fluid index
(AFI)
NST
Reactive
In pregnancies > 32 weeks: > 15 bpm
above baseline lasting > 15 sec
Non-reactive- define what this
means:
Insufficient accelerations in 40
minutes. Needs follow up testing to
In pregnancies 28-32 weeks: > 10 bpm determine if its due to poor
above baseline lasing > 10 seconds
oxygenation or due to sleep,
prescription or nonprescription
drugs.
Symptom
Pain
Placenta Previa
Painless
Placental Abruption
Pain disproportionate to the
strength of uterine contractions
Vaginal Bleeding
Present
Possible
Uterine tone
Soft and relaxed
Firm to hard
PROM
(premature
rupture of
membranes)
PPROM
(preterm
premature
rupture of
membranes)
Preterm labor
Multiple
gestation
Definition
The rupturing of the amniotic sac any time after 37 weeks of gestation
The rupturing of the amniotic sac before 37 weeks of gestation
Definition
Regular contractions of
the uterus resulting in
changes in the cervix that
begin before 37 weeks
Three complications at increased risk for:
1) Premature birth
2) Low birthweight
3) Preeclampsia
4) Twin-twin transfusion syndrome
5) Gestational diabetes
6)
Fetal fibronectin (Ffn)
Tocolytics
Cerclage
Risk factors (list at least 5)
1) Previous preterm births
2) Pregnant with multiples
3) Underweight or Overweight throughout
pregnancy
4) Smoking
5) Health conditions such as diabetes,
hypertension, preeclampsia, or certain
infections.
What is it?
A protein that acts like glue, it
helps the amniotic sac attach to the
lining of the uterus
How is it used in OB?
Predicts chances of preterm labor, if
none is present it means low chance
of preterm labor or birth. If it is
present there's an increased risk of
preterm labor or birth
Agents that inhibit uterine
Used to delay labor and give more
contractions and suppress pre-term time for fetal growth and for the fetal
labor
lungs to mature
Procedure where sutures are used
to close the cervix
Helps prevent premature birth in
women who have an incompetent or
weak cervix
