OB Exam 2 Already Graded A+
Stages of Labor
1st Stage: Dilation and Effacement of the Cervix - Latent Phase (0-4 cm dilation): - Longest phase of labor. - Contractions are mild to palpation and feel like menstrual cramps. - Active Phase (5-7 cm dilation): - Women may become more focused and exp...
- Contractions are mild to palpation and feel like menstrual cramps.
- Active Phase (5-7 cm dilation):
- Women may become more focused and experience increased anxiety or restlessness.
- Contractions become more regular and painful.
- Transition Phase (8-10 cm dilation):
- Strong contractions that are closer together.
- Women may feel out of control, irritable, or dependent.
- This is the shortest phase of labor.
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2nd Stage: Pushing
- Definition: Begins with complete dilation of the cervix and ends with the birth of the baby.
- Duration: May last from 20 minutes to 2 hours.
- Fetal Descent Stages:
1. Engagement: Fetal head at the level of ischial spines.
2. Descent: Fetal head moves past the ischial spines.
3. Flexion: Fetal chin touches chest in response to pressure from maternal tissue.
4. Extension: Fetal chin comes off the chest; neck arches as the head is born.
5. External rotation: Fetal head rotates as shoulders move into position for delivery.
, 6. Expulsion: Birth of the fetal body.
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3rd Stage: Delivery of the Placenta
- Definition: Begins with the birth of the baby and ends with the delivery of the placenta.
- Duration: Typically complete within 5-30 minutes.
- Concern: Failure to contract may lead to uterine atony, a primary cause of postpartum hemorrhage.
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4th Stage: Recovery
- Definition: Begins with the delivery of the placenta and lasts for about 4 hours or until the mother is
clinically stable.
- Nursing Assessment:
- Assess uterine position, vaginal bleeding (lochia), and vital signs.
- Administer pain medication as needed.
- Assist the patient with skin-to-skin contact and initiating breastfeeding.
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Fetal Heart Rate (FHR) Monitoring
- Purpose: To assess FHR patterns indicative of fetal compromise.
- Abnormal patterns can indicate hypoxemia and lead to hypoxia.
- Monitoring Techniques:
- Intermittent Monitoring: FHR assessed every 15-30 minutes during the active phase; every 5-15
minutes during the second stage.
, - Continuous Monitoring: Evaluated every 30 minutes for low-risk women in the first stage; every 15
minutes for the second stage. Higher frequency for high-risk women.
- Characteristics:
- Baseline heart rate normally between 110-160 bpm.
- Variability: Reflects the normal fluctuations in FHR.
- Moderate Variability: 6-25 bpm (desirable).
- Absent Variability: 0-2 bpm.
- Minimal Variability: 2-6 bpm.
- Marked Variability: >25 bpm.
- Accelerations: Increase of at least 15 bpm lasting at least 15 seconds.
- Decelerations: Decreases from baseline; categorized as:
- Late Decelerations: Due to poor placental perfusion.
- Variable Decelerations: Due to cord compression.
- Early Decelerations: Benign, due to head compression.
- Prolonged Decelerations: Lasting 2-5 minutes.
Interventions for Decelerations
- Change maternal position.
- Discontinue oxytocin infusion if in use.
- Administer oxygen (8-10 L via non-rebreather mask).
- Correct any present hypotension.
- Notify the provider of significant changes.
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FHR Categories
- Category 1: Good (HR 110-160, moderate variability, no late or variable decelerations).
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