Term
| Internal fetal scalp electrode |
|
Definition
| inserted through cervix (must be at least 2 cm dilated with ROM) and attached to epidermis of presenting part providing a direct ECF of fetal heart |
|
|
Term
| Baseline fetal heart rate |
|
Definition
| average heart rate btw contractions; measured in beats per minute; normal range is 120-160 |
|
|
Term
|
Definition
- change in rate btw one fetal heart beat and the next
- creates jaggedness or zigzag appearance in baseline FHR
- determined by interplay btw sympathetic and parasympathetic nervous systems
- decreased by fetal tachycardia, prematurity, fetal heart and CNS anomalies, and fetal sleep
- normal is 2-3 bpm
- classified as present or absent and can be evaluated only by internal monitoring
|
|
|
Term
|
Definition
- rhythmic fluctuations that occur 2-6 times/min
- determined by interplay btw fetal sympathetic and parasympathetic nervous systems
- increased by fetal movement and decreased by fetal sleep or hypoxia and subsequent acidosis
- average or moderate: 6-25 bpm
|
|
|
Term
|
Definition
| deviations from baseline separate from variability and occur in relationship to or independent of contractions |
|
|
Term
|
Definition
| transient increases in FHR |
|
|
Term
| non-periodic (spontaneous) accelerations |
|
Definition
- symmetric
- uniform
- not r/t contractions
- occur in response to fetal movement and indicate fetal well-being
|
|
|
Term
|
Definition
| occur with contractions and may indicate decreased amniotic fluid or mild umbilical cord compression |
|
|
Term
|
Definition
- decrease in FHR beginning at onset of a contraction and returning to baseline by end of contraction with nadir at acme
- uniform in shape inversely mirrors contraction
- caused by fetal head compression; usually benign
|
|
|
Term
| Nursing interventions for early decelerations |
|
Definition
- vaginal exam to determine fetal descent
- notify provider if fetus is not descending
|
|
|
Term
|
Definition
- begin after contraction starts, with nadir occurring after peak of contraction and returning to baseline after end of contraction
- smooth, uniform shape that inversely mirrors contractions but late in onset and recovery
|
|
|
Term
| Nursing interventions for late decelerations |
|
Definition
- reposition client to left lateral side
- administer oxygen by mask at 7-10 L/min
- correct hypotension through increased IV fluid rate or administration of medications
- discontinue oxytocin if being administered
- report to health care provider
|
|
|
Term
|
Definition
- occur suddenly, vary in duration and intensity, vary in relation to contractions, and resolve abruptly
- variable shape, usually U or V, with steep sides; may or may not be associated with contractions
- categorized as mild, moderate, or severe based on lowest FHR reading and duration of deceleration
|
|
|
Term
| Cause of variable decelerations |
|
Definition
| compression of umbilical cord |
|
|
Term
| Variable decelerations indicating fetal asphyxia |
|
Definition
repetitive, prolonged, or more severe decelerations with a slow return or overshoot to baseline
|
|
|
Term
| Nursing interventions for variable decelerations |
|
Definition
- reposition client until improvement occurs
- vaginal exam to detect prolapsed cord
- oxygen if severe or uncorrectable
- amnio-infusion to recreate cushioning effect on umbilical cord during contractions that is normally provided by amniotic fluid
|
|
|
Term
|
Definition
| the instillation of warmed NS through an intrauterine pressure catheter |
|
|
Term
|
Definition
| tocodynamomenter is placed on maternal abdomen near fundus; accurate only for documenting contraction frequency and duration |
|
|
Term
| Factors affected by external monitoring |
|
Definition
- fetal or maternal movement
- transverse or oblique lie
- maternal abdominal fat
|
|
|
Term
| Intrauterine pressure catheter (IUPC) |
|
Definition
- a wire with pressure gauge on one end or a saline-filled tube, which is inserted through cervix and past presenting part into amniotic fluid in uterus
- increase in intrauterine pressure is detected and measured in mm of Hg
- cervix must be at least 2-3 cm dilated with ruptured membranes before an IUPC can be inserted
|
|
|
Term
|
Definition
| standing or sitting in a warm shower or reclining in a tub during labor |
|
|
Term
| Hormonal influences on initiation of labor |
|
Definition
- prostaglandins
- oxytocin
- fetal cortisol
- estrogen
- progesterone
|
|
|
Term
|
Definition
| differentiated by cervical change: effacement and dilatation |
|
|
Term
|
Definition
- passageway
- passenger
- powers
- psyche
|
|
|
Term
|
Definition
| maternal boney pelvis comprised of innominate bones, sacrum and coccyx |
|
|
Term
|
Definition
|
|
Term
|
Definition
| lies above pelvic brim, supports increasing weight of enlarging pregnant uterus, and directs presenting part into true pelvis below |
|
|
Term
|
Definition
| consists of the inlet, midpelvis, and outlet and represents bony limits of birth canal; adequacy of each part, measured as transverse and anterior-posterior diameters, must be sufficient to allow passage of fetus through passageway |
|
|
Term
|
Definition
- gynecoid
- android
- anthropoid
- platypelloid
|
|
|
Term
|
Definition
| the fetus; attitude, lie, presentation, position, engagement, station |
|
|
Term
|
Definition
| relationship of fetal parts to one another; normal attitude is flexion of neck, arms, and legs |
|
|
Term
|
Definition
| relationship of longitudinal axis of fetus to longitudinal axis of mother (vertex, breech, transverse, and oblique) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| fetal part entering pelvis first; most common presentation is cephalic, but breech and shoulder can also occur |
|
|
Term
|
Definition
| relationship of fetal presenting part to maternal pelvis; a 3-letter notation is used to describe fetal position |
|
|
Term
| most common positions at delivery |
|
Definition
| ROA (right occiput anterior) and LOA (left occiput anterior) |
|
|
Term
|
Definition
- A: acromion process
- M: mentum
- O: occiput
- S: sacrum
|
|
|
Term
|
Definition
- P: posterior
- A: anterior
- T: transverse
|
|
|
Term
|
Definition
| occurs when largest diameter of presenting part reaches pelvic inlet and can be detected by vaginal examination (floating, ballotable, or engaged) |
|
|
Term
|
Definition
| presenting part is directed toward pelvis but can easily be moved out of inlet |
|
|
Term
|
Definition
| presenting part dips into inlet but can be displaced with upward pressure from examiner's fingers |
|
|
Term
|
Definition
| presenting part is fixed in pelvic inlet and cannot be displaced |
|
|
Term
|
Definition
| relationship of presenting part to ischial spines of pelvis; measured in cm above (-1 to -5), at (0 station), or below (+1 to +4 station) the ischial spines |
|
|
Term
| Gynecoid Pelvis characteristics |
|
Definition
- 50% incidence
- Inlet: round, adequate diameters
- Midpelvis: round, adequate diameters
- Outlet: wide transverse, long anterior-posterior diameters
- Implications for birth: occiput anterior most common, NSVD favorable
|
|
|
Term
| Android Pelvis Characteristics |
|
Definition
- 20% incidence
- Inlet: heart-shaped, angulated
- Midpelvis: short anterior-posterior diameter
- Outlet: short anterior-posterior diameter
- Implications for birth: slow descent, arrest of labor, operative birth more common
|
|
|
Term
| Anthropoid Pelvis characteristics |
|
Definition
- 25% incidence
- Inlet: ovoid, long anterior-posterior diameter
- Midpelvis: rounded, adequate diameters
- Outlet: narrow transverse
- Implications for birth: occiput anterior or posterior NSVD favorable
|
|
|
Term
| Platypelloid Pelvis characteristics |
|
Definition
- 5% incidence
- Inlet: ovoid, wide transverse diameter
- Midpelvis: rounded, wide transverse diameter
- Outlet: wide transverse, short anterior-posterior diameter
- Implications for birth: occiput posterior more common, NSVD not favorable
|
|
|
Term
|
Definition
| primary and secondary forces of labor |
|
|
Term
|
Definition
| involuntary contractions of uterine muscle fibers, which are stimulated by a pacemaker located in upper uterine segment |
|
|
Term
|
Definition
| building-up phase of contraction |
|
|
Term
|
Definition
|
|
Term
|
Definition
| letting-up phase of contraction |
|
|
Term
|
Definition
| resting phase of contraction; facilitates uteroplacental-fetal reoxygentation |
|
|
Term
|
Definition
| the time in seconds or minutes from onset of one contraction to onset of next |
|
|
Term
|
Definition
| strength of contraction at acme, which can be palpated as mild, moderate, or strong; detected with fetal monitor externally; or measured internally in mm Hg |
|
|
Term
|
Definition
| length of contraction measured in seconds form beginning of increment to end of decrement |
|
|
Term
|
Definition
- the thinning and drawing up of internal os and cervical canal into uterine side walls
- muscles of upper uterine segment shorten and exert longitudinal traction on cervix
- measured from 0-100%
- effacement precedes dilatation in primigravidas
- effacement and dilatation occur simultaneously in multigravidas
|
|
|
Term
|
Definition
- as uterus elongates with contractions, fetal body straightens and exerts pressure against lower uterine segment and cervix; opening of cervix
- measured from 0-10 cm
- allows for birth of fetus
|
|
|
Term
| Secondary forces of power |
|
Definition
| consists of voluntary use of abdominal muscles during second stage of labor to facilitate descent and delivery of fetus |
|
|
Term
| Psyche component of childbearing |
|
Definition
- excitement
- fear
- perceived loss of control
- anxiety
- increased V/S
- pain from muscular tension associated with extreme emotions
|
|
|
Term
|
Definition
| involves only the epidermal layers; if no bleeding, may not need repair |
|
|
Term
|
Definition
| epidermal and muscle/fascia involvement, which requires suturing |
|
|
Term
|
Definition
| extends into the rectal sphincter |
|
|
Term
|
Definition
| extends through the rectal mucosa |
|
|
Term
|
Definition
- color (blue, pale = 0; blue extremities, pink body = 1 pt; completely pink = 2pts)
- Pulse (absent = 0; <100 = 1 pt; >100 = 2 pts)
- Reflex irritability (reflex); (absent = 0 pt; grimace = 1 pt; vigorous cry = 2 pts)
- Muscle Tone (activity); (absent = 0; some flexion of extremities = 1 pt; active motion = 2 pts)
- Respiratory effort; (absent = 0; slow, irregular = 1 pt; good cry = 2 pts)
|
|
|
Term
| Cardinal movements (mnemonic phrase) |
|
Definition
- Every: engagement
- Darn: descent
- Fool: flexion
- In Rotterdam: internal rotation
- Eats: extension
- Rotten: restitution
- Egg Rolls: external rotation
- Everyday: expulsion
|
|
|
Term
|
Definition
| extends from onset of true labor to complete dilatation of cervix (0-10 cm) and is divided inot 3 phases: latent, active, and transition |
|
|
Term
|
Definition
- 0-3 cm dilated, little descent occurs
- contractions usually begin irregularly and become more regular, with increasing frequency, duration, and intensity (mild to moderate)
- client is usually relieved labor has started
- average duration is 8.6hrs for nulliparas and 5.3hours for multiparas
|
|
|
Term
|
Definition
- 4-7 cm dilated, effacement and descent are progressive
- contractions usually every 2-3 min, 60 sec in duration, and moderate to strong intensity
- client usually serious, intense, and needs increase concentration
- average duration is 4.6hrs for nulliparas and 2.4hrs for multiparas
|
|
|
Term
| Transition stage of labor |
|
Definition
- 8-10 cm dilated, effacement is completed, and descent increases
- contractions every 1 1/2-2 min, lasting 60-90 sec, strong intensity
- client working hard with intense concentration
- average duration is 3.6 hrs for nulliparas and 30 min for mulitparas
|
|
|
Term
| nursing assessment during latent phase |
|
Definition
- V/S q1hr if normal
- temperature q4h if normal or membranes intact; q2h if abnormal or membranes ruptured
- monitor contractions q3omin
- FHR q1hr for low-risk women or q30min if high-risk women or nonreassuring pattern
|
|
|
Term
| nursing assessments for active phase |
|
Definition
- V/S same as latent phase
- FHR q30min for low-risk women or q15min for high-risk women or nonreassuring pattern
- look for blood show
|
|
|
Term
| Nursing assessments for transition phase |
|
Definition
- V/S q30min
- temp same as latent phase
- contractions q15min
- FHR q15min
|
|
|
Term
| laboring client should be encouraged to void q__hrs |
|
Definition
|
|
Term
|
Definition
| extends from complete dilatation of cervix to delivery of fetus; accompanied by involuntary efforts to expel fetus characterized by low-pitched, guttural, grunting sounds; normal duration is up to 3hrs for nulliparas and up to 30 min for multiparas |
|
|
Term
|
Definition
| adaptations that fetus undertakes to maneuver through pelvis during labor and birth |
|
|
Term
|
Definition
|
|
Term
|
Definition
| outward bulging and thinning of perineum and opening of vagina that occurs as fetal presenting part presses downward onto perineum and becomes visible prior to delivery; this process is slower in nulliparous client than mulitparous |
|
|
Term
| Nursing assessment during second stage |
|
Definition
- V/S q5-15min
- contractions palpated continuously
- FHR q15min if low risk, q5min if high risk, and if nonreassuring pattern, monitor continuously
- monitor fetal descent, cardinal fetal movements. and crowning
|
|
|
Term
|
Definition
| a surgical incision into perineium to enlarge vaginal opening; usually done during or just prior to crowning; medically indicated in presence of fetal distress, but often performed to prevent tearing of perineal tissues bc lacerations have irregular edges and are more difficult to repair |
|
|
Term
|
Definition
| 1 to 3 cm incision straight back from vagina toward rectum |
|
|
Term
|
Definition
| 4 to 5 cm incision from vagina toward rectum |
|
|
Term
|
Definition
| extends from birth of NB to delivery of placenta; average duration is 30min for nulliparas and multiparas |
|
|
Term
|
Definition
| includes first 1-4hrs after delivery; actually part of postpartal period |
|
|
Term
| Assessments during forth stage of labor |
|
Definition
- V/S
- fundus
- lochia
- perineum
- usually q15 min for 1hr, q30min for 2 hrs; q60min for 1r
|
|
|
Term
| Maternal assessments during 3rd stage of labor |
|
Definition
- V/S q5min
- uterine fundus
- monitor for signs of placental separation
|
|
|
Term
| How does uterine fundus maintain tone and contraction pattern to deliver placenta? |
|
Definition
| By decreasing surface volume of uterus and shearing placenta from uterine wall |
|
|
Term
| Signs of placental separation |
|
Definition
- utuerus rises up in abdomen
- uterine volume shrinks as a result of contractions creating a gush of blood vaginally as uterine contents are expelled
- umbilical cord protrudes further from vagina and appears to lengthen
|
|
|
Term
|
Definition
| need for minimal intervention (nasopharyngeal suction and oxgyen near face) |
|
|
Term
|
Definition
| indicate need for oropharyngeal suctioning, tactile stimulation, and oxygen administration |
|
|
Term
|
Definition
| indicate need for resuscitation |
|
|
Term
|
Definition
- Resp: 30-60, may be irregular
- Apical pulse: 120-160, may be irregular
- Temp: skin temp above 97.8F (36.5C)
- umbilical cord: 2 arteries, 1 vien
|
|
|
Term
| estimated delivery blood loss |
|
Definition
|
|
