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by: Christie Kepler
Christie Kepler
GPA 3.39

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Childbearing, these notes review the physiologic factors that occur prior to childbirth
Childbearing 3200
Professor Stark
Study Guide
Nursing 3200 Childbearing
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This 20 page Study Guide was uploaded by Christie Kepler on Sunday February 14, 2016. The Study Guide belongs to NURS 3200 at Western Michigan University taught by Professor Stark in Fall 2015. Since its upload, it has received 25 views. For similar materials see Childbearing 3200 in Nursing and Health Sciences at Western Michigan University.


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Date Created: 02/14/16
OB Exam #1 Antepartum Menstruation: periodic uterine bleeding that begins approximately 14 days after ovulation.  28 day cycle  Controlled by the feedback system of three cycles: o Hypothalamic-pituitary o Ovarian o Endometrial  Average loss of blood 50 mL Hypothalamic-pituitary: Toward the end of the normal menstrual cycle, blood levels of estrogen and progesterone decrease.  Stimulate the hypothalamus to secrete gonadotropin-hormone GnRH. o Stimulates FSH  Stimulates ovarian follicles and their production of estrogen.  Estrogen decreases triggering GnRH  Triggers LH  Before ovulation from 1-30 follicles begin to mature in each ovary under the influence of FSH and estrogen. Ovarian Cycle: The oocyte matures, ovulation occurs, and the empty follicle begins its transformation to the corpus luteum.  After ovulation, estrogen levels decrease.  90% of women a small amount of bleeding occurs.  The corpus luteum reaches its peak of functional activity 8 days after ovulation, secreting the steroid estrogen and progesterone.  Implantation of the fertilized ovum beings about 7-10 days after ovulation  Before ovulation basal temperature is less than 37degrees  Increase in mucus and basal temperature 24-48 hours after Implantation: 6-10 days after conception the trophoblast secretes enzymes that enable it to burrow into the endometrium. When the blastocyst is covered, this is implantation  Chorionic Villi develop out of the trophoblast and extend into the blood-filled spaces of the endometrium.  When burrowing occurs HCG is secreted.  Human Chorionic Gonadotropin Hormone is produced by the Chorion.  HCG is (+) pregnancy test  HCG maintains the corpus luteum. o Corpus luteum _ where the follicle was omitted secretes progesterone.  Reaches peak 8 days after ovulation secreting estrogen and progesterone. Amniotic Fluid: Amniotic Fluid is produced by the amnion.  Helps to maintain constant body temperature  Maintenance of fluid and electrolyte homeostasis  Cushions fetus from traumas  Creates a barrier to infection and allows fetal lung development  Keeps the embryo from tangling with the membranes, facilitating symmetric growth Placenta: Forms at implantation and during the third week after conception.  Placental function depends on the maternal blood pressure.  Waste products and carbon dioxide diffuse into the maternal blood.  Many viruses can cross the placental membrane and infect the fetus. Some bacteria and protozoa first infect the placenta and then infect the fetus.  12 weeks starts functioning  The placenta starts producing HCG to preserve the function of the corpus luteum o Ensuring the continuing supply of estrogen and progesterone.  Progesterone maintains the endometrium, decreases the contractility of the uterus and stimulates maternal metabolism and the development of breast alveoli.  Metabolic function: o Respiration o Nutrition o Excretion o Storage  Carbohydrates  Proteins  Calcium  Iron  Vasoconstriction caused by hypertension and cocaine use, diminishes uterine blood flow.  Braxton-Hicks contractions appear to enhance the movement of blood and aid in placenta circulation. Gravidity: Pregnancies Parity: the # of pregnancies in which fetus or fetuses have reached 20 weeks of gestation, whether they are born or not. Preterm: A pregnancy that has reached 20 weeks of gestation but ends before completion of 37 weeks Term: A pregnancy from the completion of 37 weeks of gestation to the end of week 42 of gestation. Pregnancy Tests: Can be tested as early as 7-10 days after conception Signs of Pregnancy: Subjective:  Amenorrhea  N/V  Fatigue  Urinary Frequency  Breast enlargement and tenderness  Quickening- fetal movement, hard to distinguish from peristalsis  Slight increase in basal temperature Objective:  Increased blood flow  Braxton Hicks Contractions  Elevated Basal body Temperature  Enlarged uterus, breasts, and vagina  Enlarged abdomen  Uterine Suffle- Soft blowing sound during auscultation  Pigment changes- Orangish freckles, Striae gravidarum, deeper pigmentation of areolae, cholasma, linea nigra.  (+)pregnancy test-urine or serum = HCG. Diagnostic  Fetal Heart rate  Fetal movement  Ultrasound finding Anatomic & Physical Changes Uterus  Increases in size and capacity o thinner and longer  Hypertrophy- of the round ligaments keeps the uterus midline  1-6 of maternal blood supply  Braxton-Hicks – After 4 months, irregular and painless throughout pregnancy  Funic Suffle- Sound made by blood rushing through the umbilical vessels and synchronous with the fetal heart rate  Growing Uterus: o Above the Symphysis – 12-14 weeks o Level of Umbilicus- 22-24 weeks o Xiphoid Process- At Term (36-40 weeks) Cervix & Vagina  Goodell Sign- Softening of the cervical tip, at six weeks.  Vagina: o Vaginal mucosa thicken o Connective tissue loosens o Smooth muscle hypertrophy’s o Vaginal vault lengthens o Chadwick Sign- Increased vascularity cause a violet –bluish mucosa and th cervix(6 wk) o Leukorrhea- white or slight gray mucosa due to response of cervical stimulation of estrogen and progesterone. o Mucus Plug- Mucus fills the endocervical canal, resulting in formation o pH secretions are more acidic- 3.5-6, due to increased lactic acid production o Increased risk of yeast infection o Increased vascularity:  High interest of sex during second trimester o External Structures:  Enlarged  Increased in vasculature  Hypertrophy of perineal body  Deposition of fat Breasts  Fullness, heightened sensitivity, tingling, and heaviness o Increased estrogen and progesterone  Nipples and areolae o Become more pigmented o More erect  Montgomery Tubules o Hypertrophy of (oil) glands embedded in primary areolae, around nipples  Increased blood supply o Venous congestion o Striae gravidarum  Mammary Glands – increase 2 and 3 trimester o Breast enlargement  Proliferation of lactiferous ducts and lobule-alveolar tissue o Generalized, coarse nodularity  Softer and looser o Glandular Tissue displaces connective tissue  Colostrum o Creamy white-to-yellowish-to-orange pre-milk fluid  16 weeks gestation Preparing for Breastfeeding:  Chemo Drugs/HIV (+)- No lactation  Education o Preemie’s lack suck and swallow  Cleanse with H2O & air drying is good. No soap is necessary due to antibacterial on nipples Cardiovascular  Cardiac Hypertrophy o Increased blood volume o Increased Cardiac output  Audible splitting of S1 , S2, and S3 can be heard at 20 weeks  Pulse increases 10-15 beats/min  Blood pressure: o Anxiety can elevate readings o Systolic remains the same o Diastolic decreases in 1 trimester o Supine-Hypotension Syndrome  Compression of iliac veins and inferior vena cava by the uterus  Increased venous pressure and reduced blood flow in the legs o Dependent edema o Varicose veins in legs o Hemorrhoids develop later in pregnancy o Blood Volume Increases – 40-50 % o Accelerated production of RBC’s o Plasma increase exceeds the increase in RBC production  Decrease in Hgb values (12-16 g/dL, normal lvls)  Decrease in Hct values (37-47 %, normal lvls) o Total WBC increases  Second Trimester  Peaks at Third Trimester o Cardiac Output  Increases 30-50 %  Caused by: o Increase in stroke volume o Increase in Heart Rate o Increase demands for oxygen o Circulation time  Decreases by week 32  Greater tendency for clotting Respiratory  Maternal Oxygen requirements increase o Increased BMR o Increased tissue mass in uterus & Breasts o Fetus requirements  Increased 02 consumption  Increased CO2 production o Diaphragm Elevated  Thoracic breathing o Increased Chest expansion  Increased estrogen  Increased vascularity o Swelling of tympanic membranes and Eustachian tubes  Impaired hearing  Earaches  Sense of fullness in the ears o Chest Congestion  Nasal and sinus stiffness  Epistaxis (nose bleeds)  Changes in Voice  Inflammatory Response o Increased Basal Metabolic Rate  Increased O2  Peripheral Vasodilation  Acceleration of sweat glands  Heat intolerance o Acid-base balance  Pco2 decreases  Base excess decreases  pH increases slightly  Constant State  Compensatory Respiratory alkalosis o Facilitates the transport of CO2 from fetus o O2 release from Mom to fetus Renal System  Renal Pelvis and ureters dilate  Ureters undergo Hyperplasia, hypertrophy, and muscle tone relaxation  Ureters elongate o Larger volume if urine is held in pelvis and ureters, urine rate is slowed  Lag occurs- between formation and the reaching the bladder  Stagnated Urine occurs- causing bacterial growth  Urinary Frequency o Bladder tone decreases o Bladder capacity increases  Compressed by growing uterus  GFR & RPF increase o Function is most proficient in lateral recumbent position o Least in supine position  Fluid and electrolyte balance o 500- 900 mEq of NA normally retained meeting fetal needs o Polydipsia o Edema- Triggered lying down o Glucose impairments o Proteinuria occurs during labor or after birth Integumentary System  Hyperpigmentation- o Melanotropin, darkening of the nipples, areola, the axillae, and the vulva  Chloasma- mask of pregnancy o Blotchy brown, hyperpigmentation of the skin over the cheeks, nose, and forehead.  Linea Nigra- pigmentation extending from the pubic symphysis pubis to the top of the fundus  Striae gravidarum- stretch marks  Vascular spiders- Angiomas, star-shaped arterioles  Spider Nevi- Spider Veins  Palmar erythema- Pinkish-red, blotches over the hands.  Epulis- Gum Hypertrophy  Increased perspiration- due to increased blood supply Musculoskeletal  Pelvis tilts forward  Decreased abdominal muscle tone  Increased weight bearing, realignment of the spinal curvature late in pregnancy  Center of gravity shifts forward  Increased lordosis  Middle and lower spine become severely stressed, musculoskeletal discomfort.  Slight relaxation and increased mobility of pelvic joints o Separation of symphysis pubis and instability of the sacroiliac joints Gastrointestinal System  Appetite o Nausea/Vomiting  Increased levels of HCG o Changes in sense of taste  Pica- non food cravings o Altered carbohydrate metabolism  Mouth o Gums  Hyperemic, spongy, and swollen- increased level of estrogen o Ptyalism- increased salivation  Esophagus, Stomach, and Intestines o Herniation of the upper portion of the stomach o Peptic Ulcers  Increased estrogen production  Decreased secretion of hydrochloric acid o Pyrosis (heartburn)  Increased progesterone o Iron absorption increased o Constipation  Increased progesterone o Hemorrhoids  Gallbladder and Liver o Increased gallstones  Increased emptying time and thickening of bile  Abdominal Discomfort o Intra-abdominal Alterations  Flatulence  Distention  Bowel cramping  Uterine Contractions Endocrine System  Elevated Levels of Estrogen and progesterone o Cause fat deposits o Estrogen  Increases blood volume  Decrease secretion of hydrochloric and pepsin  Relaxin o Relaxation of pelvic joints  Oxytocin o Increases as fetus matures o Stimulates milk let-down  HCG o Decreases maternal metabolism of glucose and increases amount of fatty acids  Blood Glucose decrease o Fetus requires significant amounts of glucose Nutrition Before Pregnancy:  Consume 0.4 mg (400mcg) of folic acid  Weight should be normal for height During Pregnancy  25-35 # weight gain  Protein o Necessary for production and support of fetal growth  Fluids o 2.3/L a day o 12 oz (coffee)& (200mg) caffeine cause miscarriages  Minerals and Vitamins o Micronutrient Supplement o Iron  Physiologic Anemia- Excess of plasma causes a modest decrease in the hgb concentration and hct  30 mg of ferrous Iron daily o Calcium  1000 mg daily  Sufficient calcium for fetal bone and tooth development o Magnesium  Dairy products, nuts, whole grains, and green leafy vegetables o Sodium  Body water is expanding- necessary for body water balance. o Potassium  Reduced risk of hypertension o Zinc  Associated with malformations of CNS system of infants  Fat Soluble Vitamins o Vitamins A, D, E, and K  Water soluble Vitamins o Folic Acid  Consume 50 % more o B6 involved in protein metabolism o Vitamin C  Tissue formation and enhances absorption of iron Pica- Consuming non-food substances Nutrients during Lactation  Need for vitamins are still high in comparison to non-pregnant women.  Important calcium intake  Caffeine can reduce iron concentrations in milk and develop anemia in infant Prenatal Nursing Care Testing to identify Risk Factors  History- o Previous Surgeries o Allergies o Chronic or handicapped conditions o Nutritional o Family History  Physical o Urine Specimen  Protein  Glucose  Leukocytes o Height of Fundus o Blood Test  Genetic conditions  Early Detection of problems o Weight loss o Weight gain o Medical Problems  Gestational diabetes  Gestational Hypertension  Bleeding Health Promotion  Nutrition  Hygiene o High sweating  Prevention of UTI  Kegals  Prep for breastfeeding  Dental care o Preterm, LBW, and preeclampsia  Physical activity o For weight bearing Physicians  90 % of births  Pharmacologic and medical management Nurse-Midwives  8 % of births  Noninterventionist, encourage active participation Direct-entry Midwives  1% of births  Home-setting Doulas  Trained to provide labor support  Physical, emotional, and informational support Prenatal Care Schedule  Begin First Trimstter nd  Every 4 wks for 1 and 2 trimester  Every 2 weeks until 36wk  Every week 36-40 weeks Centering- authority is shifted from provider to the other woman and other women who have similar due dates. Promotes  Learning  Mutual support  Encourage discussion Discomforts during Pregnancy- PG 354 Naegle’s Rule  First day of LMP, subtract 3 months and add 7 days  Add 7 days to LMP and count 9 months. Feelings on Pregnancy Ambivalence_ mixed feelings or contradictory ideas about something or someone Relationship with Fetus  Three phases o Accepts the pregnancy o Accepts the growing fetus as distinct from herself o Attachment – woman prepares for birth and parenting Accepting Pregnancy Announcement Phase- Accepting pregnancy Moratorium – father adjusts to pregnancy Focusing- Active role in relationship of child, father thinks of himself as a father Mother – Mother relationship  Mother availability (past and present)  Her reactions to daughters pregnancy  Respect for daughter’s autonomy  Willingness to reminisce Mother – Baby father Two major needs: o Feeling loved and valued o Having the child accepted by the partner Couvade Syndrome- pregnancy like symptoms, such as nausea, weight gain, and other physical symptoms Sibling Adaptation A sense of loss or feels jealous Factors:  The Parents attitudes  The role of father  Length of separation from mother Developmental Stages:  1 y.o. – unaware  2 y.o. – notices changes  3-4 y.o. – like to be told stories of their upbringing  School age- more clinical interest  Early and Middle Adolescents- preoccupied with establishing sexual identity  Late Adolescents – undisturbed Five P’s:  Passenger (fetus and placenta) o Interacting Factors:  Size of fetal head  Fontanels- Membrane-filled spaces located where the sutures intersect  The Anterior fontanel is the larger of the fontanels o Closes at 18 months after birth  Posterior fontanel – sits at the two parietal bones and the occipital bone o Closes at 6-8 weeks after birth  Molding- overlapping of the bones during labor o Head assumes normal shape 3 days after birth  Fetal Presentation  Refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor. o Cephalic -96 % o Breech- Buttocks, feet or both – 3% o Shoulder – 1%  Presenting part- Part of the fetus that lies closest to the internal os of the cervix. Part of fetal body felt first during vaginal examination.  Vertex- Presenting part, is the occiput  Fetal lie  Know Leopold Maneuvers o Know position where to palpate  Back, head, and butt  Relation of the long axis (spine) of the fetus to the long axis (spine) of the mother.  Fetal Attitude  The relationship of fetal body and extremities to themselves  General Flexion – the arms are crossed over the thorax, and the umbilical cord lies between the arms and the legs  Biparietal Diameter- the largest transverse diameter and most important indicator of fetal head size  Suboccipitobregmatic diameter- the smallest and most critical  Fetal Position – relationship of a reference point on the presenting part to the four quadrants of the mother’s pelvis. o R & L – Right or left side o Middle Letter- Presenting part of the fetus o Final Letter- A (Anterior), P (Posterior), and T (Transverse)  Station- Relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines and is a measure of the degree of descent of the presenting part of the fetus through the birth canal.  Engagement – Indicates the largest transverse diameter of the presenting part has passed through the maternal pelvic brim or inlet into the true pelvis and usually corresponds to Station 0  Passageway o Birth Canal  True & false  Gynecoid- The classic female type of pelvis (50% of all women)  Size  Soft Tissues  Cervix o Effaces (thins) and dilates (open) sufficiently to allow the first fetal portion to descend into the vagina  Pelvic Floor Muscles o Muscular layer that separates the pelvic cavity above from the perineal space below  Powers o Primary Powers  Involuntary Uterine Contractions- Signaling the beginning of labor.  Frequency- from beginning to beginning  Duration- How long? (1-2 min)  Intensity- Strength at peak  RESULTS IN: o Effacement – The cervix thins and shortens o Dilation- Enlargement or Widening of the cervical opening and the cervical canal that occurs once labor has begun (1 cm-10 cm) o Full Dilation marks the end of the first stage of labor. o Ferguson Reflex – when the presenting part of the fetus reaches the perineal floor. Stretch receptors in the posterior vagina cause release of endogenous oxytocin that triggers the maternal “urge to bear down” o Labor down- don’t push till you feel you need to o Urge to poop- pressure of the baby on the rectum o Open Glottis- calm breath helps quicken labor (blow out) o PUSH DON’T BEAR DOWN o Secondary Powers  Voluntary bearing-down efforts  Expulsion of the fetus as she contracts her diaphragm and abdominal muscles and pushes.  Has no effect on cervical dilation  Pushing is more effective in the second stage and the woman is less fatigued when she begins.  Vansalva Maneuver- Closed glottis and bearing down  Position of Mother o Upright – (walking, sitting, kneeling, or squatting)  # of advantages  Gravity promotes decent  Uterine contractions are stronger and more efficient in effacing and dilating the cervix- shorter labor  Beneficial to cardiac output- Pressure on maternal vessels is reduced. o Movement  Helps funneling of the baby to the pelvic inlet o Frequent Position changes  “All fours” may be used to relieve backache if fetus is in the occipitoposterior position  Lithotomy- Standard position in US –SUPINE  Semirecumbent- Effective body support to push effectively  Sitting and squatting – abdominal muscles work in greater synchrony with uterine contractions  Kneeling or squatting – moves the uterus forward and aligns the fetus with the pelvic inlet, increasing pelvic outlet  Lateral- Helps rotate babies in the posterior position  Psychological Response o Concerns and Anxiety  Stress lengthens labor and decreases Apgar Score  Post-partum depression increases , if had pre-partum depression o Support o Culture o Calm birth environment  Light music, who’s there, keep calm voices Assessment  Palpation o Fundus  Electronic Fetal Monitoring  Maternal Report o Fetal- Ask mother how she feels Process of Labor Signs Preceding Labor  “Lightening”- Dropping o Less congestion and can breathe more easily  Back pain o Sacroiliac distress- relaxation of joints  Mucus Plus o Obstructs the cervical canal, passes  Bloody Show o Brownish or blood-tinged cervical mucus, passes  Weight loss o 0.5-1.5 kg, water loss  Burst of Energy o Often clean the house and put things in order False Labor- Braxton Hicks Syndrome Stops with change in position or activity Stages of Labor First Stage  Onset of regular uterine contractions to full effacement and dilation of the cervix o Latent phase:  Effacement of the cervix and little increase in decent o Active & Transition phase:  More rapid dilation of the cervix and increased rate of descent of the presenting part Second Stage  Cervix is fully effaced and dilated to the birth of the fetus o Latent phase  Fetus continues to descend passively through the birth canal and rotate to anterior position as a part of ongoing uterine contractions o Active pushing phase  Woman has strong urges to bear down. Presenting part of fetus descends and presses on the stress receptors of the pelvic floor. Third Stage  From birth of the fetus until the placenta is delivered o The placenta normally separates with the third and fourth strong uterine contractions o Placenta is expelled 10-15 minutes after the birth of the baby Fourth Stage  Lasts 1-2 hours after delivery of the placenta o Immediate recovery and homeostasis is reestablished o OBSERVE FOR COMPLICATIONS Mechanisms of Labor  Engagement o The head passes the pelvic inlet, the head is said to be engaged in the pelvic inlet  Descent o Progress of the presenting part through the pelvis  Depends on Four Forces:  Pressure exerted by the amniotic fluid  Pressure from the contracting fundus on the fetus  Contraction of diaphragm and abdominal muscles  Extension and straightening of the fetal body  Flexion o Descending head meets resistance from the cervix, pelvic wall, or pelvic floor o Chin is brought closer contact with the fetal chest  Internal Rotation o Fetal head passes the inlet into the true pelvis in the occipitotransverse position  Extension o The head reaches the perineum for birth  First the occiput  Then face  Finally, chin  External Rotation o Head is born it rotates briefly to the position  Expulsion o Birth of the shoulders, the head and the shoulders are lifted up toward the mother’s pubic bone Factors influencing labor & Birth  Rupture of membranes o Prostaglandins are released in amniotic fluid makes contractions stronger  Elimination o More stooling and voiding (don’t know it )  Oral intake- Fluids o increased  Bowel Elimination  Pushing  Episiotomy o Perineum will stretch on its own o Causes more problems o Most tears are anteriorly Physiologic Adaptations to Labor Cardiovascular  Increased CO  Increased Peripheral Resistance  Increased BP No Supine Positions- Increased Risk of Supine Hypotension Respiratory  Increased respiratory rate  Increased oxygen consumption(double in un-medicated pregnancy) Renal  Increased GFR  Increased Renal flow  Polyuria  Protein uria- Due to physical work of labor  Frequent voiding GI  Decreased GI mobility  Decreased absorption  N/V undigested food after labor  Nausea and Belching after cervix dilation  Diarrhea accompanied labor Immune  Increased WBC  Decreased blood glucose Pain During Labor  Ischemia o Decreased blood flow and local oxygen deficit o Compression of the arteries supplying the myometrium during uterine contraction  Distention o Lower uterine segment. Stretching of cervical tissues as it effaces and dilates, pressure and traction on adjacent structures.  Dilation Factors influencing Pain  Physiologic Factors o Hx of Dysmenorrhea, due to high levels of prostaglandin  Culture o Culture and Religious Belief system that determines how they will perceive, interpret, and respond to and manage the pain.  Anxiety o Increased blood flow and increased muscle tension  Previous Experience o Previous childbirth o Fatigue magnifies pain Gate Control Theory of pain  Helps explain the way hypnosis and the pain relief techniques taught in childbirth preparation classes’ work to relieve the pain of labor.  Comfort  Support  Environment Non-Pharmacologic Pain Management  Child birth Preparation  Relaxation and Breathing techniques  Massage and counter pressure(sacral area with a firm object)  Music  Hydrotherapy o Stimulates the release of endorphins, closes the gate on pain o Active labor at 5 cm  Heat and Cold Pharmacologic Management  Sedatives o Relieve anxiety and induce sleep o Reduce nausea, potentiate narcotic  Barbituates  CNS Depression, contraindicated if birth in 12-24 hours  Phenothiazines  Decrease anxiety  Reglan  Antimimetic  Potentiates Analgesics  Benzodiazapine  Enhance pain relief  Decrease Nausea and vomiting  Analgesia and Anethesia o Anesthesia  Block all sensation o Analgesia  Block some sedation  Systemic (IV vs IM) o Narcotic  Morphine Sulfate o Opioid Agonist  Dilaudid, Demerol, Fentanyl o Agonist Antagonist  Nubain/Stadol  Weak agonist o Opioid Antagonist  Narcan  Reverse CNS Depression  Regional o Pudendal Nerve Block  Second Stage of Labor, Episiotomy o Local Perineal Infiltration  Episiotomy o Epidural  Lumbar puncture through dura mater  Watch VS for two hours  Motor Function Compromised  Needs to be told to push  Urination and Elimination  Potential Effects  Vasodilation & hypotension  Loss of Sensation  Maternal Fever  Neonate Behavior o Decreased blood flow o Tachycardia o Don’t latch in 2 hours  Give IV fluids  Catheter, potential foley o Spinal block  Motor Loss  Hypotension  Stops Contractions  For C-section only ! o General Anesthesia  Risk inability to intubate  Aspiration of gastric contents  Give H2 receptor to decrease gastric acid production  Apply pressure to cricoid to stop Aspiration Fetal Response Oxygen can be decreased in a number of ways:  Reduction of blood flow in the maternal vessels o Maternal Hypertension  Reduction of Oxygen content in Maternal blood o Hemorrhage or severe anemia  Compression of umbilical cord  Reduction in blood flow to the intervillous space in the placenta secondary to uterine hypertonus o Excess Oxytocin Fetal Assessment One hour upon admission, before, during, and after contractions. Intermittent Auscultation Listening to fetal heart sounds at periodic intervals Ultrasound Stethoscopes Transmit high-frequency sound waves reflecting movement of the fetal heart and converting to electronic singal Uterine Contractions Fingers placed over fundus before, during, and after contractions o Duration is measured in Seconds o Frequency is measured in minutes  Baseline Fetal Heart Rate o Average 10 minute segment  Excludes periodic or episodic changes, periods of marked variability, and segments of baseline that differs more than 25 beats/min  Measure at the closest 5- beats/ min  Normal Range is 110-160 beats/min o Variability- irregular waves or fluctuations in the baseline FHR of two cycles per minute or greater.  Push and pull effect of sympathetic and parasympathetic nervous system  Four Categories  Absent- Sleep state, extreme preemie, drugs  Minimal  Moderate  Marked o Tachycardia-160 beats/min for 10 minutes or longer  Fetal hypoxia, fever, anemia, dehydration, infection, and drugs o Bradycardia – 110 beats/ min for 10 minutes or longer  Fetal structural defects, viral infections, maternal hypoglycemia, maternal hypothermia  Heartblock, hypotension, PROLONGED CORD COMPRESSION o Accelerations- Increase in FHR above the baseline. Peak 15 beats/min above the baseline  Associated with fetal movement or spontaneously o Deceleration  Caused by dominance of parasympathetic response  Early Decelerations- gradual decrease in and return to baseline FHR associated with UC’s  Correspond to beginning, peak, and end of a contraction o Caused by transient fetal head compression- normal and begnin  Late Decelerations- begins after contraction has started, and the lowest point of the deceleration occurs AFTER the peak of the contraction o Caused by uteroplacental Insufficiency – indicates fetal hypoxemia, hypotension  Variable Decelerations- Decrease 15 beats/min, lasts 15 seconds, have a U, V, or W shape, rapid decent and ascent to and from nadir. o Caused by umbilical cord compression and stretching during fetal descent Monitoring Contractions  Uterine Contractions 60-90 seconds  Fundus must be touched during contractions- Fundus= soft between UC  Hyperstimulation- if no or brief return to baseline o Bad due to lack of o2, decreased perfusion to the placenta o Caused by Pitocin Interventions Nursing  Change the positions  Discontinue Pitocin  Increase IV fluids  Oxygen by nasal canula Medical  Amnioinfusion- infusion of room-temperature isotonic fluid into the uterine cavity if the volume of the amniotic fluid is low. o Relieve intermittent umbilical cord compression that results in variable deceleration and transient fetal hypoxemia by restoring the amniotic fluid volume to a normal or near-normal level.  Tocolytic Therapy- Control relaxation of the uterus through drugs that inhibit UC’s o For Fetal Stress and increased uterine activity. o Used when position changed and D/C of Oxytocin infusion, given for c-section o Improves Apgar scores and cord pH values without apparent complications


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