Maternal & Fetal Assessment During Labor

- Maternal Assessment: take a thorough history

            - lab tests: Rh Status - if necessary mom will get Rhogam at 28 weeks; Rubella Titer - if mom not immune she is immunized (with MMR) right after birth & she is not allowed to be near anyway w/Rubella during pregnancy; AFP can be a urine test; all screening tests are ONLY screening tests and abnormal results mean more testing is needed; serology is done for STD testing & mom can be treated if possible

            - subsequent visits: 20 wk fundal height umbilicus is benchmark, watch closely for IUGR, if mom’s systolic BP is 30 above normal or diastolic is 15 above normal, check for PIH

            - during progressive true labor contractions get longer as the time between them gets shorter; in the hospital mom is given milliunits of oxytocin before birth and after birth given whole units to induce introversion (Pitocin, Oxytocin, Methergine, Hemabate, and there is a pitocin nasal spray)

- External Fetal heart monitoring: FHR best heard through the babies back d/t bone conducting sound better,

            - non-stress tests are done w/any mom who has chronic health problems or multiple fetuses & the purpose is to check the placenta’s ability to supply O2 when the baby needs it after movement or trauma

- Internal Fetal heart monitoring: done w/scalp monitor, only during active labor once mom is 4-7cm dilated

- FHR characteristics: Tachycardia (over 160) maybe d/t maternal fever, chorioamniotis, infection in fetus, turbutaline, magnesium sulfate (tocolytics) given to control preterm labor; Bradycardia (below 110) Down syndrome, CNS problems, mom’s using street drugs

            - you always want to see short and long term variability

            - long term variability shows responses to movement, short term shows beat to beat changes in HR

            - if only seeing short term variability baby may be asleep

            - paying attention to variability shows us whether or not baby can handle trauma of birth of if C/S delivery is necessary

            - variability is minimal in a mom w/anemia

- Changes: Periodic: during a contraction

            - Non-periodic or Episodic: not during contraction, usually related to fetal movement, show healthy CNS

- Decelerations:

            - early: head compression, during contraction, usually innocuous as long as FHR comes back up after contraction; this is normal during pushing

            - Variable: maybe tight nuchal cord, baby holding cord, knot in cord, not usually related to contractions, must be watched closely, may need C/S delivery

            - Late: uteroplacental insufficiency: ALWAYS DANGEROUS, FHR still decreased at end of contraction, baby is not recovering from contraction, might need C/S

                        - nursing actions: mom on her (right) side, increase O2, turn up Lactated Ringers IV, turn off Pit, call Dr.

- Amnioinfusion: used to thin (dilute) meconium in utero, (meconium can cause late decels), only needed for severe decels; Lactated Ringers via IUPC