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