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oBishop score:ScoreDilation (cm)EffacementStationConsistencyPosition of Cervix0Closed0-30-3FirmPosterior11-240-50-2MediumMidposition23-460-70-1, 0SoftAnterior3≥ 5≥ 80+1, +2----Determination of Fetal Position and Presentation/(Table 23-4)=2 TQ•Inspection of woman’s abd- look for size and if the baby is positioned up or down•Palpation—Leopold’s maneuvers•Vaginal exam—determine presenting part•U/S- assess fetal lie, presentation and position, as well as biparametal diameter, geststional age, placement of placenta,Leopold’s Maneuvers•1stmaneuver: facing woman, palpate upper abdomen w/both hands. oNurse determines shape, size, consistency, & mobility of the form that is found. oHead is firm, hard, & round & moves independently of trunk. oBreech feels softer & symmetric & has small bony prominences; it moves w/the trunk•2ndmaneuver: nurse tries to determine location of fetal backoStill facing woman, nurse palpates abdomen w/deep but gentle pressure, using the palmsoFetal back should feel firm & smooth & should connect what was found in the fundus w/a mass in the inletoOnce back if found, nurse validates findings by palpating the fetal extremities on opposite side of the abdomen•3rdmaneuver: determines what fetal part is lying above inletoGently grasp the lower portion of the abdomen just above the symphysis pubis with the thumb & fingers of the right handoManeuver yields the opposite information form what was found in the fundus & validates the presenting part•4thmaneuver: faces the woman’s feet & attempts to locate the cephalic prominence or browoFingers of both hands are moved gently down the sides of the uterus toward the pubis
oCephalic prominence (brow) is located on the side where there is the greatest resistance to the descent of the fingers toward the pubis. It is located on the opposite side from the fetal back if the head is will flexed. However, when the fetal head is extended, brow is located on the same side as the backFHR Patterns (Fetal Heart Rate Changes) =3 TQAuscultation•Direct auditory monitoring & interpretations of FHR in utero•Fetoscope or ultrasound Doppler used to listen to & count FHR•Listen for 30-60 seconds•FHR heard most clearly at fetal back (Leopold’s maneuver)•Listen before, during, & just after UC to detect FHR decelerations•Frequency of auscultation assessment and documentation:oLow Risk Patients: 1ststage of labor: q. 30 min and 2ndstage of labor: q. 15 minoHigh Risk Patients: 1ststage of labor: q. 15 min and 2ndstage of labor: q. 5 minoAssess FHR before:Initiation of labor-enhancing procedures (i.e. AROM)Periods of ambulationAdministration of medicationsAdministration or initiation of analgesia/anesthesiaoAssess FHR following:Rupture of membranesRecognition of abnormal uterine activityEvaluation of oxytocin (maintenance, increase, or decrease of dosage)Administration of medicationsExpulsion of enemaUrinary catheterizationVaginal examination