o
Bishop score:
Score
Dilation (cm)
Effacement
Station
Consistency
Position of Cervix
0
Closed
0-30
-3
Firm
Posterior
1
1-2
40-50
-2
Medium
Midposition
2
3-4
60-70
-1, 0
Soft
Anterior
3
≥ 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
•
1
st
maneuver:
facing woman, palpate upper abdomen w/both hands.
o
Nurse determines shape, size, consistency, & mobility of the form that is found.
o
Head is firm, hard, & round & moves
independently of trunk.
o
Breech feels softer & symmetric & has small bony prominences;
it moves w/the
trunk
•
2
nd
maneuver: nurse tries to determine location of
fetal back
o
Still facing woman, nurse palpates abdomen w/deep but gentle pressure, using the
palms
o
Fetal back should feel firm & smooth & should connect what was found in the
fundus w/a mass in the inlet
o
Once back if found, nurse validates findings by palpating the fetal extremities on
opposite side of the abdomen
•
3
rd
maneuver:
determines
what fetal part is lying above inlet
o
Gently grasp the lower portion of the abdomen just above the symphysis pubis
with the thumb & fingers of the right hand
o
Maneuver yields the opposite information form what was found in the fundus &
validates the presenting part
•
4
th
maneuver:
faces the woman’s feet & attempts to
locate the cephalic prominence or
brow
o
Fingers of both hands are moved gently down the sides of the uterus toward the
pubis
o
Cephalic 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 back
FHR Patterns (Fetal Heart Rate Changes) =3 TQ
Auscultation
•
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:
o
Low Risk Patients: 1
st
stage of labor:
q. 30 min and 2
nd
stage of labor:
q. 15 min
o
High Risk Patients: 1
st
stage of labor:
q. 15 min and 2
nd
stage of labor:
q. 5 min
o
Assess FHR before:
Initiation of labor-enhancing procedures (i.e. AROM)
Periods of ambulation
Administration of medications
Administration or initiation of analgesia/anesthesia
o
Assess FHR following:
Rupture of membranes
Recognition of abnormal uterine activity
Evaluation of oxytocin (maintenance, increase, or decrease of dosage)
Administration of medications
Expulsion of enema
Urinary catheterization
Vaginal examination
