o Bishop score Score Dilation cm Effacement Station Consistency Position of

O bishop score score dilation cm effacement station

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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
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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
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