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OB Exam 2 Already Graded A+
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OB Exam 2 Already Graded A+ Stages of Labor 1st Stage: Dilation and Effacement of the Cervix - Latent Phase (0-4 cm dilation): - Longest phase of labor. - Contractions are mild to palpation and feel like menstrual cramps. - Active Phase (5-7 cm dilation): - Women may become more focused and exp...

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  • August 20, 2024
  • 17
  • 2024/2025
  • Exam (elaborations)
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OB Exam 2 Already Graded A+
Stages of Labor



1st Stage: Dilation and Effacement of the Cervix

- Latent Phase (0-4 cm dilation):

- Longest phase of labor.

- Contractions are mild to palpation and feel like menstrual cramps.



- Active Phase (5-7 cm dilation):

- Women may become more focused and experience increased anxiety or restlessness.

- Contractions become more regular and painful.



- Transition Phase (8-10 cm dilation):

- Strong contractions that are closer together.

- Women may feel out of control, irritable, or dependent.

- This is the shortest phase of labor.



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2nd Stage: Pushing

- Definition: Begins with complete dilation of the cervix and ends with the birth of the baby.

- Duration: May last from 20 minutes to 2 hours.

- Fetal Descent Stages:

1. Engagement: Fetal head at the level of ischial spines.

2. Descent: Fetal head moves past the ischial spines.

3. Flexion: Fetal chin touches chest in response to pressure from maternal tissue.

4. Extension: Fetal chin comes off the chest; neck arches as the head is born.

5. External rotation: Fetal head rotates as shoulders move into position for delivery.

, 6. Expulsion: Birth of the fetal body.



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3rd Stage: Delivery of the Placenta

- Definition: Begins with the birth of the baby and ends with the delivery of the placenta.

- Duration: Typically complete within 5-30 minutes.

- Concern: Failure to contract may lead to uterine atony, a primary cause of postpartum hemorrhage.



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4th Stage: Recovery

- Definition: Begins with the delivery of the placenta and lasts for about 4 hours or until the mother is
clinically stable.

- Nursing Assessment:

- Assess uterine position, vaginal bleeding (lochia), and vital signs.

- Administer pain medication as needed.

- Assist the patient with skin-to-skin contact and initiating breastfeeding.



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Fetal Heart Rate (FHR) Monitoring



- Purpose: To assess FHR patterns indicative of fetal compromise.

- Abnormal patterns can indicate hypoxemia and lead to hypoxia.



- Monitoring Techniques:

- Intermittent Monitoring: FHR assessed every 15-30 minutes during the active phase; every 5-15
minutes during the second stage.

, - Continuous Monitoring: Evaluated every 30 minutes for low-risk women in the first stage; every 15
minutes for the second stage. Higher frequency for high-risk women.



- Characteristics:

- Baseline heart rate normally between 110-160 bpm.

- Variability: Reflects the normal fluctuations in FHR.

- Moderate Variability: 6-25 bpm (desirable).

- Absent Variability: 0-2 bpm.

- Minimal Variability: 2-6 bpm.

- Marked Variability: >25 bpm.



- Accelerations: Increase of at least 15 bpm lasting at least 15 seconds.

- Decelerations: Decreases from baseline; categorized as:

- Late Decelerations: Due to poor placental perfusion.

- Variable Decelerations: Due to cord compression.

- Early Decelerations: Benign, due to head compression.

- Prolonged Decelerations: Lasting 2-5 minutes.



Interventions for Decelerations

- Change maternal position.

- Discontinue oxytocin infusion if in use.

- Administer oxygen (8-10 L via non-rebreather mask).

- Correct any present hypotension.

- Notify the provider of significant changes.



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FHR Categories

- Category 1: Good (HR 110-160, moderate variability, no late or variable decelerations).

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