1. INTRAPARTAL NURSING ASSESSMENT

2. Maternal Assessment 1. History General health Medications Allergies Obstetrical Labor Birth plan

3. Risk Assessment Bleeding Rom Hospitalizations Preterm labor PIH Diabetes Abnormal presentation

4. Physical Assessment Admission Assessment Labor status Contraction pattern Cervical dilation and effacement Fetal descent Membranes Fetal status laboratory

5. Fetal Assessment Assess fetal position Inspection Palpation: Leopold’s maneuvers Vaginal exam and ultrasound

6. Fetal Heart Rate Tools Fetoscope Doppler EFM External or internal Baseline rate: 120 to 160 Abnormal Fetal Heart Rates Tachycardia: sustained rate of 161 or above Marked: 180 or above Causes Early Hypoxia Maternal Fever Dehydration Drugs Amniotitis Hyperthyroidism Fetal anemia

7. Fetal Bradycardia Rate Less than 120 during a 10 minute period or longer Causes: Late or severe fetal hypoxia Maternal Hypotension Prolonged umbilical cord compression Fetal arrhythmia

8. Variability: Short Term Long – Term Absent decreased Average Increased Marked

9. Decelerations Early Late Variable

10. Non-Reassuring Patterns Severe variable decelerations or FHR drops below 70 for longer than 30 to 45 seconds Late decelerations of any magnitude Absence of variability Prolonged decels that lasts 60-90 seconds or more Severe marked bradycardia of 70 or less

11. Nursing management of Decelerations Turn mom to left side Administer O2 by face mask at 7-10 L Discontinue oxytocin Increase IV fluids Assess labor progress by SVE Notify physician Monitor VS and stay with pt.

12. Scalp Stimulation Fetal scalp blood sampling