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:__________________________________________________ Date performed:_____________________ Rating Scale: 3-Very good Description 1. Engagement The widest diameter of the presenting part (with a wellflexed head, where the largest transverse diameter of the fetal occiput is the biparietal diameter) enters the maternal pelvis to a level below the plane of the pelvic inlet. On the pelvic examination, the presenting part is at 0 station, or at the level of the maternal ischial spines. 2. Descent The downward passage of the presenting part through the pelvis. This occurs intermittently with contractions. The rate is greatest during the second stage of labor. 3. Flexion As the fetal vertex descents, it encounters resistance from the bony pelvis or the soft tissues of the pelvic floor, resulting in passive flexion of the fetal occiput. The chin is brought into contact with the fetal thorax, and the presenting diameter changes from occipitofrontal (11.0 cm) to suboccipitobregmatic (9.5 cm) for optimal passage through the pelvis. 4. Internal rotation As the head descends, the presenting part, usually in the transverse position, is rotated about 45° to anteroposterior (AP) position under the symphysis. Internal rotation brings the AP diameter of the head in line with the AP diameter of the pelvic outlet. 5. Extension With further descent and full flexion of the head, the base of the occiput comes in contact with the inferior margin of the pubic symphysis. Upward resistance from the pelvic floor and the downward forces from the uterine contractions cause the occiput to extend and rotate around the symphysis. This is followed by the delivery of the fetus' head. 6. Restitution and external rotation When the fetus' head is free of resistance, it untwists about 45° left or right, returning to its original anatomic position in relation to the body. 7. Expulsion After the fetus' head is delivered, further descent brings the anterior shoulder to the level of the pubic symphysis. The anterior shoulder is then rotated under the symphysis, followed by the posterior shoulder and the rest of the fetus. Total Score: /21 Student’s Signature:____________________________ _____/_____/_____ 2- Good 1-Needs practice 3 2 1 0 0- Unperformed Remarks
Evaluated by: ________________________________ _____/______/_______
d. May ask the mother to blow so that she avoids pushing 2. When placing the woman’s legs in stirrups. Repeat for the other inner thigh. Do not separate her legs widely. perform it when the head is well crowned. c. perineum.Unperformed Remarks . Apply sterile drapes if desired. 2. Prepping and Draping 7. After handwashing. Six sponges are needed. Continue observing the fetal heart rate (FHR) with continuous monitoring or intermittent auscultation. and do not return to a clean area with a used sponge.Take fresh sponge to begin each new area. 6. Continue observing the perineum while making final preparations for birth. and head with a wedge (on a delivery table) or by raising the head of the birthing bed. When the woman is almost ready to give birth. 4. 11. Birth of the Head 10. and anus. Stirrups or foot rests to support the woman’s legs and feet may be used on a birthing bed. If an episiotomy is needed. Repeat for the other side. transfer her to the delivery room or position the birthing bed. 9. 3. Use warm water to dilute iodophor scrub. Pad the surface. Elevate the woman’s back. As the vaginal orifice encircles the fetal head. 8. elevate them and remove them simultaneously. cleanse the perineal area with a sterile iodophor and water preparation unless she is allergic. Use a single stroke in the middle from the clitoris over the vulva and perineum. apply gentle pressure to the woman’s perineum with one hand while applying counterpressure to the fetal head with the other hand (Ritgen’s maneuver). apply sterile gloves for the procedure.Use a zig-zag motion on the inner thigh from the labia majora to about halfway between the hip and knee. b. After the woman is in position. The proper order and motions are as follows: a. Use a zig-zag motion from clitoris to lower abdomen just above the public hairline.Good 1-Needs practice 3 2 1 0 0. 5. shoulders.Christian University of Thailand College of Nursing Evaluation Checklist for Assisting in Birth and Delivery Student number:_____________________ Name-Surname:__________________________________________________ Date performed:_____________________ Rating Scale: 3-Very good Action Identify the patient Explain the procedure to the patient Prepare the equipments needed for the procedure Transfer and Positioning for Birth 1. Apply a single stroke on one side on one side from clitoris over labia.
24. Delivery of Placenta 18. 17. Save all evidence of blood loss. (5) Sex of infant. Gently massage the uterus if the fundus is soft or boggy. The rest of the infant’s body is born quickly after the shoulders are born. 12. (9) Any unusual occurrences during the delivery. 13. If tight it is clamped and cut between two clamps before the rest of the baby is born. 21. Assess the amount of blood loss from the delivery. Normally. Wipes secretions from the infant’s face and suctions the nose and mouth with a bulb syringe. Inspects both sides of the placenta. appearance. 15. Birth of the Shoulders 14. (8) Maternal condition (affect.If it loose. Feels for a cord around the fetal neck (nuchal cord). Assess for intactness of the placenta 23. Then lift the head toward the mother’s symphysis pubis. it is slipped over the head. (7) Approximate time of placental expulsion. (2) Presence of nuchal cord and method of reduction. and status of uterine contraction).Make notations about the birth to include: (1) Fetal position and presentation. and completeness. Maintains the infant in a slightly head-dependent position while suctioning excess secretions with a bulb syringe.After external rotation. Either the father or the attendant cuts the cord above the clamp. (3) Color. amount of bleeding. and amount of amniotic fluid. May pull gently on the cord. 19. After the placenta separates. Monitor BP and administer methergin drug Total: /99 Evaluated by: ________________________________ _____/______/_______ Student’s Signature:____________________________ _____/_____/_____ . Clearing the infant’s airway and cutting the cord 16. character. blood loss is less than 500 cc. (6) APGAR scores. apply gentle traction on the fetal head in the direction of the mother’s perineum.or to push gently. Clamps the cord. need for stimulation or resuscitation. The infant is often placed on the mother’s abdomen. 22. (4) Time of delivery. 20. it can usually be delivered of the mother bears down.
12. 6. press in slightly and make gentle movements from side to side. Place the patient in dorsal recumbent position. 2. 8.Good 3 1-Needs practice 2 1 0 0. First maneuver: Fundal Grip Using both hands. 9. 10. Drape properly to maintain privacy. Identify the patient.Third maneuver: Pawlik’s Grip Using thumb and finger. Use both hands. Fourth maneuver: Pelvic Grip Facing foot part of the woman. Warm the hands and apply it to the abdomen of the mother by using form and gentle pressure. 4. grasp the lower portion of the abdomen above symphisis pubis. 11. Explain the procedure to the patient. 3. Use gentle but deep pressure. palpate fetal head pressing downward about 2 inches above the inguinal ligament.Christian University of Thailand College of Nursing Evaluation Checklist for Abdominal Examination and Leopold’s Maneuver Student number:_____________________ Name-Surname:__________________________________________________ Date performed:_____________________ Rating Scale: 3-Very good 2. Second maneuver: Umbilical Grip One hand is used to steady the uterus on one side of the abdomen while the other hand moves slightly on a circular motion from top to the lower segment of the uterus to feel for the fetal back and small fetal parts. 5. 13. Ask the mother to empty the bladder. supine with knees flexed to relax abdominal muscles.Document Findings Total: /42 Evaluated by: ________________________________ _____/______/_______ Student’s Signature:____________________________ _____/_____/_____ . 7.Listen to the fetal heart sound correctly. Explain the results of the examination 14. feel for the fetal part lying in the fundus.Unperformed Remarks Description 1. Use the palm for palpation and not the fingers.
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