Maternal and Fetal

Assessment During
Labor

Prepared by:
Myrna T. Pedido RN RM MAN
MATERNAL ASSESSMENT
 LEARNING OUTCOMES

At the end of this session you are expected to:

1. Assess a pregnant woman during labor and delivery.

2. Enumerate the parameters in assessing women in labor and delivery.
 
 Normal Labor
 Consists of:

-Regular progression of uterine contractions

-Effacement and progressive dilation of cervix

-Progress in descent of the presenting part

 
 Definition of Terms:

• BOW Bag of water

• Intrapartal period - Extend from the beginning of
contractions that cause cervical dilation to the first 1 to 4
hours delivery of the newborn and placenta
• Intrapartal Care- refers to to the medical and nursing care
given to to a pregnant woman and her family during labor
and delivery.
• Labor - is the process by which the fetus and products of
conception are expelled as the result of regular, progressive,
frequent, and strong uterine contractions
• Lightening - At the end of the third trimester, the baby
settles, or drops lower, into the mother's pelvis.
• is not a good predictor of when labor will begin. In first-time
mothers, dropping usually occurs 2 to 4 weeks
before delivery, but it can happen earlier.
• Primipara- a woman who is giving birth for the first time.
• Multipara-A woman who has had two or
more pregnancies resulting in potentially viable offspring.
The term para refers to births.
• Nullipara- A woman who has not given birth to a viable child.
• Parturient -
childbirth, givingbirth, birth, birthing, delivery,labor
• Rupture of membranes (ROM) - is a term used during
pregnancy to describe a rupture of the amniotic sac. Normally,
it occurs spontaneously at full term either during or at the
beginning of labor. 
• Uterine contraction - The tightening and shortening of
the uterine muscles.
During labor, contractions accomplish two things:
(1) They cause the cervix to thin and dilate (open)
(2) They help the baby to descend into the birth canal
 During labor, contractions accomplish two things:
• (1) They cause the cervix to thin ( effaced) and dilate (open).
.
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(2) They help the baby to
descend into the birth
canal

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 The immediate assessment of a woman in the
First stage of labor.

a. The initial interview

Upon admission of the woman in labor, her previous
prenatal checkup record is needed to get the important
information about her pregnancy. This information will help the
health care practitioner to know if the parturient is in active
labor and about to deliver her baby, and at the same time
assist the mother of the discomfort pain she is experiencing.
ASSESS THE FOLLOWING:
Vital signs (temperature, pulse rate, respiratory rate, and blood
pressure). Take note that the blood pressure must be taken in
between uterine contractions to get its accuracy. Taking blood
pressure during contraction will show an increase in blood
pressure due to pain
Nature of her contraction (frequency, duration, interval, and
intensity)
Rating in pain scale of 10
The action did to be prepared for labor
A urine specimen for checking of protein and glucose content.
Position and presentation of the baby
b. The Detailed Assessment – if upon admission the woman is
not yet in active labor, and birth is not imminent, the detailed
taking of history and physical examination must be done:
The History – The current pregnancy history, Past pregnancy
history, Past health history, and family medical history,
The Physical examination- physical examination for the patient
in labor includes the following:
•The abdominal and lower leg examination, determining fetal
presentation position and lie, doing Leopold' s Maneuver. The
vaginal examination, sonography, assessing rupture of
membrane, vital signs (temperature, pulse and respiration, and
blood pressure) and assessment of uterine contraction and
pelvic adequacy. Take note to observe the PATIENT'S PRIVACY.
• The Vaginal Exam – are best done between uterine
contraction. This examination is done to know the range of
patient’s cervical dilatation and effacement, baby’s position,
presentation, and degree of descent.

• SONOGRAPHY- This is done to know the extent of the

patient's cervical ripening and the baby's position,
presentation, flexion, and degree of descent of a fetus at the
beginning of labor and to know the diameter or measurement
of the fetal skull.
• RUPTURE OF MEMBRANE- This is when the woman in
labor experience a sudden gush or a slow trickle of amniotic
fluid from her vagina. The amniotic fluid is assessed by
determining its alkalinity. Several ways of the diagnostic test
will be conducted: Nitrazine test, Ferning test, and sterile
speculum examination to check for any deviation of color
from normal signifying of an impending risk for fetal health
status.  
• PELVIC ADEQUACY- This is done to determine the
adequacy of the pelvic diameter or measurement of the
woman for delivery. Also, assessment of the pelvis will help
us to know if the patient has a disproportion of her pelvic
measurement termed cephalopelvic disproportion.
c. Laboratory exam
BLOOD – a blood sample is drawn from the patient to test for
blood typing in preparation for unexpected blood transfusion.
This is also to determine the mother having any existing health
condition of the blood.
URINE –Is obtained by catching up and using the specimen
bottle for the examination of the urine.
d. The assessment of the Uterine Contraction
In birthing facility monitoring of the uterine contraction is
usually done by the use of :

HANDS ( manually)
 
-With the use of monitor to determine the length or duration of
the uterine contraction just simply observe the rhythm strip,
using the time in, count the number of seconds the contraction
lasted.
-Using the monitor, the uterine intensity or strength is
determined by observing the height of the wave into the rhythm
strip.
 Monitoring Uterine Contractions:
 Caringfor a woman in labor entails monitoring her uterine contractions.
In order to monitor uterine contraction accurately, there should be an
understanding of the “basics” related to uterine contraction.
•The uterine Contraction

Uterine contractions are involuntary (and for the most part, are
independent of extra uterine control ), rhythmical , intermittent,
regular, and painful.
The upper uterine segment of the uterus contracts, retracts, and expels
the fetus, while the lower uterine segment and the cervix dilate and
thereby form a greatly expanded, thinned- out muscular and
fibromuscular tube through which the fetus can pass.
 
• Phases of Uterine Contraction

A. Increment is the “building up” of contraction (period of

increasing contraction and is the longest phase).
B. Acme is the peak of a contraction; it is the most painful
period.
C. Decrement is the period of “lettings up “or decreasing
contractions.
In describing a contraction, the following
characteristics should be considered:

duration, frequency, intensity and interval.

 Characteristics of Uterine Contractions
A. Duration refers to the length of time a contraction lasts; the time from
the start of increment(increasing contraction ) of one contraction to the
end of decrement ( decreasing contraction) of the same contraction.
-Duration is expressed in seconds.
B.Frequency is the time interval between the start of one contraction to
the start of the next contraction. Frequency is expressed in “every ____
minute.
C. Interval or resting period denotes the time from the end of one
contraction to the start of the next contraction. It corresponds to
the period of rest of the uterus. It is expressed in minutes.
Mathematically, one can compute for the interval: frequency
minus duration equals interval.
The interval of contractions is the best time to:
1. Auscultate the FHT
2. Check maternal blood pressure; and
3. Deliver the fetal head in extension
The interval between contractions diminishes
gradually from about 10 minutes at the onset of
the first stage of labor to as little as one minute
or less in the second stage.
D.Intensity refers to the strength of a contraction at acme. It is
usually estimated by palpating the contraction. Judging the
amount of indentability of uterine wall during the acme of a
contraction, the health care provider determines whether it is
mild, moderate or strong.
•1. Mild the uterine wall can be indented with ease.
•2. Moderate the uterine wall can be indented with difficulty.
•3. Strong the uterine wall can no longer be indented.
• Stages of labor

A .First Stage/ Cervical stage- The period from onset of true

labor contractions until full cervical dilation and effacement is
achieved.
Three Phases
a. latent Phase- This phase begins with the onset of regular
contractions, and effacement and dilation of the cervix to 3 to
4cm. It lasts an average of 6.4 hours for nuliparas and 4.8
hours for multiparas. Contractions become increasingly
stronger and more frequent.
b. Active Phase - Dilation continues from 3 to 4 cm to 7 cm.
Contractions become stronger more frequent, longer and more
painful.
c. Transition Phase- The culmination of the first stage is the
transition phase during which the cervix dilates from 8 to 10cm.
The intensity, frequency and duration of contractions peak and
there is an irresistible urge to push
• Characteristics of Uterine Contractions

A. First stage
1. Duration
a. Latent ( cervix 0-3 cm ): 15 – 30 seconds
b. Active (cervix 4-7 cm ): 30-45 seconds
c. Transition ( cervix 8-10cm ) : 45-90 seconds; average, 60
seconds
 
 
2. Frequency
a. Latent: every 5-8 minutes; or greater than 10 minutes
in early labor
b. Active; every 3-5 minutes
c. Transition: every 2-3 minutes
B. Second stage Contractions are strong, occurring every 2 to
3 minutes and lasting for 60 to 90 seconds .They oftentimes
have the same characteristics as the transition phase of the
first stage of labor.
 How can you tell which station your baby is in?
• The placement of the presenting part is measured (through
internal or vaginal examination ) in centimeter (cm) above or
below the ischial spines.
• Your doctor determines the fetal station by examining your
cervix and locating where the lowest part of your baby is in
relation to your pelvis. Your doctor will then assign a number
from -5 to +5 to describe where your baby's presenting part
(usually the head) is located.
INTERNAL EXAMINATION (IE)
 

• An internal, or vaginal, examination is usually conducted by

your OB- gyne, who will gently inserting her gloved fingers
into your cervix to confirm how your labor is progressing.

• Floating – Head is movable above pelvic inlet

• + 1 station – fetus is engaged
• + 2 station – fetus is in pelvis
• + 4 station- perineum is bulging
FETAL HEAD STATION
FETAL ASSESSMENT
 LEARNING OUTCOMES

At the end of this session students are expected to:

1. Discuss fetal assessment during labor and delivery.

2. Give the importance of monitoring the fetal heart rate.
 The Initial Fetal Assessment
 During woman’s labor, both of the mother and fetal
conditions must be check and monitored specifically the
baby’s fetal heart rate.
A. Auscultate fetal heart sound (FHS)
Fetal heart sound and fetal heart rate can best be heard
depending on the baby's position and presentation inside the
mother's womb. This both can be determined by first doing
Leopold's maneuver to check for the fetal back.
FETAL PRESENTATION LOCATION

Vertex or breech Fetal heart sound best heard at the

fetal back
Face Fetal heart sound best heard at the
more convex thorax

Breech Fetal heart sound most clearly high

the uterus, at the woman’s umbilicus
or above
Cephalic Loudest low in a woman’s abdomen

Right occipital anterior Sounds best heard in the left lower

position (ROA) quadrant

LOA Left lower quadrant

Left occiput anterior and Sounds heard loudest at a woman’s
ROP side
Points to Remember:
Fetal heart rate monitoring is to monitor the baby’s health status
during labor and delivery by using these ways:
a.Auscultation using either stethoscope or a doppler transducer
b.Using an electronic monitoring device
The purpose of monitoring the baby's FHR during labor is to
anticipate for any deviation from the normal rate that may harm
the baby's condition and thus provide immediate remediation.
 
 electronic monitoring device

doppler transducer
Periodic changes in the rate
-refers to the fluctuation in FHR.
- Are described in terms of acceleration and deceleration

Acceleration is a non- periodic acceleration, an increase in FHR

caused by the following reasons: movement of the baby, a
change in maternal position and administration of analgesics for
labor pain.
Deceleration a periodic decrease in FHR during uterine
contraction.
-Late deceleration
-Prolonged deceleration
 YOU ARE NOW READY
TO ANSWER YOUR
LEARNING ACTIVITIES..
Goodluck!!