Katie is a gravida 1 para O who is admitted to the labor roo

Katie is a gravida 1 para O who is admitted to the labor room for observation. She is at 38 weeks gestation. She began having contractions 3 hours ago at 8 to 10 minute intervals lasting 30 seconds each. Her membranes are intact. On admission, dilation is 1 cm 80% effacement, and O station. After 1 hour of observation, her cervix in unchanged, but contractions are 5 minutes apart, lasting 40 seconds. Fetal lie is longitudinal with a cephalic presentation.

1. At this point, should Katie be sent home or observed for a longer period?

2.How did the nurse determine the lie and presentation and what do each of these mean?

Solution

1. Since, the contractions and duration are increasing, Katie should be observed for a longer period.

2. The fetal lie is the anatomical position of fetus with respect to the mother dorsal column.Presentation is the lowermost fetal structure in the maternal pelvis. The nurse determine the fetal lie and presentation by Leopold\'s maneuvers or abdominal examination by palpating the gravid uterus and fetus. The examination occurs in four steps.

Maneuver I: in this step the uterus is identified and the fundus is palpated with the fingertips of both hands facing toward the maternal xiphoid cartilage. In this step fetal parts in the upper pole (fundus) of the uterus are identified.

Maneuver II: After assessment of fetal parts in the uterine fundus, the hands are placed at either side of the maternal abdomen to identify the fetal back.

Maneuver III: The lower abdomen, a few centimeters above the symphysis pubis is observed by placing on ehand and assessed between the thumb and fingers. This will identify more fetal parts.

Maneuver IV: This last step is similar to the first step, but pelvis of the patient is examined. The palms of both hands are placed on either side of the lower maternal abdomen, with the fingertips facing toward the pelvic inlet. The fetal parts at lower pole of uterus are observed.

At this stage, the fetal head is at lower pole of uterus and in few hours of time Katie is going to deliver the baby.