2
CRAM SHEET
Maneuvers
A.) Ritgen’s Maneuver - allows controlled
fetal head delivery
–
Performed during uterine
1
contractions rather than between
–
–
–
contractions originally
Reduces obstetric anal sphincter
injuries
Reduced episiotomies
Done routinely at 2nd stage of labor
5
Procedure:
4
. Puts right hand on perineum
between maternal anus and coccyx
3
. Left hand uses thumb and finger
2
holding fetal head (occiput)
1
. Delivers fetal head through
controlled gradual extension
B.) Leopold’s Maneuvers - determines
position, presentation, and engagement of
fetus; after 28 weeks of gestation
*Before procedure:
3
. Verify patient
. Emptied bladder
2
. Dorsal position with knees flexed;
shoulder with pillow support
1
. Warm hands before touching mother
. Face the mother for the first 3
maneuvers
Procedures
1st MANEUVER (Fundal Grip)
. Determining if head or buttocks: feel
–
–
the top of fundus with both hands
head: big, firm, round, moves
independently
Butt: soft, moves with the body
2nd MANEUVER (Umbilical Grip)
. Determining location of back and
.
2
anterior shoulders: putting hands on
–
–
each side
back: firm, smooth
extremities: small bumps, bent
3rd MANEUVER (Pawlik’s Grip)
. Determining if fetal head is
engaged: form L-shape with thumb
and fingers, then lift symphysis
–
pubis
cannot lift head: engaged
4th MANEUVER
. Determining cephalic prominence:
turn to patient’s feet; feel both
hands from bottom (symphysis
–
pubis) to up (below fundus)
brow should be opposite to the back
Essential Intrapartum Newborn
Care (EINC)
. Immediate drying
. Skin-skin contact
. Proper cord clamping and cutting
. Non-separation and breastfeed
initiation
True Labor vs. False Labor
True Labor
False Labor
Bloody show - Braxton hicks
mucus and
contractions blood
disappear
with walking
or change
position
Water
breaking amniotic sac
rupture
No dilatation
of cervix
True labor
contractions increased
frequency and
duration
Decreased
contractions
in intensity
with
ambulation
Contract Regular
ions
(increasi
ng
frequenc
y,
duration,
&
intensity
Irregular,
false
(braxton
hicks
contracti
ons)
Pain
Does not
decreas
e with
rest
Alleviate
d with
rest or
change
position
Cervix
Progress No
ive
change
change
(dilatatio
n and
effacem
ent)
Internal Examination
●
Dilatation - widening (D = door
opens)
●
Effacement - thinning and
shortening (E = elastic)
How to check dilatation
How to check effacement
Vaginal Exam:
0% - thick as finger
50% - middle knuckle
80% - halfway between tip and 1st knuckle
100% - paper thin
** 4 cm dilated and 60% effaced = cervix
opening is 4cm and cervical canal is 60%
shorter than normal**
Stages of Labor
Stage 1: Get to 10cm
Latent - “Baby is coming”; pain isn’t too
bad; 0-3 cm dilated
Active - 4-7 cm; stronger contractions,
“starting to hurt a lot”
Transition - feels strong urge to push; fear
and pain; 8-10 cm
Stage 2: Delivery of Baby
Stage 3: Placenta Delivery
Types of Placenta
Schultz
Duncan
- sac that
attaches to
the placenta
- adheres to
uterine wall
the placenta
- full of
- maternal
amniotic fluid side; rough
and previously
the baby
- umbilical
cord
- fetal side;
shiny
Stage 4: Postpartum Recovery (Ensure no
heavy bleeding)
Signs of Placenta Separation
–
–
–
–
–
–
–
–
–
Vaginal bleeding/gush of blood
(common)
Pain
Contractions
Discomfort
Tenderness
Back pain
Belly pain
Hard & boggy uterus
Lengthening of cord
Fetal Stations
(-) numbers = baby is not ready to come
out
(+) numbers = baby is ready
0 = ischial spine (baby is engaged)
+2 = mom starts pushing
+4 = baby is most likely crowning
Fetal Presentations
. Attitude
. Engagement
. Station
. Fetal Lie
Mechanisms of Labor (DFIEEE)
. Descent
. Flexion
. Internal Rotation (45°; crowning)
. Extension
. External Rotation
. Expulsion
Gravidity and Parity
Gravida
Para
- number of
tomes woman
has been
pregnant
- number of
births/
completed
pregnancies
at >20 weeks
- outcome of
pregnancy is
irrelevant
- includes
alive or
stillborn
babies
- includes
current
pregnancy
- includes
current
pregnancy if
>20 weeks
- multiple
births count
as one
- multiple
births count
as one
as one
Apgar Scoring