Maternal Newborn - Test 2 Chapter 36

Front 1

-preterm labor is defined as

Back 1

cervical changes and uterine contractions occurring b/w 20-37 weeks of pregnancy

Front 2

-preterm birth is

Back 2

any birth that occurs before the completed of 37 wks of pregnancy

Front 3

-a pregnancy ending before 20 wks gestations

Back 3

miscarriage

Front 4

-what are serious complications of pregnancy and lead to 90% of all neonatal deaths

Back 4

preterm labor and birth

Front 5

what describes length of gestation (less than 37 wks regardless of the weight of the infant)-more dangerous

Back 5

-preterm birth

Front 6

what describes only weight at the time of birth (2500 g or less)

Back 6

-low birth weight-

Front 7

-low birth weight can be caused by

Back 7

intrauterine growth restriction -IUGR- (a condition of inadequate fetal growth)

Front 8

Fetal Fibronectin

-biochemical marker used for what?

Back 8

to predict who might experience preterm labor

-it is glycoproteins found in plasma and produced during fetal life

Front 9

Fetal Fibronectin

-the negative predictive value
-the positive predictive value

Back 9

-the negative predictive value is high (up to 94%)
-the positive predictive value is lower (46%)

Front 10

Bed Rest
-commonly used intervention for the prevention of

Back 10

preterm birth

Front 11

Bed Rest
-after 3 days, there is 4 things that can happen?

Back 11

decreased muscle tone,
weight loss,
calcium loss,
glucose intolerance

Front 12

Bed Rest
-weeks of bed rest can lead to

Back 12

bone demineralization, constipation, fatigue, isolation, loneliness , anxiety, depression

Front 13

Bed Rest
-symptoms are not resolved by

Back 13

6 wks postpartum

Front 14

Tocolytics
--medications that do what

may be used for?

Back 14

suppress uterine activity

-may be used for preterm labor

Front 15

Tocolytics

--the best reason to use tocolytics is that they afford the opportunity to

Back 15

begin administering antenatal corticosteroids to accelerate fetal lung maturity and reduce the severity of sequelae in infants born preterm

Front 16

Tocolytics

-nifedipine (Procardia) is used to

Back 16

suppress preterm labor.

Front 17

Tocolytics
-most commonly used tocolytic is:



why?

Back 17

magnesium sulfate

-- because maternal and fetal adverse reactions are less common (promotes relaxation of smooth muscles)

Front 18

Tocolytics

-nifedipine (Procardia) is used to

Back 18

suppress preterm labor.

Front 19

Tocolytics
- ritodrine and terbutaline, beta adrenergic agonist medications work by relaxing uterine some muscle as a result of stimulation. they may have many maternal and fetal adverse reactions (2)

Back 19

(tachycardia and hyperglycemia)

Front 20

Tocolytics

-nifedipine (Procardia) is used to

Back 20

suppress preterm labor.

Front 21

Tocolytics -caution when administering IV fluids to women in preterm labor. there can be an increase in the risk for

Back 21

tocolytic induced pulmonary edema

Front 22

Tocolytics
-most commonly used tocolytic is:



why?

Back 22

magnesium sulfate

-- because maternal and fetal adverse reactions are less common (promotes relaxation of smooth muscles)

Front 23

Tocolytic
-Nifedipine, calcium channel blocker, can suppress contractions (inhibits Ca+ from entering cells, reducing uterine contractions)

-fewer maternal side effects occurred with Nifedipine or magnesium sulfate

Back 23

Nifedipine

Front 24

Tocolytics
- ritodrine and terbutaline, beta adrenergic agonist medications work by relaxing uterine some muscle as a result of stimulation. they may have many maternal and fetal adverse reactions (2)

Back 24

(tachycardia and hyperglycemia)

Front 25

Tocolytics
-most commonly used tocolytic is:



why?

Back 25

magnesium sulfate

-- because maternal and fetal adverse reactions are less common (promotes relaxation of smooth muscles)

Front 26

Tocolytics -caution when administering IV fluids to women in preterm labor. there can be an increase in the risk for

Back 26

tocolytic induced pulmonary edema

Front 27

Tocolytics
- ritodrine and terbutaline, beta adrenergic agonist medications work by relaxing uterine some muscle as a result of stimulation. they may have many maternal and fetal adverse reactions (2)

Back 27

(tachycardia and hyperglycemia)

Front 28

Tocolytic
-Nifedipine, calcium channel blocker, can suppress contractions (inhibits Ca+ from entering cells, reducing uterine contractions)

-fewer maternal side effects occurred with Nifedipine or magnesium sulfate

Back 28

Nifedipine

Front 29

Tocolytics -caution when administering IV fluids to women in preterm labor. there can be an increase in the risk for

Back 29

tocolytic induced pulmonary edema

Front 30

Tocolytic
-Nifedipine, calcium channel blocker, can suppress contractions (inhibits Ca+ from entering cells, reducing uterine contractions)

-fewer maternal side effects occurred with Nifedipine or magnesium sulfate

Back 30

Nifedipine

Front 31

Antenatal Corticosteroids
-given IM to the mom to do what?

Back 31

accelerate fetal lung maturity

Front 32

Antenatal Corticosteroids

-decrease in the incidence of neonatal ____ & ____

Back 32

intaventricular hemorrhage and necrotizing enterocoloitis

Front 33

Antenatal Corticosteroids

-recommendation when preterm birth is threatened?

Back 33

all woman between 24 and 34 wks of gestation should be given Antenatal Corticosteroids

Front 34

Antenatal Corticosteroids

-a Corticosteroid should not be given after ___ wks gestation unless fetal pulmonary immaturity is confirmed

Back 34

34 wks of

Front 35

Hypertonic or Hypotonic uterine dysfunction

-aka primary dysfunctional labor

Back 35

Hypertonic uterine dysfunction

Front 36

Hypertonic or Hypotonic uterine dysfunction

-often is an anxious first time mother who is having painful and frequent contractions that are ineffective in causing cervical dilation or effacement to progress

Back 36

Hypertonic uterine dysfunction

Front 37

Hypertonic or Hypotonic uterine dysfunction

-contractions usually occur in the latent stage (dilation of 4 cm or less) and are usually uncoordinated

Back 37

Hypertonic uterine dysfunction

Front 38

Hypertonic or Hypotonic uterine dysfunction

-may be exhausted and express concern about loss of control because of the intense pain they are experiencing and the lack of progress

Back 38

Hypertonic uterine dysfunction

Front 39

Hypertonic or Hypotonic uterine dysfunction

-therapeutic rest, which is achieved with a warm bath or shower and the administration of analgesics to inhibit uterine contractions, reduce pain, and encourage sleep is usually prescribed

Back 39

Hypertonic uterine dysfunction

Front 40

Hypertonic or Hypotonic uterine dysfunction

-after 4-6 hour rest, these women are likely to awaken in active labor with a normal uterine contraction pattern

Back 40

Hypertonic uterine dysfunction

Front 41

Hypertonic or Hypotonic uterine dysfunction

-force of contractions may be in the midsection of the uterus rather than in the fundus and the uterus can’t apply downward pressure to push the presenting part against the cervix

Back 41

Hypertonic uterine dysfunction

Front 42

Hypertonic or Hypotonic uterine dysfunction

-aka secondary uterine inertia

Back 42

Hypotonic Uterine dysfunction

Front 43

Hypertonic or Hypotonic
uterine dysfunction

-the woman initially makes normal progress into the active stage of labor; then the contractions become weak and inefficient or stop altogether

Back 43

Hypotonic Uterine dysfunction

Front 44

Hypertonic or Hypotonic uterine dysfunction

-uterus is indented

Back 44

Hypotonic Uterine dysfunction

Front 45

Hypertonic or Hypotonic uterine dysfunction

-intrauterine pressure (IUP) during the contraction is insufficient for progress of cervical effacement and dilation

Back 45

Hypotonic Uterine dysfunction

Front 46

Hypertonic or Hypotonic uterine dysfunction

-cephalopelvic disporportion and malpositions are common causes of this type of uterine dysfunction

Back 46

Hypotonic Uterine dysfunction

Front 47

Hypertonic or Hypotonic uterine dysfunction-the woman may become exhausted with an increased risk for infection

Back 47

Hypotonic Uterine dysfunction

Front 48

Hypertonic or Hypotonic uterine dysfunction

-management: performing an ultrasound or radiographic exam to rule out CPD and assessing the FHR and pattern, characteristics of amniotic fluid

Back 48

Hypotonic Uterine dysfunction

Front 49

Hypertonic or Hypotonic uterine dysfunction

-if findings are normal, then measures such as ambulation, hydrotherapy, enema, stripping or rupture of membranes, nipple stimulation, and oxytocin infusion can be used to augment the progress of labor

Back 49

Hypotonic Uterine dysfunction

Front 50

Malposition
-most common fetal Malposition is _________ occurring in 25% of labors

Back 50

persistent occipitoposterior position (ROP or LOP)

Front 51

Malposition-persistent occipitoposterior position (ROP or LOP)

when stage is labor prolonged?

Back 51

-labor , in the 2nd stage, is prolonged

Front 52

Malposition-persistent occipitoposterior position (ROP or LOP)
-women complain of severe back pain from the pressure of the fetal head pressuring against their sacrum

Back 52

-p. 943 for box

Front 53

Amniotomy-artificial rupture of membranes (AROM) can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if progress beings to slow

labor usually begins in how many hours after rupture?

Back 53

-labor usually begins within 12 hours of the rupture

Front 54

Amniotomy-artificial rupture of membranes (AROM) can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if progress beings to slow

-if amniotomy does not stimulate labor, the resulting prolonged rupture may lead to what 3 things?

Back 54

infection, umbilical cord prolapsed, and fetal injury

Front 55

Amniotomy-artificial rupture of membranes (AROM) can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if progress beings to slow

woman should be assured that the actual rupture of the membranes is

Back 55

painless for her and the fetus but she may experience discomfort

Front 56

Amniotomy-artificial rupture of membranes (AROM) can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if progress beings to slow


-the presenting part of the fetus should be where?

Back 56

engaged and well applied to the cervix to prevent cord prolapsed

Front 57

Amniotomy-artificial rupture of membranes (AROM) can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if progress beings to slow


-the woman should be free of

Back 57

active infections of the genital tract and HIV

Front 58

Amniotomy-artificial rupture of membranes (AROM) can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if progress beings to slow


what is assessed before and immediately after the amniotomy to detect any changes that may indicate cord compression or prolapsed

Back 58

-the FHR

(transient tachycardia is common)

-the woman’s temp should be checked every 2 hours to rule out infection

Front 59

Magnesium Sulfate

what must the nurse assess before beginning therapy and then before and after each increment?

Back 59

assess woman and fetus to obtain baseline

Front 60

Magnesium Sulfate

-monitor serum levels with higher doses, therapeutic range is between

Back 60

4-7.5 mEq/L
or
5-8mg/dl

Front 61

Magnesium Sulfate
-what do you do if intolerable adverse reactions occur?

Back 61

-discontinue infusion and notify physician

Front 62

Preterm Labor and Birth

Risk Factors

Back 62

Hx of preterm birth, race (non Caucasian),

low socioeconomic status,

low prepregnancy weight (start the pregnancy behind),

multiples (uterus stretches as far as it can and a lot of times doesn’t make it to term)

Front 63

what is the best outcome that can be expected with the use of tocolytics

Back 63

a gain of 48 hours to several days

Front 64

Best reason to use tocolytic therapy is to

Back 64

achieve sufficient time to administer glucocorticoids in an effort to accelerate fetal lung maturity and reduce severity of respiratory complications in preterm infants

Front 65

Dystocia =

Back 65

Long, difficult, or abnormal labor

Front 66

Effacement
-primary or secondary powers?

Back 66

Effacement (primary powers)

Front 67

Descent
-primary or secondary powers?

Back 67

Descent (secondary powers)

Front 68

Cervical ripening methods

Chemical agents – cytotec vs cervidil

Back 68

(tiny piece of a pill that is put in and melts and absorbs and causes contractions),




cervidil (flat disc with a string, put in and left in, and there is prostaglandins which is supposed to soften the cervix)

Front 69

Shoulder Dystocia broken

Back 69

clavicle

Front 70

Prolapsed umbilical cord

Occurs when ?

Back 70

when the cord lies below the presenting part of the fetus


put fingers in to hold head up and leave them in, and call for help

Front 71

Prolapsed umbilical cord
Contributing factors include:
-3

Back 71

Long cord (longer than 100 cm)
Malpresentation (breech)
Unengaged presenting part