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46 Cards in this Set

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  • Back
Define Fetal presentation and list types
Part of fetus that enters the pelvic outlet 1st and leads thru the birth canal during labor at term.

(1) cephalic (96%)
(2) breach
(3) shoulder
Define Fetal lie and list types
Relation of fetal spine to maternal spine.

(1)Longitudinal/vertical, spines are parallel
(2) Tranverse/horizontal/ oblique. Spines are at right angles
Define Fetal attitude
Relationship of the fetal parts to each other.
Define Fetal Position
The relation of the presenting part (occiput, sacrum, mentum or sinciput) to the 4 quadrants of the mothers pelvis.

1st letter: denotes location of presenting part (R)/(L) side of mothers pelvis.

Middle letter: denotes presenting part of the fetus (O)cciput, (M)entum, (Sc)apula, (S)acrum.

Third letter: stands for location of the presenting part in relation to the (A)nterior, (P)osterior, (T)ransverse
Define Fetal Station
Relation of presenting part of fetus to imaginary line (b/t maternal ischial spines). Is a measure of the degree of descent.

The placement of the presenting part is measureed in cm abouve or below the ischial spines.
Define engagement in relation to the maternal pelvis.
Indicates when largest transverse diameter of the presenting part passes through the maternal pelvic brim (station 0)
What are terms used to define involuntary contractions?
(1)Frequency: time from beginning of one contraction to the beginning of the next one

(2)Duration: time from the beginging to the end of one contraction in sec.

(3)Intensity: strength per pt. or monitor
Explain effacement of the cervix.
Shortening and thining of cervix in 1st stage of labor.
Explain dilation of the cervix.
Opening of the cervix. Full dilation marks the end of stage one of labor. Caused by pressure of the head of on the cervix and by drawing upward of the musculofibroius components of the cervix
What is the Fergunson reflex?
Stretch sensors in the posterior wall of the vagina that stimulate release of oxytocin which gives urge to bear down.
What are some signs and Sx preceding labor?
-Urinary freq
-Increase in Cxn strength
-Wt loss 0.5-1.5kg
-Burst of energy
-Increased bag dischrg
-Cervix softening
What indicates the onset of labor?
-Sustained regular contraction s that cause the cervix to dilate.
-38-42 weeks of gestation
? Loss of mucus plug
What hormones are associated with the onset of labor
-Oxytocin= stimulated contractions. Uterus becomes increasingly responsive to.

-Prostoglandins: stimulate smooth muscle contraction.

-Fetal cortisol: slows production of progesterone

-Progesterone: decreases at end of pregnancy.
What are the cardinal movements of labor?
(a)Engagement & descent
(c)Internal rotation to OA
(f)External rotation
What are the 4 stages of labor?
STAGE 1:onset to full dilation
Latent phase: 3-4cms
Active phase: 4-7cms
Transition: 8-10cm

STAGE 2: full dilation to delivery of baby

STAGE 3: delivery of baby to delivery of placenta

STAGE 4: delivery of placenta to 1hr pp.
What are the fetal adaptions to labor?
(1)Fetal HR: avg range 110-160bp/min. Can expect temp accelerations and early decels.

(2)Fetal circulation: Can be affected by maternal position, cxn, BP, umbilical blood flow. There is a decrease in circ thru sprial arteries. Most fetuses can cope. Usually fetal cord flow uneffected.

(3)Fetal respiration:
-Fetal lung fluid cleared from airway during vaginal labor
-Fetal O2 pressure decreases
-Arterial CO2 pressure increases
-Arterial pH decreases
-Bicarb levels decreases
-Fetal resp mv't decreases during labor.
What are the maternal physiological responses to labor?
-CO: 1st stage inc 10-15%,
2nd stage in 30-50%
-HR: slightly increases
-BP: 1st stage inc sys 10mm/hg
2nd stage inc sys 25mm/hg
-WBC: ct increases

-RR/O2 consumption increases

-Fluid balance: inc insen loss
-UO: decreased
-Proteinuria: 1+ normal

-Joint laxity: increased
-Back/joint ache

-Pain threshold: increases

-Motility: decreased
What should be assesed regarding maternal well-being upon admission?
-Birth plan
-Psycosocial factors
-Touch (hx of sexual abuse)
-Support people
What are the appropriate nursing care assesment measures?
-Uterine activity:
-Vaginal show
-Behavior experience
-Vaginal exam
What is the timeline for charting fetal monitoring during labor?
FLOWSHEET: rate/variability
-latent phase stage one: q1h
-active phase stage one: q30m
-2nd stage: q15min

MONITOR STRIP: meds, position change, OOB, vag exam, ROM
List the location and nature of pain during the different stages of labor
-When: usually only expereinced during cxns.
-Type: viseral
-Where: Lower ab, referred to
low back, butt, iliac crest
and thigh

-Type: Somatic, sharp, intense, burning.
-Where: Localized, uterine, low back and vaginal
What are the indications for fetal ultrasound by trimester
-confirm preg and viability
-determine gest age/ multi?
-R/O etopic, fibroids

-Confirm EDC
-detect anomalies, IUGR
-confirm placental placement
-For placement of amniocent

-Confirm EDC
-detect anomalies, IUGR, macrosome
-confirm placental placement
-For placement of amniocent
-Fetal position
-determine AFI
-dopple flow study
-placental maturity
Describe indication and use of biophysical profile
Procedure: NST combined with ultrasound.

Indication: if info on from NST is not enough to reassure fetal stats.

(1) fetal breathing
(2) FHR
(3) movement,
(4) AFV,
(5) tone
Describe indication and use of Amniocentesis
Procedure: Under ultrasound a needle is inserted into the uterus to collect amionic fluid.

When: >14 weeks

Indication: diagnosis of genetic/congenital anomalies, MTD, lung maturity, fetal hemolytic dx.
Describe indication and use of Percutaneous umbilical blood sampling (PUBS)
Procedure: needle inserted into umbilical vessel guided w/ultrasound

When: 2nd & 3rd trimester

Indications: diag inherited blood disorders, karyotyping of malformed fetuses, fetal infection, acid/base balance.
Treatment: Isoimmunizationa dn thrombocytopenia
Describe indication and use of Chorionic blood sampling.
Procedure: Remove tissue spec from fetal side of placenta
When: 10-12 weeks gest
Indications: Same as amiocent
Describe indication and use of Non-stress test (NST).
Procedure: Use toco and FH monitor to look at movement and FHR

When: +28 wks

Indications: DX in mother, IUGR, decreased fetal movement, meconium, older women
Interpretation of NST
->2 accelerations (+15 beats/min) within 20 min
- Baseline WNL
- long-term amplitude of >10 beats/min

NONREACTIVE: if doesn't meet criteria w/in 40min

*n=110-160 beats/min
Describe indication and use of Contraction stress test (CST).
Procedure: EFM used to check fetal rxn to cxn. Nipple stim or oxytocin stim. Baseline taken first.

Result (+) with repetitve late decels
What factors can effect fetal response during EFT
-Hyper/hypotension, hypovolemia
-Decreased mat. bld O2=anemia
-Cord compression
-Head compression
-Uterine hyperstim
-deterioration of placental vasculature
What are the classes of FHR variability w/EFM.
-Absent: undetect=nonreassuring
-Min: 3-5 BPM =reassuring
-Mod: 5-25 BPM =reassuring
-Marked: >25 BPM =nonreassuring
What is normal FHR baseline values at term?
110-160 BPM
In Presence/absence of risk factors how often should FHR be ascultated
*First* q30min
*second* q15min

*First* q15min
*second* q5min
What are some nursing interventions if FHR is found to be tachy/brady
*non-reassuring when associated w/late decel, severe vari decels or absence of variability
-reduce fever if present
-O2 8-10L/min

*non-reassuring is associated w/loss of variability and late decels
-O2 8-10L/min
-Can test w/scalp stim
Describe cause, significance and treatment of early decels.
*cause* Fetal head compression
*Timing* b/f peak cxn end with
*significance* None
*treatment* None
*Lowest pt* >100
Describe cause, significance and treatment of late decels.
*cause* uternie hyperactivity, mat supine hypotension, epidural/spinal impaired placental exchange/insuff, placenta previa, abruption, HTN, postmaturity, IUGR, DM

*Timing* >20s post peak cxn

*Appearance* sim to early, shift to right uniform, return to baseline post cxn.

*significance* hypoxemia, acidemia, low APGAR

*treatment* change mat posit (lat), correct hypo, discont PIT, O2 8-10L/min, fetal scalp stim, Inc fluid IV, assist w/birth if not corrected.

*Lowest pt* doesn't reflect severity
Describe cause, significance and treatment of variable decels.
*cause* umbilical cord compression
*timing* variable, nonreasuring if <70bpm for >60s

*significance* transient vari decels occur in 50% of L/D. acidemia, hypoxia, low APGAR

*treatment* change mat position, discont PIT, O2 8-10L/min, assist w/exam, if prolapse raise cord w/ presenting part, amnio infusion, assist w/birth, fetal scalp sampling.
Where to look for PMI of the FHR?
VERTEX: just below umbilicus in lower R/L quad

BREACH: just above umbilicus

ON DESCENT: heard lower and close to midline
Describe Leopolds maneuvers.
-Have mom empty bladder

(1)Determine prt fetus @ fundus
-Place hand on either side of ab, palp around fundus. Head hard, butt soft.

(2)move hands down either side of ab to locate back.

(3)place hand above symphysis pubis, bring thumb and forefinger together. Confirm fetal postion

(4)In late stage to determine how far down fetus is. Place hands on lower side of ab and side downward and press inward
What is the procedure used for a NST?
(1)perform leopolds maneuvers to determine which side the fetal back is located on.
(2)Place ultrasound transducer on this side
(3) Place toco at fundus of uterus
(4)Have mom on left side
Descrive procedure used for CST and results.
1)perform leopolds maneuvers to determine which side the fetal back is located on.
(2)Place ultrasound transducer on this side
(3) Place toco at fundus of uterus
(4)monitor 10-20m for baseline
(5a)Nipple stim unitil adequat cxn
(5b)PIT 10u/1000ml until ad cxn

NEGATIVE= no late decel
POSITIVE= late decels
Outline the changes that occur to the uterus puerperium.
INVOLUTION: uterus return to nonpreg state. Being @ end 3rd stage finished about 6 weeks. Autolysis due to decrease in E/P hormones. Endomertrial regen 2.5 wks

CONTRACTIONS:controled by oxytocin release. Help to clamp dwn blood vessels.

AFTERPAINS: >multips, >if uterus more streched

FUNDAL HEIGHT: descends 1-2cm every 24hrs. Winthin 2 weeks back in true pelvis.

PLACENTAL SITE: cells regen from beneath, slough off old tissue, no scaring. Complete 6 weeks after birth.
Describe different types of Lochia
LOCHIA RUBRA: red, blood & tissue, 3-4 days

LOCHIA SEROSA: serous fluid, pink/brown, 7-10 days

LOCHIA ALBA: whitish, WBCs, decidual, epith cells, bacteria, mucus, serum
What are two causes of subinvolution
(2)retained placental fragments
Outline the changes that occur to the perineum puerperium.
-Decreased estrogen can lead to vaginal dryness
-May be swollen and red intially
-Import hygiene w/in first couple of weeks
-Care of episiotomy
-Vagina returns to normal size within 6-10 weeks
Outline the fluid shifts that occur puerperium.
(1)Diuresis: PM 2-4x's lasts 2-3 days, worry if not diuresising

(2)Diaphoresis: increased

(3)Urinary system: Kidney function returns to norm 1 month. Dilation of urinary tract can last +3months.
-BUN: increases
-Proteinuria(+1): 1-2days post
-Bladder: returns to norm tone 5-7days post