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105 Cards in this Set

  • Front
  • Back
What can we do to prevent preterm labor?
What can we do to prevent preterm labor?

- Keep patient hydrated
- Ensuring hydration (decreases oxytocin)
- Activity Restriction
- Identifying and treating infection
- Administering tocolytic Medications (suppresses contractions)
- Terbutaline (Brethine) – tocolytic given SC or PO
- Ritodrine (Yutopar) – tocolytic given IV
- Magnesium Sulfate – tocolytic given IV
- Nifedipine (Procardia) – tocolytic given PO
- Indomethacin (Indocin) – tocolytic given PO or PR
- Accelerating fetal lung maturity with glucocorticoids
- Betamethasone or dexamethasone – glucocorticoid given IM
What is a risk for the fetus with (DIC) disseminated intravascular coagulation, what can happen to the baby?
What is a risk for the fetus with (DIC) disseminated intravascular coagulation, what can happen to the baby?

- Eruption can happen and DIC is secondary
- The baby dies
- Serious coagulation problems such as disseminated intravascular coagulopathy (DIC) can occur
- DIC is also associated with internal fetal demise (death) in utero
What would you do if the patient came to you and said I feel like something’s coming out and you notice it’s the umbilical cord (prolapsed umbilical cord)?
What would you do if the patient came to you and said I feel like something’s coming out and you notice it’s the umbilical cord (prolapsed umbilical cord)?

- You’re going to push the baby's head up; you’re going to get the baby off the cord to relieve pressure
- Notify primary care provider
- Using sterile gloved hand, insert 2 fingers into vagina and apply to the fetal presenting part to elevate it off the cord
- Apply sterile saline soaked towel to cord
NEED TO KNOW pH of baby’s blood acidotic and alkalosis?
NEED TO KNOW pH of baby’s blood acidotic and alkalosis?

- Early indications of fetal distress are established by pH levels
- FHR is < 110 beats/min or > 160 beats/min, FHR shows decreased or no variability, fetal hyperactivity or no fetal activity, fetal blood pH is < 7.2
- Fetal scalp pH sampling or fetal oxygen saturation to determine fetal acidosis (Post term pregnancy)
Remember about genital herpes (HSV) and how the baby is supposed to be delivered?
Remember about genital herpes (HSV) and how the baby is supposed to be delivered?

- NOT BY VACUUM, NOT SCALPAL ELECTRO (can pass HSV to baby)
- Deliver by C-section
Are episiotomies routine?
Are episiotomies routine?

- No
- Episiotomy – incision made into the perineum to enlarge the vaginal opening to more easily facilitate delivery and minimize soft tissue (no longer routine, has its own risks and benefits)
Would we use episiotomy (an incision into the perineum and vagina to allow sufficient clearance for birth) for shoulder dystocia (abnormal, slow, or difficult childbirth, usually because of disordered or ineffective contractions of the uterus)?
Would we use episiotomy (an incision into the perineum and vagina to allow sufficient clearance for birth) for shoulder dystocia (abnormal, slow, or difficult childbirth, usually because of disordered or ineffective contractions of the uterus)?

- Yes
- Indications – The baby’s shoulders are stuck in the birth canal after the head is born (shoulder dystocia)
- The head will not rotate from an occiput-posterior position (persistent occiput-posterior)
- The fetus is in breech presentation
- Instruments (forceps or vacuum) are used to shorten the second stage of labor
Patient admitted to facility for preterm labor; to halt the uterus contraction the nurse expects the physician to prescribe?
Patient admitted to facility for preterm labor; to halt the uterus contraction the nurse expects the physician to prescribe?

- Ritodrine (med given to prevent contractions/preterm labor but been taken off the market)
- Ritodrine (Yutopar) – tocolytic given IV (answer)
- Usually Terbutaline (Brethine) – tocolytic given SC or PO
Why do we check for heart tones right after we break their water?
Why do we check for heart tones right after we break their water?

- Cord compression and cord "prolapse" (to fall or slip down or out of place)
- Prolapsed umbilical cord risk factors – Rupture of amniotic membranes
- Check Fetal Bradycardia (Answer)
What happens if we can't get the heart tones back up; baby is bradycardic pulse in 60's what are you going to do?
What happens if we can't get the heart tones back up; baby is bradycardic pulse in 60's what are you going to do?

- STAT caesarian section going to get her delivered "C-section"
- Indications for C-section – Dystocia (difficult birth), multiple gestations, and umbilical cord prolapse
We’re assessing the heart tones left side, oxygen, IV fluids, what are we trying to prevent? Fetal hypoxia (first it compensates go to bradycardia then tachycardia then hypoxia)

Turn pt on left side, turn off oxytocin, give oxygen, give IV fluids, what does it improve?
We’re assessing the heart tones left side, oxygen, IV fluids, what are we trying to prevent? Fetal hypoxia (first it compensates go to bradycardia then tachycardia then hypoxia)

Turn pt on left side, turn off oxytocin, give oxygen, give IV fluids, what does it improve?

NOT:
- Not prolapsed cord
- Not maternal comfort
- Not contraction patterns


- It is easier to resuscitate a baby in the uterus than after it is delivered (turn on left side, give fluids, and Oxygen)
- Trying to prevent fetal hypoxia
- (in utero resuscitation is a lot more effective then extra uterine resuscitation) (before u can give them fluids, turn them on their side, giving oxygen)
- Place client in left side lying reclining position with legs elevated
- Administer oxygen, discontinue oxytocin, increase IV fluid if hypotensive
- Monitor maternal VS and FHR
We give Pitocin "oxytocin" to induce labor; do u think contractions are going to be stronger or weaker?
We give Pitocin "oxytocin" to induce labor; do u think contractions are going to be stronger or weaker?

- Stronger (for difficult for induction "induce" then going in labor on your own)
- Contractions are stronger and more uncomfortable, beginning is harder
- Contractions: stronger, > painful, abrupt peak
When a patient goes into labor on their own its kind of gradual process, you can have what’s is called late and phase of labor can last 2 weeks there's 0-4 and as time progresses as contraction starts they go into active part of labor then transition, so the early part of labor were kind of throwing them into active part
When a patient goes into labor on their own its kind of gradual process, you can have what’s is called late and phase of labor can last 2 weeks there's 0-4 and as time progresses as contraction starts they go into active part of labor then transition, so the early part of labor were kind of throwing them into active part

- Induction with Pitocin (oxytocin) is faster and contractions are more painful
Highest priority in managing/taking care of patient in labor?
Highest priority in managing/taking care of patient in labor?

- Maintain tissue perfusion of the baby
- Baby is the priority
Complication of oxytocin (Pitocin) is what?
Complication of oxytocin (Pitocin) is what?

- Tachysystole (condition of excessively frequent contractions of the uterus during pregnancy)
- Tetanic contractions
- Can lead to fetal Hypoxia
- S/E of Pitocin (oxytocin) – Fluid overload, edema (watch strict I&O), water retention, make sure urine output is adequate
- Monitor: water intoxication and HTN (check I&O)
- May cause uterine hyper stimulation and serious uterine tetany (tetany can lead to fetal hypoxia)
Too much oxytocin?
Too much oxytocin?

- Water intoxication
- Monitor I&O
With oxytocin (Tachysystole); if giving too much?
With oxytocin (Tachysystole); if giving too much?

- Not enough perfusion then the placenta breaks or Abrupts
- Fetal hypoxia
- Placental Abruption
- May cause uterine hyperstimulation and serious uterine tetany (tetany can lead to fetal hypoxia
Do you have to worry about late decelerations?
Do you have to worry about late decelerations?

- Yes
- Late decelerations start after the beginning of a contraction and indicate decreased blood flow to the placenta and cord during contractions
- Late decelerations are transitory decreases in heart rate caused by uteroplacental insufficiency, a compromised blood flow to the baby that does not deliver the amount of oxygen needed to withstand the stress of labor
- The late deceleration begins after the onset of the peak or middle of the contraction and ends after the contraction
- A late deceleration begins during or after a contraction and has not recovered by the time that the contraction has ended
- A late deceleration indicates decreased blood flow during uterine contraction
- Persistent late decelerations are ominous, especially if the decelerations are associated with loss of short-term variability
Do you have to worry about early deceleration?
Do you have to worry about early deceleration?

- No
- Early decelerations (coincide) occur at the same time as the contraction due to head compression and are not an indication of fetal problems
- The early deceleration begins at the onset of the contraction and ends with the end of the contraction
- Early deceleration is caused by vagal stimulation from head compression, and is a reassuring pattern that may be prevented by avoiding early rupture of membranes
- An early deceleration begins at or after the onset of a contraction and returns to the baseline rate by the time the contraction has finished and produces a mirror image of the contraction
- Early decelerations are not a sign of fetal problems
- Early decelerations occur: During vaginal exams, in 2nd stage of labor during pushing, during application of internal FHR electrode, with cephalopelvic disproportion (head is too large), After amniotic sac has ruptured, with vertex (head first) presentations
What are variable decelerations?
What are variable decelerations?

- Variable decelerations are transitory decreases in FHR caused by umbilical cord compression
- Variable decelerations (V or U shaped) suggest umbilical cord compression
- If the baseline FHR remains stable and the variability remains good, variable decelerations are not associated with poor fetal outcome
- They indicate possible compromise if they become prolonged or are persistent
Normal FHR?
Normal FHR?

- 110 or 120-160
In a 10min to 15min window we want variability we want min to moderate variability, when would variable decelerations be a problem?
In a 10min to 15min window we want variability we want min to moderate variability, when would variable decelerations be a problem?

- If they last too long (over 20-40 min)
- Variable decelerations indicate possible compromise if they become prolonged or are persistent
What are FHR accelerations?
What are FHR accelerations?

- The FHR will normally remain steady or accelerate during uterine contractions
- Look at the FHR and what is happening with contractions
- Accelerations are defined as a transient increase in heart rate of greater than 15 bpm for at least 15 seconds (the 15 x 15 rule)
- Two accelerations in 20 minutes is considered a reactive trace
- Accelerations are a reassuring sign as they show fetal responsiveness and the integrity of the mechanisms controlling the heart
- Shows that baby is healthy
- Variability of 10-15 beats above or below FHR baseline is acceptable and indicates that the placenta and the fetus have adequate blood flow
How can we prevent variable heart rates if they ruptured amniotic membrane?
How can we prevent variable heart rates if they ruptured amniotic membrane?

- Amnioinfusion (put water back in their environment to help the cord be more buoyant)
- Instillation of NS or lactated Ringers’s solution into the amniotic cavity through a transcervical catheter to reduce severity of variable decelerations caused by cord compression or dilute meconium stained amniotic fluid
When we’re monitoring for contractions what are we checking for?
When we’re monitoring for contractions what are we checking for?

- Frequency, duration, intensity
- Frequency – Established from the beginning of 1 contraction to the beginning of the next
- Duration – The time between the beginning of a contraction to the end of the same contraction
- Intensity – Strength of the contraction at its peak described as milk, moderate, or strong
What correlates with contractions, in term of the baby’s heart rate what are u going to see with the contractions?
What correlates with contractions, in term of the baby’s heart rate what are u going to see with the contractions?

- Early decelerations (were not worried about that)
- Early decelerations (coincide) occur at the same time as the contraction due to head compression and are not an indication of fetal problems
What must occur when we need to put on a (internal) scalp electrode?
What must occur when we need to put on a (internal) scalp electrode?

- Membranes need to be ruptured (can't put a scalp electrode on when cervix is close)
- Membranes must rupture, cervix open 2-3 cm
- Continuous internal fetal monitoring with a scalp electrode is performed by attaching a small electrode to the presenting part of the fetus to monitor FHR
If a patient had previous lost in the late term pregnancy (gestation), what are they going to do?
If a patient had previous lost in the late term pregnancy (gestation), what are they going to do?

- Their going to monitor the baby while she’s in labor with a fetal scalp electrode
- Indications for the use of external and internal fetal monitoring
- Previous stillbirth
- Meconium Staining (indicates fetal distress)
- Amnionitis (amniotic membrane infection)
- Regional anesthesia (may cause maternal hypotension reducing blood flow to the fetus)
- Epidural and Spinal
Side effects of anesthesia (Epidural Block)?
Side effects of anesthesia (Epidural Block)?

- (prior to anesthesia we give them lots of fluids) because side effect is hypotension, because then baby infected to and goes in to bradycardia (hydration, at least 1,000cc) - answer
- May cause hypotension, fetal bradycardia, inability to feel urge to void, and loss of bearing down reflex
- Administer IV fluids prior to anesthetic (at least one liter) to offset hypotension
Biparietal diameter?
Biparietal diameter?

- It tells u what station the babies at (where the babies at) you are checking the head of the baby NEED TO KNOW WHAT BIPARIETAL DIAMETER IS IN RELATIONSHIP TO THE MOMS PELVIS
- Engagement – occurs when the presenting part, usually biparietal (largest) diameter of the fetal head reaches the pelvic inlet at the level of the ischial spines (referred to as station 0)
- (-3, -2, -1, 0, +1. +2. +3)…..
To check the position of the baby's body/position we use?
To check the position of the baby's body/position we use?

- Leopold’s maneuvers
- Leopold's Maneuvers are a common and systematic way to determine the position of a fetus inside the woman's uterus
- Leopold’s maneuvers – abdominal palpation of the number of fetuses, the fetal presenting part, lie, attitude, descent, and the probably location where fetal heart tones may be best auscultated
(4th stage of labor) For postpartum what are we looking for?
(4th stage of labor) For postpartum what are we looking for?

- Massaging the fundus/uterus
- Massaging the uterine fundus and/or administering oxytocics as prescribed to maintain uterine tone to prevent uterine atony (boggy uterus) and hemorrhage
- Teach patients to massage the fundus
- Give Pitocin
Postpartum, if you were massaging the fundus (base of organ) and we leave the room and come back what could have happened in that half hour? (Immediate action)
Postpartum, if you were massaging the fundus (base of organ) and we leave the room and come back what could have happened in that half hour? (Immediate action)

- Uterine atony (uterine without tone) means uterus is boggy and hemorrhaging
- Massaging the fundus/uterus is the priority
- Give Pitocin
One of the signs of placenta delivery once the baby is out, what might u see?
One of the signs of placenta delivery once the baby is out, what might u see?

- blood gushing
- Increased bleeding with swift gush of dark blood from the introitus (vaginal opening)
- Fundus firmly contracting forming a globular shape
- Increased number of contractions
- Umbilical cord appears to lengthen as placenta descends
- Vaginal fullness on exam
What is the first stage - transition stage?
What is the first stage - transition stage?

- The patient is the most uncomfortable
- A very difficult phase of labor, most difficult they are irritable
- Begins with cervix at 7/8-10cm dilation and ends with complete dilation
- Strong to very strong contractions occurring every 2-3 minutes with 45-91 second duration
- Mother is tired, restless, irritable, feeling out of control
- May have N/V, urge to push, increased rectal pressure, feelings of needing to have bowel movement, increased bloody show
- Shortest, most difficult part of labor
What do you think might be the first part of second stage of labor?
What do you think might be the first part of second stage of labor?

- She wants to feel like she wants to push
- Involuntary urge to push and voluntary bearing down in the 2nd stage to expel fetus
- Begins with full dilation and ends with birth
- Rectum dilates, perineum bulges and, the top of the fetal head appears – “crowning”
- Pushing results in birth of the fetus
- Duration 30 min to 3 hrs in primigravidas and 5-30 min in multigravidas
- Intense contractions every 1-2 minutes
The 3rd stage of delivery is?
The 3rd stage of delivery is?

- The delivery of the placenta
- Begins with delivery of the infant and ends with delivery of the placenta
- Duration 5-30 minutes in both primigravidas and multigravidas
- Placental separation and expulsion
- Schultze presentation: shiny fetal surface of placenta emerges first
- Duncan presentation: dull maternal surface of placenta emerges first
The 4th stage of delivery is?
The 4th stage of delivery is?

- Begins with delivery of the placenta and ends with maternal stabilization of VS
- Duration 1-4 hours in both primigravidas and multigravidas
- Achievement of VS homeostasis
- Uterine fundus at the umbilicus and firm
- Lochia (vaginal discharge) scant to moderate rubra (red)
The 1st stage of delivery is?
The 1st stage of delivery is?

- Begins with the onset of labor and ends with complete dilation
- Duration 8-10 hours after reaching active phase for primigravidas, 2-10 hours after reaching active phase for multigravidas, on average
- Cervical dilation 1cm/hour for primigravidas and 1.5cm/hour for multigravida, on average
- First Stage: Latent Phase
- Begins with cervix at 0cm dilated and ends with cervix 3cm dilated
- Some dilation
- Some effacement
- Mother is talkative and eager
- Irregular, mild to moderate contraction of 5-30 minute frequency with duration of 30-45 seconds
- First Stage: Active Phase
- Begins with cervix 4 cm dilated and ends with cervix 7 cm dilated
- Rapid dilation and effacement
- More regular, moderate to strong contractions of 3-5 minute frequency with 40-70 sec duration
- Some fetal descent
- Maternal helplessness, anxiety, and restlessness
- First Stage: Transition
- Begins with cervix at 7/8-10cm dilation and ends with complete dilation
- Strong to very strong contractions occurring every 2-3 minutes with 45-91 second duration
- Mother is tired, restless, irritable, feeling out of control
- May have N/V, urge to push, increased rectal pressure, feelings of needing to have bowel movement, increased bloody show
- Shortest, most difficult part of labor
After the babies born we are waiting for the placenta to be delivered, what do u think u might see with the cord?
After the babies born we are waiting for the placenta to be delivered, what do u think u might see with the cord?

- The shiny Shultz (fetal side) (u'll see the gushing blood and the lengthening of the unbillical cord then u'll see the fetal)
What might you see with umbilical cord before the placenta is delivered?
What might you see with umbilical cord before the placenta is delivered?

- Umbilical cord lengthens (when coming out of vagina), when placenta is coming out
- Umbilical cord appears to lengthen as placenta descends
When you are coning you are feeling u feel like there's a lot of pressure and rectal pressure and patient will tell u i feel like i have to have a bowel movement and you'll say it's okay, it’s the baby’s head and even if they do it’s not a big deal, and if they say to u the babies coming that means the babies coming
When you are coning you are feeling u feel like there's a lot of pressure and rectal pressure and patient will tell u i feel like i have to have a bowel movement and you'll say it's okay, it’s the baby’s head and even if they do it’s not a big deal, and if they say to u the babies coming that means the babies coming
When do we measure contractions?
When do we measure contractions?

- beginning of the 1st contraction to the beginning of the next contractions
- Ex. contraction starts 5 after then next one 10 after how far apart are they 5mins
- Frequency – Established from the beginning of 1 contraction to the beginning of the next
What does engagement mean?
What does engagement mean?

- Fetal head engaged into the pelvis
- Engagement - occurs when the presenting part, usually biparietal (largest) diameter of the fetal head reaches the pelvic inlet at the level of the ischial spines (referred to as station 0)
- Baby's head well into the pelvis - engaged
What position causes maternal hypotension?
What position causes maternal hypotension?

- Supine (laying on her back)
Need to know LOA, LOP, LOT (checking for the position of the baby’s head in relationship to the mothers pelvis) (on test their going to give u a picture of the baby’s head and ur going to need to know the fontanel etc.)
Need to know LOA, LOP, LOT (checking for the position of the baby’s head in relationship to the mothers pelvis) (on test their going to give u a picture of the baby’s head and ur going to need to know the fontanel etc.)

- Fetopelvic or fetal position is labeled with 3 letters
- First letter – references the right (R) or left (L) side of the maternal pelvis
- Second letter – references fetal presenting part: occiput (O), sacrum (S), mentum (M), or scapula (S)
- Third Letter – references maternal pelvis: anterior (A), posterior (P), or transverse (T)
If you were describing the fetal position (fetopelvic) you would be describing the position of the baby’s head in relationship to the mother’s pelvis
If you were describing the fetal position (fetopelvic) you would be describing the position of the baby’s head in relationship to the mother’s pelvis
Biparietal diameter is -1 station?
Biparietal diameter is -1 station?

- Baby’s head is 1 cm above the ischial spine (station of babies head)
(Is considered centimeters)
- Station – measurement of fetal descent in centimeters
- Station 0 – at the level of an imaginary line at the level of the ischial spines
- Minus Stations – superior to the ischial spines
- Plus Stations – inferior to the ischial spines
(I think determining the mom) know ROA, LOA EX. roa = right occiput anterior rot= right occiput transverse
(I think determining the mom) know ROA, LOA EX. roa = right occiput anterior rot= right occiput transverse

Answer might be ROA
What color does nitrazene paper turn if it is in fact amniotic fluid?
What color does nitrazene paper turn if it is in fact amniotic fluid?

- blue..can it turn blue with other fluids? Yes
- Nitrazine paper should be utilized to confirm that fluid is amniotic fluid, it tests the pH of fluid and will turn deep blue if amniotic, remains yellow if urine
- Fernlike pattern when amniotic fluid is placed on a glass slide and allowed to dry
- Vaginal pooling of amniotic fluid
- Color – should be pale to straw color
- Odor – should not be foul
- Clarity – should appear watery and clear
- Volume – 500-1,000mL
Know about fern test...if pt comes in only 37weeks and says i think i ruptured u'll do 3 things
Know about fern test...if pt comes in only 37weeks and says i think i ruptured u'll do 3 things

- Fern test is most conclusive
- first vaginal pooling ( at the cervical you'll see water pooling if it is) if u don't see it you'll take a swab put it on a little slide a microscope once its dry and if its amniotic fluid it'll say fern plant positive..3 fern (most reliable), nitrazene, vaginal pooling for test
- Fernlike pattern when amniotic fluid is placed on a glass slide and allowed to dry (most definitive)
Are you worried about infection after 12hrs of rupture of membranes?
Are you worried about infection after 12hrs of rupture of membranes?

- Priority is Fetal heart tones and Mom's VS
- Yes
- Rupture of membranes – spontaneous rupture of membranes can initiate labor or can occur any time during labor, most commonly during transition phase
- Rupture may be spontaneous (SROM) or artificial (AROM) – monitor FHR
- Labor usually occurs within 12-24 hours before delivery can lead to infection
What is the definition of labor?
What is the definition of labor?

- Contractions with cervical change (answer)
- Dilation of cervic
- Lightening – fetal head descends into true pelvis about 14 days before labor
- Backache – constant low, dull backache, caused by pelvic muscle relaxation
- Contractions – begins with irregular uterine contractions (Braxton Hicks) that eventually progress in strength and regularity, more intense during walking
- Bloody show – brownish or blood-tinged mucus discharge caused by expulsion of the cervical mucus plug
- 1-3 pounds
- Energy burst – sometimes called the “nesting” response
- GI changes – may include N/V, and indigestion
- Rupture of membranes – spontaneous rupture of membranes can initiate labor or can occur any time during labor, most commonly during transition phase
- Rupture may be spontaneous (SROM) or artificial (AROM) – monitor FHR
- Labor usually occurs within 12-24 hours before delivery can lead to infection
An important factor to know if patient says her bag and water has ruptured, you diagnosed that she has ruptured, what do u want to know from her if she’s at home when it breaks?
An important factor to know if patient says her bag and water has ruptured, you diagnosed that she has ruptured, what do u want to know from her if she’s at home when it breaks?

- You need to know what time it ruptured
- Rupture of membranes – spontaneous rupture of membranes can initiate labor or can occur any time during labor, most commonly during transition phase
- Rupture may be spontaneous (SROM) or artificial (AROM) – monitor FHR
- Labor usually occurs within 12-24 hours before delivery can lead to infection
Patient comes to the desk and she says to you that i want to be seen for my pregnancy and you are in labor and delivery, you are the triage nurse, what do you want to ask her?
Patient comes to the desk and she says to you that i want to be seen for my pregnancy and you are in labor and delivery, you are the triage nurse, what do you want to ask her?

- “When are you due”
Need to know TPAL?
Need to know TPAL?

- Term, premature, abortion, living
- G-gravida – total number of pregnancies a woman has had
- Primigravida – pregnant for the first time
- Multigravida – has had multiple births
- P-para – number of babies born at 20 or > weeks
- Grand multipara – has given birth at least five times
- P-para – outcome of pregnancies are classified as using FPAL or TPAL
- F-full term – number of babies born at 37 or > weeks of gestation (some use T for Term)
- P-preterm – number of babies born between 20-37 weeks gestation
- A-abortions – total number of spontaneous and elective abortions
- L-living – children as of today
Determine labor from not labor, since patient can’t check her own cervical what are u going to tell her about labor. True signs of labor.
Determine labor from not labor, since patient can’t check her own cervical what are u going to tell her about labor. True signs of labor.

- Pain in lower back radiating to front (abdomen) (answer)
- Not above umbilical
- Labor contractions are regular and frequency (LOOK UP)
- True labor – Pain in lower abdominal and then lower back
- Pain gets worse when patient walks
- Backache – constant low, dull backache, caused by pelvic muscle relaxation
- Contractions – begins with irregular uterine contractions (Braxton Hicks) that eventually progress in strength and regularity, more intense during walking
Patient with intrauterine death, what are we worried about?
Patient with intrauterine death, what are we worried about?

- Worried about DIC (isseminated intravascular coagulation)
Is fetal tachycardia ok with fetal scalp stimulation?
Is fetal tachycardia ok with fetal scalp stimulation?

- Yes
What is the fetal pH < 7.2 a sign of?
What is the fetal pH < 7.2 a sign of?

- Fetal Distress
#1 concern of Oxytocin?
#1 concern of Oxytocin?

- It can cause tetany (fetal hypoxia), tachysystole
After water breaks and after doing assessment for fetal bradycardia, what is our goal?
After water breaks and after doing assessment for fetal bradycardia, what is our goal?

- Promoting fetal tissue perfusion
One identifying factor of a reassuring strip on a fetal heart tone monitor, what would that be?
One identifying factor of a reassuring strip on a fetal heart tone monitor, what would that be?

- Short term variability
- Indication that baby is not hypoxic
- Fetal heart rate variability of at least 10-15 bpm over a period of one minute
- Short-term variability (beat-to-beat) from the fetal heart rate baseline
What are the 5 characteristics of 'ERYTHROCYTES'?
1. NO NUCLEUS
2. CANNOT MULTIPLY
3. BICONCAVE DISCS
4. NO ENDOPLASMIC RETICULUM
5. DO NOT SYNTHESIZE PROTEINS
What are you worried about with anesthesia (epidural)?
What are you worried about with anesthesia (epidural)?

- Hypotensive crisis, (causes fetal bradycardia
What happens at the end of the 3rd stage?
What happens at the end of the 3rd stage?

- Delivery of the Placenta
Beginning of stage 2?
Beginning of stage 2?

- Completely dilated (beginning of stage 2) to delivery of baby
What happens in Transition?
What happens in Transition?

NOT:
- Not FHR accelerations
- Not bloody show
- Not decrease urge to push

- Answer is "start to see crowning"
- Observe for perineal bulging/crowning
If she is progressing quickly (transition stage), what might you see?
If she is progressing quickly (transition stage), what might you see?

- Feels rectal pressure
If she tells you the baby is coming, the baby is coming!
If she tells you the baby is coming, the baby is coming!
What is Fetal Decent - Flexion, Internal rotation, extension, external rotation, and expulsion?
What is Fetal Decent - Flexion, Internal rotation, extension, external rotation, and expulsion?

- Cardinal Movements of Labor
What describes fetal position?
What describes fetal position?

- Fetus' presenting part in relationship to mother's pelvis
- Fetus' body in relationship to mom's pelvis
- Fetopelvic or fetal position - The relationship of the presenting part of the fetus (sacrum, mentum, or occiput) preferably the occiput, in reference to its directional position as it relates to one of the four maternal pelvic quadrants
gravida
gravida

- total number of pregnancies
para
para

- number of babies born at 20 weeks or greater
Real labor
Real labor

- cervical changes, dilate to at least 2 cm and effacement
New admit, what is most important info to obtain?
New admit, what is most important info to obtain?

when did the water break
How do you determine if urine or amniotic fluid?
How do you determine if urine or amniotic fluid?

Nitrazine paper test or fern test
Passenger?
Passenger?

The fetus and the placenta
What is the first thing to assess for a woman in labor?
What is the first thing to assess for a woman in labor?

FHR
Best position for the baby to be in for delivery?
Best position for the baby to be in for delivery?

ROA (Right occiptal anterior), looking down at the floor when coming out
Station?
Station?

Where in the canal the baby is located. (-) is above is ischial spines and (+) is below the ischial spines
Engagement
Engagement

- presenting part, usually the biparietal (largest) diameter of the fetal head reaches station 0
Measuring a contractions duration
Measuring a contractions duration

- time between the beginning and the end of the contraction
4 stages of labor
4 stages of labor

1 = dilation + 3 phases, latent (happy), active (not happy) and transitional (not speaking)
2 = expulsion because client is fully dilated
3 = placenta delivered
4 = recovery
How will mom be during transitional phase?
How will mom be during transitional phase?

irritable and withdrawn, this is the shortest and most difficult stage, she is 8-10 cm dilated, the baby is coming
How will you know she is going from the transitional phase of stage 1 to stage 2?
How will you know she is going from the transitional phase of stage 1 to stage 2?

bulging
During 2nd stage, what do you instruct your pt to do?
During 2nd stage, what do you instruct your pt to do?

Push only during a contraction
Signs of placental separation?
Signs of placental separation?

cord begins to lengthen and a gush of blood
During stage 4, watch for?
During stage 4, watch for?

Uterine atony, may bleed to death. make sure fundus is firm
Leopolds maneuver?
Leopolds maneuver?

checking fetus position, where its at in uterus
What needs to happen before you can apply an internal monitor?
What needs to happen before you can apply an internal monitor?

Membrane needs to be broken
When is an epidural block given?
When is an epidural block given?

Usually around 4 cm (2nd stage), make sure she has adequate hydration to prevent hypotension (500-1000mls) and watch for fetus bradycardia
Indication for internal FHR monitoring?
Indication for internal FHR monitoring?

Previous stillbirths, meconium staining (fetal distress)
Fetal heart rate variability?
Fetal heart rate variability?

Short term variability (beat to beat) from the FHR baseline is the best way to measure
10-15 beats above or below baseline is ok, variable can happen with or without contractions
10-15 beats above or below baseline is ok, variable can happen with or without contractions
Acceleration
Acceleration

= a transient increase in FHR of greater than 15 bpm for at least 15 seconds. they are a reassuring sign of fetal responsiveness and heart control
Early deceleration
Early deceleration

- the baby is still ok, but late deceleration means the baby needs to come out. if in distress, give 8-10 LPM of O2, open up IV fluids and turn mom on side and stop pitocin
Amniotomy (artificial rupture of membranes)
Amniotomy (artificial rupture of membranes)

should be done at 0 station, if its broken while at- 3 station will have cord prolapse Cord coming out first, no bueno
Admin of Pitocin?
Admin of Pitocin?

Fetus must be at station 0. May cause uterine hyperstimulation and serious uterine tetany which leads to fetal hypoxia
What do you teach mom about Pitocin?
What do you teach mom about Pitocin?

Contractions will get stronger and more painful with an abrupt peak
Medications for preterm labor?
Medications for preterm labor?

tocolytics, ritodrine, terbutaline, magnesium sulfate, nifepidine, betamethasone.
Goal of preterm labor is to stop or slow the contractions, tocolytics help with this
Goal of preterm labor is to stop or slow the contractions, tocolytics help with this
5 P's
5 P's

= Passenger, Passageway, Powers, Position of Laboring Woman, Psyche
What do you check before you induce labor?
What do you check before you induce labor?

Is the baby's head engaged against the cervix
Preterm?
Preterm?

20-37 weeks