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114 Cards in this Set

  • Front
  • Back
What is preterm labor?
Cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy
What is preterm birth?
Any birth that occurs before the completion of 37 weeks of pregnancy
What is a miscarriage?
A pregnancy ending before 20 weeks of gestation
Why are preterm labor and preterm birth the most serious complications of pregnancy?
Because they lead to about 90% of all neonatal deaths, with more than 75% of these deaths occurring in infants born at fewer than 32 weeks gestation
What is the leading cause of infant mortality?
Congenital anomalies
What is the second leading cause of infant mortality?
Preterm birth
What is very preterm birth?
Birth that occurs before the completion of 32 weeks of pregnancy
What is low birth weight?
2500 g or less at birth
What risk factor is the most commonly associated with preterm labor and birth?
1. History of preterm birth
2. Low socioeconomic status
3. Low pregnancy weight
4. Multiple gestation
What are the two most common biochemical markers used in an effort to predict who might experience preterm labor?
1. Fetal fibronectins
2. Salivary estriol
What are fetal fibronectins?
Glycoproteins found in plasma and produced during fetal life
What is the significance of fetal fibronectins?
Their appearance between 24 to 34 weeks gestation predicts labor
What is salivary estriol?
A form of estrogen produced by the fetus that is present in the plasma at 9 weeks of gestation
What is the cause of preterm labor?
Unknown
What is the major etiologic factor associated with preterm labor?
Infection
What maternal factors are associated with preterm labor and birth?
1. Smoking
2. Substance abuse (alcohol, drugs)
3. Poor nutrition
4. Employment/work involving long hours and periods of standing
5. Short interpregnancy interval (<1 yr)
6. Sexual activity
What maternal characteristics are associated with preterm labor and birth?
1. Young or older age (<16, >35)
2. Previous preterm birth
3. Short stature
4. Short cervix
5. Uterine anomalies
6. Diethylstilbestrol exposure
7. Prematurely dilated cervix
8. Low prepregnancy weight; obesity
9. Race (e.g. African-American, Hispanic)
10. Unmarried
11. Low socioeconomic status
12. Intimate partner abuse
What other factors are associated with preterm labor and birth?
1. Inadequate support systems
2. Stress
3. Uterine irritability
4. Multiple gestation
5. Late or no prenatal care
6. PROM
7. Anemia
8. Infection
What are the signs and symptoms of preterm labor?
1. Uterine contractions occurring q10 minutes or more frequently and persisting for more than 1 hour

2. Uterine contractions may be painful or painless

3. Lower abd cramping similar to gas pains; pay be accompanied by diarrhea

4. Dull, intermittent lower back pain

5. Painful, menstrual-like cramps

6. Suprapubic pain or pressure

7. Pelvic pressure of heaviness; feeling the baby is pushing down

8. Urinary frequency

9. Change in character or increase in amount of usual discharge - thicker (mucoid) or thinner (watery), bloody, brown or colorless, increased amount, odor

10. Rupture of amniotic membranes
What are the nursing diagnoses relevant for women at risk for preterm birth?
1. Risk for imbalanced fluid volume
2. Interrupted family process
3. Impaired physical mobility
4. Anticipatory grieving
5. Risk for impaired parent-infant attachment
What are the major diagnostic criteria for preterm labor?
1. Gestational age between 20 and 37 weeks

2. Uterine activity (e.g. contractions)

3. Progressive cervical change (e.g. effacement of 80% or cervical dilation of 2cm or greater)
When should a pregnant woman be prompt to call her MD?
If contractions or cramping do not go away
What activities are associated with preterm labor?
1. Sexual activity
2. Riding long distances in cars, trains, or buses
3. Carrying heavy loads such as laundry, groceries, or a small child
4. Standing more than 50% of the time
5. Heavy housework
6. Climbing stairs
7. Hard physical work
8. Being unable to stop and rest when tired
What are the adverse effects of bedrest?
1. Weight loss; indigestion; loss of appetite
2. Muscle dystrophy
3. Bone demineralization and calcium loss
4. Risk for thrombophlebitis
5. Alteration in bowel function
6. Prolonged postpartum recovery
7. Sleep disturbances; fatigue
What are tocolytics?
Medications that suppress uterine activity
What are the maternal contraindications to tocolytics?
1. Gestational HTN
2. Active vaginal bleeding
3. Intrauterine infection (chorioamniotitis)
4. Cardiac disease
5. Medical or obstetric condition that contraindicates continuation of pregnancy
6. Cervical dilation greater than 6cm
What are the fetal contraindications to tocolytics?
1. Estimated gestational age > 34 wks
2. Fetal death
3. Lethal fetal anomaly
4. Acute fetal distress
5. Chronic intrauterine growth restriction
What are some tocolytic medications?
1. Magnesium sulfate
2. Nifedipine (Procardia)
3. Indomethacin
What is PROM?
Premature rupture of membranes = the rupture of the amniotic sac and leakage of amniotic fluid beginning at least 1 hour before the onset of labor at any gestational age
What is PPROM?
Preterm premature rupture of membranes = membranes rupture before 37 weeks of gestation
What is dystocia?
A long, difficult, or abnormal labor
What causes dystocia?
1. Dysfunctional labor, resulting in ineffective uterine contractions and maternal bearing-down efforts (POWERS)

2. Alterations in pelvic structure (the PASSAGE)

3. Fetal causes, including abnormal presentation or position, anomalies, excessive size, and number of fetuses (the PASSENGER)

4. Maternal POSITION during labor and birth

5. PSYCHOLOGIC responses of the mother to labor
What is hypotonic uterine dysfunction?
Secondary uterine inertia, where contractions become weak and inefficient or stop altogether
What is the management of hypotonic uterine dysfunction?
1. Performing an ultrasound or radiographic exam to rule out CPD

2. Assessment of the FHR and pattern, characteristics of amniotic fluid if membranes are ruptured, and maternal well-being
If findings are normal, what can be used to augment the progress of labor?
1. Ambulation
2. Hydrotherapy
3. Enema
4. Stripping or rupture of membranes
5. Nipple stimulation
6. Oxytocin infusion
What causes abnormal labor patterns?
1. Ineffective uterine contractions
2. Pelvic contractures
3. CPD
4. Abnormal fetal presentation or position
5. Early use of analgesics
6. Nerve block analgesia/anesthesia
7. Anxiety and stress
What is CPD?
Cephalopelvic disproportion
What is precipitous labor?
Abnormal labor that lasts less than 3 hours from the onset of contractions to the time of birth
What maternal complications can result from precipitous labor?
1. Uterine rupture
2. Lacerations of the birth canal
3. Amniotic fluid embolism
4. Postpartum hemorrhage
What fetal complications can result from precipitous labor?
1. Hypoxia caused by decreased periods of uterine relaxation between contractions

2. Intracranial hemorrhage r/t rapid birth
What is the LEAST common cause of dystocia?
Disproportion of the pelvis
What is an inlet contracture?
The diagonal conjugate is less than 11.5 cm
What is the MOST common cause of pelvic dystocia?
Midplane contracture
What is a midplane contracture?
The sum of the interischial spinous and posterior sagittal diameters of the midpelvis is 13.5 cm or less
What is outlet contracture?
The interischial diameter is 8 cm or less
What causes soft tissue dystocia?
Obstruction of the birth passage by an anatomic abnormality other than that involving the pelvis
What can obstruct the birth passage?
1. Placenta previa
2. Leiomyomas in the lower uterine
3. Ovarian tumors
4. Full bladder or rectum
What are leiomyomas?
Uterine fibroids
What is the effect of STIs on labor?
STIs can alter cervical tissue integrity and thus interfere with adequate effacement and dilation
What is a Bandl ring?
A pathologic retraction ring that forms between the upper and lower uterine segments
What is a Bandl ring associated with?
Prolonged rupture of membranes, protracted labor, and increased risk for uterine rupture
What are the fetal causes of dystocia?
1. Fetal anomalies
2. Excessive fetal size
3. Fetal malpresentation
4. Fetal malposition
5. Multifetal pregnancy
What is cephalopelvic disproportion often related to?
Excessive fetal size 4000 g or more
What can cause excessive fetal size (macrosomia)?
1. Maternal DM
2. Multiparity
3. Large size of one or both parents
What is the most common fetal malposition?
Persistent occipitoposterior position
What is fetal malposition associated with?
Prolonged second stage labor
What does the mother usually complain of when there is fetal malposition?
Severe back pain from the pressure of the fetal head (occiput) pressing against her sacrum
What is the second most commonly reported complication of labor and birth?
Fetal malpresentation
What is the most common type of fetal malpresentation?
Breech presentation
What are the types of breech presentation?
1. Frank breech
2. Complete breech
3. Incomplete breech with foot extending below the buttocks
4. Incomplete breech with knee extending below the buttocks
What is frank breech?
The thighs are flexed on the hips, the knees are extended and the buttocks are engaged in the pelvis
What is complete breech?
The thighs and knees are flexed, and the buttocks are engaged in the pelvis
What are breech presentations associated with?
1. Multifetal gestation
2. Preterm birth
3. Fetal and maternal anomalies
4. Hydramnios
5. Oligohydramnios
What are the measures to relieve low back pain during a contraction?
1. Counterpressure with fist or heel of hand on sacral area
2. Heat or cold application
3. Double hip squeeze
4. Knee press
What are the measures to facilitate the rotation of the fetal head?
1. Lateral abdominal stroking
2. Hands-and-knees position (all-fours)
3. Squatting
4. Pelvic rocking
5. Stair climbing
6. Lateral position
7. Lunges
What can be used to turn the fetus to the vertex presentation?
External cephalic version
What factors can be a source of dysfunctional labor?
1. Anxiety or fear
2. A complication of pregnancy
3. Previous labor complications
What information do the initial physical assessment and ongoing assessments provide?
1. Maternal well-being
2. Status of the labor
3. Characteristics of uterine contractions
4. Progress of cervical effacement and dilation
5. Fetal well-being
6. FHR and pattern
7. Fetal presentation, station, and position
8. Status of amniotic membranes
What are the nursing diagnoses for women experiencing dystocia?
1. Risk for maternal or fetal injury
2. Powerlessness
3. Risk for infection
4. Ineffective coping
5. Risk for impaired parent-infant attachment
What interventions can be implemented by nurses when labor is complicated?
1. External cephalic version (ECV)
2. Trial of labor
3. Cervical ripening with prostaglandins
4. Induction or augmentation with oxytocin
5. Amniotomy
6. Operative procedures or care for C-sections
How is ECV accomplished?
By the exertion of gentle, constant pressure on the abdomen
What must be done before ECV is attempted?
1. Ultrasound scanning to determine fetal position
2. Locate the umbilical cord
3. Rule out placenta previa
4. Evaluate the adequacy of the maternal pelvis
5. Assess the amount of amniotic fluid
6. Assess fetal age
7. Assess for presence of any anomalies
What must the nurses do before and during an attempted ECV?
1. Monitor FHR and pattern, especially for bradycardia and variable decelerations
2. Check maternal VS
3. Assess mother's level of comfort
What is trial of labor?
The observance of a woman and her fetus for a reasonable period (e.g. 4 to 6 hours) of spontaneous active labor to assess safety of vaginal birth for the mother and infant
When should trial of labor be initiated?
1. The mother's pelvis is of questionable size or shape
2. Fetus is in an abnormal presentation
3. The mother wishes to have a vaginal birth after a previous cesarean birth
What is induction of labor?
The mechanical or chemical initiation of uterine contractions before their spontaneous onset for the purpose of bringing about the birth
What are the indications for induction of labor?
1. Preeclampsia
2. Diabetes mellulitis
3. Chorioamnionitis
4. PROM
5. Postterm gestation
6. Suspected fetal jeopardy (IUGR)
7. Logistics factors such as history of previous rapid birth or distance of the woman's home from the hospital
8. Fetal death
What are the most common methods of inducing labor?
IV oxytocin and amniotomy
What are the less commonly used methods for inducing labor?
1. Stripping of membranes
2. Nipple stimulation
3. Acupuncture
What is does the Bishop score evaluate?
1. Dilation
2. Effacement
3. Station
4. Cervical consistency
5. Cervix position
What is the significance of the Bishop score?
A score of 9 or more on the 13-point scale indicates that the cervix is soft, anterior, 50% or more effaced, and dilated 2 cm or more; and that the presenting part is engaged
What are the benefits of using prostaglandin E1 to "ripen" (soften and thin) the cervix?
1. Higher success rates for induction of labor
2. The need for lower dosages of oxytocin during induction
3. Shorter induction times
4. Less expensive and more effective than oxytocin
What are some mechanical dilators used to ripen the cervix?
1. Balloon catheters
2. Hydroscopic dilators
What is an amniotomy?
Artificial rupture of membranes
When does labor usually begin after an amniotomy?
Within 12 hours of the rupture; the duration can be decreased up to 2 hours, especially if combined with oxytocin
What is oxytocin?
1. A hormone normally produced by the posterior pituitary gland

2. It stimulates uterine contractions
What are the indications for administration of oxytocin?
1. Suspected fetal jeopardy (e.g. IUGR)
2. Inadequate uterine contractions; dystocia
3. PROM
4. Postterm pregnancy
5. Chorionamnionitis
6. Maternal medical problems
7. Gestational HTN
8. Fetal death
9. Multiparous women with a history of precipitous labor or who live far away from the hospital
10. CPD, prolapsed cord, transverse lie
11. Nonreassuring FHR and pattern
12. Placenta previa or vasa previa

etc.....
What are the nursing interventions for hyperstimulation with oxytocin?
1. Administering O2 by face mask
2. Positioning the woman on her side
3. Infusing more IV fluids
What are the signs of hyperstimulation with oxytocin?
1. Uterine contractions lasting > 90 seconds and occurring more frequently than q2 minutes

2. Uterine resting tone > 20 mmHg

3. Nonreassuring FHR and pattern - Abnormal baseline (<110 or >160 BPM); Absent variability; Repeated late decelerations or prolonged decelerations
What is augmentation of labor?
The stimulation of uterine contractions after labor has started spontaneously but progress is unsatisfactory
What are the common augmentation methods?
1. Oxytocin infusion
2. Amniotomy
3. Nipple stimulation
4. Emptying the bladder
5. Ambulation and position changes
6. Relaxation measures
7. Nourishment and hydration
8. Hydrotherapy
What conditions are required for forceps-assisted birth to be successful?
1. Woman's cervix must be fully dilated to avert lacerations and hemorrhage

2. Presenting part must be engaged with preferred vertex presentation

3. Membranes must be ruptured to firmly grasp fetal head with forceps

4. Bladder should be empty

5. CPD should not be present
What are the prerequisites for vacuum extraction?
1. Vertex presentation
2. Ruptured membranes
3. Absence of CPD
What are the risks of vacuum extraction?
1. Cephalhematoma
2. Scalp lacerations
3. Subdural hematoma
4. Hyperbilirubinemia
5. Neonatal jaundice
What are the nursing considerations for vacuum extraction?
1. Support and educate the woman
2. Assess FHR
3. After the birth, observe for signs of trauma and infection; and for cerebral irritation
What is the purpose of cesarean birth?
1. To preserve the life or health of the mother and the fetus

2. It may be the best choice for birth when there is evidence of maternal or fetal complications
What increases the likelihood of having a cesarean birth?
Increased maternal age
What labor management approach facilitates the progress of labor and reduces the incidence of dystocia?
1. One-on-one support
2. Emphasis on ambulation
3. Maternal position changes
4. Relaxation measures
5. Oral fluids and nutrition
6. Hydrotherapy
7. Nonpharmacologic pain relief
What are the indications for cesarean birth?
1. CPD
2. Malpresentations such as breech and shoulder
3. Abnormalities such as previa & abruptio
4. Dysfunctional labor pattern
5. Umbilical cord prolapse
6. Fetal distress
7. Multiple gestation
What ethical consideration must be considered regarding cesarean birth?
If a woman refuses surgery, the health care provider must decide if it is ethical to get a court order for the surgery; however, every effort must be made to avoid this legal step
What is the difference between the classic and the low cervical cesarean birth?
1. Classic = vertical incisions of skin and uterus

2. Low cervical = horizontal incision through skin and vertical or horizontal incision through the uterus
What are the complications of cesarean birth?
1. Aspiration
2. Pulmonary embolism
3. Wound infection
4. UTI
5. Injuries to the bladder or bowel
6. Complications r/t anesthesia
7. Fetal injuries
8. Feelings of fear, disappointment, frustration at losing control, anger, or loss of self-esteem
9. Delayed ability to interact with newborns
10. Less satisfied birth experience
11. More fatigue
12. Poorer physical functioning during the first few weeks after discharge
What are the contraindications of vaginal birth?
1. Complete placenta previa
2. Active genital herpes
3. Positive HIV status
What problems must be addressed with unplanned cesarean birth?
1. The woman may be dehydrated, with low glycogen reserves

2. Preoperative procedures must be done quickly and competently, explanation time is often short
What must be assessed after a cesarean birth?
1. Infant's physiologic stability
2. Maternal VS, incision, fundus, lochia
3. Breath sounds, bowel sounds, circulatory status of lower extremities, urinary and bowel elimination
4. Maternal emotional status
What are the signs of postoperative complications after discharge?
1. T > 38 degrees C
2. Painful urination
3. Lochia heavier than a normal period
4. Wound separation
5. Redness or oozing at the incision site
6. Severe abdominal pain
What is umbilical cord prolapse?
The cord lies below the presenting part of the fetus
What techniques are used to help deliver a fetus presenting shoulder dystocia?
1. Mazzanti technique
2. Rubin technique
What is the Mazzanti technique?
Pressure is applied directly posteriorly and laterally above the symphysis pubis
What is the Rubin technique?
Pressure is applied obliquely posteriorly against the anterior shoulder
What are the signs of prolapsed cord?
1. Fetal bradycardia with variable decelerations during uterine contractions

2. Woman reports feeling the cord after membranes rupture

3. Cord is seen or felt in or protruding from the vagina
What are the interventions of a prolapsed cord?
1. Call for assistance

2. Notify PCP immediately

3. Insert gloved finger into vagina and exert upward force to relieve pressure on the cord

4. Position woman in extreme Trendelenburg or modified Sims position, or a knee-chest position
What are the signs of amniotic fluid embolism?
1. Respiratory distress = restlessness, dyspnea, cyanosis, pulmonary edema, respiratory arrest

2. Circulatory collapse = hypotension, tachycardia, shock, cardiac arrest

3. Hemorrhage = coagulation failure, uterine atony
What are the interventions for amniotic fluid embolism?
1. Oxygenation - 8 to 10 L/min by face mask

2. Maintain cardiac output and replace fluids

3. Correct coagulation failure

4. Monitor fetal and maternal status

5. Prepare for emergency birth

6. Provide emotional support