Exam 2

hypotonic, hypertonic

Dysfunctional Uterine Contractions include ___ and ___ uterine dysfunction

ectopic pregnancy

Early signs of ___: vaginal spotting, abdominal/pelvic pain, missed menstrual period

fetal shoulder dystocia, fetal occiput posterior position

Episiotomy indications (2)

Nonstress test (NST)

Evaluates FHR accelerations, with or without fetal movement. Reactivity is associated with adequate fetal oxygenation and intact neural pathways

Bishop scoring system

Evaluates the cervical response to induction procedures *A high score (Above 6) is predictive of successful labor induction* Under 6 looking at C-section

incomplete

In ___ spontaneous abortion, retained tissue prevents uterus from contracting and profuse bleeding may occur

missed

In ___ spontaneous abortion, ultrasound is used to confirm absence of heartbeat before D&C or D&E.

complete

In ___spontaneous abortion, all products of conception have been expelled

inevitable

In ___spontaneous abortion, membranes rupture and cervix dilates

incomplete

In ___spontaneous abortion, some products of conception have been expelled, but some remain

missed

In ___spontaneous abortion, the fetus dies but is retained in the uterus

recurrent (habitual)

In ___spontaneous abortion, there are 3 or more consecutive spontaneous abortions

threatened

In ___spontaneous abortion, vaginal bleeding occurs

upper

In a paper strip, the ___ grid is for recording fetal HR.

lower

In a paper strip, the ___ grid is for recording uterine activity

Progressive cervical dilation

In evaluating the effectiveness of IV Pitocin for a client with secondary dystocia. The nurse should expect:

vacuum, forceps

In operative vaginal birth, ___ extraction is 4 times more common than ___

Episiotomy

Incision of the perineum just before birth.

Fetal Accelerations

Increase in FHR of 15 bpm or more for 15 sec. Associated with fetal movement. Reassuring- shows fetal arterial pH is Greater Than 7.2

placental abruption

Risk factors of ___: abdominal trauma, smoking, cocaine, hypertension, hx of abruption, autoimmune factors, certain coagulopathies

locate the placenta, locate pool of amniotic fluid, determine needle insertion

Routine ultrasound prior to amniocentesis is used to (3)

Early

(Late/Early/Variable Decelerations) Maternal position changes usually have no effect on pattern

Early

(Late/Early/Variable Decelerations) Mirror images of contraction

Early

(Late/Early/Variable Decelerations) Not associated with fetal compromise

Late

(Late/Early/Variable Decelerations) Nursing intervention required to improve placental blood flow and fetal oxygen supply.

Variable

(Late/Early/Variable Decelerations) Nursing interventions: alleviate the pressure on the umbilical cord and minimize fetal head compression by changing MATERNAL POSITION. IV BOLUS to increase blood pressure. EXAMINE CERVIX for prolapsed cord or change in labor progress.

variable

(Late/Early/Variable Decelerations) fall and rise in rate are abrupt and may be nonperiodic

Late

(Late/Early/Variable Decelerations) looks like the other, but shifted to the right

Late

(Late/Early/Variable Decelerations) not reassuring

variable

(Late/Early/Variable Decelerations) shape, duration, and degree of decelerations change

Placenta previa

(Placenta previa or Abruptio placentae) Bright red blood

Abruptio placentae

(Placenta previa or Abruptio placentae) FHS usually absent

Placenta previa

(Placenta previa or Abruptio placentae) FHS usually present

Abruptio placentae

(Placenta previa or Abruptio placentae) Preeclampsia is present in one-third of cases

Abruptio placentae

(Placenta previa or Abruptio placentae) dark colored blood

Abruptio placentae

(Placenta previa or Abruptio placentae) general condition and anemia are NOT proportionate to visible blood loss

Placenta previa

(Placenta previa or Abruptio placentae) general condition and anemia are proportionate to visible blood loss

Placenta previa

(Placenta previa or Abruptio placentae) height of uterus is proportional to gestational age

Abruptio placentae

(Placenta previa or Abruptio placentae) height of uterus may be disproportionately enlarged

Abruptio placentae

(Placenta previa or Abruptio placentae) painful

Placenta previa

(Placenta previa or Abruptio placentae) painless

Placenta previa

(Placenta previa or Abruptio placentae) soft and relaxed uterus

Abruptio placentae

(Placenta previa or Abruptio placentae) uterus may be tense, ridged, tender

fallopian tubes

95% of ectopic pregnancies occur in the ___

combined spinal-epidural

A ___ may be done to inject analgesic medication into the subarachnoid space before an epidural block

pudendal

A ____ block will help the client feel relief in their perineum

Preterm Premature Rupture of Membranes (PPROM)

Rupture and leakage of amniotic sac prior to 37 weeks. Often associated with preterm labor with the greatest risk occurring prior to 34 weeks

Premature Rupture of Membranes (PROM)

Rupture and leakage of amniotic sac prior to contractions at or after 37 weeks

molar pregnancies

Symptoms of ___ vary but can include include: vaginal bleeding, larger than expected uterus, excessive N/V, early preeclampsia

Nitrous Oxide (N2O)

Systemic Drug for Labor: A colorless sweet gas used along with oxygen to produce a conscious sedation

Naloxone (naltrexone)

Systemic Drug for Labor: Opioid Antagonists

Sedatives

Systemic Drug for Labor: drugs used to relieve anxiety and help you relax.

Opioid Analgesics

Systemic Drug for Labor: synthetic drugs that bind to opiate receptors to relieve pain. Observe for respiratory depression in neonate.

Indeterminate

Absence of FHR accelerations after fetal stimulation (Reassuring/Indeterminate/Non reassuring Pattern)

Indeterminate

Absent FHR variability with no recurrent decelerations (Reassuring/Indeterminate/Non reassuring Pattern)

Change maternal position

While monitoring your full-term labor patient, you notice persistent variable decelerations. Your first intervention for maximizing fetal oxygenation is to ___

Preterm labor

Contractions with cervical change prior to 37 weeks' gestation. May be induced or spontaneous.

ultrasound transducer

Device that converts electric energy to ultrasound energy and vice versa used to monitor FHR

trial of labor

"Once a cesarean, always a cesarean" is no longer the standard of care. Women should discuss VBAC with their providers to determine if a ___ is appropriate.

Early

(Late/Early/Variable Decelerations) Associated with fetal head compression

Late

(Late/Early/Variable Decelerations) Begin after the peak of the contraction and return to baseline after contraction ends

Variable

(Late/Early/Variable Decelerations) Caused by reduced flow through umbilical cord (cord compression)

Early

(Late/Early/Variable Decelerations) Consistent in appearance. Returns to baseline FHR by end of contraction

Late

(Late/Early/Variable Decelerations) Impaired oxygen exchange

Fetal fibronectin (fFN)

A glycoprotein that is produced by the trophoblast and fetal tissues whose presence between 20 and 34 weeks' gestation is a strong predictor of preterm birth associated with preterm spontaneous rupture of membranes.

Amniotic Fluid Index (AFI)

A method to quantify the amount of amniotic fluid visualized by ultrasound

Abruptio placenta, maternal tachycardia

A nurse is admitting a client who is in labor. The client admits to recent cocaine use. For which of the following complications should the nurse assess? (2)

Painless, red vaginal bleeding

A nurse is caring for a client who is at 36 weeks of gestation and has a suspected placenta previa. Which of the following findings support this diagnosis?

Blood patch

A procedure in which a cerebrospinal fluid leak is closed by means of an injection of the patient's blood into the area used during spinal anesthesia. Relief of spinal headache.

Pudendal block

A transvaginal injection of a local anesthetic into the area in front of the nerve that anesthetizes the perineum, vulva, and rectal areas for episiotomy, expulsion of the fetus, and episiotomy repair.

Non reassuring

A visually undulating sinusoidal pattern (Reassuring/Indeterminate/Non reassuring Pattern)

second half

Abruptio placentae is premature separation of normally implanted placenta during the ____ of pregnancy, usually with severe hemorrhage?

hyperbilirubinemia

ABO incompatibility may result in ___ of the infant

open body wall defects, chromosomal abnormalities

AFP assessment is performed on maternal serum or amniotic fluid to identify (2)

tocolytic

Administer ___ drugs during external cephalic version.

epidural opioids

Adverse effects of ___: V/V, pruritis

epidural block

Adverse effects of ___: maternal hypotension, bladder distortion, migration of catheter, fever

variable decelerations

Amnioinfusion is only used for ___

methotrexate

An early ectopic pregnancy without unstable bleeding is most often treated with a medication called ___, which stops cell growth and dissolves existing cells. (SubQ)

local infiltration anesthesia

Anesthesia method that places anesthetic solution into the tissues near the small terminal nerve branches for absorption

Amniocentesis

Aspiration of fluid from the sac for examination done during the second and third trimester.

body movement, muscle tone, breathing movements, amniotic fluid, heart beat

BPP assesses fetal (5)

0-3

BPP test results to consider immediate delivery

4-6

BPP test results to consider repeating test in 24 hours. Worrisome.

chorioamnionitis

Diagnostic criteria: maternal fever or at least two of the following: Uterine tenderness, foul smelling discharge, maternal WBC's over 15,000, maternal tachycardia or FHR tachycardia (> 160 bpm)

III

Category __ FHR pattern: Non reassuring (favorable signs absent)

I

Category __ FHR pattern: Reassuring

II

Category __ FHR pattern: indeterminate, ambiguous

recurrent (habitual)

Causes of ___ spontaneous abortion: genetic, chromosomal anomalies, reproductive tract anomalies, insufficient progesterone secretion, lupus, diabetes, STDs, TORCH infections

late decelerations

Causes of ___: placental insufficiency, uterine tachysystole, maternal hypotension

increasing obesity, increased induction rate, delayed childbearing

Cesarean birth rate increasing because (3)

gestational trophoblastic neoplasm

Choriocarcinoma is also called ___

threatened, inevitable

Clinical findings of ___ and ___ spontaneous abortions are report of cramping, closed cervix but bleeding evident

complete

Clinical findings of ___ spontaneous abortion, heavy cramping and bleeding, passing clots and tissue, closed cervix, residual blood present

incomplete

Clinical findings of ___ spontaneous abortion, severe cramping, active uterine bleeding, some POC expelled

infection or inflammation, uterine overdistension, bleeding, maternal stress

Common risk factors for spontaneous preterm labor (4)

infection, disseminated intravascular coagulation

Complications of missed spontaneous abortions (2)

frequency, duration, intensity of contractions, resting tone

Components of uterine activity assessment (4)

transvaginal ultrasound (no gestational sac), beta-hCG level (lower than expected), laparoscopy

Diagnostic evaluation of ectopic pregnancy (3)

vaginal examination, uterine contractions, mild cord compression, breech presentation

FHR accelerations may also occur with (4)

Non reassuring

FHR bradycardia without variability (Reassuring/Indeterminate/Non reassuring Pattern)

Reassuring

FHR reactivity with accelerations (Reassuring/Indeterminate/Non reassuring Pattern)

hypotonic

Factors contributing to ___ uterine dysfunction include overdistension of the uterus (polyhydramnios, macrosomia, multiple pregnancy)

Indeterminate

Fetal Tachycardia (Reassuring/Indeterminate/Non reassuring Pattern)

bradycardia

Fetal ___ is a sign of uteroplacental insufficiency

tachycardia

Fetal ___ is an early sign of fetal distress

<110 bpm

Fetal bradycardia

Indeterminate

Fetal bradycardia with presence of variability (Reassuring/Indeterminate/Non reassuring Pattern)

Kick counts, ultrasound for fetal growth, non-stress test, biophysical profile

Fetal surveillance for gestational diabetes (4)

>160 bpm

Fetal tachycardia

magnesium sulfate

For eclampsia, antihypertensive medications, supplemental oxygen are given along with an initial dose of ___ followed by maintenance dose

calcium gluconate

For magnesium sulfate toxicity, stop infusion immediately then administer ___

Misoprostol (Cytotec)

For missed spontaneous abortions in the second trimester, ____ may be needed to induce contractions

chorionic villi, trophoblasts

GTD is characterized by proliferation and edema of the ___ (fluid-filled grapelike vesicles) that grows large enough to fill the uterus similar to an advanced pregnancy. ____ develop abnormally.

40

Generally in newborns, report blood sugar levels below ___mg/dL

Adjunctive drugs

Given to improve effectiveness of analgesics and relieve side effects like nausea and vomiting.

8-10

Good BPP test results.

vacuum, curettage, IV oxytocin, follow up

Hydatidiform mole management

membranes ruptured, postpartum hemorrhage

Hypotonic Uterine Contractions: If ___, may increase risk for infection due to prolonged labor. Higher risk of developing ___

malposition of fetus, cephalopelvic disproportion (CPD)

Hypotonic Uterine Contractions: Most common reasons for reduction of uterine activity (2)

isotonic crystalloid solution

IV Fluids/Labor: If blood glucose high, patient will receive an ___ as the primary fluid and may also receive an insulin infusion

D5LR

IV Fluids/Labor: If blood glucose low, patient will receive ___ as the primary fluid

-, +, rhoGAM

If an Rh__ woman concieves an Rh__ child, maternal antibodies may develop. ___ should be administered.

90

If contraction intensity is over ___ mmHg it is cause for concern

missed

If infection is present with ___ spontaneous abortion, uterine evacuation is delayed until antibiotic therapy is started

amniocentesis

If multiple marker screening test is positive, ___ is recommended

Ectopic Pregnancy

Implantation of the fertilized ovum in an area outside of the uterine cavity

Placenta previa

Implantation of the placenta in the lower uterus. Requires delivery by C-section.

Placenta accreta

Improper implantation of placenta to the myometrium with little or no intervening decidua

Hemolysis

In HELLP, ___ occurs as a result of the fragmentation and distortion of erythrocytes during passage through damaged blood vessels.

fibrin deposits

In HELLP, liver enzyme levels increase when blood flow is obstructed by ___.

vascular damage

In HELLP, low platelet levels are caused by ___ resulting from vasospasm.

right upper

In HELLP, there will be pain in the ___ quadrant

incomplete, pitocin, methergin

In ___ spontaneous abortion, a dilation and evacuation (D&E) followed by vacuum and curettage is done. Administer ___ or ____

complete

In ___ spontaneous abortion, medical intervention is rarely required, and signs of infection or hemorrhage are not expected.

resting uterine tone increases to 45mmHg

Indication of amnioinfusion overfilling

ruptured membranes, 2cm

Internal fetal monitoring requires ___ and ___ of cervical dilation

Percutaneous Umbilical Blood Sampling (PUBS)

Involves the aspiration of fetal blood from the umbilical cord near the placenta to detect blood disorders, acid-base imbalance, infection or fetal genetic disease. Also called cordocentesis.

Internal version

Is sometimes used to change the presentation of the second twin after the birth of the first twin.

Fall risk

Laboring patient has pain of 9/10 and request IV pain medication. Most important statement for nurse to make and monitor for about narcotic medications?

ultrasound transducer

Less accurate than internal devices but noninvasive and suitable FHR monitor for most women in labor

rupture

Low transverse uterine incisions reduce the risk of

brain

Magnesium sulfate also protects the fetal ___

labor, postpartum

Magnesium sulfate is administered IV throughout ___ and ___

4-6g, 1-2g, 4-8

Magnesium sulfate loading dose of ___ over 15-30 mins, then maintenance dose of ___/hour to maintain therapeutic serum magnesium range of ___ mEq/L

Oxytocin, nipple stimulation

Management of hypotonic uterine contractions: Administer ___ to augment labor or ___ to increase endogenous oxytocin. Rupture of membranes. Ambulation.

10, 5-10

Maternal Assessment of fetal movement. Passing "kick counts"= __/12hr or ___/hour

contraction stress test

Maternal diabetes mellitus and post term pregnancy are appropriate indicators for performing a ___

preexisting diabetes

Maternal effects of ___ on pregnancy: preeclampsia, ketoacidosis, UTIs, hydramnios, dystocia

tachycardia

Maternal fever can lead to fetal ___

Indeterminate

Minimal or marked baseline FHR variability (Reassuring/Indeterminate/Non reassuring Pattern)

6-25 bpm

Moderate variability FHR

high

Molar pregnancies are diagnosed by ultrasound and ___ levels of beta-hCG

Alpha-Fetoprotein Screening (AFP)

Must be viewed as a first step in screening. Only requires a blood sample. Ideally performed between 16-18 weeks of gestation

preexisting diabetes

Neonatal effects of ___ on pregnancy: birth injuries due to macrosomia, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome

uterine rupture

Nonsurgical disruption of the uterine cavity (complete, incomplete, partial)

60sec

Normal duration of contractions

110-160 bpm

Normal fetal heart rate

2-3/min

Normal frequency of contractions

60mmHg

Normal intensity of contractions

60sec

Normal resting period

Tachysystole

Over 5 contractions in 10 minutes

isotonic solution

Oxytocin is diluted in an __ and given as a secondary infusion

Second trimester amniocentesis

Performed between 15-20 weeks to detect chromosomal or biochemical abnormalities

Indeterminate

Periodic or episodic FHR variations (Reassuring/Indeterminate/Non reassuring Pattern)

on their left side

Position the mother ____ to relieve compression of vena cava

1-2 weeks, 1-2 months

Post molar pregnancy, serum beta-hCG levels must be ran every ___ until 3 normal pre-pregnancy levels, then every ____ for up to a year.

renal, liver, pulmonary, peripheral, cerebral, scotomata

Preeclampsia maternal problems: ___ and ___ damage. ___, ___, and ___ edema. Blurry vision and ____ (blind spots). Thrombocytopenia.

molar pregnancies

Pregnancy must be avoided for one year following

cricoid pressure

Pressure on the cricoid cartilage; applied to occlude the esophagus to inhibit gastric distention and regurgitation of vomitus in the unconscious patient.

oligohydramnios, placenta abruption, intrauterine growth restriction

Problems with the fetus in preeclampsia (3)

External cephalic version

Promotes vaginal birth by changing the fetal presentation from a breech or transverse lie to a cephalic lie.

umbilical cord prolapse

Protrusion of the umbilical cord alongside or ahead of the presenting part of the fetus

Non reassuring

Recurrent late decelerations with no variability (Reassuring/Indeterminate/Non reassuring Pattern)

Non reassuring

Recurrent variable decelerations (Reassuring/Indeterminate/Non reassuring Pattern)

Beta human chorionic gonadotropin

Released from the placenta in increasing amounts Levels should double every 48 hours in a normally developing pregnancy Peaks at week 10 and then declines SHOULD BE Almost undetectable at term

fluid leaking from the vagina, fishy or foul-smelling discharge, vaginal bleeding, contractions every 10 minutes or less for an hour

When to seek care for preterm labor (4)

preeclampsia

Risk factors for ___: <20yrs or >35yrs, first pregnancy, pregnancy with new partner, hx of issue, chronic hypertension, obseity, diabetes, kidney disease, thrombophilia, african descent

missed abortion

Which type of abortion is associated with sepsis, abdominal tenderness, and light bleeding?

Placental abruption (abruptio placentae)

Separation of a normally implanted placenta before the fetus is born

magnesium sulfate toxicity

Signs and symptoms of ___: low RR, low HR, slurred spech, muscle weakness, lethargy, hyporeflexa (decreased DTRs)

hypovolemic shock

Signs and symptoms of ____: increased HR, increased RR, decreased BP, "thready" peripheral pulses, cool/moist skin, decreased urine output, decreased hemoglobin/hematocrit, change in mental statue

hyperglycemia

Signs and symptoms of maternal ___: fatigue, flushed/hot skin, dry mouth, excessive thirst, frequent urination, rapid/deep respiration, acetone odor breath, drowsiness, headache, depressed reflexes

hypoglycemia

Signs and symptoms of maternal ___: shakiness, tremors, pallor, cold/clammy skin, disorientation, irritability, headache, hunger, blurred vision

hypoglycemia

Signs of ___ in newborns: jitteriness, tremors, hypothermia, respiratory distress, lethargy

tubal rupture

Signs of ___: sudden, severe pain in one of the lower quadrants, shoulder or neck pain, hypovolemic shock

shoulder dystocia

Signs that precede ___: failure to progress, prolonged 2nd stage of labor, "turtle sign"

chromosomal abnormalities

Spontaneous abortion are most commonly due to ____ incompatible with life

Subarachnoid block

Technique for ___: A 25- to 27- gauge spinal needle with a stylet occluding its lumen is passed into the spinal space below where the spinal cord ends. The stylet is removed and drops of clear cerebrospinal fluid at needle hub confirms correct placement. Medication is injected and the needle is removed.

Epidural block

Technique for ___: the spinal space is entered with a needle below where the spinal cord ends. A free catheter is threaded through the needle. The needle is then removed and the catheter is left in place for intermittent or continuous analgesic administration through labor and birth.

cervical ripening, oxytocin administration

Techniques for Induction (2)

third trimester amniocentesis

Test to determine fetal lung maturity or hemolytic disease

ectopic pregnancy

The incidence of ___ increases as a result of pelvic inflammation (PID)

Spontaneous abortion

The leading cause of pregnancy loss prior to 20 weeks. The rate increases with age.

low transverse

The preferred uterine incision for cesarean birth is the ___

ischial spine, sacrospinous ligament

The pudendal nerve is located in the pelvic floor between the ___ and ____.

hypovolemic shock, infection

The treatment of spontaneous abortion includes preventing complications such as ___ and ___

glyburide

Therapeutic management of gestational diabetes may include an oral hyperglycemic agent, ___

cervical ripening

There are both medical methods (prostaglandins) and mechanical methods (transcervical catheter, laminaria) for ___

Toco transducer

Top external device that is pressure-sensitive and detects uterine activity.

suppression of labor, physical activity restriction, progesterone supplementation

Treatment of preterm labor (3)

corticosteroids, antibiotics, tocolytics, magnesium sulfate, best rest, preterm delivery

Treatments for PROM/PPROM (6)

know it is a common side effect and administer PRN benadryl

Two hours after epidural infusion, patient complains of itching on her face and neck. The nurse should

regional anesthesia, pudendal block, local infiltration anesthesia, epidural block, combined spinal-epidural, subarachnoid block

Types of Regional Pain Management (6)

threatened, inevitable, incomplete, complete, missed, recurrent (habitual)

Types of spontaneous abortions (6)

doppler blood flow

Ultrasound assessment used in pregnancies complicated by hypertension, fetal growth restriction, or placental insufficiency to assess blood flow to the fetus.

delivery

Ultrasound indicated abruptio placentae is present. Nurse should prepare the client for ___

bradycardia

Umbilical cord prolapse, regional anesthesia, and MgSO4 administration can lead to fetal ___

Contraction stress test (CST)

Used to determine how the fetal heart responds to uterine contractions that temporarily decrease placental blood flow. Nipple stimulation or low-dose oxytocin. Cannot be done if stimulated uterine contractions are contraindicated

Indeterminate

Variable decelerations with other positive characteristics (Reassuring/Indeterminate/Non reassuring Pattern)

headache, blurred vision

Warning signs of pending eclamptic seizure (2)

feed, formula supplementation, D10 IVF

Ways to treat hypoglycemia in newborns (3)

severe preeclampsia

With ___ liver enzymes can be twice the normal concentration and/or severe right upper: quadrant or epigastric pain that does not improve with analgesics

severe preeclampsia

With ___ the progressive renal insufficiency can be seen with doubling of serum creatinine and/or serum creatinine level > 1.1 mg/dL

ectopic pregnancy

With ____ the woman must refrain from alcohol and vitamin with folic acid

1-2 hours

With diabetes and labor: If patient is insulin dependent, blood sugar checks should be done every ___ once in active labor

stop oxytocin

With late decelerations, nurse MUST ___

choriocarcinoma

With molar pregnancies, suspect ___ if beta-hCG levels do not fall or if they rise after an initial fall

Beta human chorionic gonadotropin

With threatened and inevitable spontaneous abortion, provide supportive measures along with careful monitoring by laboratory testing of ____ and ultrasound.

artery

You obtain a sample of cord blood through the umbilical ___

Dysfunctional

__ Uterine Contractions: Irregular in timing, strength, or both and do not contribute to cervical changes or fetal descent

Uterine Rupture

___ Causes: TOLAC (trial of labor after cesarean), Previous uterine surgery, Increased uterine pressure, Interval of births less than 18 months, Inadequate closure performed with a previous cesarean, Version, Certain congenital uterine disorders

Sinusoidal

___ FHR can be caused by maternal abdominal trauma leading to fetal blood loss. Emergency C-section.

internal fetal scalp electrode

___ FHR monitoring that improves accuracy, but slightly increases risk for infection

Uterine Rupture

___ Interventions: Stop Pitocin if infusing and start fluid bolus of NS or LR Oxygen via tight face mask (8-10L) Immediately contact OB/CNM Prepare for immediate cesarean section and notify all personnel Prepare for possible blood transfusion Anticipate possible hysterectomy

Regional

___ Pain management advantages: woman actively participates in labor, potentially good pain control, she retains her airway reflex

Amniotomy

___ Purpose: Often done in conjunction with induction of labor. Enables internal electronic fetal monitoring

Amniotomy

___ Risks: Prolapse and compression of the umbilical cord. Infection (chorioamnionitis) and abrupio placentae

Uterine Rupture

___ Symptoms: Non-reassuring fetal heart rate, Sensation of "ripping" or "tearing", Loss of fetal station on palpation, Constant abdominal pain, uterine tenderness, Change in uterus shape, Cessation of contractions, Hematuria, Signs of shock

Hypertonic

___ Uterine Contractions: Because of the frequency of the contractions and failure of the uterus to relax between contractions, evidence of a non-reassuring fetal heart rate pattern (FHR) may be evident

Hypertonic

___ Uterine Contractions: Nurses may facilitate a period of rest (administration of an opioid as ordered to reduce pain and lessen contractions); sleep medication may also be ordered

remote surveillance

___ allows surveillance when the nurse is not at the bedside

Late fetal HR decelerations

___ an unhealthy fetal response during contraction.

Tocolytics

___ and IV hydration are used to delay delivery and allow administration of corticosteroids for preterm labor.

Abnormal labor patterns

___ are associated with increased risks for mother and newborn: operative delivery, lacerations, chorioamnionitis, fetal asphyxia, postpartum hemorrhage/urinary retention, NICU admission

multiple marker screening

___ assesses for hCG, and unconjugated estriol, along with open body wall defects, and increased detection of chromosomal abnormalities

Methotrexate

___ chemotherapy is the primary treatment for choriocarcinoma (high cure)

Hypotonic

___ contractions feel soft on palpation and occur at a rate of less than 3 or 4 every ten minutes

Hypotonic

___ contractions may be productive initially but may become weaker, less effective, or stop altogether.

negative

___ fFN= woman is NOT at risk for preterm labor

positive

___ fFN= woman is at risk for preterm labor

magnesium sulfate

___ is an anticonvulsant medication that reduces central nervous system irritability caused by cerebral edema and increases the seizure threshold

Eclampsia

___ is preeclampsia with tonic-clonic seizure activity that has no other known cause

steroids

___ medications can be used to help mature fetal lungs

tocolytic

___ medications prevent contractions

Choriocarcinoma

___ mole: Malignant change and proliferation of residual trophoblastic tissue. Vesicles of the mole enter woman's circulation causing embolism. Life threatening. May spread to distant sites.

Partial

___ mole: fetal tissue or membranes present. Maternal contribution is usually present, but paternal contribution is double.

Complete

___ mole: ovum is fertilized by sperm that duplicates its own chromosomes while the chromosomes of the ovum are inactivated. No fetus is present.

gestational trophoblastic disease

___ represents a unique spectrum of tumors and tumor like conditions characterized by proliferation of placenta tissue

Fetal HR accelerations

___ show the fetus moving around between contractions. Good to see.

Early fetal HR decelerations

___ shows healthy fetal reaction of the compression right before a contraction

Doppler flow studies

___ uses sound waves to assess blood flow. Can be used in the umbilical vein and arteries, fetal brain, fetal heart, and other organs.

Chorionic Villus Sampling

___ uses transcervical or transabdominal sampling to obtain test matter. Provides information about numerous chromosomal defects, metabolic or DNA abnormalities. Can be performed between 10-13 weeks gestation, much earlier than amniocentesis

intrauterine pressure catheter

___ uterine activity monitoring that improves accuracy, but slightly increases risk for infection. (2 types0

hypertonic

___ uterine dysfunction: Contractions are frequent, have irregular tone, and do not contribute to cervical effacement or dilation or fetal descent

Hypotonic

___ uterine dysfunction: Uterine contractions are either too uncoordinated or insufficiently strong to effectively dilate the cervix in the first stage of labor

Gestational diabetes, GDM A1, GDM A2

___: Onset of glucose intolerance first diagnosed during pregnancy. Two subgroups are ___ (diet control) and ___ (Insulin control w/ diet).

umbilical cord prolapse

____ Call for help!! Initial action = gloved hand used to elevate the presenting fetal part to reduce compression on cord (life saving!!) - can place in knee-chest or deep Trendelenburg position to further relieve compression -prepare for immediate c-section

Absent variability

____ indicates the fetus is not moving around and may be intolerance to labor.

Incompetent cervix

____ is incompatible with pregnancy. Can be sewn shut during course of pregnancy

Disseminated Intravascular Coagulation (DIC)

abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues

shoulder dystocia

delayed or difficult birth of the fetal shoulders after the head is born

dystocia

difficult labor/birth

Low profile cup

enable placement over the flexion point of the baby's head no matter the fetal head position. This is vital in order to realign the head so that the smallest diameters of the fetal head are presented to the birth canal.

hydatidiform mole

gestational trophoblastic disease can also be called ___

HELLP syndrome

hemolysis, elevated liver enzymes, low platelets

preeclampsia

hypertension, edema, and proteinuria during pregnancy

chorioamnionitis

inflammation of the chorion, amnion, or both

>25 bpm

marked variability in FHR

<6 bpm

minimal variability in FHR

shoulder dystocia

most common reason for primary (first-time) cesarean sections

cervical os

opening of the cervix to the uterus

placenta percreta

perforation of uterus by placenta

placenta increta

placenta invades myometrium

Thrombocytopenia

platelet count <100,000/mm3

salpingectomy

surgical removal of a fallopian tube

ABO incompatibility

type O mothers and fetuses with type A or B blood (less severe than Rh incompatibility)

Ultrasound

•Used to determine a variety of fetal and placental conditions -Presence and location of pregnancy -Multifetal gestation -Gestational age -Viability confirmation -Identifying fetal abnormalities