OB Test 2

Nalbuphine Hydrochloride (Nubain) dosage

IV: 5 to 10 mg every 3 hours as needed IM: 10 mg every 3 hours as needed

Signs of preceding labor

Lightening, return of urinary frequency, backache, stronger braxton Hicks contractions, weight loss of 1 to 3.5 lbs, surge of energy, increased vaginal discharge, bloody show, cervical ripening, possible rupture of membranes.

Fentanyl Citrate (Sublimaze) indications

Moderate to severe labor pain and postoperative pain after cesarean birth

Meperidine Hydrochloride (Demerol) used for

Moderate to severe labor pain and postoperative pain after cesarean birth

Nalbuphine Hydrochloride (Nubain) indication

Moderate to severe labor pain and postoperative pain after cesarean birth

clinical significance of fetal accelerations

Normal pattern: Acceleration with fetal movement signifies fetal well-being representing fetal alertness or arousal states.

Clinical significance of early decelerations

Normal pattern; not associated with fetal hypoxemia, acidemia, or low Apgar scores

Naloxone Hydrochloride (Narcan) dosage

Opioid overdose: 0.4 to 2 mg IV, may repeat IV at 2- to 3-minute intervals until a maximum of 10 mg has been given; if IV route unavailable, IM or subcutaneous administration may be used

Oxytocin indications

Oxytocin is used primarily for labor induction and augmentation; it is also used to control postpartum bleeding.

Remifentanil Hydrochloride (Ultiva) typical dosage

PCA Pump (Sample setting, as the ideal dosing regimen has not been determined): 0.5 mcg/kg every 2 to 3 minutes with no basal rate

True labor contractions

• Occur regularly, becoming stronger, lasting longer, and occurring closer together • Become more intense with walking • Are usually felt in the lower back, radiating to the lower portion of abdomen • Continue despite use of comfort measures

Fentanyl citrate (sublimaze) typical dosage

-IV: 50 to 100 mcg every hour -IM: 50 to 100 mcg every hour -PCA Pump: (sample setting) 50 mcg incremental dose with a 10 minute lockout and no basal rate. -Maximum total dose for labor is usually 500 to 600 mcg.

Remifentanil Hydrochloride (Ultiva) nursing considerations

-Close maternal monitoring (suggested 1 : 1 nurse/patient ratio) and continuous oxygen saturation monitoring are required. -Administer through a dedicated intravenous line. -Implement safety measures as appropriate; continue use of nonpharmacologic pain relief measures. -Can be given to patients with impaired renal or hepatic function.

Clinical significance of fetal bradycardia

Baseline bradycardia alone is not specifically related to fetal oxygenation. Clinical significance of bradycardia depends on underlying cause and accompanying FHR patterns, including variability, accelerations, or decelerations.

Moderate intensity contraction

Chin

Nursing interventions for fetal tachycardia

Dependent on cause; reduce maternal fever with antipyretics as ordered and cooling measures; oxygen at 10 L/min by nonrebreather face mask may be of some value; carry out health care provider's orders based on alleviating cause.

fetal late decelerations causes

Disruption of oxygen transfer from environment to fetus, resulting in transient fetal hypoxemia. Late decelerations are caused by the following: • Uterine tachysystole • Maternal supine hypotension • Epidural or spinal anesthesia • Placenta previa • Placental abruption • Hypertensive disorders • Postterm gestation • Intrauterine growth restriction • Diabetes mellitus • Intraamniotic infection

parity

Pregnancy that resulted in a viable birth (after 20 weeks)

multigravida

woman who has been pregnant more than once

multipara

woman who has given birth to two or more children

False labor fetus

• Presenting part is usually not engaged in pelvis

Fentanyl Citrate (Sublimaze) nursing considerations

-Assess for respiratory depression; naloxone should be available as an antidote. -Implement safety measures as appropriate, including use of side rails and assistance with ambulation; continue use of nonpharmacologic pain relief measures. -Because of its short duration of action, frequent dosing will be necessary when given intravenously. Maximum total dose for labor is usually 500 to 600 mcg.

meperidine hydrochloride contraindications

-Do not give if birth is expected to occur within 1 to 4 hours after administration because infants born to women who received meperidine during labor may have respiratory depression -neonates whose mothers received meperidine during labor can exhibit sedation and neurobehavioral changes for the first 2 to 3 days of life

meperidine hydrochloride nursing considerations

-Implement safety measures as appropriate, including use of side rails and assistance with ambulation; continue use of nonpharmacologic pain relief measures. -peaking at 2 to 3 hours after administration of the drug. -Respiratory depression caused by normeperidine, an active metabolite of meperidine, cannot be reversed by naloxone.

Signs of potential complications in labor

-Intrauterine pressure >80mmHg or resting tone of >20mmHg -Contractions lasting >90 seconds -More than five contractions in 10 minutes -Relaxation between contractions last <30 seconds -Fetal bradycardia/tachycardia -Absent/minimal variability not related to sleeping or maternal medications -Irregular heart rate -Meconium-stained or blood fluid from vagina -arrest in progress of cervical dilation or effacement, descent of the fetus, or both -Maternal temperature >100.4 -Foul smelling vaginal discharge -Persistent bright or dark red vaginal bleeding

The latent phase of labor

0-6 cm mild to moderate contractions irregular q 5-30 min lasts 30-40 sec

Overweight BMI

25-29.9

Obese BMI

30-34.5

Very obese BMI

35-40

Clinical significance of fetal tachycardia

Persistent tachycardia in absence of periodic changes does not appear serious in terms of neonatal outcome (especially true if tachycardia is associated with maternal fever); tachycardia is abnormal when associated with late decelerations, severe variable decelerations, or absent variability.

Nalbuphine Hydrochloride (Nubain) nursing considerations

-May precipitate withdrawal symptoms in opioid-dependent women and their newborns. -Assess maternal vital signs, degree of pain, FHR, and uterine activity before and after administration. -Observe for maternal respiratory depression, notifying obstetric health care provider if maternal respirations are ≤12 breaths per minute. -Encourage voiding every 2 hours, and palpate for bladder distention. -If birth occurs within 1 to 4 hours of dose administration, observe newborn for respiratory depression. -Implement safety measures as appropriate, including use of side rails and assistance with ambulation. -Continue use of nonpharmacologic pain relief measures.

Naloxone Hydrochloride (Narcan) nursing considerations

-The woman should delay breastfeeding until medication is out of her system (approximately 2 hours after the last dose is given). -Do not give to the woman or the newborn if the woman is opioid dependent—may cause abrupt withdrawal in the woman and newborn. -If given to the woman for reversal of respiratory depression caused by opioid analgesic, pain will return suddenly. -The duration of action of naloxone is shorter than that of most opioids. Therefore, the woman must be monitored closely for the return of opioid depression when the effects of naloxone are gone. Additional doses of naloxone may be necessary to maintain reversal.

nursing interventions for variable decelerations

1. Discontinue oxytocin if infusing. 2. Change maternal position (side to side, knee chest). 3. Administer oxygen at 10 L/min by nonrebreather face mask. 4. Notify physician or nurse-midwife. 5. Assist with vaginal or speculum examination to assess for cord prolapse. 6. Assist with amnioinfusion if ordered. 7. Assist with birth (vaginal assisted or cesarean) if pattern cannot be corrected.

the active phase of labor

6-10 cm moderate to strong contractions regular q 3-5 min lasts 40-70 sec

How much amniotic fluid is present at term ?

700-1000 mL

clinical significance of fetal late decelerations

Abnormal pattern associated with fetal hypoxemia, acidemia, and low Apgar scores; considered ominous if persistent and uncorrected, especially when associated with absent or minimal baseline variability

Fetal indications for induction

Any condition in which a variety of fetal tests demonstrate significant fetal jeopardy in any of the following situations: • Diabetes • Postterm pregnancy, especially when oligohydramnios is present • Hypertensive complications of pregnancy • Intrauterine growth restriction • Isoimmunization • Chorioamnionitis • Premature rupture of membranes with established fetal maturity

viability

The capacity to live outside the uterus; there are no clear limits of gestational age or weight. Infants born at 22 to 25 weeks of gestation are considered to be on the threshold of viability and are especially vulnerable to brain injury if they survive.

What is the chorion?

The covering of the fetal side of the placenta

What is the amnion?

The covering of the umbilical cord and covers the chorion on the fetal surface of the placenta

primipara

first birth of viable child

platypelloid

flat pelvis

Strong intensity contraction

forehead

2nd stage of labor

full dilation to birth- pushing

contraindications to tocolytic therapy fetal

gestational age of 37 weeks or more, fetal demise, lethal fetal anomaly, chorioamnionitis (infection of the chorion and amnion), evidence of acute or chronic fetal compromise

cephalic presentation

head first

Interventions for uterine tachysystole

• Reduce or discontinue dose of any uterine stimulants in use (e.g., oxytocin [Pitocin]). • Administer uterine relaxant (tocolytic) (e.g., terbutaline [Brethine]).

Dinoprostone (Cervidil dosage

Dosage is 10 mg of dinoprostone designed to be gradually released (approximately 0.3 mg/hour) over 12 hours. Insert is placed transvaginally into the posterior fornix of the vagina. The insert is removed after 12 hours or at the onset of active labor or earlier if tachysystole or abnormal FHR and pattern occur. Prepidil Gel Dosage is 0.5 mg of dinoprostone in a 2.5-mL syringe. Gel is administered through a catheter attached to the syringe into the cervical canal just below the internal cervical os. Dose may be repeated every 6 hours as needed for cervical ripening up to a maximum cumulative dose of 1.5 mg (3 doses) in a 24-hour period.

Fetal early decelerations cause

Head compression resulting from the following: • Uterine contractions • Vaginal examination • Fundal pressure • Placement of internal mode of monitoring

Misoprostol (Cytotec) side effects

Higher doses (e.g., 50 mcg every 6 hours) are more likely to result in adverse reactions such as nausea and vomiting, diarrhea, fever, uterine tachysystole with or without an abnormal FHR and pattern, or fetal passage of meconium. The risk for adverse reactions is reduced with lower dosages and longer intervals between doses.

meperidine hydrochloride typical dosage

IV: 25 to 50 mg every 1 to 2 hours. PCA Pump: 15 mg every 10 minutes as needed until birth

What functions does the amniotic fluid serve

Maintains constant body temperature Oral fluid and as a respiratory for waste and assists in maintenance of fluid and electrolyte homeostasis Cushions the fetus from trauma Allows freedom of movement for musculoskeletal development Acts as a barrier to infection and allows fetal lung development

Naloxone Hydrochloride (Narcan) side effects

Maternal hypotension or hypertension, tachycardia, hyperventilation, nausea and vomiting, sweating, and tremulousness

Remifentanil Hydrochloride (Ultiva) indications

Moderate to severe first-stage labor pain

Dinoprostone (Cervidil side effects

Potential adverse effects include headache, nausea and vomiting, diarrhea, fever, hypotension, uterine tachysystole with or without an abnormal FHR and pattern, or fetal passage of meconium.

Naloxone Hydrochloride (Narcan) indication

Reverses opioid-induced respiratory depression in woman or newborn; may be used to reverse pruritus from epidural opioids

Remifentanil Hydrochloride (Ultiva) side effects

Sedation and hypoventilation with oxygen desaturations

Nalbuphine Hydrochloride (Nubain) side effects

Sedation, drowsiness, nausea, vomiting, dizziness, respiratory depression, temporary absent or minimal fetal heart rate (FHR) variability

Fentanyl Citrate (Sublimaze) side effects

Sedation, respiratory depression, nausea, and vomiting

Patient teaching after C-section

Splint the incision for moving or coughing, use relaxation techniques, walk as often as you, avoid gas containing foods, do not use straws, take antiflatulence medication, lie on left side to expel gas

meperidine hydrochloride side effects

Tachycardia, sedation, nausea and vomiting, dizziness, altered mental status, euphoria, decreased gastric motility, delayed gastric emptying, and urinary retention

True labor cervix

• Shows progressive change (softening, effacement, and dilation signaled by appearance of bloody show) • Moves to an increasingly anterior position

nursing interventions for late decelerations

The usual priority is as follows: 1. Discontinue oxytocin if infusing. 2. Assist woman to lateral (side-lying) position. 3. Administer oxygen at 10 L/min by nonrebreather face mask. 4. Correct maternal hypotension by elevating legs. 5. Increase rate of maintenance intravenous solution. 6. Palpate uterus to assess for tachysystole. 7. Notify physician or nurse-midwife. 8. Consider internal monitoring for more accurate fetal and uterine assessment. 9. Assist with birth (vaginal assisted or cesarean) if pattern cannot be corrected.

Mild intensity contraction

Tip of nose

Nuchal cord

Umbilical cord around the fetal neck.

variable decelerations causes

Umbilical cord compression caused by the following: • Maternal position with cord between fetus and maternal pelvis • Cord around fetal neck, arm, leg, or other body part • Short cord • Knot in cord • Prolapsed cord

clinical significance of variable decelerations

Variable decelerations occur in approximately 50% of all labors and usually are transient and correctable

preterm

a pregnancy that has reached 20 weeks of gestation but ends before completion of 37 weeks of gestation

late preterm

a pregnancy that has reached between 34 weeks 0 days and 36 weeks 6 days of gestation

full term

a pregnancy that has reached between 39 weeks 0 days and 40 weeks 6 days of gestation

late term

a pregnancy that has reached between 41 weeks 0 days and 41 weeks 6 days of gestation

nulligravida

a woman who has never been pregnant

nullipara

a woman who has never borne a viable child

primigravida

a woman who is pregnant for the first time

post term

after 42 weeks

4th stage of labor

after placenta up to 2 hours

Possible causes of fetal bradycardia

atrioventricular dissociation (heart block), structural defects, viral infections, medications, fetal heart failure, maternal hypoglycemia

3rd stage of labor

birth to placenta

breech presentation

buttocks, feet, or both first

what does the vein of the umbilical cord do?

carries oxygenated blood to the fetus

What do the arteries of the umbilical cord do?

carry blood to placenta

third degree laceration

continues through anal sphincter muscle

Possible causes of fetal tachycardia

early fetal hypoxemia, fetal cardiac arrhythmias, maternal fever, infection, parasympatholytic drugs, terbutaline, fetal anemia, drugs (caffeine, theophylline, cocaine, meth)

fourth degree laceration

extends completely through the anal sphincter and rectal mucosa

second degree laceration

extends through muscles of the perineal body

first degree laceration

extends through the skin and structures superficial to muscles

Side effects of epidural

hypotension, lightheadedness, dizziness, tinnitus, metallic taste, numbness of the tongue/mouth, bizarre behavior, slurred speech, convulsions, loss of consciousness, fever, urinary retention, pruritus, increased risk of forceps/vacuum-assisted birth, high or total spinal anesthesia

Preterm labor

labor from 20-36 weeks

gravidity

number of pregnancies

anthropoid

oval shaped, with a wider anteroposterior diameter

factors affecting labor

passenger: fetus size, presentation, lie, attitude, position. passageway: mom's anatomical structure, powers: dilation and pushing, positions: mom, physiological

Contraindications to tocolytic therapy maternal

preeclampsia or gestational hypertension with severe features, hemorrhage, significant cardiac disease

gravida

pregnant woman

android

resembling a male pelvis

Fentanyl Citrate (Sublimaze) what to assess

respiratory depression

shoulder presentation

shoulder first

Hagar sign

softening of the lower uterine segment

1st stage of labor

start of regular contractions to full dilation

gynecoid

the classic female type - most desired

What does the chorion contain?

the major umbilical blood vessels

Contraindications for labor

• Acute, severe fetal distress • Shoulder presentation (transverse lie) • Floating fetal presenting part • Uncontrolled hemorrhage • Placenta previa • Previous uterine incision that prohibits a trial of labor

Maternal physiological changes during labor

• Cardiac output increases 10% to 15% in first stage; 30% to 50% in second stage. • Heart rate increases slightly in first and second stages. • Blood pressure (both systolic and diastolic) increases during contractions and returns to baseline levels between contractions. Systolic values increase more than diastolic values. • White blood cell (WBC) count increases. • Respiratory rate increases. • Temperature may be slightly elevated. • Proteinuria may occur. • Gastric motility and absorption of solid food are decreased; nausea and vomiting may occur during transition to second-stage labor. • Blood glucose level decreases.

Maternal-Fetal indications for C-section

• Cephalopelvic disproportion • Placental abruption • Placenta previa • History of previous cesarean birth • Cesarean birth on maternal request

Dinoprostone (Cervidil) nursing considerations

• Explain the procedure to the woman and her family. Ensure that an informed consent has been obtained per agency policy. • Assess the woman and fetus before each insertion and during treatment following agency protocol for frequency. Assess maternal vital signs and health status, FHR and pattern, and status of pregnancy, including indications for cervical ripening or induction of labor, signs of labor or impending labor, and the Bishop score. Recognize that an abnormal FHR and pattern; maternal fever, infection, vaginal bleeding, or hypersensitivity; and regular, progressive uterine contractions contraindicate the use of dinoprostone. • Avoid use in women with asthma, glaucoma, and hypotension or hypertension. • Use with caution if the woman has cardiac, renal, or hepatic disease; anemia; jaundice; diabetes; epilepsy; or genitourinary (GU) infections. • Bring the gel to room temperature just before administration. Do not force the warming process by using a warm-water bath or other source of external heat such as microwave because heat may cause inactivation. • Keep the insert frozen until just before insertion. No warming is needed. • Have the woman void before insertion. • Assist the woman to maintain a supine position with a lateral tilt or a side-lying position for at least 30 minutes after insertion of the gel or for 2 hours after placement of the insert. • Allow the woman to ambulate after the recommended period of bed rest and observation. • Prepare to pull the string to remove the insert and to administer terbutaline 0.25 mg subcutaneously if significant adverse effects occur. There is no effective way to remove the gel from the vagina if uterine tachysystole or abnormal FHR and pattern occur. • Delay the initiation of oxytocin for induction of labor for 6 to 12 hours after the last instillation of the gel or for 30 to 60 minutes after removal of the insert, or follow agency protocol for induction if ripening has occurred but labor has not begun. • Document all assessment findings and administration procedures.

Cultural considerations of birth

• Somalia: Because Somalis in general do not like to show any sign of weakness, women are extremely stoic during childbirth. • Japan: Natural childbirth methods practiced; may labor silently; may eat during labor; father may be present • China: Stoic response to pain; father not usually present; side-lying position preferred for labor and birth because this position is thought to reduce infant trauma • India: Natural childbirth methods preferred; father not usually present; female relatives usually present • Iran: Father not present; female support and female caregivers preferred • Mexico: May be stoic about discomfort until second stage, and then may request pain relief; father and female relatives may be present • Laos: May use squatting position for birth; father may or may not be present; female attendants preferred

Misoprostol (Cytotec) nursing considerations

• Explain the procedure to the woman and her family; ensure that an informed consent has been obtained as per agency policy. • Assess the woman and fetus before each insertion and during treatment following agency protocol for frequency. Assess maternal vital signs and health status, FHR and pattern, and status of pregnancy, including indications for cervical ripening or induction of labor, signs of labor or impending labor, and the Bishop score. Recognize that an abnormal FHR and pattern; maternal fever, infection, vaginal bleeding, or hypersensitivity; and regular, progressive uterine contractions contraindicate the use of misoprostol. • Avoid giving aluminum hydroxide and magnesium-containing antacids along with misoprostol. • Use with caution in women with renal failure because the medication is eliminated through the kidneys. • Have the woman void before insertion. • Assist the woman to maintain a supine position with a lateral tilt or a side-lying position for 30 to 40 minutes after insertion. • Prepare to (1) swab the vagina to remove unabsorbed medication using a saline-soaked gauze wrapped around fingers or (2) administer terbutaline 0.25 mg subcutaneously if significant adverse effects occur. • Initiate oxytocin for induction of labor no sooner than 4 hours after the last dose of misoprostol was administered, following agency protocol, if ripening has occurred and labor has not begun. • Document all assessment findings and administration procedures.

risk factors for preterm labor

• History of genital tract colonization, infection, or instrumentation • African-American race • Bleeding of uncertain origin in pregnancy • History of a previous spontaneous preterm birth between 16 and 36 weeks of gestation* • Uterine anomaly • Use of assisted reproductive technology • Multifetal gestation • Cigarette smoking, substance abuse • Prepregnancy underweight (BMI <19.6) and prepregnancy obesity (BMI >30) • Periodontal disease • Limited education and low socioeconomic status • Late entry into prenatal care • High levels of personal stress in one or more domains of life

Maternal indications for induction

• Hypertensive complications of pregnancy: gestational hypertension, preeclampsia, eclampsia • Fetal death • Chorioamnionitis

Interventions for maternal hypotension

• Increase rate of primary IV infusion. • Change to lateral or Trendelenburg positioning. • Administer ephedrine or phenylephrine if other measures are unsuccessful in increasing blood pressure.

False labor cervix

• May be soft but with no significant change in effacement or dilation or evidence of bloody show • Is often in a posterior position

Misoprostol (Cytotec) dosage

• Misoprostol is available either as a 100- or a 200-mcg tablet. Therefore, tablets must be broken to prepare the correct dose. This preparation should take place in the pharmacy to ensure accurate doses. • Recommended initial dose is 25 mcg. Insert intravaginally into the posterior vaginal fornix using the tips of index and middle fingers without the use of a lubricant. Repeat every 4 hours or until an effective contraction pattern is established (three or more uterine contractions in 10 minutes), the cervix ripens (Bishop score of 8 or greater), or significant adverse effects occur.

Fetal indication for C-Section

• Nonreassuring fetal status • Malpresentation (breech or transverse lie) • Active maternal herpes infection

False labor contractions

• Occur irregularly or become regular only temporarily • Often stop with walking or position change • Can be felt in the back or the abdomen above the umbilicus • Can often be stopped through the use of comfort measures

Oxytocin nursing considerations

• Oxytocin is considered a high-alert medication because it has the potential to cause significant harm when used inappropriately. • Patient and partner teaching and support: • Reasons for use of oxytocin (e.g., start or improve labor) • Reactions to expect concerning the nature of contractions: the intensity of the contraction increases more rapidly, holds the peak longer, and ends more quickly; contractions come regularly and more often • Monitoring to anticipate • Continue to keep woman and her partner informed regarding progress. • Remember that women vary greatly in their response to oxytocin; some require only very small amounts of medication to produce adequate contractions, whereas others need larger doses. • Assessment: • Assess fetal status using electronic fetal monitoring; evaluate tracing every 15 minutes and with every change in dose during the first stage of labor and every 5 minutes during the active pushing phase of the second stage of labor. • Monitor the contraction pattern and uterine resting tone every 15 minutes and with every change in dose during the first stage of labor and every 5 minutes during the second stage of labor. • Monitor blood pressure, pulse, and respirations every 30 to 60 minutes and with every change in dose. • Assess intake and output; limit IV intake to 1000 mL in 8 hours; urine output should be 120 mL or more every 4 hours. • Perform a vaginal examination as indicated. • Monitor for side effects, including nausea, vomiting, headache, and hypotension. • Observe emotional responses of the woman and her partner. • Use a standard definition for uterine tachysystole that does not include an abnormal FHR and pattern or the woman's perception of pain (see Emergency Treatment box: Uterine Tachysystole with Oxytocin [Pitocin] Infusion). • The rate of oxytocin infusion should be continually titrated to the lowest dose that achieves acceptable labor progress. Usually the oxytocin dose can be decreased or discontinued after rupture of membranes and in the active phase of first-stage labor. • Documentation: • The time the oxytocin infusion is begun, and each time the infusion is increased, decreased, or discontinued • Assessment data as described above • Interventions for uterine tachysystole and abnormal FHR and pattern and the response to the interventions • Notification of the obstetric health care provider and that person's response

Misoprostol (Cytotec) indications

• PGE1 is used for preinduction cervical ripening (ripen the cervix before oxytocin induction of labor when the Bishop score is 4 or less) and to induce labor or abortion (abortifacient agent); it has not yet been approved by the FDA for cervical ripening or labor induction (i.e., this is an off-label use for obstetrics). • It should not be used if the woman has a history of previous cesarean birth or other major uterine surgery.

Dinoprostone (Cervidil Insert indications

• PGE2 is used for preinduction cervical ripening (ripen the cervix before oxytocin induction of labor when the Bishop score is 4 or less) and for induction of labor or abortion (abortifacient agent). • It is not recommended for use if the woman has a history of previous cesarean birth or other major uterine surgery.

oxytocin side effects

• Possible maternal adverse effects include uterine tachysystole, placental abruption, uterine rupture, unplanned cesarean birth caused by abnormal FHR and pattern, postpartum hemorrhage, infection, and death from water intoxication (e.g., severe hyponatremia). • Possible fetal adverse effects include hypoxemia and acidosis, eventually resulting in abnormal FHR and pattern.

True labor fetus

• Presenting part usually becomes engaged in the pelvis, which results in increased ease of breathing; at the same time, the presenting part presses downward and compresses the bladder, resulting in urinary frequency

Maternal indication for C-Section

• Specific cardiac disease (e.g., Marfan syndrome with dilated aortic root)

Causes of fetal accelerations

• Spontaneous fetal movement • Vaginal examination • Electrode application • Fetal scalp stimulation • Fetal reaction to external sounds • Breech presentation • Occiput posterior position • Uterine contractions • Fundal pressure • Abdominal palpation

Oxytocin dosage

• The IV solution containing oxytocin should be mixed in a standard concentration. Concentrations often used are 10 units in 1000 mL of fluid, 20 units in 1000 mL of fluid, or 30 units in 500 mL of fluid. • Oxytocin is administered intravenously through a secondary line connected to the main line at the proximal port (connection closest to the IV insertion site). Oxytocin is always administered by infusion pump. • Begin oxytocin administration at 1 milliunit/minute. Increase the rate by 1 to 2 milliunits/minute, no more frequently than every 30 to 60 minutes based on the response of the woman and fetus and the progress of labor. • The goal of oxytocin administration is to produce acceptable uterine contractions as evidenced by: • Consistent achievement of 200 to 220 MVUs or • A consistent pattern of one contraction every 2 to 3 minutes, lasting 80 to 90 seconds, and strong to palpation