FINAL EXAM STUDY GUIDE - OB -
Nancy is pregnant. Her first pregnancy resulted in a stillbirth at 36 weeks of gestation and her second pregnancy resulted in the birth of her daughter at 42 weeks gestation.
Nancy (3-1-1-0-1)
Sara had intercourse on February 4, 2020. She has not had a menstrual period since the one that began on January 19, 2020, and ended 5 days later.
October 26, 2020
preterm labor interventions
Stop uterine contractions and possible labor cause: a. Diagnosis/treatment of infections b. Empty bladder/left lateral position c. Hydrate pt (po/IV) contractions (3-4 cups po)irritability may result in dehydration d. Assess for uterine contractions q 10 minutes e. Maintain bedrest or restrict activity...monitor fetal activity f. If contractions stop, resume activities slowly If not, notify physician g. Administer tocolyticdrugs per Dr. Order: MgSO4, Terbutaline , Ritodrine(yutopar) Procardia h. Administer antenatal glucocortercoidas ordered—betamethasone (Celestone) stimulates the production of more mature surfactant in fetal lungs to prevent respiratory distress i. teaching/emotional support ------------------------------------------ Try to stop labor! ● If at all possible, we want contractions to stop so that the pregnancy can continue and the baby can be born at a normal gestational age. ● Ways to stop labor: ○ Tocolytics ■ Terbutaline ■ Magnesium Sulfate ○ Bedrest ○ Fluids ● Must monitor both mother and baby closely ● Evaluate the mothers contractions and their frequency, and how the fetus is tolerating the contractions. ● If PROM or PPROM monitor closely for infection.
Stages of labor
1st: dilating stage (0-10 cm) latent: 0 - 5 cm active: 6 - 10 cm 2nd stage: delivery active pushing baby born at the end 3rd: placental delivery 4th: recovery- 2h - vaginal delivery 3h - C- section primary goal to prevent hemorrhage from uterine atony, 1st void within 1 hour and then q2-3 hrs, Rhogam
Hydatidiform mole (MOLAR pregnancy)
"cancer-like" pregancy abnormal cells no embryo clinical manifestation : dark red/prune juice like bleeding Diagnostics: hormone levels (elevated hcg) Can d/c pregnancy or use meds monitor hcg levels for a year recommend women not to get pregnant for a year
Trimesters of pregnancy
- 1st trimester: 0 - 13 6/7 weeks - 2nd trimester: 14 0/7 - 27 6/7 weeks - 3rd trimester: 28 0/7 - 40 6/7 week s
Bleeding during pregnancy/ labor
- Miscarriage (spontaneous abortion) - cervical insufficiency - Ectopic pregnancy - Hydatidiform mole (MOLAR pregnancy) More likely to have intense vaginal bleeding during pregnancy - Advanced maternal age - Smoking exposure - Prior preterm birth placental abruption : *DARK RED BLEEDING* *PAIN* *ABDOMINAL SWELLING* EMERGENCY Abruptio placentae is a cause of bleeding disorders in later pregnancy premature separation of the placenta from the uterine wall vaginal bleeding severe abdominal pain the placenta prematurely detaches from the uterine wall separation occurs in the area of the dexidua basalis after 20 weeks of gestation and before birth usually occurs in 3rd trimester before 37 weeks maternal hypertension is an identified risk as well as cocaine or meth use Trauma to the abdomen while pregnant (MVAs, domestic violence) Placental Previa
Labor induction
- can give pitocin - nipple stimulation - walking/movement mechanical: - break the bag - strip membrane - insert foley catheter chemical: - cytotec (prostaglandin for cervical ripening)
Risk factors for preeclampsia
- nulliparity - multifetal gestations - preeclampsia in previous pregnancy - chronic hypertension - pregestational diabetes - gestational diabetes - thrombophilia - systemic lupus erythematosus - prepregnancy BMI >30 - antiphospholipid antibody syndrome - maternal age >35 years - kidney disease - assisted reproductive technology - obstructive sleep apnea
Estimated date of delivery calculation
-subtract 3 months from *1st day of last menstrual period* and add 7 days to that date
For vaginal birth to be successful, the fetus must adapt to the birth canal during the descent. The turns and other adjustments necessary in the human birth process are termed the ―mechanism of labor. Please list the seven cardinal movements in the mechanism of labor in the correct order. a. Flexion b. Internal rotation c. External rotation d. Expulsion e. Engagement f. Descent g. Extension 1-7
1. E Engagement 2. F Descent 3. A Flexion 4. B Internal rotation 5. G Extension 6. C External rotation 7. D Expulsion In a vertex presentation the cardinal movements, in order, are: engagement, descent, flexion, internal rotation, extension, external rotation (restitution), and finally birth by expulsion. Although these movements are discussed separately, in actuality a combination of movements occurs simultaneously (i.e., engagement involves both descent and flexion).
ALONE fetal tests
A- Amniocentesis L- L/S Ratio O - Oxytocin Test N - Non-Stress Test E - Estriol Level
ALONE fetal tests +
A- Amniocentesis L- L/S Ratio O - Oxytocin Test N - Non-Stress Test E - Estriol Level
amniotic fluid
AFV demonstrates the adequacy of the placental function over a longer period oligohydraminos : too little/scant amniotic fluid - fundal height that is small for gestational age and a fetus that is easily palpated - vertical pocket of amniotic fluid is less than 2 cm polyhydramnios (hydramnios): excessive amniotic fluid - fundal height is large for gestational age - fetus is not easily palpated or unable to palpate (ballotable) - vertical pocket of amniotic fluid measuring more than 8 cm Hydramnios occurs 10 times more often in diabetic pregnancies.
A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a a. primipara. b. primigravida. c. multipara. d. nulligravida.
ANS: A A primipara is a woman who has completed one pregnancy with a viable fetus. To remember terms, keep in mind: gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. A primigravida is a woman pregnant for the first time. A multipara is a woman who has completed two or more pregnancies with a viable fetus. A nulligravida is a woman who has never been pregnant.
With regard to the process of augmentation of labor, the nurse should be aware that it a. is part of the active management of labor that is instituted when the labor process is unsatisfactory. b. relies on more invasive methods when oxytocin and amniotomy have failed. c. is a modern management term to cover up the negative connotations of forceps-assisted birth. d. uses vacuum cups.
ANS: A Augmentation is part of the active management of labor that stimulates uterine contractions after labor has started but is not progressing satisfactorily. Augmentation uses amniotomy and oxytocin infusion, as well as some gentler, noninvasive methods. Forceps-assisted births andvacuum-assisted births are appropriately used at the end of labor and are not part of augmentation.
A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature of 37.1 C, pulse rate of 96 beats/min, respiratory rate of 24 breaths/min, blood pressure (BP) of 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for a. hydralazine. b. magnesium sulfate bolus. c. diazepam. d. calcium gluconate.
ANS: A Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically, it is administered for a systolic BP greater than 160 mm Hg or a diastolic BP greater than 110 mm Hg. An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The patient is not currently displaying any signs or symptoms of magnesium toxicity.
Which presentation is described accurately in terms of both presenting part and frequency of occurrence? a. Cephalic: occiput; at least 95% b. Breech: sacrum; 10% to 15% c. Shoulder: scapula; 10% to 15% d. Cephalic: cranial; 80% to 85%
ANS: A In cephalic presentations (head first), the presenting part is the occiput; this occurs in 96% of births. In a breech birth, the sacrum emerges first; this occurs in about 3% of births. Inshoulder presentations, the scapula emerges first; this occurs in only 1% of births.
In evaluating the effectiveness of oxytocin induction, the nurse would expect a. contractions lasting 80 to 90 seconds, 2 to 3 minutes apart. b. the intensity of contractions to be at least 110 to 130 mm Hg. c. labor to progress at least 2 cm/hr dilation. d. at least 30 mU/min of oxytocin will be needed to achieve cervical dilation
ANS: A The goal of induction of labor would be to produce contractions that occur every 2 to 3 minutes and last 60 to 90 seconds. The intensity of the contractions should be 80 to 90 mm Hg by intrauterine pressure catheter. Cervical dilation of 1 cm/hr in the active phase of labor would be the goal in an oxytocin induction. The dose is increased by 1 to 2 mU/min atintervals of 30 to 60 minutes until the desired contraction pattern is achieved. Doses are increased up to a maximum of 20 to 40 mU/min.
Identify the goal of a patient with the following nursing diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to diet choices inadequate to meet nutrient requirements of pregnancy. a. Gain a total of 30 lbs. b. Take daily supplements consistently. c. Decrease intake of snack foods. d. Increase intake of complex carbohydrates.
ANS: A A weight gain of 30 lbs is one indication that the patient has gained a sufficient amount for the nutritional needs of pregnancy. A daily supplement is not the best goal for this patient. It does not meet the basic need of proper nutrition during pregnancy. Decreasing snack foods may be a problem and should be assessed; however, assessing weight gain is the best method of monitoring nutritional intake for this pregnant patient. Increasing the intake of complex carbohydrates is important for this patient, but monitoring the weight gain should be the end goal.
A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is said to be a. negative. b. positive. c. satisfactory. d. unsatisfactory.
ANS: A Adequate uterine activity necessary for a CST consists of the *presence of three contractions in a 10-minute time frame. If no decelerations are observed in the FHR pattern with the contractions, the findings are considered to be negative.* A positive CST indicates the presence of repetitive later FHR decelerations. Satisfactory and unsatisfactory are not applicable terms.
A maternity nurse should be aware of which fact about the amniotic fluid? a. It serves as a source of oral fluid and a repository for waste from the fetus. b. The volume remains about the same throughout the term of a healthy pregnancy. c. A volume of less than 300 mL is associated with gastrointestinal malformations. d. A volume of more than 2 L is associated with fetal renal abnormalities.
ANS: A Amniotic fluid serves as a source of oral fluid, serves as a repository for waste from the fetus, cushions the fetus, and helps maintain a constant body temperature. The volume of amniotic fluid changes constantly. Too little amniotic fluid (oligohydramnios) is associated with renal abnormalities. Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.
Rho immune globulin will be ordered after birth if which situation occurs? a. Mother Rh-, baby Rh+ b. Mother Rh-, baby Rh- c. Mother Rh+, baby Rh+ d. Mother Rh+, baby Rh-
ANS: A An Rh- mother delivering an Rh+ baby may develop antibodies to fetal cells that entered her bloodstream when the placenta separated. The Rho immune globulin works to destroy the fetal cells in the maternal circulation before sensitization occurs. If mother and baby are both Rh+ or Rh- the blood types are alike, so no antibody formation would be anticipated. If the Rh+ blood of the mother comes in contact with the Rh- blood of the infant, no antibodies would develop because the antigens are in the mother's blood, not the infant's.
Nurses should be aware that the biophysical profile (BPP) a. is an accurate indicator of impending fetal death. b. is a compilation of health risk factors of the mother during the later stages of pregnancy. c. consists of a Doppler blood flow analysis and an amniotic fluid index. d. involves an invasive form of ultrasound examination.
ANS: A An abnormal BPP score is an indication that labor should be induced. The BPP evaluates the health of the fetus, requires many different measures, and is a noninvasive procedure.
The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what other tool would be useful in confirming the diagnosis? a. Doppler blood flow analysis b. Contraction stress test (CST) c. Amniocentesis d. Daily fetal movement counts
ANS: A Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high risk pregnancies because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, CST is not performed on a woman whose fetus is preterm. Indications for amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and diagnosis of fetal hemolytic disease, not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this woman's pregnancy, it is not used to diagnose IUGR.
In planning care for women with preeclampsia, nurses should be aware that a. induction of labor is likely, as near term as possible. b. if at home, the woman should be confined to her bed, even with mild preeclampsia. c. a special diet low in protein and salt should be initiated. d. vaginal birth is still an option, even in severe cases.
ANS: A Induction of labor is likely, as near term as possible; however, at less than 37 weeks of gestation, immediate delivery may not be in the best interest of the fetus. Strict bed rest is becoming controversial for mild cases; some women in the hospital are even allowed to move around. Diet and fluid recommendations are much the same as for healthy pregnant women, although some authorities have suggested a diet high in protein. Women with severe preeclampsia should expect a cesarean delivery.
Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for a. macrosomia. b. congenital anomalies of the central nervous system. c. preterm birth. d. low birth weight.
ANS: A Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. Increased weight, or macrosomia, is the greatest risk factor for this woman.
The nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is a. hypertension. b. hyperemesis gravidarum. c. hemorrhagic complications. d. infections.
ANS: A Preeclampsia and eclampsia are two noted deadly forms of hypertension. A large percentage of pregnant women will have nausea and vomiting, but a relatively few have the severe form called hyperemesis gravidarum. Hemorrhagic complications are the second most common medical complication of pregnancy; hypertension is the most common.
To teach patients about the process of labor adequately, the nurse knows that which event is the best indicator of true labor? a. Bloody show b. Cervical dilation and effacement c. Fetal descent into the pelvic inlet d. Uterine contractions every 7 minutes
ANS: B The conclusive distinction between true and false labor is that contractions of true labor cause progressive change in the cervix. Bloody show can occur before true labor (associated with cervical dilation & effacement). Fetal descent can occur before true labor. False labor may have contractions that occur this frequently; however, this is usually inconsistent.
The reported incidence of ectopic pregnancy in the United States has risen steadily over the past two decades. Causes include the increase in STDs accompanied by tubal infection and damage. The popularity of contraceptive devices such as the IUD has also increased the risk for ectopic pregnancy. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for symptoms such as (Select all that apply.) a. pelvic pain. b. abdominal pain. c. unanticipated heavy bleeding. d. vaginal spotting or light bleeding. e. missed period.
ANS: A, B, D, E A missed period or spotting can easily be mistaken by the patient as early signs of pregnancy. More subtle signs depend on exactly where the implantation occurs. The nurse must be thorough in her assessment because pain is not a normal symptom of early pregnancy. As the fallopian tube tears open and the embryo is expelled, the patient often exhibits severe pain accompanied by intra-abdominal hemorrhage. This may progress to hypovolemic shock with minimal or even no external bleeding. In about half of women, shoulder and neck pain results from irritation of the diaphragm from the hemorrhage.
Signs that precede labor include (Select all that apply.) a. lightening. b. exhaustion. c. bloody show. d. rupture of membranes. e. decreased fetal movement.
ANS: A, C, D Signs that precede labor may include lightening, urinary frequency, backache, weight loss, surge of energy, bloody show, and rupture of membranes. Many women experience a burst of energy before labor. A decrease in fetal movement is an ominous sign that does not alwayscorrelate with labor.
Induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse in the labor and delivery unit is often asked to schedule patients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. These include (Select all that apply.) a. rupture of membranes at or near term. b. convenience of the woman or her physician. c. chorioamnionitis (inflammation of the amniotic sac). d. postterm pregnancy. e. fetal death.
ANS: A, C, D, E These are all acceptable indications for induction. Other conditions include intrauterine growth retardation (IUGR), maternal-fetal blood incompatibility, hypertension, and placentalabruption. Elective inductions for the convenience of the woman or her provider are not recommended; however, they have become commonplace. Factors such as rapid labors and living a long distance from a health care facility may be valid reasons in such a circumstance.Elective delivery should not occur before 39 weeks' completed gestation.
While caring for the patient who requires an induction of labor, the nurse should be cognizant that a. ripening the cervix usually results in a decreased success rate for induction. b. labor sometimes can be induced with balloon catheters or laminaria tents. c. oxytocin is less expensive than prostaglandins and more effective but creates greater health risks. d. amniotomy can be used to make the cervix more favorable for labor.
ANS: B Balloon catheters or laminaria tents are mechanical means of ripening the cervix. Ripening the cervix, making it softer and thinner, increases the success rate of induced labor. Prostaglandin E1 is less expensive and more effective than oxytocin but carries a greater risk. Amniotomy isthe artificial rupture of membranes, which is used to induce labor only when the cervix is already ripe
Nurses should know some basic definitions concerning preterm birth, preterm labor, and low birth weight. For instance a. the terms preterm birth and low birth weight can be used interchangeably. b. preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy. c. low birth weight is anything below 3.7 lbs. d. in the United States early in this century, preterm birth accounted for 18% to 20% of all births.
ANS: B Before 20 weeks, it is not viable (miscarriage); after 37 weeks, it can be considered term. Although these terms are used interchangeably, they have different meanings: preterm birthdescribes the length of gestation (37 weeks) regardless of weight; low birth weight describes weight only (2500 g or less) at the time of birth, whenever it occurs. Low birth weight is anything less than 2500 g, or about 5.5 lbs. In 2003 the preterm birth rate in the United States was 12.3%, but it is increasing in frequency.
Which time-based description of a stage of development in pregnancy is accurate? a. Viability—22 to 37 weeks since the last menstrual period (LMP) (assuming a fetal weight >500 g). b. Full Term—Pregnancy from the beginning of week 39 of gestation to the end of week 40. c. Preterm—Pregnancy from 20 to 28 weeks. d. Postdate—Pregnancy that extends beyond 38 weeks.
ANS: B Full Term is 39 to 40 weeks of gestation. Viability is the ability of the fetus to live outside the uterus before coming to term, or 22 to 24 weeks since LMP. Preterm is 20 to 37 weeks of gestation. Postdate or postterm is a pregnancy that extends beyond 42 weeks or what is considered the limit of full term.
The nurse has received report regarding her patient in labor. The woman's last vaginal examination was recorded as 3 cm, 30%, and -2. The nurse's interpretation of this assessment is that a. the cervix is effaced 3 cm, it is dilated 30%, and the presenting part is 2 cm above the ischial spines. b. the cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines. c. the cervix is effaced 3 cm, it is dilated 30%, and the presenting part is 2 cm below the ischial spines. d. the cervix is dilated 3 cm, it is effaced 30%, and the presenting part is 2 cm below the ischial spines.
ANS: B The correct description of the vaginal examination for this woman in labor is the cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines. The sterile vaginal examination is recorded as centimeters of cervical dilation, percentage of cervical dilation, and the relationship of the presenting part to the ischial spines (either aboveor below).
A patient whose cervix is dilated to 5 cm is considered to be in which phase of labor? a. Latent phase b. Active phase c. Second stage d. Third stage
ANS: B The latent phase is from the beginning of true labor until 3 cm of cervical dilation. The active phase of labor is characterized by cervical dilation of 4 to 7 cm. The second stage of laborbegins when the cervix is completely dilated until the birth of the baby. The third stage of labor is from the birth of the baby until the expulsion of the placenta. This patient is in theactive phase of labor.
As relates to fetal positioning during labor, nurses should be aware that a. position is a measure of the degree of descent of the presenting part of the fetus through the birth canal. b. birth is imminent when the presenting part is at +4 to +5 cm below the spine. c. the largest transverse diameter of the presenting part is the suboccipitobregmatic diameter. d. engagement is the term used to describe the beginning of labor
ANS: B The station of the presenting part should be noted at the beginning of labor so that the rate of descent can be determined. Position is the relation of the presenting part of the fetus to the four quadrants of the mother's pelvis; station is the measure of degree of descent. The largest diameter usually is the biparietal diameter. The suboccipitobregmatic diameter is the smallest, although one of the most critical. Engagement often occurs in the weeks just before labor innulliparas and before or during labor in multiparas.
The perinatal nurse is giving discharge instructions to a woman after suction curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse would be a. ―If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available.‖ b. ―The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult.‖ c. ―If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, it is better not to get pregnant at this time.‖ d. ―Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy.‖
ANS: B This is an accurate statement. Beta-human chorionic gonadotropin (hCG) levels will be drawnfor 1 year to ensure that the mole is completely gone. There is an increased chance ofdeveloping choriocarcinoma after the development of a hydatidiform mole. The goal is toachieve a ―zero‖ hCG level. If the woman were to become pregnant, it could obscure thepresence of the potentially carcinogenic cells. Women should be instructed to use birth controlfor 1 year after treatment for a hydatidiform mole. The rationale for avoiding pregnancy for 1year is to ensure that carcinogenic cells are not present. Any contraceptive method except anintrauterine device is acceptable.
Which maternal condition always necessitates delivery by cesarean section? a. Partial abruptio placentae b. Total placenta previa c. Ectopic pregnancy d. Eclampsia
ANS: B In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal delivery occurred. If the mother has stable vital signs and the fetus is alive, a vaginal delivery can be attempted in cases of partial abruptio placentae. If the fetus has died, a vaginal delivery is preferred. The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. Labor can be safely induced if the eclampsia is under control
An abortion in which the fetus dies but is retained within the uterus is called a(n) a. inevitable abortion. b. missed abortion. c. incomplete abortion. d. threatened abortion.
ANS: B Missed abortion refers to retention of a dead fetus in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all of the products of conception were expelled. With a threatened abortion the woman has cramping and bleeding but not cervical dilation. An abortion is the termination of pregnancy before the age of viability (20 weeks).
Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a laboring patient with diabetes mellitus, the nurse is aware that she is at a greater risk for a. oligohydramnios. b. polyhydramnios. c. postterm pregnancy. d. chromosomal abnormalities
ANS: B Polyhydramnios (amniotic fluid >2000 mL) is 10 times more likely to occur in diabetic compared with nondiabetic pregnancies. Polyhydramnios puts the mother at risk for premature rupture of membranes, premature labor, and after birth hemorrhage. Prolonged rupture of membranes, intrauterine growth restriction, intrauterine fetal death, and renal agenesis (Potter syndrome) all put the patient at risk for developing oligohydramnios. Anencephaly, placental insufficiency, and perinatal hypoxia all contribute to the risk for postterm pregnancy. Maternal age older than 35 years and balanced translocation (maternal and paternal) are risk factors for chromosome abnormalities.
A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool would yield more detailed information about the fetus? a. Ultrasound for fetal anomalies b. Biophysical profile (BPP) c. Maternal serum alpha-fetoprotein (MSAFP) screening d. Percutaneous umbilical blood sampling (PUBS)
ANS: B Real-time ultrasound permits detailed assessment of the physical and physiologic characteristics of the developing fetus and cataloging of normal and abnormal biophysical responses to stimuli. BPP is a noninvasive, dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease. An ultrasound for fetal anomalies would most likely have been performed earlier in the pregnancy. It is too late in the pregnancy to perform MSAFP screening. Also, MSAFP screening does not provide information related to fetal well-being. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection,term-47 determination of the acid-base status of a fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.
A woman's obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system? a. 3-1-1-1-3 b. 4-1-2-0-4 c. 3-0-3-0-3 d. 4-2-1-0-3
ANS: B The correct calculation of this woman's gravidity and parity is 4-1-2-0-4. The numbers reflect the woman's gravidity and parity information. Using the GPTAL system, her information is calculated as: G: The first number reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time. T: This number indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies has resulted in a fetus at term. P: This is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm. A: This number signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not. L: This number signifies the number of children born who are currently living; the woman has four children.
The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is a. bleeding. b. intense abdominal pain. c. uterine activity. d. cramping.
ANS: B Pain is absent with placenta previa and may be agonizing with abruptio placentae. Bleeding may be present in varying degrees for both placental conditions. Uterine activity and cramping may be present with both placental conditions.
Which condition indicates concealed hemorrhage when the patient experiences an abruptio placentae? a. Decrease in abdominal pain b. Bradycardia c. Hard, board-like abdomen d. Decrease in fundal height
ANS: C Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, board-like abdomen. Abdominal pain may increase. The patient will have shock symptoms that include tachycardia. As bleeding occurs, the fundal height will increase.
When assessing a woman in labor, the nurse is aware that the relationship of the fetal body parts to one another is called fetal a. lie. b. presentation. c. attitude. d. position.
ANS: C Attitude is the relation of the fetal body parts to one another. Lie is the relation of the long axis(spine) of the fetus to the long axis (spine) of the mother. Presentation refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor at term. Position is the relation of the presenting part to the four quadrants of the mother's pelvis.
A woman arrives for evaluation of her symptoms, which include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination the nurse notices an ecchymotic blueness around the woman's umbilicus and recognizes this assessment finding as a. normal integumentary changes associated with pregnancy. b. Turner's sign associated with appendicitis. c. Cullen's sign associated with a ruptured ectopic pregnancy. d. Chadwick's sign associated with early pregnancy.
ANS: C Cullen's sign, the blue ecchymosis seen in the umbilical area, indicates hematoperitoneum associated with an undiagnosed ruptured intraabdominal ectopic pregnancy. Linea nigra on the abdomen is the normal integumentary change associated with pregnancy. It manifests as a brown, pigmented, vertical line on the lower abdomen. Turner's sign is ecchymosis in the flank area, often associated with pancreatitis. Chadwick's sign is the blue-purple color of the cervix that may be seen during or around the eighth week of pregnancy.
Prepidil (prostaglandin gel) has been ordered for a pregnant woman at 43 weeks of gestation. The nurse recognizes that this medication will be administered to a. enhance uteroplacental perfusion in an aging placenta. b. increase amniotic fluid volume. c. ripen the cervix in preparation for labor induction. d. stimulate the amniotic membranes to rupture.
ANS: C It is accurate to state that Prepidil will be administered to ripen the cervix in preparation for labor induction. It is not administered to enhance uteroplacental perfusion in an agingplacenta, increase amniotic fluid volume, or stimulate the amniotic membranes to rupture.
Methotrexate is recommended as part of the treatment plan for which obstetric complication? a. Complete hydatidiform mole b. Missed abortion c. Unruptured ectopic pregnancy d. Abruptio placentae
ANS: C Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 4 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for complete hydatidiform mole, missed abortion, and abruptio placentae.
Surgical, medical, or mechanical methods may be used for labor induction. Which technique is considered a mechanical method of induction? a. Amniotomy b. Intravenous Pitocin c. Transcervical catheter d. Vaginal insertion of prostaglandins
ANS: C Placement of a balloon-tipped Foley catheter into the cervix is a mechanical method of induction. Other methods to expand and gradually dilate the cervix include hydroscopic dilators such as laminaria tents (made from desiccated seaweed), or Lamicel (containsmagnesium sulfate). Amniotomy is a surgical method of augmentation and induction. Intravenous Pitocin and insertion of prostaglandins are medical methods of induction.
In planning for home care of a woman with preterm labor, which concern must the nurse address? a. Nursing assessments will be different from those done in the hospital setting. b. Restricted activity and medications will be necessary to prevent recurrence of preterm labor. c. Prolonged bed rest may cause negative physiologic effects. d. Home health care providers will be necessary.
ANS: C Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle wasting, weakness, bone demineralization, decreased cardiac output, risk forthrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonged after birth recovery. Nursing assessments will differ somewhat from those performed in the acute care setting, but this is not the concern that needs to be addressed. Restricted activity and medication may prevent preterm labor, but not in all women. In addition, the plan of care isindividualized to meet the needs of each woman. Many women will receive home health nurse visits, but care is individualized for each woman.
The nurse recognizes that a woman is in true labor when she states a. ―I passed some thick, pink mucus when I urinated this morning. b. ―My bag of waters just broke. c. ―The contractions in my uterus are getting stronger and closer together. d. ―My baby dropped, and I have to urinate more frequently now.
ANS: C Regular, strong contractions with the presence of cervical change indicate that the woman is experiencing true labor. Loss of the mucous plug (operculum) often occurs during the first stage of labor or before the onset of labor, but it is not the indicator of true labor. Spontaneous rupture of membranes often occurs during the first stage of labor, but it is not the indicator of true labor. The presenting part of the fetus typically becomes engaged in the pelvis at theonset of labor, but this is not the indicator of true labor.
When assessing the fetus using Leopold maneuvers, the nurse feels a round, firm, movable fetal part in the fundal portion of the uterus and a long, smooth surface in the mother's right side close to midline. What is the likely position of the fetus? a. ROA b. LSP c. RSA d. LOA
ANS: C The fetus is positioned anteriorly in the right side of the maternal pelvis with the sacrum as the presenting part. RSA is the correct three-letter abbreviation to indicate this fetal position. Thefirst letter indicates the presenting part in either the right or left side of the maternal pelvis. The second letter indicates the anatomic presenting part of the fetus. The third letter stands forthe location of the presenting part in relation to the anterior, posterior, or transverse portion of the maternal pelvis. Palpation of a round, firm fetal part in the fundal portion of the uteruswould be the fetal head, indicating that the fetus is in a breech position with the sacrum as the presenting part in the maternal pelvis. Palpation of the fetal spine along the mother's right side denotes the location of the presenting part in the mother's pelvis. The ability to palpate the fetal spine indicates that the fetus is anteriorly positioned in the maternal pelvis.
A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature of 37.3 C, pulse rate of 88 beats/min, respiratory rate of 10 breaths/min, blood pressure (BP) of 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The patient complains, ―I'm so thirsty and warm. The nurse a. calls for a stat magnesium sulfate level. b. administers oxygen. c. discontinues the magnesium sulfate infusion. d. prepares to administer hydralazine.
ANS: C The patient is displaying clinical signs and symptoms of magnesium toxicity. Magnesium should be discontinued immediately. In addition, *calcium gluconate, the antidote for magnesium* , may be administered. *Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia* . Typically, it is administered for a systolic BP greater than 160 mm Hg or a diastolic BP greater than 110 mm Hg.
With regard to the turns and other adjustments of the fetus during the birth process, known as the mechanism of labor, nurses should be aware that a. the seven critical movements must progress in a more or less orderly sequence. b. asynclitism sometimes is achieved by means of the Leopold maneuver. c. the effects of the forces determining descent are modified by the shape of the woman's pelvis and the size of the fetal head. d. at birth the baby is said to achieve ―restitution (i.e., a return to the C-shape of the womb).
ANS: C The size of the maternal pelvis and the ability of the fetal head to mold also affect the process. The seven identifiable movements of the mechanism of labor occur in combinations simultaneously, not in precise sequences. Asynclitism is the deflection of the baby's head; theLeopold maneuver is a means of judging descent by palpating the mother's abdomen. Restitution is the rotation of the baby's head after the infant is born.
Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth? a. The fetal head is felt at 0 station during vaginal examination. b. Bloody mucus discharge increases. c. The vulva bulges and encircles the fetal head. d. The membranes rupture during a contraction.
ANS: C A bulging vulva that encircles the fetal head describes crowning, which occurs shortly before birth. Birth of the head occurs when the station is +4. A 0 station indicates engagement. Bloody show occurs throughout the labor process and is not an indication of an imminent birth. Rupture of membranes can occur at any time during the labor process and does not indicate an imminent birth.
A woman presents to the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion? a. Incomplete b. Inevitable c. Threatened d. Septic
ANS: C A woman with a threatened abortion presents with spotting, mild cramps, and no cervical dilation. A woman with an incomplete abortion would present with heavy bleeding, mild to severe cramping, and cervical dilation. An inevitable abortion manifests with the same symptoms as an incomplete abortion: heavy bleeding, mild to severe cramping, and cervical dilation. A woman with a septic abortion presents with malodorous bleeding and typically a dilated cervix.
The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician because the laboratory results are indicative of a. eclampsia. b. disseminated intravascular coagulation (DIC). c. HELLP syndrome. d. idiopathic thrombocytopenia.
ANS: C HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction characterized by hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). Eclampsia is determined by the presence of seizures. DIC is a potential complication associated with HELLP syndrome. Idiopathic thrombocytopenia is the presence of low platelets of unknown cause and is not associated with preeclampsia.
Which minerals and vitamins usually are recommended to supplement a pregnant woman's diet? a. Fat-soluble vitamins A and D b. Water-soluble vitamins C and B6 c. Iron and folate d. Calcium and zinc
ANS: C Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important. Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet. Zinc sometimes is supplemented. Most women obtain enough calcium through their regular diet.
A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse? a. Blood pressure (BP) increase to 138/86 mm Hg. b. Weight gain of 0.5 kg during the past 2 weeks. c. A dipstick value of 3+ for protein in her urine. d. Pitting pedal edema at the end of the day.
ANS: C Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ should alert the nurse that additional testing or assessment should be made. Generally, hypertension is defined as a BP of 140/90 or an increase in systolic pressure of 30 mm Hg or in diastolic pressure of 15 mm Hg. Preeclampsia may be manifested as a rapid weight gain of more than 2 kg in 1 week. Edema occurs in many normal pregnancies and in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia.
Which condition would not be classified as a bleeding disorder in late pregnancy? a. Placenta previa b. Abruptio placentae c. Spontaneous abortion d. Cord insertion
ANS: C Spontaneous abortion is another name for miscarriage; by definition it occurs early in pregnancy. Placenta previa is a cause of bleeding disorders in later pregnancy. Abruptio placentae is a cause of bleeding disorders in later pregnancy. Cord insertion is a cause of bleeding disorders in later pregnancy.
A pregnant woman's diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. The nurse would be most concerned about this woman's intake of a. calcium. b. protein. c. vitamin B12. d. folic acid.
ANS: C This diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12.
A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 18.0. The nurse knows that this woman's total recommended weight gain during pregnancy should be at least a. 20 kg (44 lbs). b. 16 kg (35 lbs). c. 12.5 kg (27.5 lbs). d. 10 kg (22 lbs).
ANS: C This woman has a normal BMI and should gain 11.5 to 16 kg during pregnancy. A weight gain of 20 kg would be unhealthy for most women. A weight gain 35 lbs is the high end of the range of weight this woman should gain in her pregnancy. A weight gain of 22 lbs would be appropriate for an obese woman.
A pregnant woman at 32 weeks of gestation comes to the emergency room because she has begun to experience bright red vaginal bleeding. She reports that she is experiencing no pain. The admission nurse suspects: A) Abruptio placentae. B) disseminated intravascular coagulation. C) placenta previa D) preterm labor
C) Placenta previa- Abruptio placentae is bright red bleeding with pain Disseminated intravascular coagulation is massive bleeding from many sites Preterm labor is not bleeding
A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. She shows the nurse her readings for the past few days. Which one should the nurse tell her indicates a need for adjustment (insulin or sugar)? a. 75 mg/dL before lunch. This is low; better eat now. b. 115 mg/dL 1 hour after lunch. This is a little high; maybe eat a little less next time. c. 115 mg/dL 2 hours after lunch; This is too high; it is time for insulin. d. 60 mg/dL just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.
ANS: D 60 mg/dL after waking from a nap is too low. During hours of sleep glucose levels should not be less than 70 mg/dL. Snacks before sleeping can be helpful. The premeal acceptable range is 65 to 95 mg/dL. The readings 1 hour after a meal should be less than 140 mg/dL. Two hours after eating, the readings should be less than 120 mg/dL.
A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring? a. Estriol is not found in maternal saliva. b. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. c. Fetal fibronectin is present in vaginal secretions. d. The cervix is effacing and dilated to 2 cm.
ANS: D Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth. Irregular, mild contractions that do not cause cervical change are not considered a threat. The presence of fetal fibronectin in vaginal secretions between 24and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor such as cervical changes.
With regard to the care management of preterm labor, nurses should be aware that a. all women must be considered at risk for preterm labor and prediction is so hit-and-miss, teaching pregnant women the symptoms probably causes more harm through false alarms. b. Braxton Hicks contractions often signal the onset of preterm labor. c. preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait several hours before contacting the primary caregiver. d. the diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.
ANS: D Gestational age of 20 to 37 weeks, uterine contractions, and a cervix that is 80% effaced or dilated 2 cm indicates preterm labor. It is essential that nurses teach women how to detect the early symptoms of preterm labor. Braxton Hicks contractions resemble preterm labor contractions, but they are not true labor. Waiting too long to see a health care provider could result in not administering essential medications. Preterm labor is not necessarily long-term labor.
Nurses should be aware that the induction of labor a. can be achieved by external and internal version techniques. b. is also known as a trial of labor (TOL). c. is almost always done for medical reasons. d. is rated for viability by a Bishop score.
ANS: D Induction of labor is likely to be more successful with a Bishop score of 9 or higher for first-time mothers and 5 or higher for veterans. Version is turning of the fetus to a better position by a physician for an easier or safer birth. A trial of labor is the observance of awoman and her fetus for several hours of active labor to assess the safety of vaginal birth. Two thirds of cases of induced labor are elective and are not done for medical reasons.
A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that a. bed rest and analgesics are the recommended treatment. b. she will be unable to conceive in the future. c. a D&C will be performed to remove the products of conception. d. hemorrhage is the major concern.
ANS: D Severe bleeding occurs if the fallopian tube ruptures. The recommended treatment is to remove the pregnancy before rupture in order to prevent hemorrhaging. If the tube must be removed, the woman's fertility will decrease; however, she will not be infertile. D&C is performed on the inside of the uterine cavity. The ectopic pregnancy is located within the tubes.
In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what finding would alert the nurse to possible side effects? a. Urine output of 160 mL in 4 hours b. Deep tendon reflexes 2+ and no clonus c. Respiratory rate of 16 breaths/min d. Serum magnesium level of 10 mg/dL
ANS: D The therapeutic range for magnesium sulfate management is 5 to 8 mg/dL. A serum magnesium level of 10 mg/dL could lead to signs and symptoms of magnesium toxicity, including oliguria and respiratory distress. Urine output of 160 mL in 4 hours, deep tendonreflexes 2+ with no clonus, and respiratory rate of 16 breaths/min are normal findings
In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the a. mother's age. b. number of years since diabetes was diagnosed. c. amount of insulin required prenatally. d. degree of glycemic control during pregnancy.
ANS: D Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes.
A placenta previa in which the placental edge just reaches the internal os is more commonly known as a. total. b. partial. c. complete. d. marginal.
ANS: D A placenta previa that does not cover any part of the cervix is termed marginal. With a total placenta previa, the placenta completely covers the os. When the patient experiences a partial placenta previa, the lower border of the placenta is within 3 cm of the internal cervical os but does not completely cover the os. A complete placenta previa is termed total. The placenta completely covers the internal cervical os.
A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to a. insert an oral airway. b. suction the mouth to prevent aspiration. c. administer oxygen by mask. d. stay with the patient and call for help.
ANS: D If a patient becomes eclamptic, the nurse should stay her and call for help. Insertion of an oral airway during seizure activity is no longer the standard of care. The nurse should attempt to keep the airway patent by turning the patient's head to the side to prevent aspiration. Once the seizure has ended, it may be necessary to suction the patient's mouth. Oxygen would be administered after the convulsion has ended.
A pregnant woman's diet may not meet her need for folates. A good source of this nutrient is a. chicken. b. cheese. c. potatoes. d. green leafy vegetables.
ANS: D Sources of folates include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Chicken and cheese are excellent sources of protein but are poor in folates. Potatoes contain carbohydrates and vitamins and minerals but are poor in folates
The nurse recognizes that a nonstress test (NST) in which two or more fetal heart rate (FHR) accelerations of 15 beats/min or more occur with fetal movement in a 20-minute period is a. nonreactive. b. positive. c. negative. d. reactive.
ANS: D The NST is reactive (normal) when two or more FHR accelerations of at least 15 beats/min (each with a duration of at least 15 seconds) occur in a 20-minute period. A nonreactive result means that the heart rate did not accelerate during fetal movement. A positive result is not used with NST. Contraction stress test (CST) uses positive as a result term. A negative result is not used with NST. CST uses negative as a result term.
A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lbs) since conception. How would the nurse interpret this? a. This weight gain indicates possible gestational hypertension. b. This weight gain indicates that the woman's infant is at risk for intrauterine growth restriction (IUGR). c. This weight gain cannot be evaluated until the woman has been observed for several more weeks. d. The woman's weight gain is appropriate for this stage of pregnancy.
ANS: D The statement ―The woman's weight gain is appropriate for this stage of pregnancy‖ is accurate. This woman's BMI is within the normal range. During the first trimester, the average total weight gain is only 1 to 2 kg. Although weight gain does indicate possible gestational hypertension, it does not apply to this patient. The desirable weight gain during pregnancy varies among women. The primary factor to consider in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman's height. A commonly used method of evaluating the appropriateness of weight for height is the BMI. Although weight gain does indicate risk for IUGR, this does not apply to this patient. Weight gain should occur at a steady rate throughout the pregnancy. The optimal rate of weight gain also depends on the stage of the pregnancy.
A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of a. eclamptic seizure. b. rupture of the uterus. c. placenta previa. d. placental abruption.
ANS: D Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture manifests as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa manifests with bright red, painless vaginal bleeding.
A 25 year old pregnant woman is at 10 weeks of gestation. Her BMI is calculated to be 24. Which one of the following is recommended in terms of weight gain during pregnancy? A) Total weight gain of 18 kg. B) First trimester weight gain of 1 to 2 kg C) Weight gain of 0.4kg each week for 40 weeks D) Weight gain of 3 kg per month during the second and third trimesters.
B) First trimester weight gain of 1 to 2 kg
A woman has been diagnosed with mid preeclampsia and will be treated at home. The nurse, in teaching this woman about her treatment regimen for mild preeclampsia, would tell her to do which of the following? (select all that apply) A) Check her respirations before and after taking her oral dose of magnesium sulfate B) Place a dipstick into a clean catch sample of her urine to test for proteins C) Reduce her fluid intake to four to five 8-ounces glasses each day D) do gentle exercises such as hand and feet circles and gently tensing and relaxing arm and leg muscles. E) Avoid excessively salty foods F) Maintain strict bed rest in a quiet dimly lighted room with minimal stimulation
B, D, E
Diane's last meses began on May 5, 2019, and it is last day occurred on May 10th, 2019.
February 12, 2020
A woman is pregnant for the second time. With her first pregnancy, she gave birth at 35 weeks; the child is currently 3 years old, alive and well.
GTPAL = 2 : 0 : 1 : 0 : 1
HELLP syndrome
Hemolysis Elevated Liver function test Low Platelet count
Signs labor is to begin
Lightening, return of urinary frequency, backache, stronger braxton Hicks contractions, weight loss of 0.5 to 1.5 kg, surge of energy, increased vaginal discharge, bloody show, cervical ripening, possible rupture of membranes.
Marsha is 6 weeks pregnant. Her previous pregnancies resulted in the live birth of a daughter at 40 weeks gestation, the live birth of a son at 38 weeks of gestation, and a spontaneous abortion at 10 weeks of gestation.
Marsha (4-2-0-1-2)
Preterm labor
Preterm is 20 to 37 weeks of gestation (under 36 weeks) Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. >>>Uterine contractions occurring more frequently than every 10 minutes persisting for 1 hour or more.<<< ---------------- 3 main criteria + Gestational age between 20 to 36 weeks+ Regular uterine activity (change in cervical effacement, dilation, or both) + initial presentation with regular contractions and cervical dilation of at least 2 cm --------------------- Diagnostic Fetal fibronectin test (fFN) -diagnostic test for PTL (preterm labor)a glycoprotein "glue" found in plasma and produced during fetal life. Test is performed by collected fluid from woman's vagina using a swab during a speculum exam. The presence is used as a predictor of preterm labor. presence of this in late 2nd or early 3rd trimester may be related to placental inflammation which can cause PTLoften a good predictor of who will NOT go into PTL because its negative value is high (less than 1% chance the woman will go into labor within 2 weeks) presence of fFN (sample of cervical fluid by sterile speculum exam)^^ done before any digital examination because lubricant used for exambleeding or intercourse within 24h can also reduce test accuracy
Station and presentation of the fetus
R : right L : left Occiput : head Anterior: baby's back is facing mom's belly Posterior: back to back Breech
Rh isoimmunization
Term: 300 mg RhoGam at 28 weeks & within 72 hrs delivery 1st trimester abortion: 50 mcg MICRogram Mom is rH negative and fetus is rH positive
FHT patterns during labor
VEAL CHOP V: variable decels C: cord compression >>>Reposition, O2, notify dr can occur with or without correlation to contractions*** E: early decels H: head compression Normal A: accels O: okay (fetal movement = reassuring) (can stimulate fetal scalp to elicit acceleration) L: late decels P: placental deficiency Turn, O2, d/c Pitocin, notify dr FHR normal range: 110-160 bpm A temporary decrease in variability can occur when the fetus is in a sleep state. These sleep states do not usually last longer than 30 minutes. -------------- Acceleration - FHR increases - Good and normal - Sometimes called tachycardia - Ok as long as not above 200 and sustained Early deceleration - HR decreases - Deceleration occurs at the same time as the contraction - Normal = head compression during labor Variable deceleration - deceleration occurs randomly w/ no correlation to contraction - Cord compression during labor - Turn mother to left side Late deceleration - deceleration occurs after contraction - Uteroplacental insufficiency - WORST type of deceleration Interventions 1. Turn mother to left side 2. Start oxygen 3. Start fluids C-section may be needed
Tests for fetal well-being
amniocentesis : - samples amniotic fluid and fetal cells - ultrasound is used although it does not produce an entirely accurate measurement - abnormalities in AFV are frequently associated with fetal disorders -uses US guidance to prevent from injuring baby - Indications for amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and diagnosis of fetal hemolytic disease, - Amniocentesis is performed after the 14th week of pregnancy (@ or after 15th week) L:S ratio : lung maturity good to know if mom is going to be induced - if mungs are immature: give betamethasone (2 doses; 24h apart) dextro (12h apart) test is done late in pregnancy by examining amniotic fluid to determine the L/S ratio (2:1) or for the presence of PG (result of "present") not commonly used due to cost, time, and complexity Oxytocin /Stress/Contraction test: want test result to be negative = baby has no decels during contractions = baby can withstand labor If positive = will probably need to have baby by C-section Non-stress test: want baby to be Reactive 2 FHR accelerations in 15/20 minute period Estrol levels: uses blood tests to determine genetic problems Biophysical profile: - AFV (amniotic fluid volume) - fetal movements - fetal breathing movements (FBMs) - fetal tone (determined by ultrasound) - FHR (determined by NST) FHR reactivity, FBMs, fetal movement, and fetal tone reflect current CNS status normal score is 8 - 10 noninvasive dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease considered a physical examination of the fetus, including determination of vital signs modBPP NST and AFV (amniotic fluid volume) Desired results: reactive NST and a single deepest vertical pocket of amniotic fluid greater than 2cm
LABOR
below
PRENATAL
below
lactation/breastfeeding nutritional needs
calories : + 450 - 500 protein : 46 (daily) + 25 g water : 3.8 liters *note* lactation is inhibited until the estrogen level declines after birth.
Pre-eclampsia
development of hypertension with proteinuria in a woman after *20 weeks* gestation who previously had neither condition. In the absence of proteinuria, new onset hypertension with thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms between 20th week and 1 week post-partum -------------------------------- Diagnostic criteria: @ least 20 weeks -Hypertension (> 140/90 2 readings) - proteinuria, - thrombocytopenia, - impaired liver function, - new-onset renal insufficiency, - pulmonary edema, - new-onset cerebral or visual disturbances ------------------------------- S/S: Pitting edema Blurred vision Severe headache (seizure precautions, low-stim environment) Oliguria protein: 300 mg or more in a 24 hour urine specimen protein/creatinine ratio greater than 0.3 g dipstick urine protein test at least 1+ 3+ deep tendon reflexes / CLONUS at the ankle joint --------------------- treatment: Hydralazine (Apresoline; Neopresol) - arteriolar vasodilator Labetalol Hydrochloride (Normodyne; Trandate) - alpha and beta blocker (vasodilation) Nifedipine (Adalat; Procardia) - calcium channel blocker ++ place mom on magnesium sulfate and antihypertensive medications Magnesium is the med of choice to prevent and treat seizure activity - usually given IV piggyback by pump - loading dose 4 to 6 g over 15 to 20 minutes - maintenance dose could be 40 g of mag in 1000 mL of LR at 1 to 2 g an hour) - therapeutic range is 4 to 7 mEq/L - *watch for mag toxicity* RR depression, absent DTR, CNS stimuli decreased *(calcium gluconate is antidote)* antihypertensives include: - labetalol & nifedipine - want BP @ 140-150/90-100 Corticosteroids to speed up lung development in the fetus at 34 weeks or less - betamethasone 12 mg IM repeated in 24 hours - dexamethasone 6 mg IM repeated 4 times, 12 hours apart serial BP measurements - reach 37 weeks, then delivery -------------------------------------- -Only cure is delivery of baby and placenta!! Vitals Q1H, cardiac monitor, urine output Q1H, monitor DTR's Q1H, fetal monitor, check for protein in urine, put patient on left side, magnesium sulfate for prevention of seizures AND induction of labor. NO FLUIDS!
Diet for pregnancy and breast feeding
first trimester: don't need a significant increase in calories 1st : 2- 4 lbs whole trimester 2nd/3rd: 1-2 lbs a week IF HUGE JUMP IN WEIGHT IN SHORT PERIOD: >> PRECLAMPSIA Drink 6/8 glasses of water per day Prenatal vitamins & folic acid Limit caffeine to 200 mg (1 cup of coffee) -- if too much caffeine = risk for IUGR/ Miscarriage avoid mercury (fish/seafood) No alcohol ----------------- recommended weight gain by body type: 25-35 lbs normal 28 - 40 lbs underweight 15 - 25 lbs overweight 11 - 20 lbs obese ----------------------
Gestational Diabetes
glucose tolerance test - 1st test: 1h after drink (BGL should be under 130-140) - 2nd test : if mom fails first test; 3h test and if failed again, then diagnosed with gestational diabetes Treat first with diet and exercise ^ if this doesn't help then use insulin or meds like metformin or glyburide ----------------- 24-28 wks with a 1 hour glucose tolerance test - use a fasting glucose and a one-hour glucose following a 50g glucose load - if fasting >126 OR one-hour glucose is greater than 130 then the patient is considered to have a positive result - if positive the pt should undergo a three-hour GTT with 100g glucose load
GTPAL
gravida : # of pregnancies, including current one term births : # of pregnancies that ended in term births (37 weeks 0 days and beyond; including early, full, late term, or postterm births) preterm births : # of pregnancies that ended in preterm birth (between 20 weeks 0 days and 36 weeks 6 days gestation) abortions : # of pregnancies that ended in miscarriage (spontaneous abortion) or elective termination (therapeutic abortion) before 20 weeks or less than 500 g at birth living children : # of living children --------------- G/P system : Pregnancies/births (gravida/para)
Cardinal movements
moving through the birth canal MOST IMPORTANT: baby is flexed descent, flexion, internal rotation, extension, restitution, external rotation, expulsion
Ectopic pregnancy
ultrasound can be used to detect these > embryo supposed to implant in uterus but implants in fallopian tube The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. S/S: bleeding, pain Treatment: methotrexate (if able to be dissolved) if not able to be dissolved, removal of fallopian tube by surgery (pt can still get pregnant bc only one fallopian at a time goes through ovulation)
preterm labor risk factors
● Infections of the urinary tract, vagina, or chorioamnionitis (infection of the amniotic sac) ● Previous preterm birth ● Multifetal pregnancy ● Hydramnios (excessive amniotic fluid) ● Age below 17 or above 35 ● Low socioeconomic status ● Smoking ● Substance use ● Domestic violence ● History of multiple miscarriages or abortions ● Diabetes mellitus or hypertension ● Lack of prenatal care ● Recurrent premature dilation of the cervix ● Placenta previa or abruptio placentae ● Preterm premature rupture of membranes ● Short interval between pregnancies ● Uterine abnormalities