Exam 2
hypotonic, hypertonic
Dysfunctional Uterine Contractions include ___ and ___ uterine dysfunction
ectopic pregnancy
Early signs of ___: vaginal spotting, abdominal/pelvic pain, missed menstrual period
fetal shoulder dystocia, fetal occiput posterior position
Episiotomy indications (2)
Nonstress test (NST)
Evaluates FHR accelerations, with or without fetal movement. Reactivity is associated with adequate fetal oxygenation and intact neural pathways
Bishop scoring system
Evaluates the cervical response to induction procedures *A high score (Above 6) is predictive of successful labor induction* Under 6 looking at C-section
incomplete
In ___ spontaneous abortion, retained tissue prevents uterus from contracting and profuse bleeding may occur
missed
In ___ spontaneous abortion, ultrasound is used to confirm absence of heartbeat before D&C or D&E.
complete
In ___spontaneous abortion, all products of conception have been expelled
inevitable
In ___spontaneous abortion, membranes rupture and cervix dilates
incomplete
In ___spontaneous abortion, some products of conception have been expelled, but some remain
missed
In ___spontaneous abortion, the fetus dies but is retained in the uterus
recurrent (habitual)
In ___spontaneous abortion, there are 3 or more consecutive spontaneous abortions
threatened
In ___spontaneous abortion, vaginal bleeding occurs
upper
In a paper strip, the ___ grid is for recording fetal HR.
lower
In a paper strip, the ___ grid is for recording uterine activity
Progressive cervical dilation
In evaluating the effectiveness of IV Pitocin for a client with secondary dystocia. The nurse should expect:
vacuum, forceps
In operative vaginal birth, ___ extraction is 4 times more common than ___
Episiotomy
Incision of the perineum just before birth.
Fetal Accelerations
Increase in FHR of 15 bpm or more for 15 sec. Associated with fetal movement. Reassuring- shows fetal arterial pH is Greater Than 7.2
placental abruption
Risk factors of ___: abdominal trauma, smoking, cocaine, hypertension, hx of abruption, autoimmune factors, certain coagulopathies
locate the placenta, locate pool of amniotic fluid, determine needle insertion
Routine ultrasound prior to amniocentesis is used to (3)
Early
(Late/Early/Variable Decelerations) Maternal position changes usually have no effect on pattern
Early
(Late/Early/Variable Decelerations) Mirror images of contraction
Early
(Late/Early/Variable Decelerations) Not associated with fetal compromise
Late
(Late/Early/Variable Decelerations) Nursing intervention required to improve placental blood flow and fetal oxygen supply.
Variable
(Late/Early/Variable Decelerations) Nursing interventions: alleviate the pressure on the umbilical cord and minimize fetal head compression by changing MATERNAL POSITION. IV BOLUS to increase blood pressure. EXAMINE CERVIX for prolapsed cord or change in labor progress.
variable
(Late/Early/Variable Decelerations) fall and rise in rate are abrupt and may be nonperiodic
Late
(Late/Early/Variable Decelerations) looks like the other, but shifted to the right
Late
(Late/Early/Variable Decelerations) not reassuring
variable
(Late/Early/Variable Decelerations) shape, duration, and degree of decelerations change
Placenta previa
(Placenta previa or Abruptio placentae) Bright red blood
Abruptio placentae
(Placenta previa or Abruptio placentae) FHS usually absent
Placenta previa
(Placenta previa or Abruptio placentae) FHS usually present
Abruptio placentae
(Placenta previa or Abruptio placentae) Preeclampsia is present in one-third of cases
Abruptio placentae
(Placenta previa or Abruptio placentae) dark colored blood
Abruptio placentae
(Placenta previa or Abruptio placentae) general condition and anemia are NOT proportionate to visible blood loss
Placenta previa
(Placenta previa or Abruptio placentae) general condition and anemia are proportionate to visible blood loss
Placenta previa
(Placenta previa or Abruptio placentae) height of uterus is proportional to gestational age
Abruptio placentae
(Placenta previa or Abruptio placentae) height of uterus may be disproportionately enlarged
Abruptio placentae
(Placenta previa or Abruptio placentae) painful
Placenta previa
(Placenta previa or Abruptio placentae) painless
Placenta previa
(Placenta previa or Abruptio placentae) soft and relaxed uterus
Abruptio placentae
(Placenta previa or Abruptio placentae) uterus may be tense, ridged, tender
fallopian tubes
95% of ectopic pregnancies occur in the ___
combined spinal-epidural
A ___ may be done to inject analgesic medication into the subarachnoid space before an epidural block
pudendal
A ____ block will help the client feel relief in their perineum
Preterm Premature Rupture of Membranes (PPROM)
Rupture and leakage of amniotic sac prior to 37 weeks. Often associated with preterm labor with the greatest risk occurring prior to 34 weeks
Premature Rupture of Membranes (PROM)
Rupture and leakage of amniotic sac prior to contractions at or after 37 weeks
molar pregnancies
Symptoms of ___ vary but can include include: vaginal bleeding, larger than expected uterus, excessive N/V, early preeclampsia
Nitrous Oxide (N2O)
Systemic Drug for Labor: A colorless sweet gas used along with oxygen to produce a conscious sedation
Naloxone (naltrexone)
Systemic Drug for Labor: Opioid Antagonists
Sedatives
Systemic Drug for Labor: drugs used to relieve anxiety and help you relax.
Opioid Analgesics
Systemic Drug for Labor: synthetic drugs that bind to opiate receptors to relieve pain. Observe for respiratory depression in neonate.
Indeterminate
Absence of FHR accelerations after fetal stimulation (Reassuring/Indeterminate/Non reassuring Pattern)
Indeterminate
Absent FHR variability with no recurrent decelerations (Reassuring/Indeterminate/Non reassuring Pattern)
Change maternal position
While monitoring your full-term labor patient, you notice persistent variable decelerations. Your first intervention for maximizing fetal oxygenation is to ___
Preterm labor
Contractions with cervical change prior to 37 weeks' gestation. May be induced or spontaneous.
ultrasound transducer
Device that converts electric energy to ultrasound energy and vice versa used to monitor FHR
trial of labor
"Once a cesarean, always a cesarean" is no longer the standard of care. Women should discuss VBAC with their providers to determine if a ___ is appropriate.
Early
(Late/Early/Variable Decelerations) Associated with fetal head compression
Late
(Late/Early/Variable Decelerations) Begin after the peak of the contraction and return to baseline after contraction ends
Variable
(Late/Early/Variable Decelerations) Caused by reduced flow through umbilical cord (cord compression)
Early
(Late/Early/Variable Decelerations) Consistent in appearance. Returns to baseline FHR by end of contraction
Late
(Late/Early/Variable Decelerations) Impaired oxygen exchange
Fetal fibronectin (fFN)
A glycoprotein that is produced by the trophoblast and fetal tissues whose presence between 20 and 34 weeks' gestation is a strong predictor of preterm birth associated with preterm spontaneous rupture of membranes.
Amniotic Fluid Index (AFI)
A method to quantify the amount of amniotic fluid visualized by ultrasound
Abruptio placenta, maternal tachycardia
A nurse is admitting a client who is in labor. The client admits to recent cocaine use. For which of the following complications should the nurse assess? (2)
Painless, red vaginal bleeding
A nurse is caring for a client who is at 36 weeks of gestation and has a suspected placenta previa. Which of the following findings support this diagnosis?
Blood patch
A procedure in which a cerebrospinal fluid leak is closed by means of an injection of the patient's blood into the area used during spinal anesthesia. Relief of spinal headache.
Pudendal block
A transvaginal injection of a local anesthetic into the area in front of the nerve that anesthetizes the perineum, vulva, and rectal areas for episiotomy, expulsion of the fetus, and episiotomy repair.
Non reassuring
A visually undulating sinusoidal pattern (Reassuring/Indeterminate/Non reassuring Pattern)
second half
Abruptio placentae is premature separation of normally implanted placenta during the ____ of pregnancy, usually with severe hemorrhage?
hyperbilirubinemia
ABO incompatibility may result in ___ of the infant
open body wall defects, chromosomal abnormalities
AFP assessment is performed on maternal serum or amniotic fluid to identify (2)
tocolytic
Administer ___ drugs during external cephalic version.
epidural opioids
Adverse effects of ___: V/V, pruritis
epidural block
Adverse effects of ___: maternal hypotension, bladder distortion, migration of catheter, fever
variable decelerations
Amnioinfusion is only used for ___
methotrexate
An early ectopic pregnancy without unstable bleeding is most often treated with a medication called ___, which stops cell growth and dissolves existing cells. (SubQ)
local infiltration anesthesia
Anesthesia method that places anesthetic solution into the tissues near the small terminal nerve branches for absorption
Amniocentesis
Aspiration of fluid from the sac for examination done during the second and third trimester.
body movement, muscle tone, breathing movements, amniotic fluid, heart beat
BPP assesses fetal (5)
0-3
BPP test results to consider immediate delivery
4-6
BPP test results to consider repeating test in 24 hours. Worrisome.
chorioamnionitis
Diagnostic criteria: maternal fever or at least two of the following: Uterine tenderness, foul smelling discharge, maternal WBC's over 15,000, maternal tachycardia or FHR tachycardia (> 160 bpm)
III
Category __ FHR pattern: Non reassuring (favorable signs absent)
I
Category __ FHR pattern: Reassuring
II
Category __ FHR pattern: indeterminate, ambiguous
recurrent (habitual)
Causes of ___ spontaneous abortion: genetic, chromosomal anomalies, reproductive tract anomalies, insufficient progesterone secretion, lupus, diabetes, STDs, TORCH infections
late decelerations
Causes of ___: placental insufficiency, uterine tachysystole, maternal hypotension
increasing obesity, increased induction rate, delayed childbearing
Cesarean birth rate increasing because (3)
gestational trophoblastic neoplasm
Choriocarcinoma is also called ___
threatened, inevitable
Clinical findings of ___ and ___ spontaneous abortions are report of cramping, closed cervix but bleeding evident
complete
Clinical findings of ___ spontaneous abortion, heavy cramping and bleeding, passing clots and tissue, closed cervix, residual blood present
incomplete
Clinical findings of ___ spontaneous abortion, severe cramping, active uterine bleeding, some POC expelled
infection or inflammation, uterine overdistension, bleeding, maternal stress
Common risk factors for spontaneous preterm labor (4)
infection, disseminated intravascular coagulation
Complications of missed spontaneous abortions (2)
frequency, duration, intensity of contractions, resting tone
Components of uterine activity assessment (4)
transvaginal ultrasound (no gestational sac), beta-hCG level (lower than expected), laparoscopy
Diagnostic evaluation of ectopic pregnancy (3)
vaginal examination, uterine contractions, mild cord compression, breech presentation
FHR accelerations may also occur with (4)
Non reassuring
FHR bradycardia without variability (Reassuring/Indeterminate/Non reassuring Pattern)
Reassuring
FHR reactivity with accelerations (Reassuring/Indeterminate/Non reassuring Pattern)
hypotonic
Factors contributing to ___ uterine dysfunction include overdistension of the uterus (polyhydramnios, macrosomia, multiple pregnancy)
Indeterminate
Fetal Tachycardia (Reassuring/Indeterminate/Non reassuring Pattern)
bradycardia
Fetal ___ is a sign of uteroplacental insufficiency
tachycardia
Fetal ___ is an early sign of fetal distress
<110 bpm
Fetal bradycardia
Indeterminate
Fetal bradycardia with presence of variability (Reassuring/Indeterminate/Non reassuring Pattern)
Kick counts, ultrasound for fetal growth, non-stress test, biophysical profile
Fetal surveillance for gestational diabetes (4)
>160 bpm
Fetal tachycardia
magnesium sulfate
For eclampsia, antihypertensive medications, supplemental oxygen are given along with an initial dose of ___ followed by maintenance dose
calcium gluconate
For magnesium sulfate toxicity, stop infusion immediately then administer ___
Misoprostol (Cytotec)
For missed spontaneous abortions in the second trimester, ____ may be needed to induce contractions
chorionic villi, trophoblasts
GTD is characterized by proliferation and edema of the ___ (fluid-filled grapelike vesicles) that grows large enough to fill the uterus similar to an advanced pregnancy. ____ develop abnormally.
40
Generally in newborns, report blood sugar levels below ___mg/dL
Adjunctive drugs
Given to improve effectiveness of analgesics and relieve side effects like nausea and vomiting.
8-10
Good BPP test results.
vacuum, curettage, IV oxytocin, follow up
Hydatidiform mole management
membranes ruptured, postpartum hemorrhage
Hypotonic Uterine Contractions: If ___, may increase risk for infection due to prolonged labor. Higher risk of developing ___
malposition of fetus, cephalopelvic disproportion (CPD)
Hypotonic Uterine Contractions: Most common reasons for reduction of uterine activity (2)
isotonic crystalloid solution
IV Fluids/Labor: If blood glucose high, patient will receive an ___ as the primary fluid and may also receive an insulin infusion
D5LR
IV Fluids/Labor: If blood glucose low, patient will receive ___ as the primary fluid
-, +, rhoGAM
If an Rh__ woman concieves an Rh__ child, maternal antibodies may develop. ___ should be administered.
90
If contraction intensity is over ___ mmHg it is cause for concern
missed
If infection is present with ___ spontaneous abortion, uterine evacuation is delayed until antibiotic therapy is started
amniocentesis
If multiple marker screening test is positive, ___ is recommended
Ectopic Pregnancy
Implantation of the fertilized ovum in an area outside of the uterine cavity
Placenta previa
Implantation of the placenta in the lower uterus. Requires delivery by C-section.
Placenta accreta
Improper implantation of placenta to the myometrium with little or no intervening decidua
Hemolysis
In HELLP, ___ occurs as a result of the fragmentation and distortion of erythrocytes during passage through damaged blood vessels.
fibrin deposits
In HELLP, liver enzyme levels increase when blood flow is obstructed by ___.
vascular damage
In HELLP, low platelet levels are caused by ___ resulting from vasospasm.
right upper
In HELLP, there will be pain in the ___ quadrant
incomplete, pitocin, methergin
In ___ spontaneous abortion, a dilation and evacuation (D&E) followed by vacuum and curettage is done. Administer ___ or ____
complete
In ___ spontaneous abortion, medical intervention is rarely required, and signs of infection or hemorrhage are not expected.
resting uterine tone increases to 45mmHg
Indication of amnioinfusion overfilling
ruptured membranes, 2cm
Internal fetal monitoring requires ___ and ___ of cervical dilation
Percutaneous Umbilical Blood Sampling (PUBS)
Involves the aspiration of fetal blood from the umbilical cord near the placenta to detect blood disorders, acid-base imbalance, infection or fetal genetic disease. Also called cordocentesis.
Internal version
Is sometimes used to change the presentation of the second twin after the birth of the first twin.
Fall risk
Laboring patient has pain of 9/10 and request IV pain medication. Most important statement for nurse to make and monitor for about narcotic medications?
ultrasound transducer
Less accurate than internal devices but noninvasive and suitable FHR monitor for most women in labor
rupture
Low transverse uterine incisions reduce the risk of
brain
Magnesium sulfate also protects the fetal ___
labor, postpartum
Magnesium sulfate is administered IV throughout ___ and ___
4-6g, 1-2g, 4-8
Magnesium sulfate loading dose of ___ over 15-30 mins, then maintenance dose of ___/hour to maintain therapeutic serum magnesium range of ___ mEq/L
Oxytocin, nipple stimulation
Management of hypotonic uterine contractions: Administer ___ to augment labor or ___ to increase endogenous oxytocin. Rupture of membranes. Ambulation.
10, 5-10
Maternal Assessment of fetal movement. Passing "kick counts"= __/12hr or ___/hour
contraction stress test
Maternal diabetes mellitus and post term pregnancy are appropriate indicators for performing a ___
preexisting diabetes
Maternal effects of ___ on pregnancy: preeclampsia, ketoacidosis, UTIs, hydramnios, dystocia
tachycardia
Maternal fever can lead to fetal ___
Indeterminate
Minimal or marked baseline FHR variability (Reassuring/Indeterminate/Non reassuring Pattern)
6-25 bpm
Moderate variability FHR
high
Molar pregnancies are diagnosed by ultrasound and ___ levels of beta-hCG
Alpha-Fetoprotein Screening (AFP)
Must be viewed as a first step in screening. Only requires a blood sample. Ideally performed between 16-18 weeks of gestation
preexisting diabetes
Neonatal effects of ___ on pregnancy: birth injuries due to macrosomia, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome
uterine rupture
Nonsurgical disruption of the uterine cavity (complete, incomplete, partial)
60sec
Normal duration of contractions
110-160 bpm
Normal fetal heart rate
2-3/min
Normal frequency of contractions
60mmHg
Normal intensity of contractions
60sec
Normal resting period
Tachysystole
Over 5 contractions in 10 minutes
isotonic solution
Oxytocin is diluted in an __ and given as a secondary infusion
Second trimester amniocentesis
Performed between 15-20 weeks to detect chromosomal or biochemical abnormalities
Indeterminate
Periodic or episodic FHR variations (Reassuring/Indeterminate/Non reassuring Pattern)
on their left side
Position the mother ____ to relieve compression of vena cava
1-2 weeks, 1-2 months
Post molar pregnancy, serum beta-hCG levels must be ran every ___ until 3 normal pre-pregnancy levels, then every ____ for up to a year.
renal, liver, pulmonary, peripheral, cerebral, scotomata
Preeclampsia maternal problems: ___ and ___ damage. ___, ___, and ___ edema. Blurry vision and ____ (blind spots). Thrombocytopenia.
molar pregnancies
Pregnancy must be avoided for one year following
cricoid pressure
Pressure on the cricoid cartilage; applied to occlude the esophagus to inhibit gastric distention and regurgitation of vomitus in the unconscious patient.
oligohydramnios, placenta abruption, intrauterine growth restriction
Problems with the fetus in preeclampsia (3)
External cephalic version
Promotes vaginal birth by changing the fetal presentation from a breech or transverse lie to a cephalic lie.
umbilical cord prolapse
Protrusion of the umbilical cord alongside or ahead of the presenting part of the fetus
Non reassuring
Recurrent late decelerations with no variability (Reassuring/Indeterminate/Non reassuring Pattern)
Non reassuring
Recurrent variable decelerations (Reassuring/Indeterminate/Non reassuring Pattern)
Beta human chorionic gonadotropin
Released from the placenta in increasing amounts Levels should double every 48 hours in a normally developing pregnancy Peaks at week 10 and then declines SHOULD BE Almost undetectable at term
fluid leaking from the vagina, fishy or foul-smelling discharge, vaginal bleeding, contractions every 10 minutes or less for an hour
When to seek care for preterm labor (4)
preeclampsia
Risk factors for ___: <20yrs or >35yrs, first pregnancy, pregnancy with new partner, hx of issue, chronic hypertension, obseity, diabetes, kidney disease, thrombophilia, african descent
missed abortion
Which type of abortion is associated with sepsis, abdominal tenderness, and light bleeding?
Placental abruption (abruptio placentae)
Separation of a normally implanted placenta before the fetus is born
magnesium sulfate toxicity
Signs and symptoms of ___: low RR, low HR, slurred spech, muscle weakness, lethargy, hyporeflexa (decreased DTRs)
hypovolemic shock
Signs and symptoms of ____: increased HR, increased RR, decreased BP, "thready" peripheral pulses, cool/moist skin, decreased urine output, decreased hemoglobin/hematocrit, change in mental statue
hyperglycemia
Signs and symptoms of maternal ___: fatigue, flushed/hot skin, dry mouth, excessive thirst, frequent urination, rapid/deep respiration, acetone odor breath, drowsiness, headache, depressed reflexes
hypoglycemia
Signs and symptoms of maternal ___: shakiness, tremors, pallor, cold/clammy skin, disorientation, irritability, headache, hunger, blurred vision
hypoglycemia
Signs of ___ in newborns: jitteriness, tremors, hypothermia, respiratory distress, lethargy
tubal rupture
Signs of ___: sudden, severe pain in one of the lower quadrants, shoulder or neck pain, hypovolemic shock
shoulder dystocia
Signs that precede ___: failure to progress, prolonged 2nd stage of labor, "turtle sign"
chromosomal abnormalities
Spontaneous abortion are most commonly due to ____ incompatible with life
Subarachnoid block
Technique for ___: A 25- to 27- gauge spinal needle with a stylet occluding its lumen is passed into the spinal space below where the spinal cord ends. The stylet is removed and drops of clear cerebrospinal fluid at needle hub confirms correct placement. Medication is injected and the needle is removed.
Epidural block
Technique for ___: the spinal space is entered with a needle below where the spinal cord ends. A free catheter is threaded through the needle. The needle is then removed and the catheter is left in place for intermittent or continuous analgesic administration through labor and birth.
cervical ripening, oxytocin administration
Techniques for Induction (2)
third trimester amniocentesis
Test to determine fetal lung maturity or hemolytic disease
ectopic pregnancy
The incidence of ___ increases as a result of pelvic inflammation (PID)
Spontaneous abortion
The leading cause of pregnancy loss prior to 20 weeks. The rate increases with age.
low transverse
The preferred uterine incision for cesarean birth is the ___
ischial spine, sacrospinous ligament
The pudendal nerve is located in the pelvic floor between the ___ and ____.
hypovolemic shock, infection
The treatment of spontaneous abortion includes preventing complications such as ___ and ___
glyburide
Therapeutic management of gestational diabetes may include an oral hyperglycemic agent, ___
cervical ripening
There are both medical methods (prostaglandins) and mechanical methods (transcervical catheter, laminaria) for ___
Toco transducer
Top external device that is pressure-sensitive and detects uterine activity.
suppression of labor, physical activity restriction, progesterone supplementation
Treatment of preterm labor (3)
corticosteroids, antibiotics, tocolytics, magnesium sulfate, best rest, preterm delivery
Treatments for PROM/PPROM (6)
know it is a common side effect and administer PRN benadryl
Two hours after epidural infusion, patient complains of itching on her face and neck. The nurse should
regional anesthesia, pudendal block, local infiltration anesthesia, epidural block, combined spinal-epidural, subarachnoid block
Types of Regional Pain Management (6)
threatened, inevitable, incomplete, complete, missed, recurrent (habitual)
Types of spontaneous abortions (6)
doppler blood flow
Ultrasound assessment used in pregnancies complicated by hypertension, fetal growth restriction, or placental insufficiency to assess blood flow to the fetus.
delivery
Ultrasound indicated abruptio placentae is present. Nurse should prepare the client for ___
bradycardia
Umbilical cord prolapse, regional anesthesia, and MgSO4 administration can lead to fetal ___
Contraction stress test (CST)
Used to determine how the fetal heart responds to uterine contractions that temporarily decrease placental blood flow. Nipple stimulation or low-dose oxytocin. Cannot be done if stimulated uterine contractions are contraindicated
Indeterminate
Variable decelerations with other positive characteristics (Reassuring/Indeterminate/Non reassuring Pattern)
headache, blurred vision
Warning signs of pending eclamptic seizure (2)
feed, formula supplementation, D10 IVF
Ways to treat hypoglycemia in newborns (3)
severe preeclampsia
With ___ liver enzymes can be twice the normal concentration and/or severe right upper: quadrant or epigastric pain that does not improve with analgesics
severe preeclampsia
With ___ the progressive renal insufficiency can be seen with doubling of serum creatinine and/or serum creatinine level > 1.1 mg/dL
ectopic pregnancy
With ____ the woman must refrain from alcohol and vitamin with folic acid
1-2 hours
With diabetes and labor: If patient is insulin dependent, blood sugar checks should be done every ___ once in active labor
stop oxytocin
With late decelerations, nurse MUST ___
choriocarcinoma
With molar pregnancies, suspect ___ if beta-hCG levels do not fall or if they rise after an initial fall
Beta human chorionic gonadotropin
With threatened and inevitable spontaneous abortion, provide supportive measures along with careful monitoring by laboratory testing of ____ and ultrasound.
artery
You obtain a sample of cord blood through the umbilical ___
Dysfunctional
__ Uterine Contractions: Irregular in timing, strength, or both and do not contribute to cervical changes or fetal descent
Uterine Rupture
___ Causes: TOLAC (trial of labor after cesarean), Previous uterine surgery, Increased uterine pressure, Interval of births less than 18 months, Inadequate closure performed with a previous cesarean, Version, Certain congenital uterine disorders
Sinusoidal
___ FHR can be caused by maternal abdominal trauma leading to fetal blood loss. Emergency C-section.
internal fetal scalp electrode
___ FHR monitoring that improves accuracy, but slightly increases risk for infection
Uterine Rupture
___ Interventions: Stop Pitocin if infusing and start fluid bolus of NS or LR Oxygen via tight face mask (8-10L) Immediately contact OB/CNM Prepare for immediate cesarean section and notify all personnel Prepare for possible blood transfusion Anticipate possible hysterectomy
Regional
___ Pain management advantages: woman actively participates in labor, potentially good pain control, she retains her airway reflex
Amniotomy
___ Purpose: Often done in conjunction with induction of labor. Enables internal electronic fetal monitoring
Amniotomy
___ Risks: Prolapse and compression of the umbilical cord. Infection (chorioamnionitis) and abrupio placentae
Uterine Rupture
___ Symptoms: Non-reassuring fetal heart rate, Sensation of "ripping" or "tearing", Loss of fetal station on palpation, Constant abdominal pain, uterine tenderness, Change in uterus shape, Cessation of contractions, Hematuria, Signs of shock
Hypertonic
___ Uterine Contractions: Because of the frequency of the contractions and failure of the uterus to relax between contractions, evidence of a non-reassuring fetal heart rate pattern (FHR) may be evident
Hypertonic
___ Uterine Contractions: Nurses may facilitate a period of rest (administration of an opioid as ordered to reduce pain and lessen contractions); sleep medication may also be ordered
remote surveillance
___ allows surveillance when the nurse is not at the bedside
Late fetal HR decelerations
___ an unhealthy fetal response during contraction.
Tocolytics
___ and IV hydration are used to delay delivery and allow administration of corticosteroids for preterm labor.
Abnormal labor patterns
___ are associated with increased risks for mother and newborn: operative delivery, lacerations, chorioamnionitis, fetal asphyxia, postpartum hemorrhage/urinary retention, NICU admission
multiple marker screening
___ assesses for hCG, and unconjugated estriol, along with open body wall defects, and increased detection of chromosomal abnormalities
Methotrexate
___ chemotherapy is the primary treatment for choriocarcinoma (high cure)
Hypotonic
___ contractions feel soft on palpation and occur at a rate of less than 3 or 4 every ten minutes
Hypotonic
___ contractions may be productive initially but may become weaker, less effective, or stop altogether.
negative
___ fFN= woman is NOT at risk for preterm labor
positive
___ fFN= woman is at risk for preterm labor
magnesium sulfate
___ is an anticonvulsant medication that reduces central nervous system irritability caused by cerebral edema and increases the seizure threshold
Eclampsia
___ is preeclampsia with tonic-clonic seizure activity that has no other known cause
steroids
___ medications can be used to help mature fetal lungs
tocolytic
___ medications prevent contractions
Choriocarcinoma
___ mole: Malignant change and proliferation of residual trophoblastic tissue. Vesicles of the mole enter woman's circulation causing embolism. Life threatening. May spread to distant sites.
Partial
___ mole: fetal tissue or membranes present. Maternal contribution is usually present, but paternal contribution is double.
Complete
___ mole: ovum is fertilized by sperm that duplicates its own chromosomes while the chromosomes of the ovum are inactivated. No fetus is present.
gestational trophoblastic disease
___ represents a unique spectrum of tumors and tumor like conditions characterized by proliferation of placenta tissue
Fetal HR accelerations
___ show the fetus moving around between contractions. Good to see.
Early fetal HR decelerations
___ shows healthy fetal reaction of the compression right before a contraction
Doppler flow studies
___ uses sound waves to assess blood flow. Can be used in the umbilical vein and arteries, fetal brain, fetal heart, and other organs.
Chorionic Villus Sampling
___ uses transcervical or transabdominal sampling to obtain test matter. Provides information about numerous chromosomal defects, metabolic or DNA abnormalities. Can be performed between 10-13 weeks gestation, much earlier than amniocentesis
intrauterine pressure catheter
___ uterine activity monitoring that improves accuracy, but slightly increases risk for infection. (2 types0
hypertonic
___ uterine dysfunction: Contractions are frequent, have irregular tone, and do not contribute to cervical effacement or dilation or fetal descent
Hypotonic
___ uterine dysfunction: Uterine contractions are either too uncoordinated or insufficiently strong to effectively dilate the cervix in the first stage of labor
Gestational diabetes, GDM A1, GDM A2
___: Onset of glucose intolerance first diagnosed during pregnancy. Two subgroups are ___ (diet control) and ___ (Insulin control w/ diet).
umbilical cord prolapse
____ Call for help!! Initial action = gloved hand used to elevate the presenting fetal part to reduce compression on cord (life saving!!) - can place in knee-chest or deep Trendelenburg position to further relieve compression -prepare for immediate c-section
Absent variability
____ indicates the fetus is not moving around and may be intolerance to labor.
Incompetent cervix
____ is incompatible with pregnancy. Can be sewn shut during course of pregnancy
Disseminated Intravascular Coagulation (DIC)
abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues
shoulder dystocia
delayed or difficult birth of the fetal shoulders after the head is born
dystocia
difficult labor/birth
Low profile cup
enable placement over the flexion point of the baby's head no matter the fetal head position. This is vital in order to realign the head so that the smallest diameters of the fetal head are presented to the birth canal.
hydatidiform mole
gestational trophoblastic disease can also be called ___
HELLP syndrome
hemolysis, elevated liver enzymes, low platelets
preeclampsia
hypertension, edema, and proteinuria during pregnancy
chorioamnionitis
inflammation of the chorion, amnion, or both
>25 bpm
marked variability in FHR
<6 bpm
minimal variability in FHR
shoulder dystocia
most common reason for primary (first-time) cesarean sections
cervical os
opening of the cervix to the uterus
placenta percreta
perforation of uterus by placenta
placenta increta
placenta invades myometrium
Thrombocytopenia
platelet count <100,000/mm3
salpingectomy
surgical removal of a fallopian tube
ABO incompatibility
type O mothers and fetuses with type A or B blood (less severe than Rh incompatibility)
Ultrasound
•Used to determine a variety of fetal and placental conditions -Presence and location of pregnancy -Multifetal gestation -Gestational age -Viability confirmation -Identifying fetal abnormalities
