NCLEX Alignment: High Risk Pregnancy and Labor Emergencies

75 vocabulary flashcards covering high-risk labor conditions, emergencies, medications, and perinatal loss according to the provided lecture notes.

Preterm labor

Regular uterine contractions occurring before $37$ weeks gestation, accompanied by cervical changes such as dilation and effacement.

Modified bed rest

An activity restriction for preterm labor where the client can walk around the house and go to the bathroom, but stays in bed to use gravity to take pressure off the cervix.

Hydration (in preterm labor)

The administration of oral or IV fluids to decrease uterine irritability, as dehydration triggers ADH which cross-reacts with oxytocin receptors.

TOCO monitor

An external disc strapped to the abdomen to monitor the frequency and strength of uterine contractions by assessing abdominal firmness.

Tocolytics

A class of medications administered to temporarily stop or lessen uterine contractions.

Antenatal corticosteroids

Medications such as Betamethasone administered to the mother during labor to mature the fetal lungs.

Fetal fibronectin (FFN) test

A vaginal swab test that collects a protein 'glue' to assess the likelihood of imminent delivery between weeks $24$ and $34$.

FFN negative result

A highly reliable finding indicating a $95 \%$ chance that the client will not go into labor for up to two weeks.

Progesterone (prophylactic)

A hormone recommended for asymptomatic women with a history of preterm birth or a short cervix to keep the uterine lining calm and thick.

Betamethasone

A specific corticosteroid used to help the fetus produce more surfactant and mature the lungs; given in two doses $24$ hours apart.

Magnesium sulfate (mechanism)

A tocolytic and CNS suppressant that competes with calcium to reduce calcium influx into uterine smooth muscles, decreasing contraction frequency.

Hypotonia

A condition of decreased muscle tone in the infant, often seen if the mother was receiving a magnesium sulfate infusion during birth.

Magnesium toxicity (Respiratory)

A dangerous state where the magnesium drip must be held if maternal respirations fall to $12$ breaths per minute or below.

Magnesium toxicity (Reflexes)

Indicated by an absence of deep tendon reflexes ($0$ on a scale of $0$ to $4$).

Calcium gluconate

The specific antidote administered to reverse magnesium sulfate toxicity.

Indomethacin

A high-potency NSAID tocolytic that inhibits prostaglandin synthesis to delay labor; not administered past $32$ weeks gestation.

Ductus arteriosus (risk)

A vital fetal heart structure that may prematurely close if the mother receives Indomethacin after $32$ weeks gestation.

Nifedipine

A calcium channel blocker used as a tocolytic that causes vasodilation, requiring monitoring of maternal blood pressure and pulse.

Nifedipine and Magnesium contraindication

These should not be given together as the combination can block neuromuscular transmitters and cause cardiovascular collapse.

Nitrazine test

A speculum exam using paper that turns blue to confirm the presence of amniotic fluid versus urine.

PROM (Premature Rupture of Membranes)

The spontaneous rupture or leakage of amniotic fluid prior to the onset of true labor at or after $37$ weeks gestation.

PPROM (Preterm Premature Rupture of Membranes)

The rupture of the amniotic sac occurring before $37$ weeks gestation.

Chorioamnionitis

A bacterial infection of the amniotic fluid, placenta, or fetal membranes, often indicated by maternal fever and fetal tachycardia.

Oxytocin (Pitocin)

A medication used to induce labor or start contractions to limit the window of infection after membranes have ruptured.

Expectant management (ROM)

The hospital-based monitoring of a client with a slow leak of amniotic fluid who shows no signs of infection or fetal distress.

Post-term pregnancy

A pregnancy that extends to or beyond $42$ weeks of gestation.

Placental insufficiency

A consequence of an aged, calcified placenta in post-term pregnancies that decreases oxygen and nutrient transfer to the fetus.

Meconium aspiration syndrome

A condition where a stressed fetus passes meconium into the amniotic fluid and subsequently inhales it into the lungs.

Meconium

The first stool of a fetus, which may be passed into the amniotic fluid in response to vagal activity and stress.

Macrosomia

A condition where the fetus is exceptionally large, increasing the risk of traumatic birth and shoulder dystocia.

Dystocia

A medical term for dysfunctional, long, difficult, or abnormal labor progression.

Postpartum hemorrhage risk (Macrosomia)

Increased risk due to an overdistended uterus (uterine atony) that fails to contract effectively after a large baby is delivered.

Oligohydramnios

A low level of amniotic fluid frequently caused by uteroplacental insufficiency or fetal renal issues.

Cord compression

The squeezing of the umbilical cord which cuts off the baby's oxygen supply; a high risk in cases of oligohydramnios.

Amnioinfusion

The instillation of warm sterile saline or lactated ringers into the uterus via a catheter to provide cushion and prevent cord compression.

Polyhydramnios

A high level of amniotic fluid often associated with maternal diabetes, multiples, or fetal hyperglycemia causing fetal polyuria.

Umbilical cord prolapse (risk factor)

An emergency more common in polyhydramnios when a large gush of fluid carries the cord ahead of the unengaged fetal head.

Passage (7 P's)

Refers to the maternal bony pelvis and soft tissues of the birth canal.

Passenger (7 P's)

Refers to the fetus, including its size and presentation (breech, transverse, or occiput posterior).

Powers (7 P's)

Refers to the uterine contractions or maternal bearing-down efforts to expel the baby.

Position (7 P's)

The physical position of the mother during labor; immobility can remove the natural help of gravity.

Psyche (7 P's)

The psychological state of the mother; high anxiety or fear can release catecholines that inhibit contractions.

Pain management (7 P's)

The timing and type of anesthesia; if given too early or excessively, it can slow labor and dull the urge to push.

Patience (7 P's)

The recognition that labor is individual; avoiding aggressive interventions when the mother and baby are stable.

Occiput posterior position

A presentation where the baby is 'sunny side up,' causing the hard fetal occiput to press against the mother's sacrum.

Back labor

Intense skeletal pain caused by a posterior fetal position, manageable via sacral massage or counter pressure.

Breech presentation

When the fetal buttocks or feet, rather than the head, enter the maternal pelvis first.

Frank breech

A presentation where the fetal hips are flexed and the knees are extended, pointing the feet toward the face with the buttocks presenting first.

Complete breech

A presentation where the fetus is 'crisscross applesauce,' with both hips and knees fully flexed.

Footling breech

When one or both fetal feet extend downward and present into the vagina below the level of the buttocks.

Head entrapment

A complication of breech birth where the cervix clamps around the unmolded fetal head after the body has delivered.

External cephalic version (ECV)

A procedure done after $37$ weeks where providers apply physical pressure to the maternal abdomen to manually turn a breech baby to a head-down position.

Shoulder dystocia

An obstetric emergency where the head delivers but the anterior shoulder becomes wedged behind the mother's pubic bone.

Turtle sign

A classic indication of shoulder dystocia where the fetal head delivers and then retracts back against the perineum.

Erb's palsy

A brachial plexus injury caused by the stretching of nerves in the baby's neck during a difficult birth or shoulder dystocia.

McRoberts maneuver

The action of flexing the woman's thighs sharply against her abdomen to flatten the sacrum and widen the pelvic diameter.

Suprapubic pressure

Firm downward pressure applied directly over the mother's pubic bone to dislodge an impacted fetal shoulder.

Occult prolapse

A hidden umbilical cord prolapse where the cord lies alongside the fetus and cannot be felt, but is suspected due to fetal heart rate decelerations.

Overt prolapse

When the umbilical cord physically protrudes through the cervix and is visible or palpable.

Manual elevation of the presenting part

Using a sterile gloved hand to apply continuous upward pressure on the fetal head or buttocks to relieve pressure on a prolapsed cord.

Knee-chest position

A maternal position used in cord prolapse to allow gravity to shift the fetus away from the pelvis.

External cord care

Wrapping a protruding umbilical cord in a sterile towel saturated with warm saline to prevent drying and spasming.

Precipitous labor

A rapid labor process lasting $3$ hours or less from the onset of true contractions to the expulsion of the infant.

Hypertonic uterine dysfunction

Very strong, frequent uterine contractions with little rest period, increasing the risk for precipitous labor and uterine rupture.

Uterine rupture

A catastrophic tearing through the layers of the uterine wall, often causing sudden, sharp abdominal pain and a stoppage of contractions.

Vertical C-section scar

A prior surgical incision that significantly increases the risk of uterine rupture during subsequent active labor.

Loss of fetal station

A sign of uterine rupture where the fetus slips out of the pelvis and into the maternal peritoneal cavity.

Anaphylactoid syndrome of pregnancy

Also known as amniotic fluid embolism (AFE), a rare and highly fatal reaction where fetal debris enters maternal circulation and triggers collapse.

Phase 1 (AFE)

Characterized by sudden hypoxia, pulmonary vasospasms, cardiovascular collapse, and potential cardiac arrest.

Phase 2 (AFE)

Characterized by profound DIC (disseminated intravascular coagulation) and massive uncontrolled hemorrhaging.

Mass transfusion protocol

An emergency hospital procedure to rapidly provide blood products, platelets, and cryoprecipitate to combat severe hemorrhage or DIC.

Perinatal loss

The involuntary death of a fetus or neonate from the time of conception up to $28$ days of life.

Intrauterine fetal demise (IUFD)

The death of a fetus in utero, confirmed by ultrasound showing an absence of cardiac activity.

Macerated skin

The physical appearance of a stillborn infant's skin, which may appear purple-hued or peeling.

Memory box

A collection of tangible mementos like handprints, footprints, and photographs provided to parents experiencing perinatal loss.