OB TEST 3 Liberty University

Preterm labor occurs between ____ and _____ weeks gestation.

20 and 37

Very common risk factors for PTL are ________ of urinary tract, vagina, or amniotic sac--which is also called _________; also previous ________ birth, excess _______ ____, _______ socioeconomic status, lack of ________ care, diabetes, age below _______ or above ______, and multifetal pregnancy

infections

chorioamnionitis

preterm

amniotic fluid

low

prenatal

17

35

Very common issue with preterm baby is issue with the _______ system, because of absence of ________, which usually is not produced til later. To stimulate the production of it, one can give two injections of _______, which must be given at least _______ hours before delivery. Important to monitor mother and child for _____ _____ and ________, as well as fetal ______ _____ changes.

respiratory

surfactant

Betamethasone

24

pulmonary edema

hyperglycemia

heart rate

Two reasons to stop giving Magnesium sulfate to stop PTL is if ____ ____ symptoms occur or if signs of ______ occur.

Pulmonary edema

toxicity

What are the symptoms of MagSulfate toxicity? What do you give as an antidote?

1. Loss of DTR's

2.

Goal of PTL is ______ from progressing to imminent delivery. 3 ways to diagnose PTL are ______ ______ testing for presence of amniotic fluid or ROM, assessing the _____ length, and finally to do HUAM, or ______ ______ ______ ______

Prevention

Fetal Fibronectin Testing

cervical

Home uterine activity monitoring

S/S of PTL include persistent ______ _______, pelvic _____ or _____, ________ discharge, contractions every __ _____ or less, _______ frequency, and GI _______ or ______.

low backache

pressure or cramping

vaginal

10 minutes

urinary

cramping or diarrhea

If PTL signs/symptoms persist, teach patient to get some ____ and lie down on her ______, empty ______, drink ___-____ cups fluid, take a ______ bath or shower, and notify her care provider for contractions q10min or less in an hour.

rest

side

bladder

3-4

warm

_______, also called _______ is a calcium channel blocker given to suppress ______ in PTL, and you must be aware of the SE ______ ______ which occurs with administration

Nifedipine

Procardia

contractions

orthostatic hypotension

Do not stop PTL if:

-Cervical dilation >______

->______ wks gest

-acute _____ ______

-Active ____ _____

-_________

6 cm

34

fetal distress

vaginal bleeding

chorioamnionitis

An NSAID you can give to suppress contractions is ________, which you give if gestational age is less than ___ weeks, but you should monitor for _____ ______ ______ because it can cause decreased _______ _______.

Indomethacin

32

post partal hemorrhage

platelet aggregation

What's the difference between PROM, Preterm PROM, and prolonged ROM?

-PROM is spontaneous ROM >37wks, 1 hour or more before true labor onset

-Preterm PROM is if ROM is >20 wks

Major risk PROM has with it is _______, such as ______ or _______

infection

chorioamnionitis or endometritis

Three ways to confirm ROM are _____ ____ to check the fluid's ____, for which the color will be ____ ____ if amniotic fluid is present; another way is _____ _____, which is NOT recommended, and finally, the _______ test

nitrazine paper

pH

dark blue

speculum exam

ferning

Cervical insufficiency (incomplete cervix) is a _____ ____ of the cervix _______ contractions

painless dilation

without

For those who haven't been diagnosed, cervical insufficiency usually shows itself in that around weeks ____ to ____, you lose the baby, and so to treat it, a _____ is placed before those weeks, most often the ________ one, and it is removed either at week ____ or when _______ _____ occurs.

14 to 18

Cerclage

McDonald

37

spontaneous labor

Risks associated with a woman with multiple gestation is ______, abnormal ______, ineffective ____ ____, post partal _____, and the biggest maternal complication with twins is ______

PTL

presentations

labor patterns

hemorrhage

HYPERTENSION

Normal amniotic fluid volume is ____-_____ mL, and hydramnios occurs when >_____mL; Oligohydramnios is volume < ______ mL.

700-1000

2000

500

Fetal ___________ and _____ _____ are very common with polyhydramnios

anomalies

preterm birth

Clinical therapy for hydramnios includes supportive therapy (if there is >______mLs, mom has ____ and _____), needle ________, and the medication ________ to decrease fetal _____ _____, but be aware this med also causes closure of the ____ ______

3000

SOB and edema

amniotomy

Indomethacin

urine output

ductus arteriosus

Risks for the baby who is victim of oligohydramnios include fetal _______, cord _______, aspiration of ______, and pulmonary _______

adhesions

compression

meconium

hypoplasia

A nurse is caring for a client who reports indications of preterm labor. Which of the following findings are risk factors of this condition? SATA

A. UTI

B. Multifetal pregnancy

C. Oligohydramnios

D. DM

E. Uterine abnormalities

A, B, D, E

Hydramnios, not oligohydramnios is risk factor

A nurse in labor and delivery is providing care for a client who is in preterm labor at 32 weeks of gestation. Which of the following medications should the nurse anticipate the provider will prescribe to hasten fetal lung maturity?

A. Calcium gluconate

B. Indomethacin

C. Nifedipine

D. Betamethasone

D. betamethason

A nurse is caring for a client who is receiving nifedipine for prevention of preterm labor. The nurse should monitor the client for which of the following manifestations?

A. Blood-tinged sputum

B. Dizziness

C. Pallor

D. Somnolence

B. Dizziness--because ortho hypo

A nurse is caring for a client who has a prescription for magnesium sulfate. The nurse should recognize that which of the following are contraindications for use of this medication? SATA

A. Fetal distress

B. Preterm labor

C. Vaginal bleeding

D. Cervical dilation >6cm

E. Severe gestational HTN

A, C, D

A nurse is reviewing discharge teaching with client who has PROM at 26 wks gestation. Which of the following instructions should the nurse include in the teaching?

A. Use a condom with sexual intercourse

B. Avoid bubble bath solution when taking a tub bath.

C. Wipe from the back to front when performing perineal hygiene.

D. Keep a daily record of fetal kick counts

D

Dystocia, or dysfunctional labor, is an abnormal or difficult labor pattern related to abnormalities with any of 5 P's of labor, which are:

Power

Passenger

Passage

Position

Psyche

Dystocia can result in either ________ contractions or _________ contractions

hypo/hypertonic

Things that put mother at risk of dystocia include moms who are older, ______ in stature, who are ______ in terms of weight, whose labor was ________, who have infection such as ____________, and whose babies are _____ in size.

shorter

obese

induced

chorioamnionitis

large

Hypotonic labor is characterized by _____ and _____ amplitude contractions,

irregular and low

1

no

2

easy

peak

Causes/risk factors for hypotonic labor include _______ of the uterus, mal___________ and mal_________ of baby, and __________ disproportion

overdistention

presentation

position

cephalopelvic

Hypertonic labor, also called _____ ______ _______, is >____ contractions in ____ mins with

tachysystolic labor pattern

5

10

60

2

2 possible causes of hypertonic labor are high dose ______ and ________ use, and 2 possible risk factors are ______ ______ and ______ ______.

oxytocin

cocaine

placental abruption

uterine rupture

Typical treatment for hypotonic labor is _____ and for hypertonic labor is _________

oxytocin

analgesics

Precipitous labor and birth is defined as labor lasting

3 hours

multi

pelvis

baby

precipitous labor

Maternal risks associated with precipitous labor and birth include uterine _______, lacerations, post partal ______, and decreased ______; risks to baby include fetal ______, fetal ____, and _____ trauma

rupture

hemorrhage

coping

distress

hypoxia

cerebral

Treatment/nursing care for precipitous labor and birth include an accurate assessment to detect it early, never leave mother _____, do not attempt to _____ ____ ______; use the _____-____ position for delivery, and maintain a controlled delivery.

unattended

stop the delivery

side-lying

Post-term pregnancy is pregnancy lasting >_____ wks.

42

Maternal risks associated with Post-term pregnancy include delivery by _______ ______, maternal _______, assisted delivery, perineal ________, and _______.

C section

hemorrhage

trauma

anxiety

Fetal-neonatal risks associated with post-term pregnancy include reduced ________ ______, decreased ____ and ______, cord _______, and birth injury/distress

placental function

oxygen and nutrition

compression

In treating post term pregnancy, you want to monitor the fetal status with _____, ______, and a ______ if indicated. You also may need to ______ the woman.

FHR, NST, and BPP

induce

_____ _______ ______ is the most common cause of fetal malposition, with the first sign of it being _____ ____ ____ in the _____ stage of labor

Persistent occiput posterior

intense back pain

first

For treating fetal malposition in the womb, ____-_____ birth may be needed, or ______ ______ of the fetus.

forceps-assisted

manual rotation

The most common malpresentation is ______ presentation, and risks that may occur with this include prolapsed cord, birth ________, ___ _______, and a higher ______ rate for both baby and momma.

breech

trauma

C section

mortality

Clinical therapy for a malpresentation such as breech is _____ ______ ______ performed at _____ weeks gestation; or _____ _____ exercises such as having mother's _____ higher than her _____

external cephalic version

37 weeks

maternal position

hips

torso

Macrosomia is when baby is >_____gms or ______ lbs., and it associated with _____ parents, ______ maturity, and _______

4000

8.5

large

post

diabetics

Most common complication of macrosomia is _______ _______, and other complications include ______ ______ injury, fractured _____, and _________ ________--because when baby is stressed, he _______

shoulder dystocia

brachial plexus

clavicle

meconium aspiration

poops

Clinical therapy for macrosomia includes monitoring the _______, and may include _______ Procedure, _____ _____ maneuver, and maybe an _________ to have a larger passage for the baby coming out

FHR

McRobert's

Wood's screw

episiotomy

An early sign of decreased O2 getting to the fetus includes fetal _________.

hyperactivity

Most common associated signs of a Non-Reassuring fetal status includes _______-______ fluid, changes in ______

meconium-stained

FHR

Clinical therapy in presence of non-reassuring fetal status includes changing mom's _______, starting _____ ______ and _______, stopping _______ if it's going, and prepping for ________.

position

IV fluids

O2

Pitocin

C/S

Common placental problems include ______, _______, and _____ placenta, and ________ and ________.

succenturiate

circumvallate

battledore

infarcts

calcifications

Succenturiate placenta looks like a _______, and the maternal complication associated with it is _______ ______ and there's ______ fetal-neonatal implications associated with it.

cylinder

postpartal hemorrhage

no

___________ placenta is when there are only blood vessels in a small circle on the placenta, and it can lead to the fetal complications of ______, ______, and intrauterine ______ _______.

Circumvallate

death

prematurity

growth restriction

Battledore placenta is where the umbilical cord attaches to the placental _______, and is associated with increased incidence of ______ ______ and ____ for the women, and risk of _____ and fetal ______ in the baby.

edge/margin

preterm labor

bleeding

prematurity

stress

_________ placenta is when the vessels of the umbilical cord divide some distance from the placenta in the placental membranes, and there is high risk of _____ in both mother and baby because the vessel can ______ more easily. Another risk for baby is fetal ______.

Velamentous

hemorrhage

torn

stress

We learned about 4 umbilical cord abnormalities. They are:

-________ of one of the _____ ______

-_________ insertion

-______ _____ ______ ( a long one can lead to ______ _____; short one can cause ______ ______ on baby or _______ _____ on mother's side)

-Lastly, there is _______ umbilical cord, defined by ______ preceding the fetal ________ ______

Absence

umbilical arteries

Velamentous

Cord length variations

nuchal cord

umbilical hernia

abruptio placenta

prolapsed

cord

presenting part

IMMEDIATELY when you notice prolapsed cord, you should first ____ _____ _____, and then secondly, get the ______ off the ______, using your _____ and having women be in the _____-_____, or _____-_____ position with towel under her hip, and also put bed in the ___________ position

call for help

baby

cord

fingers (sterile gloved)

knee-chest

side-lying

Trendelenburg

After the two immediate interventions for prolapse cord, you want to start ____ and ____ _____, monitor the baby closely, and prep mom for possible ________

O2

IV fluids

C/S

When meconium, amniotic fluid, fetal cells, or another substance enters the mommy's circulation, she could get _____ _____ of _____ or _______ ______ ______(OBSTETRIC EMERGENCIES), which both look identical to a ______ ______, except they also can lead to _____ ______ ______, causing lots of bleeding

anaphylactoid syndrome of pregnancy

amniotic fluid embolism

pulmonary embolism

disseminated intravascular coagulation (DIC)

40 year old pre-eclamptic woman who was induced with pitocin for her 2 large twins, had a difficult labor and she starts complaining of sudden chest pain, dyspnea, pulmonary edema. You notice her heart rate is elevated and her IV site is bleeding. You recognize this to be either _____ _____ of ______ or _________ _____ _____, with DIC, and can expect to give ______, establish __ _____ if havent done so yet, have the patient be in the _____-______ position, possibly give _____ to the patient, prep for _______, monitor the baby, and have CPR and ventilator ready.

anaphylactioid syndrome of pregnancy

amniotic fluid embolism

O2

IV access

side-lying

blood

C/S

Woman with a uterine abnormality is having a difficult labor for her 5th child which was big and overdistending the uterus--the doctors currently are trying to use forceps, version, and she even had someone hit her belly earlier today because they were upset. You're monitoring her as she is in labor and notice her uterus no longer is firm, you can feel the baby body parts on her belly, contractions have stopped, and the baby has a FHR of

uterine rupture

fluids

blood

C/S

hysterectomy

If there is fetal demise/death (death >20wks), it is important to deliver the baby within __ _____ because it could result in ________ _______ ________; important to offer emotional support during this time; it is also associated with a _______ labor when delivering the baby.

2 weeks

disseminated intravascular coagulation

prolonged

________ _________ happens when placenta is not delivered within ___ minutes, and so the doctor will have to manually scoop it out.

Retained placenta

30

A nurse is caring for a client who is in labor and experiencing incomplete uterine relaxation btwn hypertonic contractions. The nurse should identify that this contraction pattern increases the risk for which of the following complications?

A. Prolonged labor

B. Reduced fetal oxygen supply

C. Delayed cervical dilation

D. Increased maternal stress

B

A nurse is caring for a client who is in active labor and reports severe back pain. During assessment, the fetus is noted to be in the occiput posterior position. Which of the following maternal positions should the nurse suggest to the client to facilitate normal labor progress?

A. Hands and knees

B. Lithotomy

C. Trendelenburg

D. Supine with a rolled towel under one hip

A.

A nurse is caring for a client who is admitted to the L&D unit. With the use of Leopold maneuvers, it is noted that the fetus is in a breech presentation. For which of the following possible complications should the nurse observe?

A. Precipitous labor

B. PROM

C. Postmaturity syndrome

D. Prolapsed umbilical cord

D.

A nurse is caring for a client who is at 42 wks gest and in active labor. Which of the following findings is the fetus at risk of developing?

A. IUGR

B. Hyperglycemia

C. Meconium aspiration

D. Polyhydramnios

C.

A nurse is caring for a client in active labor. When last examined 2 hrs ago, the cervix was 3 cm dilated, 100% effaced, membranes intact, and fetus at -2 station. The client suddenly states, "My water broke." The monitor reveals FHR of 80-85bpm, and the nurse performs a vag exam, noticing clear fluid and a pulsing loop of umbilical cord in the client's vagina. Which of the following actions should the nurse perform first?

A. Place the client in the Trendelenburg position

B. Apply pressure to the presenting part with her fingers

C. Administer O2 10L/min via face mask

D. Call for assistance

D.

Where is the FHR most clearly heard?

fetal back

______ patterns are associated with uterine contractions, and _______ patterns of fetal heart rate are not.

Periodic

episodic

Fetal tachycardia is FHR >______ bpm for at least _____ _____, and fetal bradycardia is

160

10 minutes

110

Butorphanol tartate (Stadol) is an analgesic which is given via _____ most frequently, should not be given to women who have been taking ______ drugs, because it can ______ the analgesic effects of the others and also precipitate ________ if she is dependent. It is also _______ potent than morhpine, and one bad effect it can have on both the mother and the baby is _______ _____, and so it should not be administered after _____ cm dilation or if labor is progressing quickly.

IV

narcotics/opioids

reverse

withdrawal

more

respiratory depression

7

As we all know, ______ (______) is the opiate antagonist used to reverese resp depression, sedation and hypotension.

Naloxone (Narcan)

A _____ ______ ______ involves injection of a local anesthetic into the epidural space, which is between the dura mater and the ligamentum flavum

lumbar epidural block

Good advantage of epidural is that it causes good analgesia while the woman is ____ ______. And the most common complication of an epidural block is maternal ________; and another disadvantage is that analgesic onset may not occur for up to __ _____

fully awake

hypotension

30 minutes

Don't give epidural block if patient refuses, if _____ is present, uncorrected _______, ________ disorders, maternal hemorrhage, increased ____ _______, or allergy to a part of it

infection

hypovolemia

coagulation

intracranial pressure

To prevent maternal hypotension during epidural block, it is good before the procedure to _______ with ____ to ______ of IV solution, as well as changing the woman's position and/or increasing the IV rate afterward

hydrate

500 to 1000 mL

One of the most serious complications of regional anesthesia is ____ ____ _____, and another complication is a spinal ______ which occurs when the dura is accidentally punctured during the epidural placement

systemic toxic reaction

headache

Be careful with premature fetus because he is more susceptible to _______ drugs due to less protein being available for binding and poorly developed blood-brain barrier. If possible, _______ analgesia or give the ______ dose that will provide _____. General anesthesia should be _______ in premature gestations, and thus, ______ ____ for the woman will be very valuable during these times.

depressant

avoid

smallest

relief

avoided

emotional support

Version is defined as ______ _____ fetal _______

deliberately altering

position

The most common type of version is ______ ____ ______, which is attempted after _____wks gestation and you must have adequate _____ ____, have ______ gestation, an _______ fetus, and a _______ NST, along with no fetal existing risk/complications

external cephalic version

37

amniotic fluid

single

engaged

reactive

Before performing ECV, have patient be NPO _____ _____ beforehand, use _____ to assess risks/eligibility, be on the birthing unit, if mom is Rh-, assure _____ was given at ___ weeks, and if >15mL fetal blood detected in maternal serum, regive it; maternal V.S./ continuous ______ monitoring _____ and __ hr/hrs after procedure; give IV fluids and tocolytics to relax uterus; put in the _____ or slight _____ position; give meds such as _____ or ______.

eight hours

U/S

Rhogam

28

FHR

during and 1

supine

Trendelenburg

Mag sulfate (MgSO4)

Terbutaline

Risks associated with external version procedure includes ____ of ______, _______, ______, and fetal _____

rupture of membranes

bleeding

contractions

distress

Cervical ripening definition is _____ cervical _____ for labor by using various methods to _____, _____, and ______ the cervix.

promoting

readiness

soften

efface

dilate

Misoprostol (Cytotec)

delivery

24

Dinoprostone

24

active labor

hyperstimulation

distress

2 pharmacological methods used for cervical ripening include ______ (_____), a prostaglandin E1 taken orally, sublingual, or vaginal, and is quite effected, often resulting in _____ in ____ hrs; ________, a Prostaglandin E2, is another med given as Prepidil gel placed intra-cervically or Cervidil intra-vaginally inserted, and vaginal birth occurs in ____ hrs often, and you want to remove the insert when ____ ___ is established or uterine _______ occurs. Risk associated with this med include fetal _____ and post partal hemorrhage

Mechanical methods for cervical ripening are less costly than hormonal methods and have fewer systemic and uterine SE's. These methods include using a _______ catheter, an extra _____ _____ _____, membrane ____ and _____, and various dilators such as ______ tents, made from seaweed, synthetic dilators, and finally, a ______ dilator, which absorbs surrounding fluids and then enlarges; risks include fetal distress and hyperstimulation of the mother.

balloon

amniotic saline infusion

stripping and amniotomy

Laminaria

hygroscopic

Terbutaline is often given to treat ______ of the uterus.

hyperstimulation

Whats the difference between labor induction and augmentation?

Induction is uterine contraction deliberate stimulation BEFORE labor onset, and augmentation is stimulation AFTER labor has begun

The most important criterion for labor induction is a _____ ____--indicated by a Bishop score of >_____ in a multiparous patient and >_____ in a nulliparous patient

favorable cervix

8

10

Requirements for induction include ____ or _____ indicated, fetal ______(>_____wks gest), and cervical _______

elective or medically

maturity

39

readiness

Methods of induction/augmentation include _________/_______ the membranes to release ______ in the woman's body, ______ infusion--for which there are risks of tachysystole, uterine _______, and _____ ______; other complementary and alternative methods include _____, _____ stimulation, herbs such as black ______, evening ______ _____, and red _______ ______, and homeopathic solutions such as walking or taking a _____ _____

stripping/sweeping

prostaglandins

oxytocin/pitocin

rupture

water intoxification

intercourse

nipple

cohosh

primrose oil

raspberry leaves

warm bath

Report or discontinue induction for FHR concerns such as

110

160

variability

decels

2

90 seconds

no

Amniotomy is an ______ ______ of the ______, using an _______, usually resulting in labor onset within _____ ____ or it.

artificial rupture of the membranes

amnihook

12 hours

Before performing AROM, ensure ______ of fetal _____ ____ to prevent _____ _____.

engagement

presenting part

cord prolapse

An amnioinfusion is performed ______ only ______ ROM, and it is an infusion of warmed ____ ___ or _____ _____ into the uterus via an _____ ____ _____. It is indicated to relieve ____ _____ ____, for _____ _____, and when _____ is present in the womb.

transcervically

AFTER

intrauterine pressure catheter

umbilical cord compression

meconium dilution

oligohydramnios

Contraindications to amnioinfusion include:

-Contraindication to vaginal delivery

-amnionitis

-_____hydramnios

-known _____ or _____ anomaly, nonreassuring fetal status requiring immediate birth

-uterine _______

-nonvertex presentation, placenta ______, vasa ______, or ______ placenta

Poly

fetal or uterine

hypertonus

previa

previa

abruptio

Absolute time limit for use of vacuum extraction is ___ ____ but most practitioners stop at ___ ___ or when ____ "pop-offs' have occurred. ABSOLUTE contra is true _____ _____; Also, to use it, you must have _____ presentation with ______; risks include trauma/hematomas/lacerations to baby's head and maternal cervix, vagina, or perineum.

30 min

20 min

CPD (Cephalopelvic Disproportion)

vertex

ROM

Positioning during a C/S involves placing the woman in the _______ position with a ____ under the ____ _____, and the patient must be NPO since ______.

supine

wedge

right hip

midnight

How much greater risk of death is there with C/S?

4-fold