Maternal, Newborn, and Women's Health: Labor, Birth, and Postpartum Complications

Comprehensive Question and Answer flashcards covering intrapartum complications, normal postpartum physiological adaptations, and postpartum complications.

How is preterm labor defined in terms of gestational timing and uterine activity?

Preterm labor is defined as regular contractions that cause cervical change prior to the 37th week of pregnancy (classified as early up to 34 weeks and late from 34 to 37 weeks).

What specific diagnostic lab test is used alongside non-stress testing (NST) and ultrasonography to assess for preterm labor?

Fetal fibronectin (fFN).

What is the primary clinical purpose of administering IV magnesium sulfate or other tocolytics during preterm labor?

To suppress contractions temporarily (tocolysis), allowing sufficient time for the administration of prescribed corticosteroids to facilitate fetal lung maturation in the event of preterm birth.

What procedure is depicted in this image, and when is it typically placed during pregnancy?

Cervical cerclage, which is placed surgically around the cervix between 12 to 16 weeks (and up to 24 weeks in an emergency) to prevent premature cervical dilation.

What microscopic pattern depicted here confirms the rupture of amniotic membranes in the fern test?

An arborized, fern-like crystallization pattern formed by dried amniotic fluid on a glass slide.

How does the nitrazine test strip differentiate amniotic fluid from normal vaginal secretions?

Amniotic fluid is alkaline (pH 6.5 to 7.5) and turns the nitrazine strip blue, whereas normal vaginal secretions are acidic (pH 5.0 to 6.0) and leave the paper yellow or brown.

What temperature criteria must be met to indicate intraamniotic infection (chorioamnionitis)?

A maternal fever greater than $38^\text{o}\text{C}$ ($100.4^\text{o}\text{F}$) measured on two separate occasions 30 minutes apart.

What is the key difference between labor augmentation and labor induction?

Augmentation is the use of medications (such as IV Pitocin) or interventions (such as an amniotomy) to assist labor progress after it has started spontaneously, whereas induction uses techniques to cause labor to begin.

Identify the three types of breech presentation shown in this diagram.

Complete breech, Footling (incomplete) breech, and Frank breech.

What criteria define a Category I fetal heart rate (FHR) tracing?

Baseline FHR of 110 to 160 beats/min, moderate variability, absence of late or variable decelerations, early decelerations present or absent, and accelerations present or absent.

What specific newborn complications are associated with vacuum extractor use compared to forceps during operative vaginal birth?

Vacuum extractors carry risk for cephalohematoma, scalp lacerations, and brachial plexus injury; forceps carry risk for facial lacerations, facial nerve palsy, ocular trauma, and skull fractures. (Both carry risk for intracranial hemorrhage.)

What immediate physical action must the nurse perform when a prolapsed umbilical cord is detected?

Elevate the fetal presenting part off the umbilical cord using a sterile gloved hand while calling for an OB rapid response team for an emergent delivery.

How does a Class 3 (Severe) placental abruption present clinically compared to a Class 1 (Mild) abruption?

Class 3 involves heavy or concealed hemorrhage, a tetanic/board-like abdomen, evidence of maternal hypovolemic shock, altered clotting profile, and fetal death; Class 1 presents with slight tenderness, minimal/no bleeding, normal maternal vital signs, and a reassuring fetal status.

What are the hallmark clinical manifestations of a uterine rupture during labor?

Sudden uterine atony (loss of uterine contractions), acute abdominal pain or tenderness, referred shoulder or chest pain, sudden change in uterine shape, loss of fetal station, maternal hypotension, and tachycardia.

What maneuver is depicted here for managing shoulder dystocia?

McRoberts maneuver, which involves elevating the client's legs to a knee-chest position, often combined with suprapubic pressure applied by an assistant to free the impacted shoulder.

Why does transient hemodilution occur during the immediate postpartum period?

Because extravascular fluid stored during pregnancy is mobilized back into the intravascular space, causing blood volume expansion and temporary fluctuations in hematocrit and hemoglobin concentration.

At what rate does the uterine fundus descend into the pelvis post-birth?

The fundus is at the umbilicus (or slightly above/at umbilicus within 6 to 12 hours) and descends approximately 1 cm (one fingerbreadth) per day until it is no longer palpable abdominally by day 10 to 14.

Differentiate the three stages of lochia by color and expected timeframe.

Lochia rubra is dark red (days 1 to 3–4 postpartum); Lochia serosa is pinkish-brown (days 4 to 10 postpartum); Lochia alba is white or yellow (days 10 to 14 postpartum).

How does the external cervical os appearance permanently change after a vaginal birth?

In nulliparous clients (no vaginal birth), the os is round; after a vaginal birth, the external os permanently changes to a transverse slit-like opening.

What amount of perineal pad saturation constitutes heavy lochia bleeding?

Saturation of one perineal pad within 1 hour.

What is the primary physiological purpose of a sitz bath in postpartum care?

It provides warm water immersion to the perineal area to increase circulation, diminish edema, promote healing, and relieve discomfort from perineal trauma or hemorrhoids.

What do the 'Four Ts' represent in the etiology of postpartum hemorrhage (PPH)?

Tone (uterine atony), Trauma (genital tract lacerations/hematomas), Tissue (retained placenta or clots), and Thrombin (coagulopathies).

What manual technique is shown in this illustration for non-responsive uterine atony?

Bimanual uterine massage, where the provider inserts one hand into the vagina and compresses the body of the uterus against the other hand positioned on the abdominal wall.

What intervention steps are summarized by the E-M-O-T-I-V-E bundle for PPH management?

Early detection, Massage, Oxytocic medication, Tranexamic acid, IV fluids, and Examination.

Distinguish between Placenta Accreta, Increta, and Percreta.

Placenta Accreta attaches directly to the surface of the myometrium; Placenta Increta invades deep into the myometrium; Placenta Percreta penetrates completely through the myometrium and may attach to adjacent organs.

What is uterine inversion, and what iatrogenic action frequently causes it?

Uterine inversion is the turning inside-out of the uterus, most commonly caused iatrogenically by pulling/excessive traction on the umbilical cord before the placenta has detached.

Compare a median episiotomy incision with a mediolateral episiotomy incision.

A median incision extends vertically straight down toward the anus; a mediolateral incision extends diagonally away from the midline to decrease the likelihood of third- or fourth-degree lacerations into the anal sphincter.

Differentiate between a 3rd-degree and 4th-degree perineal laceration.

A 3rd-degree laceration extends through the vaginal mucosa and perineal muscles into the anal sphincter; a 4th-degree laceration extends entirely through the anal sphincter and anterior rectal mucosa.

What does each letter in the REEDA acronym stand for during a perineal assessment?

Redness, Edema, Ecchymosis, Drainage, and Approximation.

What device is shown here to help stabilize a patient in severe postpartum shock and hemorrhage?

Non-pneumatic anti-shock garment (NASG), which applies circumferential pressure to the lower body and abdomen to restore blood pressure and perfusion to vital organs.

What clinical manifestations in the lower extremity alert the nurse to Deep Vein Thrombosis (DVT)?

Unilateral leg pain, calf swelling, warmth, redness (erythema), and focal tenderness along the affected deep vein.

What clinical signs of mastitis are outlined by the FASTR acronym?

Fever, Abnormal appearance of milk, Swelling / Sensation of burning / Salty flavor of milk, Tenderness, and Redness of the breast.

How does von Willebrand disease (vWD) impair hemostasis during the postpartum period?

A deficiency or defect in von Willebrand factor prevents normal platelet adhesion and fails to stabilize factor VIII, leading to impaired clot formation and an increased risk of postpartum hemorrhage.