NURS 380: OB Exam #3 - Comprehensive Study Guide 2

What are the three categories of pregnancy signs?

Presumptive, probable, and positive signs.

What is an example of a presumptive sign of pregnancy?

Amenorrhea, fatigue, nausea and vomiting, urinary frequency, or breast changes.

What is quickening in pregnancy?

Slight fluttering movements of the fetus felt by the mother, usually around 16 to 20 weeks gestation.

What are probable signs of pregnancy?

Findings that make the practitioner suspect pregnancy, such as uterine enlargement and positive pregnancy test.

What is Hegar's sign?

Softening and compressibility of the lower uterus.

What is Chadwick's sign?

Deepened violet or purplish color of cervix and vaginal mucosa.

What constitutes a positive sign of pregnancy?

Findings that confirm pregnancy, such as fetal heart sounds or visualization of the fetus by ultrasound.

How is gestational age determined?

Counted from the first day of the last menstrual period and measured in completed weeks.

What is Naegele's rule for estimating due date?

Take the first day of the last menstrual period, subtract 3 months, add 7 days, and adjust the year if needed.

What does GTPAL stand for?

Gravida, Term births, Preterm births, Abortions, Living children.

What is the definition of Gravida?

Total number of times a patient has been pregnant, including current pregnancy.

What physiological changes occur in the cardiovascular system during pregnancy?

Cardiac output increases by 30 to 50%, blood volume increases by 30 to 45%, and maternal heart rate increases by 15 to 20 beats per minute.

What respiratory changes occur during pregnancy?

Maternal oxygenation needs increase, diaphragm is displaced upward, and respiratory rate increases.

What musculoskeletal changes occur during pregnancy?

Altered posture, shifted center of gravity, and joint instability due to hormonal changes.

What gastrointestinal changes are common during pregnancy?

Nausea, vomiting, slowed digestive process, heartburn, and constipation.

What renal changes occur during pregnancy?

Increased filtration rate and common urinary symptoms such as frequency and urgency.

What are the main functions of the placenta?

Gas and nutrient exchange, waste removal, and hormone production.

What is the structure of the umbilical cord?

Contains 3 vessels: 2 arteries carrying deoxygenated blood and 1 vein carrying oxygenated blood.

What is the healthy fetal heart rate range?

110 to 160 beats per minute.

What are the categories of fetal heart rate variability?

Absent, minimal, moderate, and marked.

What are accelerations in fetal heart rate?

Increases in FHR that are a reassuring sign.

What are decelerations in fetal heart rate?

Decreases in FHR that require further evaluation.

What is the significance of fetal movement assessment?

It is used to evaluate fetal well-being.

What connects the fetus to the placenta?

The umbilical cord

How many vessels are in the umbilical cord?

Three vessels: two arteries and one vein

What do the two arteries in the umbilical cord carry?

Deoxygenated blood away from the fetus

What does the vein in the umbilical cord carry?

Oxygenated blood toward the fetus

What surrounds the vessels in the umbilical cord for protection?

Wharton's jelly

What are the risks associated with a two-vessel cord?

Growth restriction, preterm delivery, stillbirth

What happens to the umbilical cord at birth?

It is clamped, stopping maternal supply of oxygen and nutrients

What is the fetal heart rate range considered healthy?

110 to 160 bpm

What do accelerations in fetal heart rate indicate?

A reassuring sign of fetal well-being

What types of decelerations in fetal heart rate need further evaluation?

Early, late, and variable decelerations

What is the primary source of amniotic fluid during the second and third trimester?

Primarily fetal urine

What are the functions of amniotic fluid?

Cushions fetus, protects from maternal movement, supports growth, assists lung and digestive development, maintains temperature

What is oligohydramnios?

Decreased amniotic fluid with an AFI <5 cm

What are some risk factors for oligohydramnios?

Congenital kidney abnormalities, post-term pregnancy, gestational diabetes

What is polyhydramnios?

Increased amniotic fluid with an AFI >24 cm

What can dark green amniotic fluid indicate?

Meconium stained fluid, which may indicate fetal compromise

What does the Ferning test confirm?

Amniotic fluid leakage

What is the prenatal care schedule for low-risk pregnancies?

Initial visit at 11-12 weeks, monthly until 28 weeks, every 2 weeks from 29-36 weeks, weekly after 36 weeks

What does the initial prenatal visit include?

EDD calculation, height, weight, vital signs, pelvic exam, health history, social assessment, risk assessment, initial labs

What does Rh incompatibility occur?

When a Rh-negative mother has a Rh-positive baby

What is the purpose of RhoGAM?

To prevent the mother from creating antibodies against fetal Rh-positive blood

What does the glucose tolerance test (GTT) assess?

Gestational diabetes

What is the purpose of Group B Strep (GBS) screening?

To detect active colonization of Group B Strep in pregnant women

What is Leopold's maneuver used for?

To determine fetal position, presentation, engagement, and lie

What is a non-stress test (NST) used to evaluate?

Fetal heart rate response to fetal movement without contractions

What does a reactive NST indicate?

Baseline heart rate of 110-160 bpm with accelerations present

What does a biophysical profile (BPP) assess?

Fetal movement, tone, breathing, and amniotic fluid

What is the normal range for amniotic fluid index (AFI)?

8-24 cm

What is the significance of a score of 8 on a BPP?

Reassuring fetal well-being

What is the goal for obtaining contractions during labor?

3 contractions lasting 40-60 seconds each in 10 minutes.

What methods can induce contractions?

Nipple stimulation and IV oxytocin.

What does a negative CST indicate?

No late decelerations.

What does a positive CST suggest?

Persistent late decelerations in 50% of contractions, indicating uteroplacental insufficiency.

When is amniocentesis typically performed?

After 14 weeks of gestation.

What are the uses of amniocentesis?

Chromosomal analysis, diagnosis of genetic disorders, fetal lung maturity assessment, and evaluation for meconium.

What defines chronic hypertension in pregnancy?

Blood pressure >140/90 before 20 weeks of gestation.

What is gestational hypertension?

Blood pressure >140/90 after 20 weeks of gestation.

What are the symptoms of preeclampsia?

Persistent headache, visual disturbances, RUQ pain, lower extremity edema, hyperreflexia, and clonus.

What lab findings are associated with preeclampsia?

Elevated AST/ALT, uric acid, BUN/creatinine, and decreased platelets.

What is eclampsia?

Severe hypertension with abnormal labs and seizures.

What are the components of HELLP syndrome?

Hemolysis, elevated liver enzymes, and low platelets.

What fetal effects can result from placental hypoperfusion?

Chronic hypoxia, IUGR, asphyxia, and fetal death.

What is placenta previa?

When the placenta implants low in the uterus and covers all or part of the cervix.

What are the risk factors for placenta previa?

Abnormal uterus, multiple pregnancies, history of C-section, IVF, smoking, cocaine use, and advanced maternal age.

What are the symptoms of placenta previa?

Sudden, usually painless vaginal bleeding, often occurring late in the second or early third trimester.

What is placenta accreta spectrum?

A condition where chorionic villi attach to the myometrium, with varying degrees of invasion.

What are the complications of placental abruption?

Painful vaginal bleeding, rigid abdomen, nonreassuring fetal heart tones, and potential need for emergency C-section.

What are the types of multiple gestation?

Di-di (2 placentas, 2 sacs), mono-di (1 placenta, 2 sacs), mono-mono (1 placenta, 1 sac).

What defines preterm labor?

Contractions and cervical change occurring between 20 and 36 6/7 weeks.

What are the symptoms of preterm labor?

Contractions, pelvic pressure, lower back pain, urinary frequency, and changes in vaginal discharge.

What is hyperemesis gravidarum?

Severe vomiting leading to dehydration, electrolyte imbalance, and weight loss.

What are the risks associated with PROM/PPROM?

Neonatal sepsis, respiratory distress, and increased risk of C-section for the mother.

What is the normal fetal heart rate (FHR) baseline?

110-160 bpm.

What does absent variability in FHR indicate?

No detectable fluctuation, which is an emergency sign.

What are accelerations in fetal heart monitoring?

Abrupt increases in FHR above baseline.

What is the criteria for reassuring fetal heart rate?

≥15 bpm lasting ≥15 sec and no more than 2 min.

What are early decelerations in fetal heart rate?

Gradual decrease that mirrors contractions, with nadir at peak of contraction, caused by head compression.

How should early decelerations be managed?

Identify labor progress.

What characterizes variable decelerations?

Abrupt V or W shaped drop, decreasing to nadir in <30 sec, caused by cord compression.

What is the management for variable decelerations?

Reposition the mother, administer IV bolus, and provide oxygen.

What are late decelerations?

Gradual drop that begins after contraction starts, nadir after peak, caused by uteroplacental insufficiency.

What is the management for late decelerations?

Reposition, provide oxygen, administer IV fluids, stop Pitocin, and notify the provider.

What defines a prolonged deceleration?

Decrease ≥15 bpm lasting >2 min but <10 min.

What does VEAL CHOP stand for?

Variable = Cord compression = Reposition; Early = Head compression = Check labor progress; Acceleration = Okay = No action; Late = Placental insufficiency = Execute interventions.

What are the characteristics of Category I fetal heart rate?

Baseline 110-160 bpm, moderate variability, no late or variable decels.

What does Category II fetal heart rate indicate?

Indeterminate, needs continued evaluation and surveillance.

What defines Category III fetal heart rate?

Abnormal, predictive of abnormal acid-base status, requires immediate evaluation.

What is intrauterine resuscitation?

Interventions when tracing is abnormal, including lateral position, IV fluid bolus, stopping contraction-stimulating meds, and administering oxygen.

What are the stages of labor?

Stage 1: Onset of labor to complete dilation; Stage 2: Complete dilation to delivery of baby; Stage 3: Delivery of placenta; Stage 4: Immediate postpartum recovery.

What is the difference between SROM and AROM?

SROM = spontaneous rupture of membranes; AROM = artificial rupture of membranes.

What is the purpose of Cytotec in labor?

Helps thin the cervix for induction.

What is the initial dose of Pitocin for induction?

Starts at 2 milliunits, increasing every 30 minutes.

What are nonpharmacologic pain management techniques in labor?

Ambulation, repositioning, peanut ball, shower/tub, music, distraction, aromatherapy.

What is the risk associated with IV pain medications like fentanyl?

Can cause maternal wooziness and minimal variability in fetal heart rate.

What is the difference between an episiotomy and a laceration?

Episiotomy = cut by doctor; Laceration = natural tear.

What are the indications for a C-section?

Breech presentation, no labor progress, fetal heart rate dropping, and prolapsed cord.

What does TOLAC stand for?

Trial of labor after cesarean.