Exam 2: Pedi/OB: intrapartum

What is external fetal monitoring?

It uses an ultrasound transducer for fetal heart rate and a tocotransducer for uterine activity; can be affected by obesity or fetal position or movement.

What is internal fetal monitoring?

It requires ruptured membranes and should be avoided with hsp, hiv, or GBS; uses a fetal scalp electrode and intrauterine pressure catheter and is not affected by obesity or fetal position.

What do contractions cause during labor?

They cause cervical dilation (opening 0-10 centimeters) and effacement (thinning 0-100 percent).

What does VEAL CHOP MINE stand for?

Variable decelerations = cord compression = maternal repositioning; Early decelerations = head compression = identify labor progress; Accelerations = okay = no intervention; Late decelerations = placental insufficiency = execute interventions.

What is an amnioinfusion?

Infusion of room temperature isotonic fluid into the uterus to relieve umbilical cord compression; must monitor for overactive uterus.

What does variability on a fetal monitor indicate?

It shows fluctuations in fetal heart rate and represents fetal oxygen reserves; normal range is 6 to 25 beats per minute from baseline.

What are accelerations in fetal heart rate?

Abrupt increases of at least fifteen beats above baseline for at least fifteen seconds; normal and indicate fetal well-being and oxygenation.

What are early decelerations?

Heart rate drops that mirror contractions and return to baseline; normal and caused by head compression.

What are late decelerations?

Heart rate drops that begin after the contraction starts and recover after it ends; caused by placental insufficiency and need intervention.

What are variable decelerations?

Abrupt drops in fetal heart rate unrelated to contractions, shaped like a U, V, or W; caused by cord compression and require repositioning or intervention.

What is tachysystole?

More than five contractions in ten minutes.

How is contraction frequency measured?

From the beginning of one contraction to the beginning of the next.

How is contraction duration measured?

From the start of one contraction to its end.

How is contraction intensity measured?

Mild-nose, moderate- chin, and strong -forehead; internal pressure of 40 to 70mmHg is most accurate.

What is fetal position?

where the baby’s presenting part (like the head) is positioned in the mother’s pelvis — front, back, left, or right.

What is fetal presentation?

The part of the fetus that enters the pelvis first and leads through the birth canal.

What is fetal lie?

The relation of the fetal spine to the mother's spine.

What is fetal attitude?

how the baby's body parts are positioned to each other — basically how "curled up" the baby is

What is true labor?

Cervical change occurs with contractions that become consistent, stronger, and more frequent.

What is false labor?

No cervical change; contractions are inconsistent and stop with activity.

What are glucocorticoids used for in labor?

Betamethasone and dexamethasone help mature fetal lungs in preterm birth.

What are tocolytic medications used for?

Terbutaline and magnesium sulfate are used to stop preterm labor.

What are prostaglandins used for?

Cervidil and misoprostol soften and ripen the cervix to induce labor.

What is oxytocin used for?

To induce labor and stimulate uterine contractions and milk ejection.

What nursing care is important during an epidural?

Monitor for low blood pressure, full bladder, movement of catheter, and fever.

What is an amniotomy?

Artificial rupture of membranes when the cervix is soft and ready.

What happens in the first stage of labor?

Begins with regular contractions and ends with full dilation; includes latent, active, and transition phases.

What are characteristics of the latent phase?

Cervix from 0 to 5 centimeters

Mild contractions

Mother excited and able to talk

Contractions mild to moderate

Frequency 2 to 3 minutes l

Duration 30 to 40 seconds.

What are characteristics of the active phase?

Cervix from 6 to 10 centimeters

Contractions moderate to severe

Frequency: 1.5 to 5 minutes

Duration: 40 to 90 seconds

mother more serious, tired, and focused.

What is important nursing care during the first stage of labor?

Assess true labor, monitor contractions, fetal heart rate, cervix, vital signs, and pain; provide comfort, fluids, infection prevention, and emotional support.

What does TACO stand for when assessing rupture of membranes?

Time, amount, color, and odor.

What tests confirm rupture of membranes?

Speculum exam, nitrizine pH test (blue is positive), and fern test under microscope.

What happens in the second stage of labor?

From full dilation to delivery of the baby.

What are characteristics of the latent phase of the second stage?

Period of rest while baby descends; mother may not feel urge to push.

What are characteristics of the active phase of the second stage?

Strong urge to push; signs include vomiting, shaking, loss of control, bloody show, and fetal station from plus two to plus four.

What nursing care is important during the second stage?

Monitor fetal heart rate, contractions, vital signs, and pushing; encourage rest and breathing; do not leave the patient; position for birth and provide reassurance.

Why should holding breath during pushing be avoided?

It can increase chest and heart pressure, reduce blood flow to uterus, and decrease oxygen to the baby.

What happens in the third stage of labor?

From delivery of baby to delivery of placenta.

What are signs of placental separation?

Lengthening of the cord, gush of dark blood, and uterus changing from flat to round as placenta moves down.

What should the nurse assess in the third stage?

Watch bleeding and check vital signs often.

What happens in the fourth stage of labor?

Stabilization stage lasting one to four hours after placenta delivery where mother's body returns to balance.

What is shoulder dystocia?

Baby's head is born but shoulders are stuck under pubic bone; causes risk of suffocation or broken bones; use McRoberts maneuver, suprapubic pressure, or Gaskin position.

What is a prolapsed umbilical cord?

Cord slips below the presenting part; cuts off oxygen to baby; lift baby's head off cord and prepare for emergency cesarean birth.

What is preterm labor?

True labor between twenty and thirty-six weeks; caused by infection, stress, or prior preterm birth.

What are signs of preterm labor?

Change in discharge, ruptured membranes, pelvic pressure, back pain, cramps, or frequent contractions.

What medications treat preterm labor?

Antibiotics, betamethasone for lung maturity, and tocolytics like magnesium sulfate, terbutaline, or nifedipine.

What is chorioamnionitis?

Infection of the amniotic fluid causing fever, fast heart rate in mother and baby, and foul fluid; treat with broad-spectrum antibiotics.

What is a breech delivery?

Baby's feet or buttocks are down; may require cesarean delivery; infant needs hip ultrasound at six weeks.

What medications are used to induce labor?

Prostaglandins such as misoprostol or cervidil to soften the cervix and oxytocin to start contractions.

What is a vaginal birth after cesarean (VBAC)?

Vaginal birth after cesarean; risk of uterine rupture; not allowed with prior vertical incision or if induction with oxytocin is needed.