Labor and Delivery, Fetal Monitoring, and Obstetric Emergencies

Comprehensive practice flashcards covering maternal-fetal intrapartum nursing care: signs and stages of labor, fetal monitoring and Leopold's maneuvers, analgesia, dystocia, high-risk complications, and obstetric emergency management.

What are the six premonitory signs of labor?

The six premonitory signs of labor are cervical changes, lightening (dropping down into the pelvis), increased energy ("nesting"), bloody show ("bloody snot"), Braxton Hicks contractions, and spontaneous rupture of membranes.

What is the normal baseline range for Fetal Heart Rate (FHR)?

The normal baseline FHR is $110\text{--}160\,\text{bpm}$.

What are the clinical requirements and primary risk associated with placing an Intrauterine Pressure Catheter (IUPC) for internal fetal monitoring?

An IUPC must be placed by a provider and requires rupture of membranes (ROM) and at least $2\,\text{cm}$ of cervical dilation. Its placement carries an infection risk.

Where should the tocotransducer (Toco) and the ultrasound transducer be positioned on the mother's abdomen for external monitoring?

The tocotransducer (Toco) is placed at the top of the uterine fundus, and the ultrasound transducer is placed over the baby's back.

What are the four categories of baseline fetal heart rate (FHR) variability and their numeric definitions?

Absent: flat line; Minimal: changes $<5/\text{min}$; Moderate: $6\text{--}25/\text{min}$ (normal/desired); Marked: $>25/\text{min}$.

What fetal heart rate interpretation and clinical action guide is illustrated in this diagram?

The VEAL CHOP MINE guide: Variable decelerations are caused by Cord compression (action: Maternal repositioning, check for presenting cord); Early decelerations are caused by Head compression (action: Identify labor progress); Accelerations are Okay! (action: No intervention); Late decelerations are caused by Placental insufficiency (action: Execute interventions, including oxygen at $8\text{--}10\,\text{L}$ and repositioning).

What causes variable decelerations, and what is the appropriate nursing intervention?

Variable decelerations are caused by cord compression. The nursing intervention is maternal repositioning and checking for a presenting umbilical cord.

What causes late decelerations, and what actions should the nurse execute?

Late decelerations are caused by placental insufficiency. The nurse should execute interventions including maternal repositioning and administering oxygen at $8\text{--}10\,\text{L}$.

What is the definitive indicator of true labor, and what is the "5-1-1 rule"?

True labor definitively causes cervical changes and progressive fetal descent. The 5-1-1 rule defines contractions that occur less than $5\,\text{minutes}$ apart, lasting $1\,\text{minute}$, for at least $1\,\text{hour}$. True labor pain begins in the lower back and radiates forward.

How is false labor clinically characterized and differentiated from true labor?

False labor (Braxton Hicks) involves belly tightening and pain felt mainly in the abdomen without progressive fetal descent. Unlike true labor, it does not change the cervix and is relieved with activity or drinking water.

Which pelvic shape is identified as best for vaginal birth?

Platypelloid pelvic shape is noted as best for vaginal birth. Mismatches can cause cephalopelvic disproportion leading to dystocia.

In terms of the passenger (fetus), which part is the most compressible and which part is the widest and most unforgiving?

The baby's skull is the most compressible and changes shape, whereas the baby's shoulders are the widest and most unforgiving part to pass through the pelvis.

What is fetal lie, and what are its two orientations?

Fetal lie describes the relationship of the fetal spine to the maternal spine: transverse lie is sideways, and longitudinal lie is up and down.

What are the variations of cephalic/vertex fetal presentation?

Military: top of the head presents (not crown); Brow: head is tilted back with the brow presenting first; Face: head is hyperextended tilted back with the face presenting downward.

What are the four types of breech presentation?

Frank breech (legs straight up toward the head, folded in half with buttocks presenting); Complete/full breech (buttocks first with hips and knees flexed in a crouch); Single footling (one foot presenting through the cervix); Double footling (both feet presenting through the cervix).

What anatomical landmarks correspond to vertex, face, breech, and shoulder fetal presentations?

Vertex: Occipital bone (O); Face: Chin or mentum (M); Breech: Buttocks or sacrum (S); Shoulder: Scapula or acromion process (A).

What maternal symptoms and labor complications are associated with an occiput posterior (OP) or "sunny side up" fetal position?

Occiput posterior (OP) positioning causes severe maternal back pain and prolonged labor.

What are the four Leopold's Maneuvers and their techniques?

1. Fundal grip: place both hands on top of the fundus to determine which fetal pole (head or buttocks) occupies the fundus. 2. Lateral grip: slide hands down the uterine sides to differentiate the baby's back from the chest/limbs. 3. Pawlik's grip: place thumb and first finger just above the pubic bone on either side of the presenting part to determine presentation. 4. Pelvic grip: face the client's feet and place hands on both lower uterine sides to determine fetal engagement.

What contraction duration threshold indicates potential danger, and what complication is feared?

A contraction duration greater than $90\,\text{seconds}$ is abnormal and raises immediate concern for uterine rupture.

What physiological responses occur in the mother during labor?

Cardiovascular: increased HR, CO, and BP; Hematologic: increased WBC count; Respiratory/Metabolic: increased RR, oxygen consumption, and BMR, elevated temperature, and decreased glucose; Gastrointestinal: delayed gastric motility, delayed food digestion, decreased gastric emptying, and decreased gastric pH.

What are the three components assessed during a sterile vaginal examination in labor?

Dilation (opening of the cervix), effacement (thinning of the cervix), and station (fetal descent relative to the maternal ischial spines).

What are the four stages of labor and their boundaries?

Stage 1: onset of labor to complete dilation ($10\,\text{cm}$), divided into Latent ($0\text{--}6\,\text{cm}$) and Active ($6\text{--}10\,\text{cm}$); Stage 2: $10\,\text{cm}$ cervical dilation to delivery of the fetus; Stage 3: delivery of the fetus to delivery of the placenta; Stage 4: $1\text{--}4\,\text{hours}$ postpartum.

What are the four clinical signs of placental separation during Stage 3 of labor?

Lengthening of the umbilical cord, contraction and upward movement of the uterus, a sudden gush of vaginal blood, and the uterus changing to a globular shape.

What key nursing interventions must be performed prior to and during epidural analgesia administration?

Administer a $1\,\text{L}$ IV fluid bolus, check platelet count prior to placement to evaluate bleeding risk, monitor blood pressure for hypotension (the most common complication), turn the client side-to-side every hour, ensure the dressing remains clean and dry, and frequently assess pain.

What is precipitous labor, and what maternal-fetal complications can result?

Precipitous labor is labor that lasts less than $3\,\text{hours}$ from onset to delivery. Major concerns include maternal perineal/cervical tearing and fetal birth trauma.

What gestational age defines preterm labor, and what tocolytic medications may be utilized?

Preterm labor occurs between $20$ to before $37\,\text{weeks}$ of gestation. Tocolytic medications used include magnesium sulfate, terbutaline, and indomethacin.

What lecithin/sphingomyelin (L/S) ratios from amniocentesis after 32 weeks indicate fetal lung maturity in standard and diabetic pregnancies?

An L/S ratio of $2:1$ indicates functional fetal lung maturity in standard pregnancies, whereas an L/S ratio of $3:1$ is required in pregnancies complicated by gestational diabetes.

What gestational age defines postterm labor, and what maternal and fetal risks are associated with it?

Postterm labor occurs after $42\,\text{weeks}$. Maternal risks include cesarean delivery, dystocia, birth trauma, postpartum hemorrhage, and infection. Fetal risks include macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome, and cephalopelvic disproportion.

What four characteristics must be documented upon Rupture of Membranes (ROM), and after how many hours does infection risk significantly rise?

Document color, odor, amount, and time (COAT). After $24\,\text{hours}$, infection risk increases substantially, potentially presenting as chorioamnionitis with maternal fever.

What immediate emergency actions must the nurse perform during an umbilical cord prolapse?

Call for help immediately and do not leave the client; reposition the client into modified Sims, lithotomy, or hands-and-knees; insert two sterile fingers into the vagina and apply upward pressure to relieve presenting part pressure off the cord; administer $8\text{--}10\,\text{L}$ of oxygen; and prepare for immediate transfer to the OR.

What are the hallmark signs and emergency management of placental abruption?

Placental abruption presents with dark red vaginal bleeding and sudden, knife-like pain, carrying a high risk of disseminated intravascular coagulation (DIC). Management involves administering $8\text{--}10\,\text{L}$ of oxygen and preparing for immediate cesarean delivery.

What is the hallmark fetal heart rate sign of uterine rupture, and what client sensation is typical?

Uterine rupture is marked by the sudden onset of fetal bradycardia. The client often reports a tearing sensation as all three layers of the uterus separate.

What clinical triad characterizes Amniotic Fluid Embolism (AFE), and what is its associated morbidity rate?

AFE is characterized by the sudden onset of hypotension, hypoxia, and coagulopathy. It carries a $50\%$ morbidity rate.

What are the clinical indications for an amnioinfusion, and what solution is infused?

Amnioinfusion involves infusing normal saline into the uterus. Indications include variable decelerations due to cord compression, oligohydramnios, postmaturity, rupture of membranes (ROM), preterm labor with premature rupture of membranes (PROM), and thick meconium-stained amniotic fluid.

Why does meconium-stained amniotic fluid occur, and after what gestational age is its incidence increased?

Meconium staining is indicative of fetal distress; fetal hypoxia triggers vagal nerve stimulation, relaxing the anal sphincter. The risk increases after $38\,\text{weeks}$ of gestation.

What is the hallmark sign of shoulder dystocia, which maneuvers are indicated, and what action is strictly contraindicated?

The hallmark sign is "turtling" of the fetal head. Indicated interventions include the McRoberts maneuver (hyperflexing the mother's legs to her shoulders) and applying suprapubic pressure. Fundal pressure is strictly contraindicated, and forceful pulling must be avoided to prevent brachial plexus nerve injury.

What clinical manifestations characterize pre-eclampsia?

$2+$ protein on urine dipstick, sudden abdominal pain (an aura for seizure), generalized swelling/weight gain, headache, blurred vision, nausea, and vomiting.

What are the signs of magnesium sulfate toxicity, and what is its specific antidote?

Signs of toxicity include respiratory rate $<12\,\text{breaths/min}$, hypotension, loss of deep tendon reflexes, minimal urine output, and lethargy. The antidote is calcium gluconate.

What mechanism and key adverse effects are associated with the tocolytic Terbutaline?

Terbutaline is a beta-2 adrenergic agonist that relaxes uterine smooth muscle. It can cause maternal and fetal tachycardia, palpitations, chest pain, and hypertension (indicating toxicity).

What mechanism and fetal adverse effect are associated with Indomethacin when used as a tocolytic?

Indomethacin is an NSAID and prostaglandin synthesis inhibitor that suppresses contractions. Its primary fetal risk is premature closure of the fetal ductus arteriosus, which reduces fetal urine output and lowers amniotic fluid volume.