OB Module 3: Intrapartum

What should be included in the medical history during a pre-op assessment for a C-section?

Medical history should include allergies, previous surgeries, and current medications.

What physical assessments are necessary before a C-section?

Assess fetal heart rate and check for signs of labor.

What lab tests should be reviewed before a C-section?

CBC and blood type.

Why is it important to assess a client's emotional state before surgery?

To identify and address any anxiety or concerns about the surgery.

What should be covered in pre-op education for a C-section?

Explain the procedure, what to expect during and after surgery, and the use of anesthesia.

Why is IV access important before a C-section?

To administer fluids and medications

What are the key vital signs to take before surgery?

Baseline blood pressure, heart rate, and temperature.

What preparations must be made in the operating room before a C-section?

Ensure a sterile field, prepare surgical instruments, and gather necessary supplies.

How can nurses provide emotional support to mothers undergoing a C-section?

Offer reassurance and be present to reduce stress and anxiety.

Why are antibiotics like cefazolin given before a C-section?

To prevent postoperative infection (prophylactic antibiotics).

What is the purpose of giving an antacid such as sodium citrate before surgery?

To reduce stomach acidity and lower the risk of aspiration during anesthesia.

What types of analgesics are commonly used for C-sections?

Epidural or spinal anesthesia; general anesthesia may be used if necessary.

Why are antiemetics like Zofran used before a C-section?

To prevent or treat nausea and vomiting associated with anesthesia.

Why are IV fluids given preoperatively before a C-section?

To maintain hydration, support circulation, and prepare the client for anesthesia.

What is the purpose of continuous fetal monitoring before a C-section?

To assess the fetus's well-being and ensure a safe delivery.

Why is skin preparation important before a C-section?

To disinfect the surgical site and reduce the risk of infection.

What does postoperative wound care for a C-section involve?

Monitoring the incision site for infection, changing dressings per protocol, and removing staples or sutures during follow-up.

What should be monitored to prevent postpartum hemorrhage after a C-section?

Lochia (vaginal bleeding) and uterine tone.

What intervention may be required if a postpartum client experiences excessive bleeding?

Blood transfusions.

How can nurses support lactation after a C-section?

By providing breastfeeding education and offering lactation consultation.

Why is incentive spirometry and deep breathing important postoperatively?

To reduce the risk of pneumonia and improve lung function.

What blood pressure changes are important to monitor in laboring women?

Monitor for hypertension (preeclampsia) or hypotension (e.g., from epidural or oxytocin).

What can maternal tachycardia during labor indicate?

Infection, blood loss, or dehydration

What might maternal bradycardia suggest during labor?

Fetal distress or effects of medications.

What should be assessed regarding the laboring woman’s pain?

Pain level (scale), pain management preferences (epidural, analgesics, natural methods), and emotional support.

What contraction characteristics are assessed during labor?

Frequency, duration, and intensity to evaluate the labor stage.

Why is it important to assess cervical dilation and effacement?

To determine labor progress and fetal descent through vaginal exam.

What does a fetal station of +2 indicate?

The baby is descending and nearing the birth canal.

Why is monitoring vaginal bleeding or discharge important during labor?

To identify abnormal bleeding and assess labor progress.

Why is continuous fetal monitoring important during labor in multiparous women?

To assess fetal well-being, as rapid labor progression can increase the risk of fetal distress.

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

110–160 beats per minute (bpm).

What can changes in baseline FHR or variability indicate?

Possible fetal distress or hypoxia.

Why is it important to monitor contractions during labor?

To assess labor progression and prevent complications due to overly strong or frequent contractions.

What might early decelerations in FHR indicate?

Head compression, usually benign and associated with labor progression.

What might variable decelerations in FHR suggest?

Umbilical cord compression

What might late decelerations in FHR indicate?

Uteroplacental insufficiency or fetal hypoxia—requires prompt intervention.

What should be assessed regarding amniotic fluid during labor?

Color and consistency—clear is normal; meconium-stained may indicate fetal distress; blood-tinged may suggest complications.

Why is it important to assess a woman’s previous obstetric history upon admission to labor and delivery?

To identify risks based on past complications such as C-sections, preeclampsia, or hemorrhage.

What cervical dilation range defines the latent phase of labor?

0–3 cm.

: What are the contraction characteristics in early labor (latent phase)?

Irregular, mild contractions lasting 30–45 seconds every 5–10 minutes.

What cervical dilation range defines the active phase of labor

4–7 cm.

What are the contraction characteristics in active labor?

Regular, stronger contractions every 2–3 minutes, lasting 45–60 seconds.

What emotional and physical changes occur during active labor?

Increased anxiety, more discomfort, and may request an epidural.

What cervical dilation range defines the transition phase of labor?

8–10 cm.

What are the contraction characteristics in the transition phase?

Very strong contractions every 1–2 minutes, lasting 60–90 seconds.

What symptoms are common during the transition phase of labor?

Nausea, vomiting, shaking, tiredness, rectal pressure, and urge to push.

What is the most common and ideal fetal presentation for birth?

Cephalic presentation (head-down).

What is a breech presentation?

When the baby’s buttocks or feet are positioned to come out first.

What is a frank breech?

The baby’s buttocks are down with legs extended straight up toward the head.

What is a complete breech?

The baby’s buttocks are down with hips and knees both flexed.

What is a footling breech?

One or both of the baby’s feet present first.

What is a transverse lie?

The baby is lying sideways, typically presenting with a shoulder first.

What is a frank breech presentation?

The baby’s buttocks are positioned first, and the legs are extended upward. It is the most common type of breech.

What is a complete breech presentation?

The baby’s buttocks present first, with the knees and hips flexed, resembling a seated position.

What is a footling breech presentation?

One or both of the baby’s feet are positioned to come out first, which can present delivery challenges.

What is an advantage of local anesthesia?

It provides pain relief in a small area and has a quick onset.

What is a disadvantage of local anesthesia?

It is only suitable for minor procedures and does not relieve pain in larger areas.

What is an advantage of a pudendal block?

It provides pain relief for vaginal delivery, especially during the second stage.

What is a disadvantage of a pudendal block?

It is limited to specific areas and may not be effective for all patients.

What is an advantage of epidural anesthesia?

It provides effective pain relief throughout labor and allows the mother to be awake and alert.

What is a disadvantage of epidural anesthesia?

Potential side effects include hypotension, difficulty pushing, or prolonged labor.

What is an advantage of spinal anesthesia?

It has a rapid onset and provides good pain relief, especially for C-sections.

What is a disadvantage of spinal anesthesia?

It carries the risk of hypotension and difficulty with pushing if used in labor.

What is an advantage of general anesthesia?

It is ideal for emergency C-sections when rapid delivery is necessary.

What is a disadvantage of general anesthesia?

It causes loss of consciousness, requires intubation, and has a longer recovery time.

What causes early decelerations in fetal heart rate (FHR)?

Fetal head compression, often seen during contractions. They are typically benign.

What causes variable decelerations in fetal heart rate (FHR)?

Umbilical cord compression. They can be variable and often require repositioning of the mother.

What causes late decelerations in fetal heart rate (FHR)?

Uteroplacental insufficiency, which is associated with uterine hypoxia and fetal distress. Immediate intervention is required.

What are the risks of an amniotomy?

Infection, prolapsed umbilical cord, and fetal heart rate changes.

What is the priority nursing care immediately after an amniotomy?

: Assess the fetal heart rate immediately.

What should be monitored after an amniotomy to detect infection?

Monitor for signs of infection such as fever or unusual discharge.

What nursing measure ensures safety during an amniotomy?

Ensure sterile technique during the procedure.

What should be monitored for after an amniotomy to prevent complications?

Monitor for excessive bleeding or signs of cord prolapse.

What are some signs of infection post-delivery?

Fever, chills, tachycardia, foul-smelling lochia, and abdominal pain or tenderness.

What is a key management strategy for infection post-delivery?

Administer antibiotics as prescribed.

How should vital signs be monitored post-delivery in the case of infection?

Vital signs should be monitored frequently to assess the client’s condition.

What supportive care should be provided for post-delivery infection?

Hydration, antipyretics, and other supportive care as needed.

What diagnostic tests may be done to manage post-delivery infection?

Cultures may be taken (e.g., blood, urine, wound) to identify the infection.

What does a tocodynamometer measure during external fetal monitoring?

It measures contractions.

What is the role of an ultrasound transducer in external fetal monitoring?

It monitors fetal heart rate.

What does a fetal scalp electrode measure in internal fetal monitoring?

: It measures fetal heart rate.

What is the purpose of an intrauterine pressure catheter (IUPC) in internal fetal monitoring?

It measures uterine contractions.

What is lightening in relation to the beginning of labor?

Lightening is when the baby drops into the pelvis.

What does the bloody show indicate about labor?

The bloody show occurs when the mucus plug is expelled with some blood, signaling the onset of labor.

What characterizes regular contractions as labor begins?

Regular contractions begin to occur at regular intervals.

What cervical changes occur as labor begins?

Cervical dilation and effacement begin as labor progresses.

What is the nesting instinct and how does it relate to labor?

Nesting is a burst of energy and urge to prepare the home, often occurring just before labor begins.

What is the normal fetal heart rate range?

The normal fetal heart rate is 110-160 bpm.

What is considered fetal tachycardia?

Fetal tachycardia is a heart rate greater than 160 bpm.

What is considered fetal bradycardia?

Fetal bradycardia is a heart rate less than 110 bpm.

What nursing actions should be taken for fetal tachycardia?

Reposition the mother, provide oxygen, and assess for infection, dehydration, or medications causing it.

What should the nurse assess for when fetal bradycardia is detected?

The nurse should assess for cord prolapse, uteroplacental insufficiency, and reposition the mother. Immediate intervention may be needed.

What is Supine Hypotension Syndrome (Vena Cava Syndrome)?

: It occurs when the weight of the uterus compresses the inferior vena cava, leading to decreased venous return, hypotension, and decreased blood flow to the fetus.

What nursing intervention can prevent Supine Hypotension Syndrome in a laboring client?

Nurses should encourage the left lateral position to prevent this complication.

What instruments are used for Fetal Heart Rate (FHR) auscultation?

Fetoscope and Doppler.

What instruments are used for internal electronic monitoring of FHR?

Intrauterine pressure catheter (IUPC) and fetal spiral (scalp) electrode (FSE).

What instruments are used for external electronic monitoring of FHR?

Ultrasound and tocodynamometer.

What do early decelerations indicate about the baby, and what are the nursing interventions?

Early decels are associated with head compression (especially the anterior fontanelle) as the head is compressed against the pelvic floor. Nursing interventions: Reassure the mother, monitor fetal heart rate, and provide position changes if necessary. Early decels are typically benign.

What medications/nursing interventions are used for Cystic Fibrosis?

Medications may include bronchodilators, mucolytics (like dornase alfa), antibiotics, and pancreatic enzymes. Nursing interventions: airway clearance techniques (e.g., chest physiotherapy), nutritional support, and monitoring for respiratory infections.

Where is the best area to place the FHR monitor?

The best area is over the fetal back or the area with the most fetal movement.