Exam 1 Lecture 1

Preconception care begins at annual ____ visits. This allows for identification of potential risk factors like ____, diabetes, and obesity. It promotes healthy lifestyles like ____ cessation, alcohol/substance use, and STI prevention. It allows for routine ____ for risk factors and preventative care.

The goal of prenatal care is to promote the ___ of the woman, fetus, newborn, and family.

The models of prenatal care include:

1. The traditional model uses ____ appointments with providers. The first visit is within the first trimester which is the first ___ weeks. From weeks 16-28, visits occur ____ and then from weeks 29-36, visits occurs every ____ weeks. After 36 weeks, visits occur ____. Advantages include one-on-one care.

2. The ____ pregnancy model focuses on prenatal care, education, and peer support in a GROUP setting. The 1st visit occurs within the 1st trimester; from weeks 16-28, visits occur every ___ weeks and from weeks 29-40, visits occur every ___ weeks. Advantages include inc social ___, education, and satisfaction. Disadvantages include a lack of ____ and difficulty scheduling group session.

Prenatal care allows women/family to make ____ and safe decisions.

gyn; HTN; smoking; screening; health; individual; 12; monthly; 2; weekly; centering; 4; 2; support; privacy; informed

Pregnant adolescents are ___ likely to receive prenatal care than older women. They are less likely to gain ___ and more likely to smoke. THey are associated with ___ birth weights and and VLBW; however, they do not have inc likelihood for ____ birth.

Pregnant women 35 and older are referred to as _____ maternal age or AMA. Two typical scenarios include multiparous women who un/intentionally become pregnant in the _____ period; OR primigravidas who have deliberately ____ childbearing or who were unable to conceive due to ____ issues and became preg through tech. These fetuses have greater chance for ____ conditions and LBW, preterm birth, ____ gestation and chromosomal abnromaltieis.

less; weight; low; cesarean; advanced; perimenopausal; delayed; fertility; preexisting; multiple

____ is the term for a women who has given birth 2 or more times. Pregnancy can bring feelings of ___ as they step into a maternal role or for those who are older, it may evoke feelings of ____ due to old age.

_____ is the term for a women who has given birth 1 time. THey may delay their pregnancy due to ____ or fertility issues. There is inc risk for ___ labor and precalmpsia. Same-sex couples who use ART may have ambivalent or ___ feelings and can lead to a ____ pregnancy.

Mutlifetal pregnancies inc the risk for complications and an increase in pregnancy ____ like HcG which contibutes to hypermesis gravidarum.

multiparous; joy; isolation; primiparous; career; preterm; mixed; multifetal; hormones

Intimate partner violence may appear as unexplained or multiple injuries at various stages of ____. Abusive behaviors often starts with _____ methods and inc w severity.

All women should be ___ at intervals during their care such as the 1st prenatal visits adn at least ____ per trimester and at the postpartum checkup. Reporting is ____ if abuse is suspected or shared with the HCP. The primary responsibility is to ____ the incident/findings accurately and concisely. Use only factual statements and make no ____.

healing; nonphysical; screened; once; mandatory; document; assumptions

Fertilization takes place in the outer ____ of the fallopian tube. Implantation occurs 6 to ___ days after conception.

The easiest biochemical marker for pregnancy is the human ____ gonadotropin or HcG. Production begins as early as day of _____. Tests include both urine and ____.

Signs include:

1. Presumptive signs which are ____ and include what the woman experiences. Common ones include ___ changes, amenorrhea, N/V, ____ frequency, and fatigue.

2. Probable signs are ____ and is observed or perceived by the examiner. Examples include the _____ sign, chadwick sign, a positive preg test, etc.

3. Positive signs are objective, such as fetal heart tones or seeing the fetus upon _____.

Physiologic adaptations are due to the ___ of pregnancies and mechanical pressures arise from the enlarging ___ and other tissues

third; 10; chorionic; implantation; subjective; breast; urinary; objective; goodell; ultrasound; hormones; uterus

A woman who is pregnant is called a _____.

Pregnancy is referred to as _____.

A woman who has had 2 or more pregnancies is called a ____.

A woman who has completed 2 or more pregnancies to stage of fetal viability is called _____.

A woman who has never been pregnant is called _____.

The term ____ refers to the # of pregnancies in which the fetus reaches viability.

A woman who has not completed a pregnancy with a fetus that has reached fetal viability is called _____.

A woman who has completed 1 preg w a fetus who has reached 20 weeks of gestation is called ____.

gravida; gravidity; multigravida; multipara; nulligravida; parity; nullipara; primipara

In the GTPAL System:

1. The G stands for ____ or the # of pregnancies.

2. The T stands for ___ or how many preg have been carried to 37 to ____ weeks.

3. The P stands for ___ birth or those who were born between ___ and 36 weeks.

4. The A stands for ____ which is less than 20 weeks.

5. The L stands for ____ children.

In the G/P system:

1. The G stands for ____ or the # of pregnancies.

2. The P stands for ___ or the # of viable pregnancies.

gravidity; term; 42; preterm; 20; abortion; living; gravidity; para

Adaptations to pregnancy include:

1. Reproductive changes like ballottement and ____ which is the first perception of fetal movement. In the cervix, the goodell sign can be observed as the cervix becomes ____ and more friable. There is no ovulation during pregnancy and in the vagina, the Chadwick sign occurs which is when the vagina appears ____. There is a lower pH and there is leukorrhea or white ____.

2. In the breasts, inc hormone levels leads to inc sensitivity, ____ and stretch marks. There is inc ____ for lactation and milk ducts.

3. In the musculoskeletal system, there are changes in posture as teh center of gravity shifts ____ and there is an inc in the normal lumbosacral curve leading to ____.

4. Muscular contractions/tension leads to ____. Alterations in sleep and ___ tunnel syndrome occur.

quickening; soft; blue; discharge; pigmentation; vascularity; forward; lordosis; headaches; carpal

Adaptations to pregnancy include:

1. In the CV, blood volume and CO will ____. Blood pressure should remain the same or slightly ____. Patients may become ___ when lying down. Upon auscultation, heart sounds will sound ___ and more rapid. There is an inc in RBC and preg woman are more likely to develop blood ____.

2. Oxygen consumption will ____ and patients will have a harder time breathing. This is a state of respiratory ____

3. Patients may have N/V, ____ due to reduced peristalsis, heartburn, etc.

4. There is an increase in total body ____.

5. The hormone melanotropin is inc which leads to _____. Examples include ____ which is the mask of pregnancy, linea nigra, striae gravidarum, etc.

6. Endocrine changes such as thyroid/pituitary gland ______. The pancreas will produce more ___ as demand inc.

increase; decrease; hypotensive; louder; clots; increase; alkalosis; constipation; water; hyperpigmentation; melasma; enlargement; insulin

At 12 weeks, the uterus moves from the pelvic to the ____ organ. At 20 weeks, the fundus is at the level of the ____ and it grows ___ centimeter each week. After the 4th month, ____ will inc leading to Braxton Hicks. Uteroplacental ____ flow will inc by 20 fold.

You can measure the uterus via measuring from the hundus to the top of the ____ bone.

When palpating the fundus, note the consistency/position. Displacement to left/right of umbilicus can be due to a distended ____.

abdominal; umbilicus; 1; contractility; blood; pelvic; bladder

Softening of the uterine isthmus is called the ___ sign. It occurs at about ___ weeks.

The first fetal movements felt by the mother is called ___ and occurs at 16 to ___ weeks.

When the HCP can feel the fetus move awak and float back when tapped is called _____ and occurs at 16-18 weeks.

Braxton Hicks are ____ that are irregular and temportary.

At 38-40 weeks, _____ occurs which is when the fundal height dec as fetus descenets into pelvis.

In the vagina/cervix, the ____ sign may occur which is a bluish color. At this stage the women are usually very ____. The ____ sign is the softening of the cervical tip. The cervix becomes more friable or the tissue is more easily ____.

hegar; 6; quickening; 20; ballottement; contractions; lightening; chadwick; tired; goodell; damaged

During pregnancy, there is a slight ___ or growth of tehe heart. The plasma inc faster than RBC leading to physiologic ____. A systolic ___ is common. BP should be the same in 1st/3rd trimester but should slightly ____ in the 2nd.

When the mom is supine, this can lead to hypotension or _____ of vena cava.

Compression of iliac veins and inferior vena cava can lead to dependent ____, varicose veins, and hemorrhoids.

They are also in a hypercoaguable state or_____.

hypertrophy; anemia; murmur; decrease; compression; edema; thrombophilia

During pregnancy there is an inc _____ rate which means an inc need for oxygen.

Estrogen causes the ligaments in rib cage to relax which leads to increased chest ____.

Estrogen also increases vascularity in the upper respiratory tract leading to nasal ____, epistaxis, ear aches, etc.

The elevation of the diaphram leads to dyspnea and increased ____ to CO2. Patients may need to sleep more ____ using pillows.

Pressures on the bladder leads to urinary ____, urgency, and nocturia. The GFR and renal plasma flow is ___ leading to spillage of protein and _____. Relaxation of smooth muscle of bladder/sphincter allows ___ to ascend into bladder. There is an inc risk of ___ due to difficulty with cleaning, yeast infections, etc. If not treated this can lead to pyelonephritis; SO you should teach patietsn to drink 8-10 glass of water and empty bladder every ___ to 3 hours to prevent stasis.

metabolic; expansion; stuffiness; sensitivity; upright; frequency; increased; glucose; bacteria; 2

Hyperpigmentation occurs due to anterior pituitary hormone ____ increase.

____ or chloasma is hyperpigmentation over the nose, cheeks, and forehead.

During the 3rd month, a pigmented line that forms is called the ____ ___.

Striae gravidarum are ____ marks that occue during the 2nd half of pregnancy due to adrenocorticosteroids.

Palmar erythema are pink/red ____ or blotches on palmar surfaces. This is caused by the hormone ____.

There is inc nail/hair growth, ____ grvidarum (itchy), enlargement/hypertrophy of the ____, etc.

Inc blood supply to the skin leads to inc ______.

melanotropin; melasma; linea nigra; stretch; mottling; estrogen; pruritis; gums; perspiration

During pregnancy, the release of relaxin/progesterone loosens the ___ in the pubic symphasis and sacroiliac joints. This allows for labor and ____.

The symphysis will ____ causing joint instability, back pain, and difficulty walking, often called the pregnancy ____.

This leads to inc pressure on the joints and ___ pain.

Edema and compression of peripheral nerves leads to ___ tunnel syndrome. This causes parathesia and ___ in wrist/hand. Muscle cramps and tetany are due to ____.

Increased levels of ____ on smooth muscle leads to decreased motility in the GI system. Slowed emptying can lead to formation of ____.

ligaments; birth; widen; waddle; knee; carpal; pain; hypocalcemia; ; progesterone; gallstones

The duration of pregnancy is called _____. It spans ___ calendar months or 40 weeks.

The 1st trimester goes from 1 to ___ weeks. The 2nd trimester goes from 14 to ____ weeks. The third goes from 27 to ___ weeks.

The most accurate assessment of EDB is based on ____ measurement of embryo/fetus.

Naegele’s rule assumes that a woman has a ____ day cycle adn that fertilzation occurs on the 14th day. First you must determine the first day of the ____. Then add _____ days and a year. Then subtract ___ months.

gestation; 9; 13; 26; 40; ultrasound; 28; LMP; 7; 3

The RhoGAM workup is done at around ___ weeks. Blood is drawn and a ____ test is done to see if she has formed any antibodies to the Rh factor.

If she is Rh negative, then she will receive an immune globulin _____ or RhoGAM.

Once the baby is born, if the baby is Rh _____, then the mother will receive another shot of RhoGAM.

This prevents the mother from producing ___ that will attach the fetal RH positive RBC.

28; coombs; injection; positive; antibodies

A fetal assessment consists of gestational age, fetal heart ____, health status, and fundal height. Use a ___ measure to measure the fundal height.

At 12 weeks, the fundus should be at the height of the ___ symphysis.

At 20 weeks, it should be at the height of the ___.

At 36 weeks it should be at the ___ process.

At 37-40 weeks, _____ or lightening occurs.

tones; tape; pubic; umbilicus; xiphoid; regression

A certified nurse midwide offers a more ____ and softer approach and allows the mother to push when they want to.

____ are considered more health coaches and are involved in external comfort measures. They do not ____ the baby at all.

With any patient, you want to review/cover the ____ and make sure the Dr. is aware.

holistic; doulas; monitor; birthplan

When trying to get pregnant or during pregnancy, the patient should increase their ____ acid intake. They should take about ___mg in fortified foods. This helps to prevent ____ tube defects.

The patient should also increase their ____, calcium, and iron intake. Foods that should be avoided include raw ____ and cookie dough, raw eggs, soft cheeses. Limit low mercury foods and ____.

The ingestion of non-nutritive substances that occur only when they are pregnant is called ____. It often displaces more ____ foods in the diet.

It is recommended that women gain about ___ to 35 pounds during pregnancy.

Those with a normal BMI should gain about 28 to ___ lbs.

For adolescents there is no any restriction as need to meet their own ____ needs.

During the first trimester, weight gain occurs primarily due to growth of ____ tissue. There is no additional kcal inake. During the 2nd trimester, the maternal tissue contines to grow, and in the 3rd trimester majority of weight gain is due to the ___. Additional caloric intake is needed.

Postpartum weight loss for nonlactating women is about 0.5 to ___ kg per week. For lactating women, they should lose about 1kg per ____.

During lactation, they should have an intake of ____ more kcal.

folic; 0.4; neural; protein; seafood; shellfish; pica; 25; 40; growth; maternal; fetus; 0.9; month; 330

One of the 5P’s affecting labor is the passenger which includes both the fetus and the ____.

To determine the ____ of the fetus in labor you can feel the baby’s head and while doing so take notice of the ___ of the baby’s head. To find the position, perform a vag exam and feel for the ____. The posterior fontanel should be in the shape of a ____, while the anterior is in the shape of a ____. There is a _____ line that can be palpated. Below the posterior fontanel is the ____ bone which is the back of the baby’s head.

Upon delivery, the baby’s head is forming and is shaped into the head of the pelvis which is called ____. It is normal and resolves afterward. They are more _____ in shape.

The _____ is the first fetal part that is in hte pelvis. The _____ part is the fetal part that is closest to itnernal os.

A fetal ___ is the relaation of the spine of the fetus to the spine of the mother.

A fetal ___ is the relation of the fetal body parts to one another.

The ____ position is best for labor (when head entering pelvis).

The fetal ____ is the relationship of the presenting part to the four quandrants of the mother’s pelvis.

When the widest part of the baby’s presenting part has descended into and entered the mother’s pelvis, this is called _____. This is when it is at the ____ spine. Anything above that is _____ and not engaged. Everything below is positive. This can be on a 5 or 3 scale. Depending on the scale, 3+ or 5+, you will see the baby’s head in the ____

placenta; position; size; fontanel; diamond; triangle; suture; occipital; molding; elongated; presentation; presenting; lie; attitude; vertex; position; engagement; ischial; negative; perineum

One of the P’s labor is called the ____ or the birth canal. This includes the bony pelvis and soft tissues. The shape of the pelvis that is the best for birth is the ____ or circular shape. The platypelloid is more ____ shape and is difficult but not impossible. The android is the ___ shape while the arthropoid is oval shape but long ways and is difficult.

Another P is the position of the laboring person. One of the best positions is ____ or squatting but less used due to monitors. Laboring moms should ___ positions frequently. Most moms are in a ____ position when delivering although it is not the best. A semi-recumbent position allows ___ to work w you.

Another P is the ____ response to motherhood. This is ____ to each woman and is affected by cultural beliefs, tolerance&expectations of ____, age, anxiety level, ____ with spouse or significant other, labor support, etc.

passageway; gynecoid; oval; heart; standing; change; lithotomy; gravity; psychological; unique; pain; relationship

One of the P’s affecting labor are the powers. The primary powers are teh uterine _____. This is the ____ of the muscle in response to stimulus w return to original length. Contractions occur in phases:

1. The ___ phase is when it starts and inc in strength.

2. The ____ phase is the peak of the contraction.

3. The ____ phase is when the intensity dec as the muscle relaxes

As these contractiuons occur, assess for ____, duration, resting tone, and intensity. If you have a ____, you can tell the acme and decrement.

The uterine ____ is the degree of pressure exerted by uterine musculature. It is measured by intrauterine pressure or _____. A normal baseline is between 8 to ___ mmHg. At peak, it ranges from 35-75. If the monitor is unavailable to determine this, then you should ____ the fundus with the uterus being soft in between contractions. A mild contraction should feel like the tip of the ____ and is easy to indent. A moderate one should feel like the ___ and is difficult to indent. A strong one feels like the ___ and is ___ to indent with fingertips.

The rise in pressure during contractions is called the ___ of the contractions. A pressure of 30 to ____ mmHg is necessary for labor. It is measured externally by palpation but measured internally by an internal uterine pressure ____ (IUPC); however, this device cannot be used unless the ___ is broken. This devices also inc risk of _____

Contracts push a baby downward and causes the cervix to ___. Then when the upper part of uterus contracts and retracts, it causes cervical _____ and dilation. Shortening and thickening of upper uterine leads to fetal ___.

____ is the thinning and shortening of cervix. First time moms, will usually have this ___. ___ is widening or opening of cervix ranging from 0 to 10 cm. First time moms will have this second while multiparous moms will have this first.

The secondary powers include the maternal ____ down efforts or pushes. This urge is called the _____ reflex. This aids in ___ of fetus but has no effect on dilation as labor only happens when the mom is dilated to ___ cm.

contractions; shortening; increment; acme; decrement; frequency; monitor; tonus; mmHg; 12; palpate; nose; chin; forehead; impossible; intensity; 50; catheter; water; infection; dilate; effacement; descent; effacement; first; dilation; bearing; ferguson; expulsion; 10

During contractions, the CO and Hr will ____ with it returning to pre-labor baseline within 1 hr PP. The BP should also be increased with ___ increasing more. During each contraction there is about ___ mL of blood emtpied from uterus and CO inc by 12 to 35% and higher in the ____ stage.

During labor, some women use the ____ maneuver whichis not recommended but can be used for short periods of time. If they use this, they need to relax in between to prevent ___. This maneuver leads to an inc in intrathoracic pressure which decreases venous return, inc venous pressure, and causes BO to inc and pulse to ____.

Due to inc physical activity and pain during labor, there is an ____ in RR. From the pain, hyperventilation can occur causing hypocapnia and respiratory ____. This is because they are pushing up on the ____.

There are voiding difficulties due to pressure of baby, pain, etc. have the patient void every 1 to ___ hours to keep bladder as empty as possible. A +1 ___ in labor is normal. Some women receive an ___ which blocks the nerves in the lower body which prevents them from urinating or feeling the urge to go.

increase; systolic; 400; second; valsalva; hypoxia; decrease; increase; alkalosis; diaphragm; epidural

During labor, integumentary changes include _____ or sweaty skin due to pain and work of labor. During the 2nd stage of labor, the ____ is extremely stretched. Educate patients to eat healthy and work with a pelvic floor ___ to help relax the perineum. Lacerations or vaginal/perineum ___ can also occur.

Musculoskeletal changes includes backaches, joint aches, and leg cramps in which oral ____ can be really helpful.

Neurologic changes include ____ are heightened, changes in mood, increased _____, elation/fatigue, and endorphins affecting ____ perception. Try to keep the room as ___ as possible.

GI changes include GI ____ and absorption is dec with stomach empyting slowed down. A _____ movement is often common with delivery. Have the patient eat ___ digested foods. Usually afterwards they will be on ____ liquid diet like ice chips. N/V commonly occurs during onset of labor and during transition and full _____.

Endocrine changes includes a ____ of progesterone and an inc in estrogen, prostaglandins, and ____ for uterine contractions. Metabolism ___ and blood glucose dec.

flushing; perineum; PT; tears; magnesium; senses; seriousness; pain; quiet; motility; bowel; easily; clear; dilation; decrease; oxytocin; increases

The normal range for fetal HR is 110 to ____ bpm. ____ are temporary inc in FHR, while decerlations are temp dec. Decelerations are commonly seen with cord _____. Vaginal exams usually cause accelerations. The #1 thing is to change ____.

During labor, fetal circulation dec as uterine contractions decrease perfusion through the ____ space. This measn less _____ available to exhange which can affect the FHR. Usually the umbilical cord moves freely in ____ fluid but if it is compressed, it causes an inc in BP which leads to a ____ in HR through the pressure reflex.

During labor, the ____ is responsible for exhanging things b/w mother and fetus. The fetus also has ____ mechanisms to maintain homeostasis.

160; accelerations; compression; positions; intervillous; oxygen; amniotic; decrease; placenta; autonomic

The process of moving fetus, placenta, and membranes out of the uterus and through the birth canal is called ____. There is no ___ cause of it.

Signs that precede labor include stronger Braxton Hicks _____, nesting or surge of ____, possible rupture of ____, passing of mucous plus, lightening, etc. When there is a surge of energy, have the patient ____ the energy as much as possible. Aftter the ROM, you want to get the baby out between18-24 hrs to avoid ____.

During labor, use ___ and adjustments needed for the fetus to adapt to the birth canal.

labor; single; contractions; energy; membranes; conserve; infection; turns

The 7 cardinal movements of labor include:

1. ____ which is when the baby’s head or widest part as passed the ischial spine or the inlet.

2. ____ which is the movement of the baby downward.

3. Flexion which is when the baby’s chin moves toward its ____ as it encounters resistance to make the diameter smaller.

4. _____ rotatioiin which is when the head rotates inside the pelvis to position itself appropriately. For a typical vertex birth, the baby’s occiput rotates toward the _____ pelvis.

5. During extension, _____ occurs which is when the baby’s head remains visible at vaginal opening and no longer slips back b/w contractions.

6. During the external rotation or restitution, the baby’s head rotates to realign with the _____.

7. Expulsion

When the head is positioned to enter the pelvis evenly, it is called _____. When it is not nicely straight, this is called asynclitism.

engagement; descent; chest; internal; anterior; crowning; shoulders; synclitism

When a pregnant lady comes in, assess to tell the difference between TRUE and FALse labor contractions:

1. True labor causes changes in the _____. Contractions are more ____, longer, and stronger. They become more intense when changing ____ and are typically felt in the ____ back/abdomen. They still continue despite ____ measures.

2. False labor is known as the ____ work. It does not change the cervix and is irregular. It may stop w change of positions and is usually felt above the _____.

When assessing FHR and pattern, the PMI is where it can be heard the ____. It is usually over the fetus’s ____. If the baby is in a vertex position, it is usually heard ___ the maternal umbilicus. If in a ____ position, it is usually heard above the umbilicus.

When doing the leopold maneuvers, have the mom ___ her legs when checking the presenting part.

Assess the amniotic membranes to see if they are intact or ruptured. There are 4 ways:

1. Look for ___ of amniotic fluid in the vagina during exam.

2. Use nitrazine paper which should turn ___ if positive.

3. The use of ___ which is placing amniotic fluid under microscope in which it should have a fern structure.

4. Use ____ to assess the amount of fluid.

The color of amniotic fluid should be relatively ___ and odorless. If it is ___ stained like green/brown, this is concerning.

Limit vaginal exams to prevent ____.

cervix; regular; positions; lower; comfort; prep; umbilicus; loudest; back; below; breech; bend; pooling; blue; ferning; ultrasound; clear; meconium; infection

For low risk patients, they do not need continuous monitoring and:

1. If they are in the latent/early phase, they should be assessed every ____ minutes.

2. in the active phase, they should be assessed every ___ min.

3. In transition/2nd stage, every ____ min.

For patients with risk factors:

1. Early phase: every ___ min

2. Active phase: every ___ min

3. Transition/2nd stage every ____ min

60; 30; 15; 30; 15; 5

The first stage of labor begins w reg uteirne ____. It ends with ____ cervical effacement/dilation. In multiparous it can occue in ___ hr and can last up to 20 in primigravisas. It can be broken up into phases:

1. Latent/early labor: The pt is dilated between 0 and ___ cm. They have progressive effacement and fetal ___ is occuring. Contractions begin to become irregular and ____ as it causes cervical change. They are of ____ to mod intensity. They may have ____ vaginal discharge which is called a bloody show.

2. During the 2nd phase called ___ labor, the patient is dilated 6-10 cm. Contractions are regular occuring every 3 to ____ min. They have intensity of abt mod to ____. THe bloody show is ____ in amount. ROM is possible. Multipara will dilate at a ___ rate than primigravida.

3. During transition phase, dilation/efffacement is complete. Contractions are very strong, bloody show is a lot and vomiting/____ movements are possible. Patients here have difficulty _____ on techniques and maintaining control. With epidural, there is extreme vaginal/rectal _____. Without epidural, there is an overwhelming urge to ___. N/V are common

contractions; full; 1; 5; descent; painful; mild; brownish; active; 5; strong; increasing; faster; bowel; focusing; pressure; push

Signs of labor progress include change in contraction ____, change in level of pain/anixety, bloody show, AROM/SROM in which should you allways check fetal ____ tones, changes in FHR, and maternal BM.

Allow labor to start ___. Encourage freedom of ____ and provide labor support. Use non-directed ____ in non-supine positions. Avoid ____ of mom/baby and allow skin to ___ contact. This warms the baby, facilitates ____, enhances transition to extrauterine life, and fosters early ____.

Provide general hygiene using ___ care like underpads, etc.

pattern; heart; spontaneously; movement; pushing; separation; skin; bonding; breastfeeding

The 2nd stage of labor begins with complete _____ and ends w birth of baby. This usually lasts ____ for a nulliparous woman compared to multiparous. There are 2 phases:

1. During the latent phase this is called laboring ____. This is relatively ____ w passive descent through birth canal.

2. During the active phase, this is the ___ phase w the urge to beat down. The fetal station is ___+.

dilation; longer; down; calm; pushing; 1

The third stage of labor lasts the birth of fetus until the ___ is delivered. It normally ____ w 3-4 contractions after baby is born. Up to ____ hour is normal but can be 3-5 minutes. As the length of this stage in, the risk for post-partal ____ also inc. Encourage the mom to _____ as soon as baby is interested to help dec bleeding.

Signs of placental separation include:

1. A firmly contracting ____.

2. A change in uterus from discoid to globular ____ shape.

3. A sudden gush of ___ blood from introitus

4. The ____ of umbilical cord

5. Vaginal fullness

The placenta should not be ____ out. It is important that the mom’s uterus stays _____ and hard postpartum.

If it comes out rough, dark and dirty, it is the ___ side. If it comes out smooth and shiny, it is the ____ side.

placenta; separates; 1; hemorrhage; breastfeed; fundus; ovoid; dark; lengthening; pulled; firm; maternal; fetal

After placental delivery, do a fundal ____ which makes it firm to prevent bleeding. Support body of uterus so that it does not ____. USe ___ hands so that the 2nd hand can block uterus from coming out.

Assess for bleeding and the bladder. Give ____ via IV to help the uterus contract. Methergine can be given for _____.

Breastfeeding can also help by stimulating the relase of ____ which leads to uterine contractions.

massage; prolapse; 2; pitocin; HTN; oxytocin

A tear in a tissue during childbirth that is not intentional is called a _____. This can occur in the perineum or in the vagina/urethral areas. There are 4 degrees:

1. A first degree extends through the skin and ____ mucous membrane but not fascia/muscle.

2. A 2nd degree extends through fascia and ___ of perineal body but not anal sphincter.

3. A 3rd dree involves ____ anal sphincter.

4. A 4th degree extends completely through ____ mucosa, disrupting both internal/external anal sphincters.

An _____ is when the provider intentionally makes an incision to enlarge the vaginal opening.

A ____ birth is birth that progresses very rapidly.

It is important to document the ____, degree, repair reformed, bleeding, and maternal responses.

Pull the appropriate ____ and place on table using sterile technqiue.

laceration; vaginal; muscle; external; rectal; episiotomy; precipitous; location; suture

After the baby is born, an APGAR score should be given at ____ and 5 minutes. If the score is less than ___, then repeat at 10 minutes.

Each category is either given a 0, 1, or ___.

1. A = _____ which is the muscle tone. 0 means absent, 1 means arms/legs are ____, and 2 is active movement.

2. P = _____ in bpm. 0 means absent, 1 poitn means below ____ bpm, and 2 is over 100bpm.

3. G = ____ or reflex irritability. 0 means ____, 1 means some flexion of extremeities, and 2 means active motion.

4. A = _____ which is skin color. 0 points is ___ or pale. 1 is that body is ____ and extremities is blue, and 2 is completely pink.

5. R = _______. 0 is absent. 1 is ____ and irregular. 2 is vigorous cry.

Excellent is from 7 to ___.

1; 7; 2; activity; flexed; pulse; 100; grimace; flaccid; appearance; blue; pink; respirations; 10

The 4th stage of labor is the immediate ____ and return to homeostasis. It lasts for ___ hours after placental delivery. It is important to monitor for complications like abnormal ____.

The most common cause of post-partum hemorrhage is uterine ____.

This is also the time for maternal-infant ____.

Postpartum patient assessmen includes:

1. B = breat

2. U = ____

3. B = bladder

4. B = bowel

5. L = ____ of vaginal discharge

6. E = episiotony, laceration, incision

7. H = ____ sign which is calf pain when foot is dorsiflexed. This is a sign of ___.

8. E = emotional state

recovery; 2; bleeding; atony; bonding; uterus; lochia; homans; DVT