Maternity Module 2 Study Guide: Antepartum, Labor, and Intrapartum Emergencies

Comprehensive vocabulary flashcards reviewing antepartum fetal surveillance, maternal-fetal complications, labor stages, pain interventions, and intrapartum emergencies from Murray Chapters 9–16.

Nonstress Test (NST)

An antepartum fetal surveillance assessment where an external monitor records the fetal heart rate (FHR), often with a movement button, without intentionally causing contractions.

Reactive Nonstress Test ($\ge 32\,\text{weeks}$)

An NST tracing at or after $32\,\text{weeks}$ of gestation demonstrating at least two accelerations of at least $15\,\text{bpm}$ above baseline lasting at least $15\,\text{seconds}$ within a $20\text{-minute}$ period.

Reactive Nonstress Test ($< 32\,\text{weeks}$)

An NST tracing before $32\,\text{weeks}$ of gestation demonstrating accelerations of at least $10\,\text{bpm}$ above baseline lasting at least $10\,\text{seconds}$.

Acceleration

A temporary rise in the fetal heart rate above the baseline rate.

Baseline Variability

The ongoing fluctuation around the fetal heart rate baseline, categorized as absent ($0\,\text{bpm}$), minimal (detectable up to $5\,\text{bpm}$), moderate ($6\text{--}25\,\text{bpm}$), or marked (over $25\,\text{bpm}$).

Contraction Stress Test (CST)

An antepartum assessment monitoring fetal heart rate and contractions while uterine contractions are induced with nipple stimulation or low-dose oxytocin.

Negative Contraction Stress Test

A CST result showing an adequate contraction pattern with no late or significant variable decelerations, reassuring fetal tolerance at the time of testing.

Positive Contraction Stress Test

A CST result characterized by recurrent late decelerations with contractions, suggesting decreased uteroplacental reserve.

Threatened Pregnancy Loss

A condition characterized by vaginal bleeding with a closed cervix in early pregnancy, in which the pregnancy may continue.

Inevitable Pregnancy Loss

A condition presenting with vaginal bleeding and cramping accompanied by an open cervix, and sometimes ruptured membranes, where pregnancy loss is expected.

Incomplete Pregnancy Loss

A pregnancy loss where some tissue has passed from the uterus but tissue remains, typically accompanied by bleeding, cramping, and an open cervix.

Complete Pregnancy Loss

A pregnancy loss in which all tissue has passed, bleeding and pain generally decrease, and the cervix closes.

Ectopic Pregnancy

A pregnancy implanted outside the uterine cavity; unruptured cases may be managed with methotrexate (expecting at least a $15\%$ decline in hCG between days $4$ and $7$), while rupture is heralded by sudden severe abdominal or shoulder pain, syncope, hypotension, or tachycardia.

Placenta Previa

A condition in which the placenta covers the cervical opening, classically presenting with painless, bright-red vaginal bleeding and a soft uterus, requiring that digital vaginal exams be avoided until excluded by ultrasound.

Placental Abruption

Premature separation of the placenta from the uterine wall, commonly presenting with pain, uterine tenderness, a firm uterus, and dark or variable bleeding that may be concealed behind the placenta.

HELLP Syndrome

A severe variant or complication of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets, often associated with severe blood pressure elevations, persistent headache, visual changes, or right upper quadrant/epigastric pain.

Magnesium Sulfate

A medication administered to prevent or treat seizures in preeclampsia; cleared by the kidneys and carrying a risk of toxicity manifested by loss of deep tendon reflexes, hypoventilation, marked drowsiness, and cardiac arrest.

Calcium Gluconate

The prescribed intravenous reversal agent prepared and administered to treat magnesium sulfate toxicity.

Fetal Lie

The relationship of the fetus's long axis relative to the long axis of the maternal uterus (described as longitudinal or transverse).

Fetal Presentation

The anatomical part of the fetus entering the maternal pelvis first (head, buttocks, or shoulder).

Fetal Position

The relationship of a designated presenting fetal landmark (such as the occiput or sacrum) to the anterior, posterior, left, or right side of the maternal pelvis.

Fetal Attitude

The posturing of the fetal body and head, reflecting either flexion or extension.

Fetal Station

The measurement in centimeters of the descent of the fetal presenting part relative to the maternal ischial spines, where station $0$ is level with the spines.

Fetal Engagement

The entrance of the widest presenting diameter of the fetal presenting part through the maternal pelvic inlet.

Leopold Maneuvers

A systematic four-part abdominal palpation technique used to evaluate fetal lie, identify the smooth firm back versus irregular limbs, determine the presenting part and its mobility, and assess descent and flexion.

First Stage of Labor

The stage of labor extending from labor onset to complete cervical dilation ($10\,\text{cm}$), with active labor generally spanning from $6\,\text{cm}$ to complete dilation.

Second Stage of Labor

The stage of labor extending from complete cervical dilation ($10\,\text{cm}$) through the birth of the baby.

Cervical Effacement

The progressive thinning and shortening of the cervix during labor.

Cervical Ripening

The process of softening, thinning, and opening an unfavorable (firm, posterior, long, uneffaced, minimally dilated) cervix using mechanical methods or pharmaceutical agents prior to contraction stimulation.

Amniotomy

The artificial rupture of the amniotic membranes, requiring immediate fetal heart rate evaluation to detect cord prolapse and inspection of the amniotic fluid for color, amount, time, and odor.

Naloxone

The prescribed opioid reversal agent prepared to treat respiratory depression in the mother or newborn following systemic opioid administration.

Epidural-Associated Hypotension

A drop in maternal blood pressure following epidural placement that can impair placental perfusion, managed with lateral repositioning, IV fluids, vasopressors, and reduction or cessation of oxytocin.

Baseline Fetal Heart Rate

The average fetal heart rate over a $10\text{-minute}$ window, normally ranging between $110\,\text{bpm}$ and $160\,\text{bpm}$.

VEAL CHOP

A fetal monitoring mnemonic defining deceleration causes: Variable = Cord compression, Early = Head compression, Accelerations = Okay, and Late = Placental insufficiency.

Early Deceleration

A gradual drop in fetal heart rate that mirrors the contraction curve, caused by fetal head compression.

Variable Deceleration

An abrupt drop in fetal heart rate below baseline with variable onset and timing relative to contractions, caused by umbilical cord compression.

Late Deceleration

A gradual drop in fetal heart rate where the nadir occurs after the contraction peak, caused by uteroplacental insufficiency.

Category III Fetal Heart Rate Tracing

An abnormal fetal heart rate pattern—such as absent baseline variability with recurrent late decelerations—signaling fetal compromise and requiring immediate escalation and preparation for expedited birth.

Umbilical Cord Prolapse

An obstetric emergency after membrane rupture in which the umbilical cord slips below the presenting part; managed by calling for urgent help, stopping oxytocin, manually elevating the presenting part off the cord, placing the client in knee-chest or steep head-down position, and preparing for expedited birth.

Uterine Tachysystole

Excessive uterine activity defined as more than $5$ contractions in $10\,\text{minutes}$ averaged over $30\,\text{minutes}$, which can decrease placental blood flow and is managed by stopping or reducing oxytocin, lateral repositioning, IV fluids, and tocolytics as indicated.

Turtle Sign

The retraction of the delivered fetal head back against the maternal perineum, indicating shoulder dystocia.

Shoulder Dystocia

An obstetric emergency where the delivered fetal head retracts and the anterior shoulder becomes impacted behind the symphysis pubis; managed with McRoberts positioning and suprapubic pressure while avoiding fundal pressure and excessive head traction.

Uterine Rupture

A catastrophic intrapartum complication especially seen with a prior uterine scar, presenting with persistent abdominal pain, sudden fetal bradycardia, loss of fetal station, bleeding, and maternal hypotension/shock.

Preterm Premature Rupture of Membranes (PPROM)

Rupture of amniotic membranes before term; managed expectantly with latency antibiotics and corticosteroids, but requiring prompt broad-spectrum antibiotics and birth planning if intraamniotic infection (fever, uterine tenderness, tachycardia, foul fluid) occurs.

Antenatal Corticosteroids

Medications administered in threatened preterm labor to accelerate fetal lung and other organ maturation.

Tocolytic

A medication administered to temporarily suppress uterine contractions to provide a window for antenatal corticosteroid administration or maternal transport.