Ch12

Front 1

How do labor contractions cause the cervix to efface & dilate? How do they cause fetal descent?

Back 1

- active contractions in upper uterus push fetus downward against cervix
-passive lower uterus & cervix become thinner and are pulled upward
-uterus becomes elongated & narrow to maintain pressure

Front 2

What differences in effacement are expected in the parous woman compared with the woman who has not previously given birth?

Back 2

- cervix of nullipara effaces more before it dilates
- cervix of multipara is usu. thicker during entire labor

Front 3

What changes occur in the maternal CV, resp., GI, renal, & hematopoietic sys. during labor?

Back 3

CV- contractions temp. stops blood flow to placenta which causes slight increase in BP & decrease in pulse; supine hypotension
Resp - increase rate & depth
GI - slows peristasis
renal - reduced sensation of full bladder
hematopoietic - elevated leukocyte & clotthing factors (esp. fibrinogen)

Front 4

Why are intermittent rather than sustained uterine contractions important?

Back 4

contractions temp. stops blood flow to placenta. If contractions were sustained, the fetus could not receive oxygenated blood, nutrients, or dispose waste products thru placenta

Front 5

How does the normal process of vaginal birth benefit the newborn after birth?

Back 5

- increases absorption of fetal lung fluid
- compresses upper airway = causes some fluid to be expelled
-catecholamines (1) speed up lung fluid clearance after birth, (2) stimulate cardiac contraction & breathing, and (3) aid in temp. regulation

Front 6

multigravida

Back 6

more than 1 pregnancy

Front 7

preterm birth

Back 7

birth after 20th wk & after start of 38th wk gestation

Front 8

multipara

Back 8

given birth 2/more times at 20/more wk gestation

Front 9

nullipara

Back 9

never completed pregnancy beyond spontaneous/elective abortion

Front 10

primigravida

Back 10

1st time pregnancy

Front 11

term birth

Back 11

birth b/t 38-42 wk gestation

Front 12

para

Back 12

# of pregnancies (20+ wk) at delievery (alive/stillborn)

Front 13

primipara

Back 13

given birth once after 20 wks

Front 14

postterm birth

Back 14

birth after 42 wk of gestation

Front 15

Braxton Hicks Contractions

Back 15

- irregular, usu. mild contractions, throughout preg
- become stronger in last tri

Front 16

striae gravidarum

Back 16

"stretch marks"
- irreg. reddish streaks on adb., breasts, thighs
- results from tear in connective tissue

Front 17

melasma

Back 17

also called chlasma/"mask of pregnancy"
- brownish pigment on face during pregnancy

Front 18

Goodell's sign

Back 18

softening of cervix during pregnancy

Front 19

what is the expected uterine growth at:
- 16 weeks of gestation
- 20 weeks
- 36 weeks

Back 19

16 wk - fundus midway b/t symphysis pubis & umbilicus
20 wk - uterus reaches level of umbilicus
36 wk - uterus extends to xiphoid process (highest level of uterine growth)

Front 20

what is the purpose of the cervical mucous plug?

Back 20

blocks bacteria from vagina into the uterus, thus protecting membrane & fetus from infection

Front 21

What is the recommened weight gain?

What is the pattern of weight gain? (1st, 2nd, 3rd tri)

Back 21

25-35 lb
1st tri: 3-5 lb
2nd tri: 10-12 lb (0.5-1.0 lb/wk)
3rd tri: 12-15 lb (0.75-1.0 lb/wk)

Front 22

What are the positive indicators that confirm pregnancy?

Back 22

1. auscultation of fetal heartbeat
2. fetal movement felt by examiner
3. ultrasound
- visual fetal outline
- fetal heartbeat

Front 23

What is the normal FHR in the 3rd tri?

Back 23

110-160 bpm

Front 24

What is a common heart sound in 90% of pregnant women?

Where is it best heard?

Back 24

1. spitting of the 1st heart sound &
2. systolic murmur

- Left sternal border

Front 25

Why do some pregnant women feel fain when in supine position?

How can this be corrected/avoided?

What are some other s/s?

Back 25

- weight of uterus on vena cava & aorta impedes blood flow = (1) decreased CO, (2) supine hypotensive syndrome

- rest in side-lying position w/a wedge/pillow under right hip

- lightheadedness, dizziness, agitation

Front 26

What is the usual schedule for prenatal assessment in normal pregnancy?

Back 26

- conception to 28 wks = q 4 wks
- 29 to 36 wks = q 2-3 wks
- 37 wks to birth = weekly

Front 27

What causes morning sickness?

Back 27

- unknown
- believed to be r/t increased levels of (1) hCG, (2) estrogen

Front 28

Why is "fetal" movement felt by the pregnant woman not a positive sign of pregnancy?

Back 28

can be intestinal gas, peristalsis, pseudocyesis (false pregnancy)

Front 29

What are some danger signs of pregnancy?

Back 29

1. pounding headache
2. visual disturbances
3. swelling of face/fingers
4. persistent vomiting
5. severe abd pain
6. change in fetal activity
7. painful urination
8. ruptured membrane
9. vaginal bleeding
10. chills/fever

Front 30

When should a pregnant woman go to the hospital?

Back 30

1. contractions become more regular, frequent, longer duration, greater intensity
2. rupture of membranes, w/or w/o contractions
3. bright red vaginal bleeding that’s not mixed w/mucus
4. substantial decrease in fetal movement

Front 31

What are the components of the birth process?

Back 31

power
passage
passenger
psyche

Front 32

What abbreviation represents the fetal presentation & position that is most favorable for vaginal birth?

Back 32

LOA

Front 33

The nurse should note how long the interval b/t contractions lasts b/c ______.

Back 33

most exchange of fetal O2 & waste products occurs then

Front 34

The most appropriate time for the nurse to assist a laboring woman to push is _______.

Back 34

during 2nd stage labor

Front 35

When assessing a laboring woman's BP, the nurse should ______.

Back 35

ck BP b/t 2 contractions

Front 36

What is the primary benefit of the stress of labor to the newborn?

Back 36

it stimulates breathing & eliminates lung fluid

Front 37

What is the normal amount of blood loss during pregnancy?

Back 37

500 mL

Front 38

What is the average leukocyte range during pregancy?

Back 38

14 - 16 thousand/mm3
25 thousand/mm3

Front 39

What causes the placenta to separate from the uterine wall?

Back 39

uterine cavity becomes small after birth
- reduced size decreases the size of placenta site, causing it to separate from the uterine wall

Front 40

Which tests may be done if the nurse is not certain whether the woman's membranes have ruptured?

Back 40

(1) nitrazine test
(2) examination of amniotic fluid under microscope for ferning

Front 41

Which characteristics of contractions may reduce blood flow to the placenta?

Back 41

hypertonic contractions (too freq., too long, or an inadequate rest period) reduce blood flow to and from the placenta. This interferes w/fetal oxygenation and waste disposal

Front 42

When should the nurse not perform a vaginal examination at a woman's admission? Why?

Back 42

1. active bleeding b/c the exam may increase bleeding; bloody show is not a C/I
2. if fetal gestation is less than or equal to 36 weeks b/c of stimulation of preterm labor or preterm membrane rupture

Front 43

What is the routine frequency for FHR assessment in uncomplicated labor? Why should the FHR be assessed after the membranes rupture?

Back 43

- at least hourly during latent labor
- q 30 min during active labor,
- q 15 min duirng the second stage

- to detect whether the fetal umbilical cord was displaced with the gush of fluid & is being compressed b/t the fetal presenting part and maternal pelvis

Front 44

What is the significance of greenish amniotic fluid? Of cloudy, yellowish, or foul-smelling amniotic fluid?

Back 44

greenish amniotic fluid contains meconium, which may have been passed by the fetus in response to transient hypoxia.

- cloudy, yellowish, or foul-smelling fluid suggests infection in the amniotic sac

Front 45

Why are frequent vaginal examinations undesirable during labor?

Back 45

may cause infection b/c microbes from perineal area can be introduced into the uterus

Front 46

What observations suggest that the woman may need additional ehlp with pain management during labor?

Back 46

- expresses ineffectiveness of nonpharmacologic measures
- show muscle tension during and b/t contractions
- have a tense facial expression,
- express an inability to tolerate the pain

Front 47

What is the significance of FHR accelerations?

Back 47

fetal responsiveness and nonacidosis

Front 48

What should the nurse watch for after birth in the infant who received naloxone?

Back 48

observe for recurrance of respiratory depression b/c effects are shorter than that of narcotic

Front 49

What is the antidote for opioid-induced respiratory depression?

Back 49

naloxone (NARCAN)

Front 50

Stage 1 of Labor

Back 50

(longest)
1. latent phase:
(1) regular contractions begin (2) effacement
(3) dilation
2. active phase:
(1) dilation 4-7cm
3. transition phase:
(1) dilation 8-10cm
(2) fetal descent
(3) begins to feel need to push

Front 51

Stage 2 of Labor

Back 51

Expulsion (Birth!)
From complete dilation to birth
“Laboring Down”
Urge to push
-“The baby’s coming!”
-“No puede”
Involuntary plus voluntary efforts

Front 52

Stage 3 of Labor

Back 52

Delivery of Placenta
Continued contraction
Placenta separates and expels
Important for uterus to remain contracted
Inspect placenta for completeness

Front 53

Stage 4 of Labor

Back 53

Recovery
1 to 4 hours after delivery of placenta
Complications
Clots, boggy uterus, distended bladder
Afterpains
Feeling cold
- Hunger/Thirst
Bonding!!

Front 54

What is an amniotomy?

Back 54

artificial rupture of the membrane (amniotic sac) with an AmniHook

Front 55

What is an episiotomy?

Back 55

surgical incision of the perineum to enlarge opening

Front 56

What is an Abruptio Placentae?

Back 56

premature separation of placenta

Front 57

What is "version"?

Back 57

turn fetal presentation; usu. from breech to cephalic

Front 58

nuchal cord

Back 58

umbilical cord around fetal neck

Front 59

latrogenic

Back 59

term used to decribe an adverse condtion resulting from treatment

Front 60

What are some pre-labor signs?

Back 60

1. Braxton Hicks Contraction
2. lightening
3. increased mucous
4. cervical ripening/blood show
5. energy spurt
- "nesting"