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Questions and Answers
What is a primary characteristic of preeclampsia during pregnancy?
What is a primary characteristic of preeclampsia during pregnancy?
Which of the following methods is NOT a form of long-acting reversible contraception available in the United States?
Which of the following methods is NOT a form of long-acting reversible contraception available in the United States?
What is a common risk factor associated with the development of preeclampsia?
What is a common risk factor associated with the development of preeclampsia?
What is one implication for the timing and type of birth for a patient diagnosed with preeclampsia?
What is one implication for the timing and type of birth for a patient diagnosed with preeclampsia?
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Which of the following strategies is part of managing gestational diabetes effectively?
Which of the following strategies is part of managing gestational diabetes effectively?
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What is the primary goal of external fetal heart rate monitoring?
What is the primary goal of external fetal heart rate monitoring?
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What does a normal fetal heart rate baseline range from?
What does a normal fetal heart rate baseline range from?
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In which circumstance would internal fetal heart rate monitoring be indicated?
In which circumstance would internal fetal heart rate monitoring be indicated?
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What aspect of newborn status is assessed with the APGAR score?
What aspect of newborn status is assessed with the APGAR score?
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Which of the following is considered an abnormal fetal heart rate baseline condition?
Which of the following is considered an abnormal fetal heart rate baseline condition?
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What must occur before internal fetal heart rate monitoring can be initiated?
What must occur before internal fetal heart rate monitoring can be initiated?
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How are cord blood gases used after birth?
How are cord blood gases used after birth?
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Which of these factors is a contraindication for internal fetal heart rate monitoring?
Which of these factors is a contraindication for internal fetal heart rate monitoring?
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What is indicated when a visually apparent abrupt increase in FHR is observed above the baseline?
What is indicated when a visually apparent abrupt increase in FHR is observed above the baseline?
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Which of the following is a nursing intervention for managing hypertonic contractions?
Which of the following is a nursing intervention for managing hypertonic contractions?
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What condition is characterized by abnormal labor due to factors such as inadequate cervical dilation or failure of fetal descent?
What condition is characterized by abnormal labor due to factors such as inadequate cervical dilation or failure of fetal descent?
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What is a potential cause of fetal dystocia during labor?
What is a potential cause of fetal dystocia during labor?
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Which strategy is NOT a part of intrauterine resuscitation?
Which strategy is NOT a part of intrauterine resuscitation?
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Which of the following describes a characteristic feature of the hormonal IUD?
Which of the following describes a characteristic feature of the hormonal IUD?
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What is a common risk factor during pregnancy that may lead to preeclampsia?
What is a common risk factor during pregnancy that may lead to preeclampsia?
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Which monitoring technique might be necessary for a laboring patient with diagnosed preeclampsia?
Which monitoring technique might be necessary for a laboring patient with diagnosed preeclampsia?
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What is an important consideration in postpartum care for families who had a cesarean birth?
What is an important consideration in postpartum care for families who had a cesarean birth?
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What aspect of neonatal care is crucial immediately after birth?
What aspect of neonatal care is crucial immediately after birth?
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What is a key purpose of using cord blood gases after birth?
What is a key purpose of using cord blood gases after birth?
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Which fetal heart rate baseline is considered abnormal?
Which fetal heart rate baseline is considered abnormal?
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What is the expected range for a normal fetal heart rate baseline?
What is the expected range for a normal fetal heart rate baseline?
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What must occur for internal fetal heart rate monitoring to be performed?
What must occur for internal fetal heart rate monitoring to be performed?
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Which of the following describes external fetal heart rate monitoring?
Which of the following describes external fetal heart rate monitoring?
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What is an important measurement included in the APGAR score?
What is an important measurement included in the APGAR score?
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Which of the following conditions is a contraindication for internal fetal heart rate monitoring?
Which of the following conditions is a contraindication for internal fetal heart rate monitoring?
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What is meant by fetal heart rate variability?
What is meant by fetal heart rate variability?
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What defines a reassuring fetal heart rate pattern during labor?
What defines a reassuring fetal heart rate pattern during labor?
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What is a common risk factor contributing to uterine dystocia?
What is a common risk factor contributing to uterine dystocia?
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Which condition is associated with hypertonic contractions during labor?
Which condition is associated with hypertonic contractions during labor?
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What is a nursing intervention for managing recurrent variable decelerations in labor?
What is a nursing intervention for managing recurrent variable decelerations in labor?
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What does a nadir represent in the context of fetal heart rate monitoring?
What does a nadir represent in the context of fetal heart rate monitoring?
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What distinguishes external fetal heart rate monitoring from internal monitoring when evaluating fetal oxygenation?
What distinguishes external fetal heart rate monitoring from internal monitoring when evaluating fetal oxygenation?
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What is the significance of measuring cord blood gases after birth?
What is the significance of measuring cord blood gases after birth?
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Which condition is an indication for the use of a fetal scalp electrode during internal fetal monitoring?
Which condition is an indication for the use of a fetal scalp electrode during internal fetal monitoring?
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What is a critical factor in determining a normal fetal heart rate baseline?
What is a critical factor in determining a normal fetal heart rate baseline?
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Which of the following factors can complicate the assessment of fetal heart rate during monitoring?
Which of the following factors can complicate the assessment of fetal heart rate during monitoring?
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What does an abnormal fetal heart rate baseline suggest about the fetus's wellbeing?
What does an abnormal fetal heart rate baseline suggest about the fetus's wellbeing?
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Which assessment is included in the APGAR score to determine infant health status after birth?
Which assessment is included in the APGAR score to determine infant health status after birth?
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During a cesarean birth, what is a primary focus of care for the family post-operation?
During a cesarean birth, what is a primary focus of care for the family post-operation?
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What is often the first sign of respiratory distress syndrome in a neonate?
What is often the first sign of respiratory distress syndrome in a neonate?
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What indicates a patent ductus arteriosus (PDA) in a newborn?
What indicates a patent ductus arteriosus (PDA) in a newborn?
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What distinguishes postpartum depression (PPD) from postpartum blues?
What distinguishes postpartum depression (PPD) from postpartum blues?
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What is a common risk factor for developing complications in cesarean birth families?
What is a common risk factor for developing complications in cesarean birth families?
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Which of the following conditions is associated with thrombin disorders during pregnancy?
Which of the following conditions is associated with thrombin disorders during pregnancy?
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What is the significance of a nadir in fetal heart rate monitoring?
What is the significance of a nadir in fetal heart rate monitoring?
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Which factor is least likely to contribute to uterine dystocia?
Which factor is least likely to contribute to uterine dystocia?
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Which intervention is specifically aimed at managing recurrent variable decelerations in labor?
Which intervention is specifically aimed at managing recurrent variable decelerations in labor?
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What common nursing intervention is used to enhance oxygenation during labor when hypotension is present?
What common nursing intervention is used to enhance oxygenation during labor when hypotension is present?
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A prolonged fetal heart rate variability may indicate which of the following conditions?
A prolonged fetal heart rate variability may indicate which of the following conditions?
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Which of the following is NOT a risk factor for hypertonic contractions during labor?
Which of the following is NOT a risk factor for hypertonic contractions during labor?
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What should be monitored in cases of hypertonic contractions?
What should be monitored in cases of hypertonic contractions?
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What is the recommended action if a visually apparent abrupt increase in fetal heart rate above baseline is observed?
What is the recommended action if a visually apparent abrupt increase in fetal heart rate above baseline is observed?
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Which condition is characterized primarily by the lack of progressive cervical dilation during labor?
Which condition is characterized primarily by the lack of progressive cervical dilation during labor?
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What effect does left lateral positioning have during labor?
What effect does left lateral positioning have during labor?
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What is a significant risk associated with a mother experiencing gestational diabetes?
What is a significant risk associated with a mother experiencing gestational diabetes?
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Which laboratory test is essential for diagnosing preeclampsia?
Which laboratory test is essential for diagnosing preeclampsia?
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Which complication is most likely to occur in an infant born to a mother with gestational diabetes?
Which complication is most likely to occur in an infant born to a mother with gestational diabetes?
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What is a common maternal risk associated with cesarean delivery?
What is a common maternal risk associated with cesarean delivery?
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What management technique is recommended for a patient with a high risk of preeclampsia?
What management technique is recommended for a patient with a high risk of preeclampsia?
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What characteristic feature of fetal heart rate is generally reassuring during labor?
What characteristic feature of fetal heart rate is generally reassuring during labor?
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Which symptom might indicate severe preeclampsia in a patient?
Which symptom might indicate severe preeclampsia in a patient?
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What is an important laboratory evaluation to monitor for a mother with gestational diabetes?
What is an important laboratory evaluation to monitor for a mother with gestational diabetes?
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After a cesarean birth, what is a recommended intervention for patient recovery?
After a cesarean birth, what is a recommended intervention for patient recovery?
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What is the primary mechanism by which a copper IUD prevents pregnancy?
What is the primary mechanism by which a copper IUD prevents pregnancy?
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What is a potential consequence of unmanaged preeclampsia for the fetus?
What is a potential consequence of unmanaged preeclampsia for the fetus?
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Which of the following is a recommended monitoring approach for a patient diagnosed with preeclampsia during labor?
Which of the following is a recommended monitoring approach for a patient diagnosed with preeclampsia during labor?
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What is a significant risk to the fetus associated with maternal preeclampsia?
What is a significant risk to the fetus associated with maternal preeclampsia?
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What is one advantage of hormonal IUDs compared to the copper IUD?
What is one advantage of hormonal IUDs compared to the copper IUD?
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What is a key consideration in postpartum care for families who had a cesarean birth?
What is a key consideration in postpartum care for families who had a cesarean birth?
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In terms of neonatal assessment, which component of the APGAR score assesses the respiratory effort?
In terms of neonatal assessment, which component of the APGAR score assesses the respiratory effort?
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Which factor is associated with a reassuring fetal heart rate pattern during labor?
Which factor is associated with a reassuring fetal heart rate pattern during labor?
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What is the primary purpose of fetal heart rate variability assessment during labor?
What is the primary purpose of fetal heart rate variability assessment during labor?
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Which of the following best describes the role of the string attached to an intrauterine device (IUD)?
Which of the following best describes the role of the string attached to an intrauterine device (IUD)?
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What is a common sign that may indicate the need for further evaluation of fetal well-being?
What is a common sign that may indicate the need for further evaluation of fetal well-being?
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Study Notes
Breech Presentations
- Frank breech: Fetus's legs are extended up toward the head, with the buttocks presenting first.
- Complete breech: Fetus's legs are flexed at the hips and knees, with the buttocks and feet presenting first.
- Incomplete breech: One leg is extended while the other is flexed, with the buttocks and one foot presenting first.
Fetal Variations for Vertex Presentation
- Occiput anterior (OA): Most favorable position for vaginal birth, with the back of the baby's head facing the mother's front.
- Occiput posterior (OP): Baby's back is facing the mother's back; may lead to longer labor and more pain.
APGAR Score
- Respiratory effort: Observing for spontaneous breaths (0), weak, irregular breaths (1), and strong, regular breaths (2).
- Heart rate: Absent (0), less than 100 bpm (1), and greater than 100 bpm (2).
- Muscle tone: Limp (0), some flexion of extremities (1), and active motion with flexion of extremities (2).
- Reflex activity: No response (0), grimace (1), and vigorous cry (2).
- Color: Blue or pale (0), body pink with blue extremities (1), and completely pink (2).
Fetal Heart Rate Monitoring
- Continuous External Fetal Monitoring (CEFM): Uses ultrasound and a tocodynamometer to non-invasively monitor the fetus.
- Intermittent Fetal Monitoring: Utilizes a Doppler device to listen to the fetal heart rate intermittently throughout labor.
- Internal Fetal Monitoring: Requires a fetal scalp electrode and an intrauterine pressure catheter for more accurate and invasive monitoring.
Cord Blood Gases
- Cord blood gases are collected after birth to assess the severity of hypoxia during labor.
Normal Fetal Heart Rate Baseline
- Baseline (BL) FHR: Between 110-160 bpm for a duration of 10 minutes or longer.
Abnormal Fetal Heart Rate Baselines
- Tachycardia: FHR greater than 160 bpm for a duration of 10 minutes or longer.
- Bradycardia: FHR less than 110 bpm for a duration of 10 minutes or longer.
Accelerations
- Acceleration: A visually apparent abrupt increase in FHR above baseline by at least 15 bpm with a duration of 15 seconds but less than 2 minutes.
Intrauterine Resuscitation Strategies
- Position change: Lateral positioning increases uteroplacental perfusion.
- IV bolus: Can improve oxygenation in cases of hypotension or hypovolemia.
- Oxygen: Administered via face mask to the birthing person.
- Sterile Vaginal Exam (SVE): Assesses labor progress and scalp stimulation can be reassuring.
- Amnioinfusion: For recurrent variable decelerations.
- Alter uterine activity: Monitor for tachysystole and adjust medications as needed.
Uterine Dystocia
- Causes: Lack of progressive cervical dilation or lack of fetal head descent.
- Risk factors: Maternal exhaustion, epidural anesthesia, fetal size, malpresentation, fetal anomalies, pelvic size or shape, weak or uncoordinated uterine contractions.
Hypertonic Contractions
-
Nursing interventions:
- Assess labor progress: Monitor cervical dilation and fetal descent.
- Administer pain relief: Over-the-counter medications or prescribed pain relievers.
- Encourage relaxation techniques: Breathing exercises, massage, and warm baths.
- Hydration: Encourage fluids orally or intravenously.
- Monitor fetal heart rate: Assess for signs of fetal distress, such as late decelerations or bradycardia.
- Consider tocolytics: Medications to reduce uterine contractions.
Intrapartum Care
-
Types of Breech Presentations
- Frank Breech
- Complete Breech
- Incomplete Breech
-
Fetal Variations for Vertex Presentation
- Occiput Anterior
- Occiput Posterior
- Occiput Transverse
-
APGAR Score
- Measures respiratory effort, heart rate, muscle tone, reflex activity, and color
- Scored at 1 minute and 5 minutes after birth
- Maximum score of 10
- Used to assess newborn status
Fetal Heart Rate Monitoring
-
Primary Goal
- Continually assess fetal oxygenation to prevent significant fetal acidemia
- Minimize unnecessary interventions
- Promote family-centered care
- Good fetal oxygenation indicates a healthy placenta.
-
External Monitoring
- Detects baseline, variability, accelerations, and decelerations
- Continuous Electrical Fetal Monitoring (CEFM)
- Intermittent (Doppler)
- Wireless Monitoring
- Contractions are measured via toco transducer
-
Internal Monitoring
- Intervention specific for troubleshooting measures
- Fetal/Internal Scalp Electrode (F/ISE) attached to the presenting part of the fetus
- Intrauterine Pressure Catheter (IUPC)
- Requires ruptured membranes
- Contraindications: chorioamnionitis, GBS+, genital herpes, placenta previa
-
Cord Blood Gases
- Collected after birth to determine the severity of hypoxia in labor
- One of the first assessments of fetal well-being after delivery
-
Normal Fetal Heart Rate Baseline
- 110-160 bpm for 10 minutes or more
-
Abnormal Fetal Heart Rate Baselines
- Tachycardia: >160 bpm for 10 minutes or more
- Bradycardia: <110 bpm for 10 minutes or more
-
Acceleration
- Visually apparent abrupt increase in FHR above baseline
-
15 bpm for 15 seconds but less than 2 minutes
- Preterm: 30 seconds to reach nadir
-
Early Decelerations:
- Mirrors contraction (nadir is at the peak of uterine contraction)
- Cause = head compression against the pelvis or soft tissue
- Reassuring
-
Variable Decelerations
- Baseline to nadir in 15 bpm lasting >2 min but <2 min
- Abrupt decrease in FHR
- Cause = compression of the umbilical cord
- Requires immediate intervention – position change (left lateral) or amnioinfusion
-
Late Decelerations
- Gradual decrease in FHR
- Nadir occurs after peak of contraction
- Cause = uteroplacental insufficiency
- Most serious type of deceleration
-
Contraction Intensity
- Measured in Montevideo Units (MVUs)
- 200 mmHg MVUs in 10 minutes → adequate contraction intensity to expect labor progression
-
Intrauterine Resuscitation Strategies
- Position change (left lateral)
- IV bolus
- Oxygen
- Sterile Vaginal Exam (SVE)
- Amnioinfusion
- Alter Uterine Activity (assess for tachysystole, adjust medications PRN)
High-Risk Labor and Birth
-
Uterine Dystocia
- Abnormal labor caused by lack of progressive cervical dilation or lack of descent of the fetal head
- Can be caused by power, passenger, passage, or psyche
-
Risk Factors:
- Maternal exhaustion
- Epidural anesthesia may decrease the urge to push
- Fetal Dystocia: fetal excessive size, malpresentation, fetal anomalies
- Pelvic Dystocia: delayed descent of the fetal head r/t pelvic size or shape
-
Uterine Dystocia: weak or uncoordinated uterine contraction in labor
- Due to hypertonic contractions or hypotonic contractions
Intrapartum Care
-
Breech presentations:
- Frank breech: Feet extended up toward the head, buttocks presenting first
- Complete breech: Feet flexed, both feet and buttocks presenting first
- Incomplete breech: One or both feet presenting first, buttocks are not presenting
-
Vertex presentation:
- Occiput anterior: Back of the head (occiput) is facing the front of the pelvis (anterior)
- Occiput posterior: Back of the head is facing the back of the pelvis (posterior)
- Occiput transverse: Back of the head is facing the side of the pelvis (transverse)
-
APGAR score assesses the newborn's health status at 1 minute and 5 minutes after birth
- Heart Rate: Absent, slow (below 100 bpm), or fast (over 100 bpm)
- Respiratory Effort: Absent, weak, or good cry
- Muscle Tone: Flaccid, some flexion, or active motion
- Reflex Irritability: No response, grimace, or cry/sneeze
- Color: Blue or pale, body pink and extremities blue, completely pink
-
External Fetal Heart Rate Monitoring (EFM): Used to assess fetal oxygenation, minimizing interventions and promoting family-centered care
- Continuous EFM: Uses ultrasound transducer to detect fetal heart rate and a toco transducer to measure contractions
- Intermittent Monitoring: Uses a Doppler to listen to the fetal heart rate periodically
- Wireless Monitoring: Allows for more freedom of movement during labor
-
Internal Fetal Heart Rate Monitoring: Used for troubleshooting fetal heart rate patterns
- Fetal Scalp Electrode (FSE): Attached to the fetal presenting part to directly record the fetal heart rate
- Intrauterine Pressure Catheter (IUPC): Placed inside the uterus to measure contractions
- Contraindications: Chorioamnionitis (infection of the amniotic sac), Group B Strep positive, genital herpes, placenta previa
- Cord Blood Gases: Collect after birth to assess the severity of fetal hypoxia during labor
- Normal Fetal Heart Rate Baseline: 110-160 bpm for at least 10 minutes
-
Abnormal Fetal Heart Rate Baselines:
- Tachycardia: Heart rate greater than 160 bpm for at least 10 minutes
- Bradycardia: Heart rate less than 110 bpm for at least 10 minutes
-
Accelerations: Brief increases in fetal heart rate that are reassuring and usually indicate good fetal oxygenation
- Minimum length: 15 seconds
- Minimum increase: 15 bpm above baseline
- Variable decelerations: Abrupt drops in fetal heart rate
- Early decelerations: Gradual drops in fetal heart rate, usually mirror the mother's contractions
- Late decelerations: Gradual drops in fetal heart rate that occur after the peak of the contraction
-
Intrauterine Resuscitation Strategies: Used to improve fetal oxygenation
- Position change: Left lateral position improves uteroplacental perfusion
- IV bolus: Helps with hypotension or hypovolemia
- Oxygen: Administered via face mask to the birthing person
- Sterile Vaginal Exam (SVE): To assess labor progress and encourage fetal movement
- Amnioinfusion: For recurrent variable decelerations
- Alter uterine activity: Assess for tachysystole (excessive contractions) and adjust medications as needed
High Risk Labor and Birth
-
Uterine Dystocia: Abnormal labor due to lack of cervical dilation or fetal descent
- Risk factors: Maternal exhaustion, epidural anesthesia, fetal size, malpresentation, fetal abnormalities, pelvic size, weak or uncoordinated contractions
-
Hypertonic Uterine Contractions: Overly strong and frequent contractions, leading to inefficiency in cervical dilation and fetal descent
- Nursing Interventions: Monitor fetal heart rate and uterine activity (EFM), assess cervical dilation and fetal descent, encourage relaxation techniques, provide comfort measures, inform the healthcare provider and consider interventions
-
Hypotonic Uterine Contractions: Weak and infrequent contractions, leading to inefficiency in cervical dilation and fetal descent
- Nursing Interventions: Monitor fetal heart rate and uterine activity (EFM), assess cervical dilation and fetal descent, encourage ambulation, provide hydration, assess for maternal complications, consider interventions such as amniotomy or oxytocin administration
High Risk Prenatal Care
-
Preeclampsia: Pregnancy-specific syndrome characterized by hypertension and proteinuria
- Diagnosis: Blood pressure ≥ 140 / 90 mmHg taken at least 4 hours apart, proteinuria ≥ 300 mg in 24 hours or protein/creatinine ratio ≥ 0.3 mg/dl
- Risk Factors: Nulliparity, maternal age ≥ 35 years, obesity, multiparity, family history of preeclampsia, pre-existing medical conditions (hypertension, diabetes, kidney disease)
- Signs and Symptoms: High blood pressure, abnormal kidney function tests, low platelet count, abnormal liver function tests, HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), visual problems, nausea/vomiting, swelling in hands and face, persistent headache, pulmonary edema, shortness of breath, epigastric pain
- Lab Tests: Blood pressure readings, 24-hour urine collection for proteinuria, liver function tests, kidney function tests, platelet count
- Management: Outpatient management with monitoring of blood pressure and fetal well-being, induction of labor at 37 weeks in the absence of severe features, medication to manage blood pressure and prevent seizures
- Risks to Fetus: Premature delivery, low birth weight, growth restriction, stillbirth, neurological problems
- Risks to Birthing Person: Eclampsia (seizures), stroke, organ damage, death
Gestational Diabetes:
-
Diagnosis: High blood sugar levels during pregnancy that are not present before pregnancy
- 1-hour 50gm Glucose Challenge Test: Non-fasting, positive if ≥ 135 mg/dL
- 3-hour 100gm Glucose Tolerance Test: Fasting for 8-12 hours, glucose levels drawn fasting and at 1, 2, and 3 hours after glucose intake
- Management: Diet control, oral hypoglycemic medications, or insulin
- Risks to Fetus: Macrosomia (large birth weight), hypoglycemia at birth, respiratory distress syndrome, polycythemia, hyperbilirubinemia, prematurity, cardiomyopathy, birth injuries
- Risks to Birthing Person: Hypoglycemia, preeclampsia, cesarean birth, development of Type 2 diabetes postpartum
Postpartum Hemorrhage (PPH): Excessive bleeding after childbirth
-
The Four Ts:
- Tone: Uterine atony (relaxed uterus) or subinvolution (delayed return of uterus to normal size)
- Tissue: Retained placental fragments
- Trauma: Lower genital tract lacerations or hematomas
- Thrombin Disorders: Disseminated intravascular coagulation (DIC), deep vein thrombosis (DVT), pulmonary embolism (PE)
Postpartum Depression (PPD) vs. Postpartum Blues ("Baby Blues"):
- Postpartum Blues (PPB): Mild mood swings and sadness that typically resolve within 2 weeks without medical intervention
- Postpartum Depression (PPD): More severe and persistent depression that requires medical intervention, can last for months or even years
High Risk Neonatal Nursing Care
- Infant Health and Survival: Dependent on length of gestation and birth weight
-
Respiratory Distress Syndrome (RDS): Life-threatening lung disorder due to underdeveloped alveoli and insufficient surfactant
- Signs and Symptoms: Tachypnea, gray or dusky skin, lethargy, hypotonia
-
Patent Ductus Arteriosus (PDA): Opening between the aorta and pulmonary artery that fails to close after birth
- Normal Closure: Usually closes within a few hours to 96 hours after birth
- Signs and Symptoms: Tachycardia, tachypnea, recurrent apnea, bounding pulses
-
Meconium Aspiration Syndrome (MAS): Meconium (first stool) is aspirated into the lungs before or during birth
- Signs and Symptoms: Respiratory distress, cyanosis, hypotonia, meconium staining of the amniotic fluid
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Description
Explore the different types of breech presentations and understand fetal variations for vertex presentation. This quiz also covers the APGAR score components essential for assessing newborn health. Test your knowledge on these critical topics in obstetrics.
