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Questions and Answers
What does full dilation of the cervix signify in labor?
What does full dilation of the cervix signify in labor?
How is effacement defined during the first stage of labor?
How is effacement defined during the first stage of labor?
In relation to ischial spines, what does a station of +4 or +5 cm indicate?
In relation to ischial spines, what does a station of +4 or +5 cm indicate?
Which of the following factors is NOT one of the 5 P's affecting the labor process?
Which of the following factors is NOT one of the 5 P's affecting the labor process?
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What is the primary significance of the fetal head during labor?
What is the primary significance of the fetal head during labor?
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How typically does effacement progress in first pregnancies compared to subsequent pregnancies?
How typically does effacement progress in first pregnancies compared to subsequent pregnancies?
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What is the primary purpose of external cephalic version (ECV)?
What is the primary purpose of external cephalic version (ECV)?
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What is the estimated success rate of ECV at 36-37 weeks gestation?
What is the estimated success rate of ECV at 36-37 weeks gestation?
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Which of the following is a risk factor for spontaneous preterm labor?
Which of the following is a risk factor for spontaneous preterm labor?
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At what gestational weeks does preterm birth occur?
At what gestational weeks does preterm birth occur?
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What is the role of the Fetal Fibronectin (fFN) Test in diagnosing preterm labor?
What is the role of the Fetal Fibronectin (fFN) Test in diagnosing preterm labor?
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Which of the following accurately describes the definition of preterm labor?
Which of the following accurately describes the definition of preterm labor?
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Which of the following statements is true regarding cervical lengths and preterm birth?
Which of the following statements is true regarding cervical lengths and preterm birth?
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What is a primary contraindication for performing an external cephalic version (ECV)?
What is a primary contraindication for performing an external cephalic version (ECV)?
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What may necessitate an emergency C-section during labor?
What may necessitate an emergency C-section during labor?
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What is the primary goal of antepartum care for women requiring insulin during pregnancy?
What is the primary goal of antepartum care for women requiring insulin during pregnancy?
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During labor, what blood glucose level should be maintained?
During labor, what blood glucose level should be maintained?
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What can Leopold's maneuvers help to determine?
What can Leopold's maneuvers help to determine?
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What condition is considered a variant of preeclampsia?
What condition is considered a variant of preeclampsia?
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What should be done for women with a history of gestational diabetes post-delivery?
What should be done for women with a history of gestational diabetes post-delivery?
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What is an important aspect of intrapartum care for women requiring insulin?
What is an important aspect of intrapartum care for women requiring insulin?
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What is a common follow-up for women who had gestational diabetes?
What is a common follow-up for women who had gestational diabetes?
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What is considered the normal range for blood pressure during pregnancy?
What is considered the normal range for blood pressure during pregnancy?
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What is the diagnosis criteria for gestational hypertension?
What is the diagnosis criteria for gestational hypertension?
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When recording blood pressure to confirm hypertension in a previously normal patient, how many readings must be taken?
When recording blood pressure to confirm hypertension in a previously normal patient, how many readings must be taken?
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Chronic hypertension is defined as hypertension present:
Chronic hypertension is defined as hypertension present:
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How long does it typically take for gestational hypertension to resolve after giving birth?
How long does it typically take for gestational hypertension to resolve after giving birth?
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Women with chronic hypertension are at risk of developing which conditions during pregnancy?
Women with chronic hypertension are at risk of developing which conditions during pregnancy?
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What defines a fourth-degree perineal laceration?
What defines a fourth-degree perineal laceration?
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Which condition is characterized by the cord lying below the presenting part of the fetus?
Which condition is characterized by the cord lying below the presenting part of the fetus?
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What is a common intervention to reduce the risk of perineal lacerations during childbirth?
What is a common intervention to reduce the risk of perineal lacerations during childbirth?
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What risk does the mother face when shoulder dystocia occurs during delivery?
What risk does the mother face when shoulder dystocia occurs during delivery?
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Which maneuver is indicated for managing shoulder dystocia?
Which maneuver is indicated for managing shoulder dystocia?
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How can cultural perceptions influence labor experience?
How can cultural perceptions influence labor experience?
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What is an immediate management step for tachysystole?
What is an immediate management step for tachysystole?
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What does meconium-stained amniotic fluid indicate?
What does meconium-stained amniotic fluid indicate?
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What factor is NOT associated with a higher risk of fetal shoulder dystocia?
What factor is NOT associated with a higher risk of fetal shoulder dystocia?
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What can lead to early decelerations in fetal heart rate?
What can lead to early decelerations in fetal heart rate?
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What is defined as fetal tachycardia?
What is defined as fetal tachycardia?
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Which condition is NOT a recognized cause of fetal tachycardia?
Which condition is NOT a recognized cause of fetal tachycardia?
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What is an initial intervention in intrauterine resuscitation to improve fetal oxygen delivery?
What is an initial intervention in intrauterine resuscitation to improve fetal oxygen delivery?
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Which of the following drugs is a known cause of fetal tachycardia when administered to the mother?
Which of the following drugs is a known cause of fetal tachycardia when administered to the mother?
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What is one specific goal of intrauterine resuscitation?
What is one specific goal of intrauterine resuscitation?
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Which physiological response is associated with early signs of fetal hypoxemia?
Which physiological response is associated with early signs of fetal hypoxemia?
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What methods are commonly used to monitor fetal heart rate during labor?
What methods are commonly used to monitor fetal heart rate during labor?
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What is the primary purpose of using external fetal monitoring during labor?
What is the primary purpose of using external fetal monitoring during labor?
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Which statement about assessing fetal heart rate (FHR) is accurate?
Which statement about assessing fetal heart rate (FHR) is accurate?
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What does EFM stand for in the context of fetal monitoring?
What does EFM stand for in the context of fetal monitoring?
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Which of the following accurately describes the method of indirect fetal heart rate monitoring?
Which of the following accurately describes the method of indirect fetal heart rate monitoring?
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Which condition could justify the use of internal fetal monitoring during labor?
Which condition could justify the use of internal fetal monitoring during labor?
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What aspect of fetal monitoring can impact decisions regarding labor interventions?
What aspect of fetal monitoring can impact decisions regarding labor interventions?
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What is a potential limitation of external fetal monitoring?
What is a potential limitation of external fetal monitoring?
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What is a critical action to take when tachysystole is detected during labor enhancement?
What is a critical action to take when tachysystole is detected during labor enhancement?
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During intrapartum care for women with diabetes, what is the target blood glucose range that should be maintained?
During intrapartum care for women with diabetes, what is the target blood glucose range that should be maintained?
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What type of monitoring is recommended for women who require insulin during pregnancy starting at 32 weeks gestation?
What type of monitoring is recommended for women who require insulin during pregnancy starting at 32 weeks gestation?
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What does a Non-Stress Test (NST) primarily assess in pregnant women?
What does a Non-Stress Test (NST) primarily assess in pregnant women?
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What indicates the need for an emergency C-section during labor enhancement?
What indicates the need for an emergency C-section during labor enhancement?
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What is an expected outcome for women who had gestational diabetes after delivery?
What is an expected outcome for women who had gestational diabetes after delivery?
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Which condition can be inferred when a Non-Stress Test indicates a non-reassuring fetal heart rate pattern?
Which condition can be inferred when a Non-Stress Test indicates a non-reassuring fetal heart rate pattern?
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What assessment does Leopold's maneuvers primarily assist with?
What assessment does Leopold's maneuvers primarily assist with?
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Study Notes
Labor and Delivery Terms
- Dilation: Enlargement of the cervical opening and canal, measured from 0 to 10 cm; full dilation marks the end of the first stage of labor.
- Effacement: Shortening and thinning of the cervix during the first stage, expressed as a percentage from 0% to 100%.
- Station: Degree of descent of the fetal part through the birth canal in relation to ischial spines; birth is imminent when the presenting part is +4 or +5 cm.
Continuous Lumbar Epidural (CLE)
- Side Effects: Various potential complications associated with the use of CLE.
- Contraindications: Specific conditions that may prevent the use of CLE during labor.
Factors Affecting Labor: The 5 P’s
- Five Major Factors: Include passenger (fetal head), passageway, powers, position of the mother, and psyche.
Fetal Position Assessment
- External Cephalic Version (ECV): A procedure to turn the fetus to a vertex position around 36-37 weeks, with a 65% success rate; ultrasound guidance is used.
- Internal Version: Rare, with questionable safety.
Preterm Labor (PTL)
- Diagnosis: Regular contractions with cervical changes or contractions and cervical dilation of at least 2 cm before 37 weeks.
- Preterm Birth: Occurs between 20-36 weeks of gestation, distinct from low birth weight (<2500 g).
- Spontaneous vs. Indicated Preterm Birth: Spontaneous (75% of cases) occurs without maternal or fetal illness; risk factors include infections, multifetal gestation, and low socioeconomic status.
- Fetal Fibronectin (fFN) Test: High predictive value for ruling out imminent preterm labor.
Lacerations During Birth
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Types of Perineal Lacerations:
- First Degree: Skin and superficial structures.
- Second Degree: Fascia and muscles of perineal body.
- Third Degree: Extends to anal sphincter.
- Fourth Degree: Continues through anal sphincters and rectal mucosa.
- Prevention: Interventions like warm compresses and perineal massage may reduce lacerations.
Cultural Differences in Labor
- Reactions to Pain: Culturally influenced; expressions may vary significantly without correlating to actual pain levels.
- Impact on Labor Choices: Cultural expectations can affect decisions regarding birth companions and the role of the father.
Emergencies in Labor
- Prolapsed Cord: Occurs when the umbilical cord lies below the presenting fetal part, often requiring prompt care and position changes.
- Meconium-Stained Amniotic Fluid: Indicates fetal distress; requires skilled neonatal resuscitation.
- Shoulder Dystocia: Complication when the shoulder cannot pass under the pubic arch, occurring in 0.2% to 3% of births.
Nursing Interventions
- Tachysystole Management: Stop/lower labor-enhancing drugs, change maternal position, and provide oxygen and IV fluids as needed.
- HELLP Syndrome: A variant of preeclampsia involving hemolysis, elevated liver enzymes, and low platelets.
Vitamin & Glucose Monitoring in Pregnancy
- Insulin Needs: Strict blood glucose control during pregnancy with monitoring pre- and post-delivery.
- Postpartum Care: Return to normal glucose levels; increased risk of recurrent gestational diabetes.
Blood Pressure and Hypertension in Pregnancy
- Normal Blood Pressure: Defined as SBP < 140 and DBP < 90.
- Gestational Hypertension: Elevated BP without proteinuria diagnosed after 20 weeks; resolves postpartum.
- Chronic Hypertension: Present before or diagnosed before 20 weeks; risk of developing preeclampsia.
Leopold's Maneuvers
- Assessment Method: Abdominal palpation to determine fetal presentation, position, and lie, aiding in the identification of fetal part and location.
Preterm Birth Prediction and Management
- Presence of fetal fibronectin (fFN) alone is not a reliable predictor of preterm birth.
- Preterm births may occur due to medical indications such as gestational diabetes mellitus (GDM), preeclampsia (Pre-E), previous cesarean section, seizures, or fetal disorders (25% likelihood).
- Prevention strategies include addressing risk factors, early recognition, and lifestyle modifications such as activity restriction and pelvic rest.
Labor Management Techniques
- Tocolytics are medications used to suppress uterine activity and delay preterm labor.
- Labor augmentation is used when spontaneous labor does not progress satisfactorily, often through oxytocin infusion and amniotomy.
- Active management aims for birth within 12 hours of admission, often through aggressive use of oxytocin.
Labor Terminology
- Back labor occurs when the baby is in the occiput posterior (OP) position.
- Station measures the baby's descent during labor, with engagement typically at station 0, indicating the largest part has passed through the pelvic brim.
- Birth is imminent at a station of +4/+5 cm.
External Fetal Monitoring
- Fetal heart rate (FHR) is monitored via intermittent auscultation (IA) or external fetal monitoring (EFM).
- Normal FHR ranges from 110 to 160 bpm, with tachycardia defined as exceeding 160 bpm for 10 minutes or longer.
Causes of Fetal Tachycardia
- Early sign of fetal hypoxemia, especially with other concerning variables like late decelerations.
- Potential causes include maternal fever, infections, hyperthyroidism, anemia, and responses to various medications.
Intrauterine Resuscitation (IUR)
- Aims to increase oxygen delivery to the placenta, reversing fetal hypoxia and acidosis.
- Initial measures include positioning, rapid fluid infusion, maternal oxygen administration, and inhibition of contractions with terbutaline if necessary.
HELLP Syndrome
- A serious condition considered a variant of preeclampsia involving hemolysis, elevated liver enzymes, and low platelet counts.
Leopold's Maneuvers
- Assesses fetal presentation using abdominal palpation, answering questions about fetal position, lie, and engagement.
Insulin Management During Pregnancy
- Antepartum care focuses on strict blood glucose control through diet, exercise, self-monitoring, pharmacological therapy, and fetal surveillance.
- Intrapartum glucose levels should be maintained between 80 to 110 mg/dl, with hourly monitoring and insulin infusion as needed.
- Postpartum, glucose levels typically normalize, but women who had GDM are at high risk for recurrence; follow-up screening is recommended at 6 to 12 weeks postpartum and every 3 years thereafter.
DM Counseling
- Counseling is recommended for diabetic management during pregnancy for optimal maternal and fetal health.
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Prepare for your N330 Exam 2 with this comprehensive study guide focused on Medical Surgical Care of Adults at California State University San Marcos. This guide will cover essential topics and equip you with the knowledge needed to succeed in your exam.
