Nursing Midwifery Quiz on Labor and Fetal Assessment

Exam Review

• Review material for the exam thoroughly and plan ahead.
• Avoid procrastination and ensure adequate preparation.
• Importance of planning ahead for exams.

GTPAL

• Gravity: Number of times pregnant
• Term: Number of babies born after 37 weeks
• Preterm: Number of babies born between 20-36.6 weeks
• Abortion: Number of spontaneous or therapeutic abortions
• Living: Number of living children

EDC/Due Date-Naegele's Rule

• Information regarding calculation of estimated due date.

Sarah's Case

• Sarah's pregnancy history includes: 8 weeks pregnant, LMP 3/15/24, 10-week miscarriage, 32-week vaginal delivery, 34-week vaginal delivery, and 37-week vaginal delivery.
• Needs to figure out Sarah's due date and pregnancy history.

Stages of Pregnancy Assessment

• Presumptive Signs: Breast changes, amenorrhea, N&V, urinary frequency, fatigue, quickening, ballottement, hyperpigmentation.
• Probable Signs: Goodell sign, Chadwick sign, Hegar sign.
• Positive Signs: Visualization of fetus by real-time ultrasound, fetal heart tones (FHT) detected by ultrasound, visualization of fetus by X-ray, FHT detected by Doppler, (fetoscope), Fetal movements palpated by examiner, Fetal movements visible to examiner.

Prenatal Visits and Tests

• The frequency of appointments—how often.
• Assessments performed during prenatal visits.
• Common discomforts during pregnancy.
• Danger signs to watch out for.
• Education and resources provided to expectant mothers.
• Fundal height measurements and assessments.
• Common prenatal tests, like amniocentesis, kick counts, fetal fibronectin.
• Other tests like NST, CST, and BPP.

Low-Risk Antepartum Client Visits

• A low-risk antepartum client visits their obstetrician or midwife monthly in the last month of pregnancy.

Positive CST (Contraction Stress Test) Result

• A positive CST indicates that the baby is well oxygenated and an induction of labor is likely.

Stage 1 of Labor

• Contractions, effacement, dilation.
• Involuntary power, early and active phases.

Dilation, Effacement, Station

• Effacement is the thinning of the cervix.
• Dilation is the opening of the cervix.
• Station describes the baby's position relative to the mother's pelvis.

Early vs. Active Phase of Labor

• Early Phase: Dilation 0-5 cm; mild-moderate contractions every 5-30 minutes; pressure in the abdomen, back. More sociable and open to instructions, eager for progress.
• Active Phase: Dilation 6-10 cm; strong contractions every 2-3 minutes; Backaches and nervous trembling. Difficulty relaxing, irritability, loss of modesty.

Stages of Labor (Stages 2, 3, and 4)

• Stage 2: Contractions and pushing, birth of the infant. Involuntary and voluntary powers. Gentle vs. forceful pushing considerations and positions. Assessments include uterus, bleeding, and perineum.
• Stage 3: Delivery of the placenta and assessment of placental separation signs. Firmly contracting uterus, globular shape, dark blood, and apparent lengthening of the umbilical cord.
• Stage 4: Immediate postpartum; assessment for bonding behaviours and infant feeding.

Nursing Interventions for Labor Stages

• Information on appropriate nursing interventions for each stage of labor.

Fetal Heart Rate (FHR)

• Normal FHR at term is 110-160 bpm; lower if postdates and higher if preterm.
• Bradycardia (<110 bpm for 10 minutes, 30 bpm drop from baseline) & Tachycardia (>160 bpm for 10 minutes, >30 bpm increase from baseline).
• Assess FHR aspects to determine fetal well-being during labor

Fetal Heart Rate Variability

• Definition: Normal irregularity of the cardiac rhythm.
• Levels: Absent (0 bpm), Minimal (1-5 bpm), Moderate (6-25 bpm), Marked (>25 bpm).
• Single most important indicator of adequate oxygenation.

FHR Baseline Changes: Accelerations

• Common with fetal movement.
• Indicative of fetal well-being.
• A reassuring sign.
• Increase of 15 bpm for 15 seconds or more.

FHR Baseline Changes: Decelerations

• May be benign or non-reassuring.
• Types: early, late, variable, and prolonged.

Early Decelerations

• Etiology: Fetal head compression.
• Uniform shape, early onset, mirrors uterine contractions.
• Minimal intervention unless variability is minimal.
• Change mom's position, increase IV fluids, check cervical dilation, and determine if ready to push.

Late Decelerations

• Etiology: Uteroplacental insufficiency.
• Smooth, curvilinear, uniform shape with lowest point after the contraction peak.
• Slow return to baseline.
• Non-reassuring pattern, associated with hypoxia progressing to hypoxia, and acidosis.
• Nursing interventions include turning mother to left side, stop Oxytocin (if administered), correct maternal hypotension, fluids/legs up, assessing for >5 uterine contractions (UC) in 10 minutes.

Variable Decelerations

• Etiology: Cord compression.
• Abrupt descent and ascent, 15 bpm drop for 15 seconds.
• Can occur with or without contractions.
• Non-reassuring, severe or accompanied by tachycardia, slow return to baseline, overshoots, decreasing variability.
• Nursing actions include changing mom's position, monitoring, decreasing or stopping oxytocin if necessary, assessing repetitive contractions.

VEAL CHOP MINE

• Memorization tool for fetal heart rate patterns (VEAL) and their causes (CHOP).
• Management (MINE) for each of the patterns.

FHR Tracing

• Identifying characteristics in fetal heart rate tracings.

Causes of Fetal Monitoring Tracing

• Possible reasons for identified fetal monitoring tracing abnormalities.

Preterm Labor

• Greatest risk factor: changes in vaginal discharge, pelvic/lower abdominal pressure, constant low/dull backache, mild abdominal cramps, regular contractions/uterine tightening, often painless, ruptured membranes (risk of chorioamnionitis).
• Tocolytics: magnesium sulfate, Mag, Terbutaline, Nifedipine/Procardia, Indomethacin, ABX, BMZ.

Hypertension in Pregnancy

• Different types of hypertension in pregnancy, with diagnostic criteria for each type.

Preeclampsia Pathology

• Inadequate vascular remodeling, decreased placental perfusion and hypoxia.
• Vasospasm, increased peripheral resistance and BP, endothelial cell dysfunction.
• Increased endothelial cell permeability, intravascular protein and fluid loss, decreased tissue perfusion.

Severe Preeclampsia Features and Interventions

• BP ≥160 systolic or BP ≥110 diastolic.
• Cerebral/visual changes and severe headaches.
• Impaired liver function; epigastric/right upper quadrant pain.
• Progressive renal insufficiency (oliguria).
• Pulmonary edema.
• Thrombocytopenia.

Patient Presentation with Preeclampsia

• A case study of a patient presenting with symptoms of preeclampsia, including headache, swelling in legs, protein in urine, and high blood pressure.
• Severe features identified and possible treatment options.

Placenta Previa, Placental Abruption, and Cord Prolapse

• Risk factors, risks to mother and fetus, nursing interventions.
• Case study example with a client presenting with bright red bleeding.

Postpartum Assessment

• Assessment details of the breasts, uterus, bladder, bowel, lochia, episiotomy/lacerations, hemorrhoids, and postpartum emotional status.

Postpartum Hemorrhage and Uterine Atony

• Blood loss >1000 ml with hypovolemia, often atony.
• Predisposing factors (overdistention, medications, high parity).
• Assessments (fundal tone, location, lochia/clots, bladder) and interventions (uterotonics, Pitocin, Methergine, Hemabate/Carboprost).

Newborn Assessment

• APGAR scores, assessments (expected vs. abnormal findings), trauma, LGA, AGA, SGA, thermoregulation, feeding and digestion, behavioral state, post-term infants, assessment findings.

Newborn Complications

• Prematurity; Definition; Complications; Assessments.
• Birth trauma; Caput & Cephalohematoma; Infections; NAS.
• Recognition and treatment of complications.
• Blood sugar; Hypoglycemia; At-risk population; Tx; Coombs; Bilirubin; Phototherapy; education.

Newborn Swelling and Heat Loss

• Swelling: reporting to the provider (report findings immediately to provider).
• Preventing heat loss: methods to dry and care for newborns, immediately after birth (assessing and preventing heat loss).

Newborn Bathing

• Information to include when teaching parents newborn bathing techniques.

Medications in Labor and Delivery

• Various medications and their use, notes, and side effects in labor and delivery.

Medication Side Effects

• Identify medications potentially associated with increased blood sugars.

Test your knowledge on the key concepts of labor and fetal assessment in nursing midwifery. This quiz covers essential topics including GTPAL, signs of pregnancy, and fetal heart rate patterns. Challenge yourself with questions that are crucial for effective labor management and nursing interventions.