Podcast
Questions and Answers
What is the primary indication for a medically induced preterm birth?
What is the primary goal of tocolytics in labor management?
What is the significance of a +4/+5 cm station in labor?
What is the primary method of fetal heart rate monitoring?
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What is the purpose of activity restriction in pregnancy?
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What is the significance of back labor in pregnancy?
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What is the primary goal of augmentation of labor?
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Why is engagement significant in labor?
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What is the recommended management approach for premature preterm premature rupture of membranes (PPROM) occurring at less than 32 weeks of gestation?
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What is the primary reason for administering antenatal glucocorticoids to women with preterm PROM between 24 0/7 and 34 0/7 weeks of gestation?
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Which of the following is considered a phase of labor, but is not typically identified based on maternal physical sensations or behavior in women with epidural anesthesia?
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What is the primary goal of administering magnesium sulfate during labor?
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Which of the following is NOT a stage of labor?
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Which of the following is considered a key aspect of the fourth stage of labor?
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Which of the following is a contributing factor to a prolapsed umbilical cord?
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Which of the following interventions is NOT typically used to manage tachysystole?
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What is the significance of meconium-stained amniotic fluid?
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Which of the following is a possible risk factor for shoulder dystocia?
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What is the primary risk to the mother in a shoulder dystocia delivery?
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Which of the following is a common intervention for a prolapsed umbilical cord?
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What is the significance of early decelerations during labor?
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Which of the following is NOT a typical sign of preeclampsia?
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What is the primary goal of managing gestational diabetes?
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What is the most common intervention for hypertension in pregnancy?
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Study Notes
Fetal Surveillance
- Determined individually for each woman
- PPROM at less than 32 weeks is managed expectantly and conservatively
- Vigilance for signs of infections
- Fetal assessment
- Antenatal glucocorticoids for all women with preterm PROM between 24 0/7 and 34 0/7 weeks of gestation
- 7-day course of broad-spectrum antibiotics
- Administering magnesium sulfate for fetal neuroprotection
Labor Stages
- First Stage of Labor: onset of regular uterine contractions to full cervix dilation
- Latent/Early Phase (0-6 cm dilation)
- Active Phase (6-10 cm dilation)
- Transition Phase (may not be identified based on maternal physical sensations/behavior in women with epidural anesthesia)
- Second Stage of Labor: Full cervix dilation to birth of baby
- Latent phase (passive fetal descent) & Active pushing phase
- Third Stage of Labor: Birth of baby to placental delivery
- Fourth Stage of Labor: Placental delivery to first 2 hours after birth
- Important to observe for complications
Interventions
- Prevention (address risk factors) and early recognition
- Lifestyle modifications: activity restriction (modified bed rest), restrict sexual activity (pelvic rest), and home care (no excessive force)
- Suppression of uterine activity: tocolytics (meds given to arrest labor after uterine contractions and cervical change have occurred)
Augmentation of Labor
- Stimulation of uterine contractions after labor has started spontaneously and progress is unsatisfactory
- Common augmentation methods include oxytocin infusion and amniotomy
- Active management of labor
- Aggressive use of oxytocin so that the woman gives birth within 12 hours of admission to the labor unit
Fetal Monitoring
- EFM (external fetal monitoring): monitors FHR and UA
- Category I: normal
- Category II: indeterminate
- Category III: abnormal
- LTV (long term viability)
- Early decels (response to fetal head compression)
Labor Complications
- Lacerations: interventions such as warm compresses, gentle perineal massage, and stretching can decrease perineal lacerations/trauma
- Prolapsed cord: occurs when cord lies below the presenting part of the fetus
- Contributing factors include long cord, malpresentation, transverse lie, and unengaged presenting part
- Interprofessional Care Management: prompt recognition, pressure off cord, and position change to keep pressure off the cord
- Meconium-stained amniotic fluid: indicates fetus has passed stool prior to birth
- Possible causes: normal physiologic function of maturity, breech presentation, hypoxia-induced peristalsis, and umbilical cord compression
- Interprofessional Care Management: presence of an interprofessional team skilled in neonatal resuscitation is required
- Shoulder dystocia: head is born, but anterior shoulder cannot pass under pubic arch
- Newborn more likely to experience birth injuries related to asphyxia, brachial plexus damage, and fracture
- Mother’s primary risk stems from excessive blood loss from uterine atony or rupture, lacerations, extension of episiotomy, or endometritis
- Interprofessional Care Management: McRoberts maneuver and suprapubic pressure, Gaskin maneuver
Cultural Differences in Labor
- Women may have an idea of the “right” way to behave in labor and may react to the pain experienced in that way
- Range from total silence to moaning/screaming, does not necessarily indicate the degree of pain being experienced
- Can influence pt’s choice of birth companion and role of the father (some are present and involved, others are not)
- Nurse should not perceive it as a lack of concern, caring or interest
Nursing Intervention
- If there is tachysystole, stop/lower dose of labor-enhancing drugs
- Treatments for tachysystole and fetal oxygen deprivation include placing the mother in the left lateral position, giving her oxygen, and increasing her IV fluids
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Description
Test your knowledge on fetal surveillance and labor stages in obstetrics, including preterm PROM management, fetal assessment, and labor stages.