Obstetrics: Fetal Surveillance and Labor Stages Quiz

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Questions and Answers

What is the primary indication for a medically induced preterm birth?

Pre-E (correct)

Fetal disorders

Gestational diabetes

Previous C-section

What is the primary goal of tocolytics in labor management?

To arrest labor after uterine contractions and cervical change (correct)

To induce labor

To reduce fetal distress

To stimulate uterine contractions

What is the significance of a +4/+5 cm station in labor?

Birth is imminent (correct)

Engagement has occurred

Uterine contractions are becoming stronger

The fetus is in distress

What is the primary method of fetal heart rate monitoring?

External fetal monitoring Signup and view all the answers

What is the purpose of activity restriction in pregnancy?

To reduce maternal risk factors Signup and view all the answers

What is the significance of back labor in pregnancy?

The baby is in an occiput posterior (OP) position Signup and view all the answers

What is the primary goal of augmentation of labor?

To stimulate uterine contractions Signup and view all the answers

Why is engagement significant in labor?

It indicates the largest transverse diameter of the presenting part has passed through the mother's pelvic brim Signup and view all the answers

What is the recommended management approach for premature preterm premature rupture of membranes (PPROM) occurring at less than 32 weeks of gestation?

Expectant and conservative management Signup and view all the answers

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?

To accelerate fetal lung maturation Signup and view all the answers

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?

Transition phase Signup and view all the answers

What is the primary goal of administering magnesium sulfate during labor?

To provide neuroprotection for the fetus Signup and view all the answers

Which of the following is NOT a stage of labor?

Fifth stage Signup and view all the answers

Which of the following is considered a key aspect of the fourth stage of labor?

Postpartum observation for complications Signup and view all the answers

Which of the following is a contributing factor to a prolapsed umbilical cord?

Long cord (longer than 100 cm) Signup and view all the answers

Which of the following interventions is NOT typically used to manage tachysystole?

Administer magnesium sulfate Signup and view all the answers

What is the significance of meconium-stained amniotic fluid?

Indicates fetal distress and possible need for immediate intervention Signup and view all the answers

Which of the following is a possible risk factor for shoulder dystocia?

Maternal obesity Signup and view all the answers

What is the primary risk to the mother in a shoulder dystocia delivery?

Excessive blood loss Signup and view all the answers

Which of the following is a common intervention for a prolapsed umbilical cord?

Applying pressure to the presenting part to relieve pressure on the cord Signup and view all the answers

What is the significance of early decelerations during labor?

They are a normal response to fetal head compression. Signup and view all the answers

Which of the following is NOT a typical sign of preeclampsia?

Increased fetal movement Signup and view all the answers

What is the primary goal of managing gestational diabetes?

To maintain tight blood sugar control to prevent complications for both the mother and fetus. Signup and view all the answers

What is the most common intervention for hypertension in pregnancy?

Antihypertensive medication Signup and view all the answers

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