When to contact a healthcare provider during the First trimester - Answers Spotting or bleeding
(miscarriage), painful urination (infection), severe persistent vomiting (hyperemesis gravidarum), fever
>100F (37.7C infection), and lower abdominal pain with dizziness and accompanied by shoulder pain
(ruptured ectopic pregnancy)
When to contact a healthcare provider during the Second trimester - Answers Regular uterine
contractions (preterm labor), pain in calf, often increased with foot flexion (blood clot in deep vein),
sudden gush or leakage of fluid from vagina (premature rupture of membranes), and absence of fetal
movement for more than 12 hours (possible fetal distress or demise)
When to contact a healthcare provider during the Third trimester - Answers Sudden weight gain,
periorbital or facial edema, severe upper abdominal pain, or headache with visual changes (gestational
hypertension and/or preeclampsia), and a decrease in fetal daily movement for more than 24 hours
(possible demise) Any of the other warning signs from the first and second trimesters.
Who and When do we do Nonstress Tests - Answers Twice weekly for clients with diabetes and other
high-risk conditions, such as IUGR, preeclampsia, postterm pregnancy, renal disease, and multifetal
pregnancies.
What position is the woman placed in for a nonstress test - Answers Left Lateral Recumbent Position
Biophysical Profile (BPP) - Answers Includes ultrasound monitoring of fetal movements, fetal tone, and
fetal breathing and ultrasound assessment of amniotic fluid volume with or without assessment of the
fetal heart rate.
Why is a BPP performed? - Answers To identify infants who may be at risk of poor pregnancy outcome,
so that additional assessments of well-being may be performed, or labor may be induced or a cesarean
section performed to expedite birth. The objective is to reduce stillbirth and to detect hypoxia early
enough to allow delivery in time to avoid permanent fetal damage resulting from fetal asphyxia.
Five components of the BPP score - Answers Body movement, Fetal tone, Fetal breathing, Amniotic fluid
volume, NST
Cervical Changes - Answers Cervical softening and possible cervical dilation with decent of the
presenting part into the pelvis.
Lightening - Answers Occurs when the fetal presenting part begins to descend into the true pelvis. The
uterus lowers and moves into a more anterior position.
Increased Energy Level - Answers • Some women report a sudden increase in energy before labor. This
is sometimes referred to as nesting.
, • usually occurs 24 to 48 hours before the onset of labor. It is thought to be the result of an increase in
epinephrine release caused by a decrease in progesterone.
Bloody Show - Answers • the mucous plug that fills the cervical canal during pregnancy is expelled as a
result of cervical softening and increased pressure of the presenting part.
• pink-tinged secretions known as bloody show.
Braxton Hicks Contractions - Answers These contractions may become stronger and more frequent as
labor nears. These contractions help move the cervix from a posterior position to anterior position. They
also help in ripening and softening the cervix.
Spontaneous Rupture of Membranes - Answers • can result in either a sudden gush or a steady leak-age
of amniotic fluid.
• the barrier to infection is gone and an ascending infection is possible.
• *notify health care provider for evaluation*
False Labor - Answers A condition occurring during the latter weeks of some pregnancies in which
irregular uterine contractions are felt, but the cervix is not affected
True Labor - Answers Contractions occurring at regular intervals that increase in frequency, duration,
and intensity. These contractions bring about progressive cervical dilation and effacement.
Factors affecting the Labor Process - Answers Passageway (birth canal)
Passenger (fetus and placenta)
Powers (contractions)
Position (maternal)
Psychological Response
Five additional P's that affect the Labor Process - Answers Philosophy (low tech, high touch)
Partners (support caregivers)
Patience (natural timing)
Patient Preparation (childbirth knowledge base)
Pain management (comfort measures)
False Pelvis - Answers Outer aspect of pelvic bones
True Pelvis - Answers Inner space the fetus must progress through