Maternal Child Concept Guide 2
The exam will consist of 50 questions. Multiple Choice, Multiple Response, and Fill in the Blank.
Covering Modules 3, 4, & 5. You will have 75 minutes to complete the exam once you begin.
Stages of Labor
Stage 1 – LABOR (all of labor) is stage one; Labor has three phases- 1) early (LATENT) 0-3cm, 2) ACTIVE 4-
7cm- number one priority is pain management, 3) TRANSITION 8-10cm, nurse is checking dilation;
consistent contractions, dilation from 0-10cm. Purpose of contractions in first stage is to dilate and efface
the cervix
LATENT phase- dilate from 0-3cm cm, contractions 5-30min apart, contraction duration 15-30sec,
intensity of contraction mild
ACTIVE phase- dilation from 4-7cm, frequency 3-5min, last 30-60sec, intensity moderate
*If you learn the active phase, you will know that anything under is latent and anything over is transition. Easy way
to remember
TRANSITION phase- dilation from 8-10cm, frequency 2-3min, last 60-90 sec, intensity is strong
Contractions should not be longer than 90 secs or closer than every 2 mins.
Uterine hyperstimulation – contractions longer than 90sec closer than 2min
Patient admission- create prenatal record, birth plan, VS, SVE, urine, labs, FHT, IV, ambulation, position
Stage 2- Delivery of the baby - primip (1-2hr); multip (less than 1hr); delivery of fetus. Purpose of uterine
contractions in the second stage is to push the baby out.
Patient support- help her with pushing techniques, duration, position, FHT, birth, lacerations, episiotomy,
placenta care following delivery, cord gasses
Episiotomy- not recommended due to natural tearing having better outcome for healing
Baby is delivered in the following order (ideal delivery):
1st deliver the head
2nd Suction the mouth and nose (in that order)
3rd Check for nuchal cord (nuchal means neck- cord around the neck)
4th Deliver shoulders and body
5th Baby must have ID band on before leaving delivery area
Stage 3- Delivery of the placenta; 30 min. Purpose of uterine contractions in the third stage is to push
the placenta out.
Placenta must be delivered intact, want to see a firm fundus, changes in uterine shape, gush of dark
blood, feeling of fullness in the vagina (placenta might be sitting there)
Two things to know:
1st make sure it’s all there
2nd check for three vessel cord (2 Arteries, 1 vein – think AVA: 2 As, 1 V)
Stage 4- Recovery- lasts 2 hours then comes PP lasting for 6 weeks. Purpose of uterine contractions in
the fourth stage to stop bleeding (contract uterine)
Post-partum begins 2 hours after the placenta is delivered.
Four things to do 4 times an hour (every 15mins) in the 4 th stage:
1st Vital signs – assessing for s/s of shock; pressure go down, rates go up and look pale, cold, clammy
2nd Check the fundus- boggy (massage it); displaced (catheterize)
3rd Check the pads- how much pt is bleeding; if pad is saturated (100%) patient is in trouble
4th Roll patient over- check for bleeding underneath patient
, True vs False Labor
True Labor- onset of regular progressive contractions, increase intensity and frequency of UC’s, pain
increases, cervix – effaces or dilates, walking contractions are more painful
False Labor- Contractions -irregular UC’s, Pain comes and goes, cervix has no change in effacement or
dilation, walking contractions are less painful
Labor Progression
Station- presenting part in relation to ischial spine
0 = baby’s head is well descended into the pelvis, engagement. Presenting part is at the ischial part
-1, -2, -3 = baby’s head is not well descended
+1, +2, +3 = baby’s head is further down into the pelvis
+4 = crowning of the cervix baby is ready to deliver
*Positive number is positive news (baby is coming soon), negative numbers are negative news (baby is
high above pelvis may not be vag delivery)
Presentation
ROA or LOA – most common presentation
Fetal Assessment:
Non-invasive fetal monitoring- tocotransducer- device to monitor uterine contractions; u/s transducer to
monitor FHR
Invasive Internal fetal monitoring – used if ROM has happened already; if mom is obese and unable to
get FHR using noninvasive devices. Electrode is placed on fetal scalp and an intrauterine pressure
transduce is also inserted to measure contractions.
Vibroacustic Stimulation- Artificial larynx or fetal acoustic stimulation device. Vibroacoustic stimulation is
only used when fetal HR baseline is within normal limits
Digital Scalp Stimulation- SVE fetal scalp stimulation
Umbilical cord gasses- acid base determination (checked after baby is delivered to ensure baby was
getting enough oxygen)
Amnioinfusion- Therapeutic option used when recurrent variable decelerations are present due to
decreased amniotic fluid (Normal saline or lactated ringers infused vie IUPC)
Fetal Heart Rate- All bad fetal heart tracing begins with L treat following LION, if it doesn’t start with L,
it’s ok, but if it’s Variable- its very bad
Low fetal heart rate (FHR under 110) this is bad, intervene with LION (Left side, IV, Oxygen, notify), if
Pitocin is running- stop pit.
High fetal heart rate (FHR over 160) no big deal, document and take moms temperature (possibly due to
mom having a fever- not a big deal, not high priority)
Variability
The exam will consist of 50 questions. Multiple Choice, Multiple Response, and Fill in the Blank.
Covering Modules 3, 4, & 5. You will have 75 minutes to complete the exam once you begin.
Stages of Labor
Stage 1 – LABOR (all of labor) is stage one; Labor has three phases- 1) early (LATENT) 0-3cm, 2) ACTIVE 4-
7cm- number one priority is pain management, 3) TRANSITION 8-10cm, nurse is checking dilation;
consistent contractions, dilation from 0-10cm. Purpose of contractions in first stage is to dilate and efface
the cervix
LATENT phase- dilate from 0-3cm cm, contractions 5-30min apart, contraction duration 15-30sec,
intensity of contraction mild
ACTIVE phase- dilation from 4-7cm, frequency 3-5min, last 30-60sec, intensity moderate
*If you learn the active phase, you will know that anything under is latent and anything over is transition. Easy way
to remember
TRANSITION phase- dilation from 8-10cm, frequency 2-3min, last 60-90 sec, intensity is strong
Contractions should not be longer than 90 secs or closer than every 2 mins.
Uterine hyperstimulation – contractions longer than 90sec closer than 2min
Patient admission- create prenatal record, birth plan, VS, SVE, urine, labs, FHT, IV, ambulation, position
Stage 2- Delivery of the baby - primip (1-2hr); multip (less than 1hr); delivery of fetus. Purpose of uterine
contractions in the second stage is to push the baby out.
Patient support- help her with pushing techniques, duration, position, FHT, birth, lacerations, episiotomy,
placenta care following delivery, cord gasses
Episiotomy- not recommended due to natural tearing having better outcome for healing
Baby is delivered in the following order (ideal delivery):
1st deliver the head
2nd Suction the mouth and nose (in that order)
3rd Check for nuchal cord (nuchal means neck- cord around the neck)
4th Deliver shoulders and body
5th Baby must have ID band on before leaving delivery area
Stage 3- Delivery of the placenta; 30 min. Purpose of uterine contractions in the third stage is to push
the placenta out.
Placenta must be delivered intact, want to see a firm fundus, changes in uterine shape, gush of dark
blood, feeling of fullness in the vagina (placenta might be sitting there)
Two things to know:
1st make sure it’s all there
2nd check for three vessel cord (2 Arteries, 1 vein – think AVA: 2 As, 1 V)
Stage 4- Recovery- lasts 2 hours then comes PP lasting for 6 weeks. Purpose of uterine contractions in
the fourth stage to stop bleeding (contract uterine)
Post-partum begins 2 hours after the placenta is delivered.
Four things to do 4 times an hour (every 15mins) in the 4 th stage:
1st Vital signs – assessing for s/s of shock; pressure go down, rates go up and look pale, cold, clammy
2nd Check the fundus- boggy (massage it); displaced (catheterize)
3rd Check the pads- how much pt is bleeding; if pad is saturated (100%) patient is in trouble
4th Roll patient over- check for bleeding underneath patient
, True vs False Labor
True Labor- onset of regular progressive contractions, increase intensity and frequency of UC’s, pain
increases, cervix – effaces or dilates, walking contractions are more painful
False Labor- Contractions -irregular UC’s, Pain comes and goes, cervix has no change in effacement or
dilation, walking contractions are less painful
Labor Progression
Station- presenting part in relation to ischial spine
0 = baby’s head is well descended into the pelvis, engagement. Presenting part is at the ischial part
-1, -2, -3 = baby’s head is not well descended
+1, +2, +3 = baby’s head is further down into the pelvis
+4 = crowning of the cervix baby is ready to deliver
*Positive number is positive news (baby is coming soon), negative numbers are negative news (baby is
high above pelvis may not be vag delivery)
Presentation
ROA or LOA – most common presentation
Fetal Assessment:
Non-invasive fetal monitoring- tocotransducer- device to monitor uterine contractions; u/s transducer to
monitor FHR
Invasive Internal fetal monitoring – used if ROM has happened already; if mom is obese and unable to
get FHR using noninvasive devices. Electrode is placed on fetal scalp and an intrauterine pressure
transduce is also inserted to measure contractions.
Vibroacustic Stimulation- Artificial larynx or fetal acoustic stimulation device. Vibroacoustic stimulation is
only used when fetal HR baseline is within normal limits
Digital Scalp Stimulation- SVE fetal scalp stimulation
Umbilical cord gasses- acid base determination (checked after baby is delivered to ensure baby was
getting enough oxygen)
Amnioinfusion- Therapeutic option used when recurrent variable decelerations are present due to
decreased amniotic fluid (Normal saline or lactated ringers infused vie IUPC)
Fetal Heart Rate- All bad fetal heart tracing begins with L treat following LION, if it doesn’t start with L,
it’s ok, but if it’s Variable- its very bad
Low fetal heart rate (FHR under 110) this is bad, intervene with LION (Left side, IV, Oxygen, notify), if
Pitocin is running- stop pit.
High fetal heart rate (FHR over 160) no big deal, document and take moms temperature (possibly due to
mom having a fever- not a big deal, not high priority)
Variability
