EXAM 1 STUDY GUIDE
(Based on recordings in class)
Gestation- age in weeks into pregnancy
Trimester- segments (13 1/3 weeks)
Antepartum- time before birth up to true labor
Intrapartum- labor and birth
Postpartum- return to pre-pregnant state (about 6 weeks)
Term- 37-42 weeks gestation
Viability- ability of a fetus to live outside of the womb (20 weeks is the earliest to have chance to live)
Braxton hicks- false contractions around 18 weeks, to check if it is true labor check the cervix
Gravidity- # pregnancies
Para- # viable pregnancies (more than 20 weeks)
Gravida- pregnant or been pregnant
Nulligravida- never pregnant
Primigravida- pregnant or one child
Multigravida- pregnant two or more times
Pt determined to be in preterm labor- goal is to slow progression of labor before mom reaches 6cm -
give a tocolytic which will relax the uterus and slow down the contractions
- second class of meds given to pt determined to be in preterm labor is Glucocorticoid steroids - this
med is expected to increase fetal lung maturity/give lungs a boost - the hope is that this boost in lung
maturity will produce more surfactant to help baby breathe
Magnesium Sulfate
- Medication given to both prevent and manage seizures in pt that are diagnosed with preeclampsia
- watch for signs of mag toxicity (respiratory depression <12, decreased urine output, DTR, altered
LOC, labs over 9 is toxic
- keep calcium gluconate at the bedside! this is given as soon as you see s/s of mag toxicity
- expected outcome of giving calcium gluconate is to reduce signs of toxicity - respiratory function
should improve, urine output should improve, pt should become more alert and oriented, 9 and under
good level for labs
Hypocoagulation disorders - bleeding risk
- replace clotting factors
- you can give mom pitocin to help uterus effectively contract
Hypercoagulation disorders - increase clotting risk
- meds heparin, warfarin, coumadin
Meds that can be given to hypertensive pt that want to breastfeed - methyldopa and hydralazine
- these meds are safe to reduce risk of transfer through breast milk
Meds given to induce an elective abortion or terminate an ectopic pregnancy - methotrexate
- make sure you explain to the pt that this is a medication they will take to terminate pregnancy and
in time you will start to feel some cramping and may notice the passage of tissue type material, you
want to make sure the pt knows to come back to ensure the uterus is completely empty
- the importance of a completely empty uterus in postpartum is because any women who has any
gestational tissue remaining is at risk of hemorrhaging and infection
, Med given to Rh- pt to prevent isoimmunization from occurring - Rhogam
- needs to be given in 72hrs to prevent isoimmunization - if you wait beyond that it is too late and
mom will develop the antibodies which means every pregnancy moving forward if the fetus is Rh+ her
body will automatically attack
- we can help a mom carry a pregnancy if she has isoimmunization which is why we do the combs
test and if it comes back positive that means mom has developed the antibodies as a Rh- women
and we will start mom on steroids to suppress the immune system, these need to be started asap
and will continue until steroid no longer work and fetus shows signs of distress and then baby needs
to be delivered
Trends expected in insulin administration for the pregnant pt through the pregnancy
First trimester- need for insulin drops
Second trimester- need for insulin increases
By the time you get ready to deliver- insulin needed could be up to 4x the amount you normally take
Once you deliver- need for insulin immediately drops
Then make sure to ask if mom plans on breastfeeding - breastfeeding moms need less insulin
Most common side effect of an epidural
- maternal hypotension
What is a contraindication for a pitocin order
- hypertonic contractions, active herpes outbreak, macrosomia, placenta previa
- you would expect to give pitocin if pt is having hypotonic contractions
Priority action for a pt who has cord prolapse
- need to immediately prepare for emergency c-section
- get pressure off cord by repositioning or lift baby off cord yourself
Variable Deceleration - priority is to reposition
mm
What is noted if placenta has detached from uterine wall and is ready for delivery
- the uterus contracting and rising, the umbilical cord suddenly lengthening, and gush of blood
- if 30 minutes goes by and none of these happen then it could be placenta accreta
Station- the position of the baby's presenting part (typically the head) in relation to the ischial spines
of the mother's pelvis
• If the presenting part of the fetus is -2 station then that means it is 2cm above the ischial spine
• If the presenting part of the fetus is +2 station then that means it is 2cm below the ischial spine
• If the presenting part of the fetus is 0 station then that means the fetus is at the ischial spine
If a mother presents with shoulder dystocia, the medical team should immediately implement a series
of maneuvers to safely dislodge the baby's shoulder and facilitate delivery.
- McRoberts maneuver (elevating the mother's knees to her chest)
- Apply suprapubic pressure (pressure on the mother's abdomen above the pubic bone).
- Goal is to relieve the shoulder from behind the bone- if unsuccessful then you need a C-section
It is most important to assess this before the mom can start pushing when in labor
- dilation: mom should be 10cm dilated
- if mom has the urge to push and she is not 10cm then she needs to be repositioned this is called
the Ferguson reflex which is caused by pressure on the pelvic floor
- if you are deciding which client to see first in a scenario you need to see the client who is stating
(Based on recordings in class)
Gestation- age in weeks into pregnancy
Trimester- segments (13 1/3 weeks)
Antepartum- time before birth up to true labor
Intrapartum- labor and birth
Postpartum- return to pre-pregnant state (about 6 weeks)
Term- 37-42 weeks gestation
Viability- ability of a fetus to live outside of the womb (20 weeks is the earliest to have chance to live)
Braxton hicks- false contractions around 18 weeks, to check if it is true labor check the cervix
Gravidity- # pregnancies
Para- # viable pregnancies (more than 20 weeks)
Gravida- pregnant or been pregnant
Nulligravida- never pregnant
Primigravida- pregnant or one child
Multigravida- pregnant two or more times
Pt determined to be in preterm labor- goal is to slow progression of labor before mom reaches 6cm -
give a tocolytic which will relax the uterus and slow down the contractions
- second class of meds given to pt determined to be in preterm labor is Glucocorticoid steroids - this
med is expected to increase fetal lung maturity/give lungs a boost - the hope is that this boost in lung
maturity will produce more surfactant to help baby breathe
Magnesium Sulfate
- Medication given to both prevent and manage seizures in pt that are diagnosed with preeclampsia
- watch for signs of mag toxicity (respiratory depression <12, decreased urine output, DTR, altered
LOC, labs over 9 is toxic
- keep calcium gluconate at the bedside! this is given as soon as you see s/s of mag toxicity
- expected outcome of giving calcium gluconate is to reduce signs of toxicity - respiratory function
should improve, urine output should improve, pt should become more alert and oriented, 9 and under
good level for labs
Hypocoagulation disorders - bleeding risk
- replace clotting factors
- you can give mom pitocin to help uterus effectively contract
Hypercoagulation disorders - increase clotting risk
- meds heparin, warfarin, coumadin
Meds that can be given to hypertensive pt that want to breastfeed - methyldopa and hydralazine
- these meds are safe to reduce risk of transfer through breast milk
Meds given to induce an elective abortion or terminate an ectopic pregnancy - methotrexate
- make sure you explain to the pt that this is a medication they will take to terminate pregnancy and
in time you will start to feel some cramping and may notice the passage of tissue type material, you
want to make sure the pt knows to come back to ensure the uterus is completely empty
- the importance of a completely empty uterus in postpartum is because any women who has any
gestational tissue remaining is at risk of hemorrhaging and infection
, Med given to Rh- pt to prevent isoimmunization from occurring - Rhogam
- needs to be given in 72hrs to prevent isoimmunization - if you wait beyond that it is too late and
mom will develop the antibodies which means every pregnancy moving forward if the fetus is Rh+ her
body will automatically attack
- we can help a mom carry a pregnancy if she has isoimmunization which is why we do the combs
test and if it comes back positive that means mom has developed the antibodies as a Rh- women
and we will start mom on steroids to suppress the immune system, these need to be started asap
and will continue until steroid no longer work and fetus shows signs of distress and then baby needs
to be delivered
Trends expected in insulin administration for the pregnant pt through the pregnancy
First trimester- need for insulin drops
Second trimester- need for insulin increases
By the time you get ready to deliver- insulin needed could be up to 4x the amount you normally take
Once you deliver- need for insulin immediately drops
Then make sure to ask if mom plans on breastfeeding - breastfeeding moms need less insulin
Most common side effect of an epidural
- maternal hypotension
What is a contraindication for a pitocin order
- hypertonic contractions, active herpes outbreak, macrosomia, placenta previa
- you would expect to give pitocin if pt is having hypotonic contractions
Priority action for a pt who has cord prolapse
- need to immediately prepare for emergency c-section
- get pressure off cord by repositioning or lift baby off cord yourself
Variable Deceleration - priority is to reposition
mm
What is noted if placenta has detached from uterine wall and is ready for delivery
- the uterus contracting and rising, the umbilical cord suddenly lengthening, and gush of blood
- if 30 minutes goes by and none of these happen then it could be placenta accreta
Station- the position of the baby's presenting part (typically the head) in relation to the ischial spines
of the mother's pelvis
• If the presenting part of the fetus is -2 station then that means it is 2cm above the ischial spine
• If the presenting part of the fetus is +2 station then that means it is 2cm below the ischial spine
• If the presenting part of the fetus is 0 station then that means the fetus is at the ischial spine
If a mother presents with shoulder dystocia, the medical team should immediately implement a series
of maneuvers to safely dislodge the baby's shoulder and facilitate delivery.
- McRoberts maneuver (elevating the mother's knees to her chest)
- Apply suprapubic pressure (pressure on the mother's abdomen above the pubic bone).
- Goal is to relieve the shoulder from behind the bone- if unsuccessful then you need a C-section
It is most important to assess this before the mom can start pushing when in labor
- dilation: mom should be 10cm dilated
- if mom has the urge to push and she is not 10cm then she needs to be repositioned this is called
the Ferguson reflex which is caused by pressure on the pelvic floor
- if you are deciding which client to see first in a scenario you need to see the client who is stating
