Complete Maternal Newborn ATI
Study Guide
First stage: initiating of ctxn to complete dilation & effacement
Latent: Little progress; focus, music
o Cervix 0–3 cm dilation, 0–40% effacement
o Contraction every 5-30 min, mild to moderate intensity, lasting 30–45
sec
Medicine can be given butrot.. & Nelbufine (SVE before meds) assess cervical
dilation, pain level and overall maternal and fetal well being before and after
administration
Eager, talkative, and relaxed
Active: 4-7 cm. Significant descent; moderate to strong uterine ctxn 40-70
sec
Rapid dilation and effacement
Some fetal descent
Feeling of helplessness
Anxiety and restlessness increase as ctxn become stronger
Treat mom for Group B streptococcus if positive during active
phase of labor with prophylactic antibiotics**
Exceptions are cesareans and if membranes are intact
***ATI
, o Sterile vaginal exam before giving pain medication.
o But if someone’s ruptured, ONLY if it’s indicated**
o If someone’s bleeding you can perform speculum, but not digital.
Transition: 8-10 cm. Peak intensity full dilation-10 cm complete effacement
and further descent
Feeling out of control, irritable, tired; feel “cannot continue”
Nausea & vomiting
o Ferguson’s reflux: urgency to push: Maternal urge to bear down.
Triggered by stretch receptors in the posterior vagina that release
endogenous oxytocin-gel
Increased rectal pressure & feeling of needing to have bowel
movement
o Nursing actions: assess FHR and UC’s every 15 min, encourage to
breath
Second stage: complete dilation ends with birth; intense ctxns every 1 to 2
minutes; assess VS, FHR, monitor well being; bear down and push during ctxn; rest
in btwn ctxn
Medical interventions: prepare for delivery, oxygen, stethoscope, Narcan,
wall suction working (80-100), warm baby bed provide reassurance while
mom pushes, perform episiotomy (cut) if needed, assist woman in the
birthing of her child. p213 Open glottis pushing is recommended & push
with contractions. Rest btwn.
Nursing actions: bear down, check FHR q 15 min or after each ctxn,
encourage rest, assist with support
Factors affecting delivery (5 Ps): size, position, & presentation of fetus; pelvic
adequacy, epidural anesthesia, ctxn, effectiveness of pushing
Third stage: Delivery of neonate to delivery of placenta:
schultze presentation: shiny fetal surface of placenta emerges first**
Duncan presentation: dull maternal “ “
Fourth stage:
Begins after delivery of placenta and is completed 4 hours later
This stage begins the postpartum period
Mechanism of homeostasis occurs
Medical intervention: repair the episiotomy or laceration, inspect
placenta, assess fundus for firmness. P. 212-213 (g = ml)
**Question about forceps & delivery and bleeding bright red blood, you
would have physician come back in to REPAIR FIRST (hematoma: look
behind back & btwn legs)
o FIGURE OUT SOURCE OF BLEEDING, don’t just check rely on VS,
and fix it (EXAM)
If you have uterus that feels like wet sponge, massage it, if it doesn’t work
add Pitocin.
Nursing actions: Explain procedure, assess lochia for color, amount, clots,
assess vs q 15, apply ice packs to perineum, monitor newborn
,Rupture of membranes “water broke”
MONITOR FETAL HEART RATE!!! to rule out umbilical cord
prolapse!
(any phase of labor)labor occurs within 24 hours of ROM
***immediately following ROM, a nurse should assess the FHR for abrupt
decelerations, which are indicative of fetal distress to rule out umbilical cord
prolapse*** ATI turn to side
Nitrate test:
deep blue = alkaline
yellow = acidic
Premature rupture of membranes caused by
Gonorrhea
Resting tone of uterine contractions:
Prolonged contraction duration (greater than 90 seconds)
Too frequent (6 or more ctxn within 10 minutes)
without sufficient time for uterine relaxation (rest less than 30 seconds) in
between
can reduce blood flow to the placenta.
This can result in fetal hypoxia and decreased FHR *****ATI
Postprocedure:
Massage fundus and locia q 15 minutes for the first hour
Massage the uterine fundus and or administer oxytocis as prescribed to
maintain uterine tone to prevent hemorrhage *****ATI
Mechanism of Labor: EXAM, FINAL & ATI (KNOW EXACT ORDER & what’s
going on) p.197
1. Engagement: when the greatest diameter of the fetal head passes through
the pelvic inlet; can occur late in pregnancy or early in labor (Early labor)
2. Descent: Movement of the fetus through the birth canal during the first and
second stages of labor (1st and 2nd stage of labor)
3. Flexion: chin of the fetus moves toward the fetal chest (Early labor)
4. Internal rotation: When the rotation of the fetal head aligns the long axis of
the fetal head with the long axis of the maternal pelvis (2nd stage)
5. Extension: Facilitated by resistance of the pelvic floor that causes the
presenting part to pivot beneath the pubic symphysis and head to be
delivered (2nd stage)
6. External rotation: sagittal sutures move to a transverse diameter.
Maintains alignment with fetal trunk as it navigates through the pelvis
7. Expulsion: shoulders and remainder of the body are delivered
Engagement, Descent, Flexion, Internal rotation, Extension, External
rotation, Expulsion
EVERY DARN FOOL IN EGYPT EATS RAW EGGS
, Erythromycin given to prevent: GC
Gonorrhea
Chlamydia
Everyone gets this including cesarean section.
Done WITHOUT consent!
Give within 1 hour
Vitamin K, also called Aqua-Mephyton
To prevent hemorrhage
Thick stuff!
Lack of clotting factors in baby’s sterile gut
Give within 2 hours of life --WTF
Hepatitis B shot for baby if mom’s not active for Hep
1st shot: hospital (at birth)
2nd shot: 1-2 months later
3rd shot: 6 months or later
Hepatitis active mom (positive):
Within 12 hours of delivery:
Vaccine on one leg
Immunoglobulin on other leg
Factors Affecting Labor (5Ps)
Powers (the contractions: to complete and push the baby out)
o Primary: hormones (physiologically directed)
o Secondary: pushing baby out: provide epidural
“labor down” let baby come down before we ask her to push so
we don’t fatigue mom out
Passageway (birth canal): pelvis, soft tissue, cervix, vagina.
o Cephalopelvic disproportion(CPD): mom would never be able to
deliver vaginally: baby will never drop in pelvic cavity
Study Guide
First stage: initiating of ctxn to complete dilation & effacement
Latent: Little progress; focus, music
o Cervix 0–3 cm dilation, 0–40% effacement
o Contraction every 5-30 min, mild to moderate intensity, lasting 30–45
sec
Medicine can be given butrot.. & Nelbufine (SVE before meds) assess cervical
dilation, pain level and overall maternal and fetal well being before and after
administration
Eager, talkative, and relaxed
Active: 4-7 cm. Significant descent; moderate to strong uterine ctxn 40-70
sec
Rapid dilation and effacement
Some fetal descent
Feeling of helplessness
Anxiety and restlessness increase as ctxn become stronger
Treat mom for Group B streptococcus if positive during active
phase of labor with prophylactic antibiotics**
Exceptions are cesareans and if membranes are intact
***ATI
, o Sterile vaginal exam before giving pain medication.
o But if someone’s ruptured, ONLY if it’s indicated**
o If someone’s bleeding you can perform speculum, but not digital.
Transition: 8-10 cm. Peak intensity full dilation-10 cm complete effacement
and further descent
Feeling out of control, irritable, tired; feel “cannot continue”
Nausea & vomiting
o Ferguson’s reflux: urgency to push: Maternal urge to bear down.
Triggered by stretch receptors in the posterior vagina that release
endogenous oxytocin-gel
Increased rectal pressure & feeling of needing to have bowel
movement
o Nursing actions: assess FHR and UC’s every 15 min, encourage to
breath
Second stage: complete dilation ends with birth; intense ctxns every 1 to 2
minutes; assess VS, FHR, monitor well being; bear down and push during ctxn; rest
in btwn ctxn
Medical interventions: prepare for delivery, oxygen, stethoscope, Narcan,
wall suction working (80-100), warm baby bed provide reassurance while
mom pushes, perform episiotomy (cut) if needed, assist woman in the
birthing of her child. p213 Open glottis pushing is recommended & push
with contractions. Rest btwn.
Nursing actions: bear down, check FHR q 15 min or after each ctxn,
encourage rest, assist with support
Factors affecting delivery (5 Ps): size, position, & presentation of fetus; pelvic
adequacy, epidural anesthesia, ctxn, effectiveness of pushing
Third stage: Delivery of neonate to delivery of placenta:
schultze presentation: shiny fetal surface of placenta emerges first**
Duncan presentation: dull maternal “ “
Fourth stage:
Begins after delivery of placenta and is completed 4 hours later
This stage begins the postpartum period
Mechanism of homeostasis occurs
Medical intervention: repair the episiotomy or laceration, inspect
placenta, assess fundus for firmness. P. 212-213 (g = ml)
**Question about forceps & delivery and bleeding bright red blood, you
would have physician come back in to REPAIR FIRST (hematoma: look
behind back & btwn legs)
o FIGURE OUT SOURCE OF BLEEDING, don’t just check rely on VS,
and fix it (EXAM)
If you have uterus that feels like wet sponge, massage it, if it doesn’t work
add Pitocin.
Nursing actions: Explain procedure, assess lochia for color, amount, clots,
assess vs q 15, apply ice packs to perineum, monitor newborn
,Rupture of membranes “water broke”
MONITOR FETAL HEART RATE!!! to rule out umbilical cord
prolapse!
(any phase of labor)labor occurs within 24 hours of ROM
***immediately following ROM, a nurse should assess the FHR for abrupt
decelerations, which are indicative of fetal distress to rule out umbilical cord
prolapse*** ATI turn to side
Nitrate test:
deep blue = alkaline
yellow = acidic
Premature rupture of membranes caused by
Gonorrhea
Resting tone of uterine contractions:
Prolonged contraction duration (greater than 90 seconds)
Too frequent (6 or more ctxn within 10 minutes)
without sufficient time for uterine relaxation (rest less than 30 seconds) in
between
can reduce blood flow to the placenta.
This can result in fetal hypoxia and decreased FHR *****ATI
Postprocedure:
Massage fundus and locia q 15 minutes for the first hour
Massage the uterine fundus and or administer oxytocis as prescribed to
maintain uterine tone to prevent hemorrhage *****ATI
Mechanism of Labor: EXAM, FINAL & ATI (KNOW EXACT ORDER & what’s
going on) p.197
1. Engagement: when the greatest diameter of the fetal head passes through
the pelvic inlet; can occur late in pregnancy or early in labor (Early labor)
2. Descent: Movement of the fetus through the birth canal during the first and
second stages of labor (1st and 2nd stage of labor)
3. Flexion: chin of the fetus moves toward the fetal chest (Early labor)
4. Internal rotation: When the rotation of the fetal head aligns the long axis of
the fetal head with the long axis of the maternal pelvis (2nd stage)
5. Extension: Facilitated by resistance of the pelvic floor that causes the
presenting part to pivot beneath the pubic symphysis and head to be
delivered (2nd stage)
6. External rotation: sagittal sutures move to a transverse diameter.
Maintains alignment with fetal trunk as it navigates through the pelvis
7. Expulsion: shoulders and remainder of the body are delivered
Engagement, Descent, Flexion, Internal rotation, Extension, External
rotation, Expulsion
EVERY DARN FOOL IN EGYPT EATS RAW EGGS
, Erythromycin given to prevent: GC
Gonorrhea
Chlamydia
Everyone gets this including cesarean section.
Done WITHOUT consent!
Give within 1 hour
Vitamin K, also called Aqua-Mephyton
To prevent hemorrhage
Thick stuff!
Lack of clotting factors in baby’s sterile gut
Give within 2 hours of life --WTF
Hepatitis B shot for baby if mom’s not active for Hep
1st shot: hospital (at birth)
2nd shot: 1-2 months later
3rd shot: 6 months or later
Hepatitis active mom (positive):
Within 12 hours of delivery:
Vaccine on one leg
Immunoglobulin on other leg
Factors Affecting Labor (5Ps)
Powers (the contractions: to complete and push the baby out)
o Primary: hormones (physiologically directed)
o Secondary: pushing baby out: provide epidural
“labor down” let baby come down before we ask her to push so
we don’t fatigue mom out
Passageway (birth canal): pelvis, soft tissue, cervix, vagina.
o Cephalopelvic disproportion(CPD): mom would never be able to
deliver vaginally: baby will never drop in pelvic cavity
