NUR 238 Topical Study Guide for Exam # 2
Fetal Monitoring
FHR Assessment, ie: late decelerations, early decelerations, variable decelerations, accelerations
variability, fetal tachycardia, fetal bradycardia
SEE PPTs / Play game
V Variability C Cord compression
E Early deceleration H Head compression
A Accelerations O OKAY!
L Late decelerations P Placental insufficiency
Normal FHR characteristics SEE PPT
Management of Preterm labor
Onset of cxs between 20-37 weeks gestation.
RISK FACTORS
o Low socioeconomic status
o 3 or more miscarriages or abortions
o Untreated vaginal or urinary tract infections
o Previous preterm labor or birth
o Multiple gestation
o Inadequate weight gain
o Smoking, alcohol, cocaine
o Heavy physical work
o High level of stress
S/S:
o TRUE cxs every 10 minutes or more often
o Menstrual-like cramps / backache / pelvic pressure
o Uterine tightening
o Increase in vaginal discharge/ROM
Prophylactic Azithromycin
Lung maturity 2:1 L/S ratio = compatible w/ life
o BETAMETHASONE given btw 24-34 weeks to stimulate surfactant production.
o 1 dose IM every 12 hrs for 24 hrs.
Txt: Monitor VS/Fetal mvmt, lie on L side, HYDRATE, keep bladder empty, TREAT INFECTION (if
applicable)
o may go home if monitoring no longer needed BED REST
MEDS (Tocolytic Therapy)
o Goal is to stop uterine contractions
o Keep fetus in utero until lungs are mature enough to adapt to extrauterine life
o Magnesium sulfate via IV / Terbutaline given orally or SQ / Nifedipine (Procardia) given orally
, Intrapartum care
Induction of labor:
Criteria
o Longitudinal lie
o Fetus is viable (>24 weeks)
o Cervix is ready “ripe” for birth (effaced & dilated)
o Presenting part is engaged
o No CPD (head not too big or baby >4000g)
o HOWEVER CAUTION IF:
Multiple gestation
Polyhydramnios
Grand parity
Previous uterine scars
Bishop score - >7 unsuccessful vaginal delivery
Prostaglandins:
o Cytotec (Misoprosol): mostly used to induce abortion in non-viable fetus but can be used to induce
labor – ORAL. Use Terbulaline if too rapid acting (also used to prevent pre-term labor).
o Cervadil: softens/dilates cervix & induces labor. Insert ‘ribbon’ into cervix and can be removed if
labor progresses too quickly.
Abrupt Rupture of Membranes (AROM) / amniotomy done via amnio hook
o Used to induce/speed up labor & dilation
o Done if internal fetal monitor to be used
o Higher risk of infection once membranes ruptured prophylactic Azithromycin
SLOW LABOR:
o HYPOTONIC CONTRACTIONS occurs during ACTIVE phase (painless)
CAUSES: Medication (Demerol) given too early; Bladder distention
TXT: Oxytocin
o ARREST of DESCENT – fetus doesn’t descend below 0 station or engage
TXT: Csection
o Prolonged LATENT Phase: labor > 20hrs fluids/anlagestion (relax uterus)/rest
o Prolonged ACTIVE Phase: 4-7cm dilation
CAUSES: Fetal malposition (brow) or Hypotonic cxs
MGMT: C-section or Oxytocin to augment labor
Fetal Monitoring
FHR Assessment, ie: late decelerations, early decelerations, variable decelerations, accelerations
variability, fetal tachycardia, fetal bradycardia
SEE PPTs / Play game
V Variability C Cord compression
E Early deceleration H Head compression
A Accelerations O OKAY!
L Late decelerations P Placental insufficiency
Normal FHR characteristics SEE PPT
Management of Preterm labor
Onset of cxs between 20-37 weeks gestation.
RISK FACTORS
o Low socioeconomic status
o 3 or more miscarriages or abortions
o Untreated vaginal or urinary tract infections
o Previous preterm labor or birth
o Multiple gestation
o Inadequate weight gain
o Smoking, alcohol, cocaine
o Heavy physical work
o High level of stress
S/S:
o TRUE cxs every 10 minutes or more often
o Menstrual-like cramps / backache / pelvic pressure
o Uterine tightening
o Increase in vaginal discharge/ROM
Prophylactic Azithromycin
Lung maturity 2:1 L/S ratio = compatible w/ life
o BETAMETHASONE given btw 24-34 weeks to stimulate surfactant production.
o 1 dose IM every 12 hrs for 24 hrs.
Txt: Monitor VS/Fetal mvmt, lie on L side, HYDRATE, keep bladder empty, TREAT INFECTION (if
applicable)
o may go home if monitoring no longer needed BED REST
MEDS (Tocolytic Therapy)
o Goal is to stop uterine contractions
o Keep fetus in utero until lungs are mature enough to adapt to extrauterine life
o Magnesium sulfate via IV / Terbutaline given orally or SQ / Nifedipine (Procardia) given orally
, Intrapartum care
Induction of labor:
Criteria
o Longitudinal lie
o Fetus is viable (>24 weeks)
o Cervix is ready “ripe” for birth (effaced & dilated)
o Presenting part is engaged
o No CPD (head not too big or baby >4000g)
o HOWEVER CAUTION IF:
Multiple gestation
Polyhydramnios
Grand parity
Previous uterine scars
Bishop score - >7 unsuccessful vaginal delivery
Prostaglandins:
o Cytotec (Misoprosol): mostly used to induce abortion in non-viable fetus but can be used to induce
labor – ORAL. Use Terbulaline if too rapid acting (also used to prevent pre-term labor).
o Cervadil: softens/dilates cervix & induces labor. Insert ‘ribbon’ into cervix and can be removed if
labor progresses too quickly.
Abrupt Rupture of Membranes (AROM) / amniotomy done via amnio hook
o Used to induce/speed up labor & dilation
o Done if internal fetal monitor to be used
o Higher risk of infection once membranes ruptured prophylactic Azithromycin
SLOW LABOR:
o HYPOTONIC CONTRACTIONS occurs during ACTIVE phase (painless)
CAUSES: Medication (Demerol) given too early; Bladder distention
TXT: Oxytocin
o ARREST of DESCENT – fetus doesn’t descend below 0 station or engage
TXT: Csection
o Prolonged LATENT Phase: labor > 20hrs fluids/anlagestion (relax uterus)/rest
o Prolonged ACTIVE Phase: 4-7cm dilation
CAUSES: Fetal malposition (brow) or Hypotonic cxs
MGMT: C-section or Oxytocin to augment labor
