Chapter 21

Question 1

risk factors for dystocia

Answer 1

epidural
analgesia/excessive analgesia
multiple gestation
hydramnios
maternal exhaustion
ineffective maternal pushing
occiput posterior pos
longer first stage
nulliparity
short femal stature
big baby
abnormal presentation
over 35 yo
overweight BMI
over 41 weeks

Question 2

precipitate labor

Answer 2

completed in less than 3 hours

Question 3

what can cause slow labor progress

Answer 3

CPD

Question 4

Maneuvers to relieve shoulder dystocia

Answer 4

McRoberst

suprapubic pressure

Question 5

preterm labor

Answer 5

regular uterine contractions accompanied by cervical effacement and dilation after start of 20th week before the end of 37th week of gestation

Question 6

symptoms of preterm labor

Answer 6

contractions
cramping
mucus plug release
bleeding
discomfort
backpain
uneasiness

Question 7

Interventions for preterm labor

3

Answer 7

risk prediction
tocolytic drugs (may prolong pregnancy for 2 to 7 days)
Antibiotic prophylaxis for GBS

Question 8

Mag sulfate

Answer 8

preterm labor:
relaxes uterine muscles
reduces infant CP risk

Question 9

INdomethacin

Answer 9

inhibits prostaglandins

Question 10

Nidfedipine

Answer 10

inhibits uterine contractions

Question 11

betamethasone adminstration

Answer 11

2 doses, IM, 24 hours apart

Question 12

Fetal fibronectin

Answer 12

normally present up to week 22 then 1-3 weeks before labor

If present in weeks 22-34 (>0.05) impending membrane rupture within 7-14 days

Question 13

Best strategy to improve outcomes of preterm labor

Answer 13

early detection

Question 14

other nursing mgmt re preterm labor

Answer 14

tocolytic admin
client edu
psychological support

Question 15

preterm labor prevention tips

Answer 15

avoid long trips
avoid lifting heavy objects
avoid hard work
mild to mod exercise
wait 18 months between pregnancies
treat periodontal disease
no sex until after 37 weeks

Question 16

what to do if exp preterm preg s/s

Answer 16

stop and rest 1 hour
empty bladder
lie down on side
drink 2-3 glasses of water
note hardness of contraction, call provider

Question 17

Prolonged pregnancy post-term labor risks

42 weeks

Answer 17

c/s
dystocia
birth trauma
post partum hem
macrosomia
shoulder dystocia
low apgar
CPD
meconium stained

Question 18

drugs for cervical ripening and labor induction

Answer 18

dinoprostone
misoprostol
oxytocin

Question 19

Bishop’s score

Answer 19

higher number - more inducible

lower than 6 - use cervical ripening measure

Question 20

What does sudden fetal bradycardia indicate?

Answer 20

uterine rupture

Question 21

amniotic fluid embolism

Answer 21

sudden onset maternal hypotension, hypoxia, coagulaopahty

Question 22

Post c/s instruction

Answer 22

splint incsion
apply heating pad to abdomen
ambulate often
avoid gas-forming foods
use anti-gas stool softeners

Question 23

contraindications for VBAC

Answer 23

classic uterine incision, prior transfundal uterine surgery (myomectomy), uterine scar other than low-transverse, contracted pelvis

Question 24

prolonged latent phase, stay at 2-3 cm

utereus never fully relaxes

Answer 24

hypertonic uterine dysfunction

Question 25

during active labor (more than 5-6 cm)

poor quality contractions

Answer 25

hypotonic uterine dysfunction

Question 26

arrest disorders

Answer 26

no dilation progress in over 2 hours

no fetal descent for 1 hour (primp) or 30 min (multip)