week 4

Question 1

preterm labor and birth

Answer 1

• labor: cervical changes and uterine contractions occurring between 20-37 weeks
• birth: any birth that occurs before completion of 37 weeks pregnancy
• describes length of gestations, regardless of birth weight
• LBW: 2500g or less

Question 2

correlates of preterm labor and birth

Answer 2

• previous preterm delivery is greatest risk factor
• infections
• iatrogenic pregnancy complications
• sociodemographic factors: poverty, low educational level, lack of social support, smoking, little or no prenatal care, domestic violence, stress

Question 3

early recognition and diagnosis of preterm labor

Answer 3

• gestational age between 20-37 weeks
• uterine activity (contractions)
• progressive cervical change: effacement of 80%, cervical dilation of 2cm or greater

Question 4

suppression of uterine activity

Answer 4

Tocolytics

• beta mimetic medications
• side effects: tachycardia, risk of pulmonary edema, increased glucose levels
• used with caution

Question 5

promotion of fetal lung maturity

Answer 5

Antenatal glucocorticoids

• NIH recommends for all women at risk for preterm
• one regimen when PTB is anticipated/inevitable
• goal: steroids within one week of delivery
• no re-dosing
• not indicated it: cord prolapse, chorioamnioitis, abruptio placentae

Question 6

forceps-assisted birth

Answer 6

shorten second stage in event of dystocia
- compensate for deficient expulsive efforts
fetal indications
- certain abnormal presentations
- arrest of rotations
(look for lacerations, scrapes, possible Bell’s Palsy)

Question 7

vacuum-assisted birth

Answer 7

• attachment of vacuum cup to fetal head, using negative pressure to assist birth of head
• prerequisites: vertex presentation, ruptured membranes
• creates cephalohematoma

Question 8

labor-related problems

Answer 8

dystocia
- ineffective labor: requires augmentation or assistance to promote progress
- Pitocin
Precipitous (opposite of augmentation)
- less than 3 hours total
- “fast and furious”
- safety is key: increased risk of vaginal trauma and PP hemorrhage- very frightening for women

Question 9

cesarean birth

Answer 9

• transabdominal incision of uterus
• major abdominal surgery
  Primary vs. repeat
• elective repeat contributes MOST to the high c-section rate.

Question 10

indications for c-section

Answer 10

Planned
- fetal malpresentation (breech, shoulder, transverse, face)
- placental implantation (complete or partial previa)
- maternal indication (anatomic or medical)
Unplanned
- arrest of labor (not progressing)
- arrest of descent (head won’t fit)
- fetal compromise
- bleeding

Question 11

nurse responsibilities during c-section

Answer 11

• consent
• foley
• prep
• verification of FHR immediately prior
• COUNTS: circulating nurse
• IV; meds; SCDs
• care of infant: coordination with peds/NICU

Question 12

shoulder dystocia

Answer 12

• head is born, but anterior shoulder cannot pass under pubic arch
• McRobert’s Maneuver
• Newborn is more likely to experience birth injuries
• mother’s primary risk stems from excessive blood loss, lacerations, extension of episiotomy, or endometritis.

Question 13

shoulder dystocia: complications

Answer 13

Infant
- risk of brachial plexus injury
- risk of fractured clavicle
- newborn assessment of neuro/motor function of arm essential
Mother
- vaginal or perineal trauma: extended epis, lac, blood loss
- suprapubic/coccyx trauma

Question 14

prolapsed umbilical cord

Answer 14

when cord lies below presenting part of fetus
contributing factors include:
- long cord (longer than 100cm)
- Malpresentation (breech)
- transverse lie
- unengaged presenting part 
relieve pressure on the cord
prepare for emergency c-section
team effort