Topic
What is the definition of labor?
When mom is in distress which side do you
turn her on?
What helps neural tube defects?
What are the feelings in each stage of
pregnancy?
How do you read an FHM?
What complications should mom report to
PCP?
Where is each station located?
Answer
Changes in the cervix
Left
Folic acid/ Folate
1st trimester – ambivalent
2nd trimester – introspection
3rd trimester – anxiety and increased
dreaming
Baseline (110-160 bpm)
Baseline FHR variability: absent, minimal (<5
bpm), moderate (6-25 bpm), marked (>25
bpm)
Late or variable decelerations?
Early decelerations: either present or absent
Accelerations: either present or absent
Pregnancy:
Severe and/or persistent vomiting
Fever, chills
Burning upon urination
Vaginal bleeding
Severe backache or abdominal pain
Severe epigastric pain
Continuous headaches
Visual disturbances
Decreased or unusual fetal movement
Postpartum:
Report oral temperatures of 100.4 and above
Report tachycardia and low blood pressures
Report high blood pressures
Report any signs of infection (c-section)
Report large bleeding and clots
-5 = 5 cm above ischial spines
-4 = 4 cm above ischial spines
-3 = 3 cm above ischial spines
-2 = 2 cm above ischial spines
-1 = 1 cm above ischial spines
0 = at the ischial spines
+1 = 1 cm below ischial spines
+2 = 2 cm below ischial spines
+3 = 3 cm below ischial spines
+4 = 4 cm below ischial spines (birth is very
close at this point)
+5 = 5 cm below ischial spines
What causes deceleration?
Variable = cord compression (reposition)
Early = head compression (normal)
Accels = baby is getting a great amount of O2
Late = Placental insufficiency
What is the positioning of baby when X marks ROA is fetal position when you can find HR in
the spot? HR?
RLQ
What is quickening?
Baby movement in utero
What is the time-period of quickening?
20 wks. for first-time moms. 16 wks.
otherwise
What is GTPAL?
G - gravidity (how many pregnancies)
T – term (births at or after 37w0d
P – preterm (births btw 20w0d & 36w6d
A – abortions or miscarriages up to 19w6d
L – living children
How do you estimate gestational age? What
1st day of last normal menstrual period
is Nagele's rule?
(LNMP) minus 3 months plus 7 days
Based on 28-day ovulatory cycle
What is a positive sign of pregnancy?
Visualization, Fetal heart tones, Fetal
movement
What do you do first when mom is in
distress?
What are the different fetal positions?
R (right) or L (left) side of maternal pelvis
Presenting Part: 
O – occiput (vertex)
M – mentum (chin
S – sacrum (breech)
Sc – scapula (shoulder)
Position:
A – anterior
P – posterior
T - transverse
OP (sunny side up) = back labor
Which position causes the longest labor?
Most pain?
What is the first thing to look at when the
FHR on monitor
membrane is ruptured?
What are postpartum interventions?
Avoid warm showers, report temp above
100.4
What are the s/s that proceed labor?
Lightening
Bloody show
Rupture of membranes
Cervical changes
What is a complication when using general
anesthesia?
What is considered normal vs. abnormal in
the 1st stage of labor?
What do you assess on a FHRM strip?
What to do r/t hyperstimulation with
contractions?
What is an epidural? Priorities?
Complications?
Surge of energy
Strong low back & sacroiliac pressure
Weight loss
Nausea and vomiting
Hypotension of mom and baby.
Persistent contractions, dilation, and
effacement allowing baby to move into the
birth canal
Early (latent) = Dilation 0-3; ctx mild-mod, 530 minutes apart, lasting 30-45 seconds
Active = Dilation 4-7; ctx mod-strong, 3-5
minutes apart, lasting 40-70 seconds
Transition = Dilation 8-10; ctx strong to very
strong, 2-3 minutes apart, lasting 45-90
seconds
Baseline (110-160 bpm)
Baseline FHR variability: absent, minimal (<5
bpm), moderate (6-25 bpm), marked (>25
bpm)
Late or variable decelerations?
Early decelerations: either present or absent
Accelerations: either present or absent
D/C any oxytocin if infusing
Reposition (lateral preferred)
Oxygen at 8-10 liters/min. by nonrebreather
mask
Increase IV rate
Correct any maternal hypotension (epidural)
Notify provider
Continue to monitor
Prepare for cesarean or operative assisted
birth if pattern is not corrected
Side effects/complications:
Hypotension
Local anesthetic toxicity
High or total spinal anesthesia
Fever
Urinary retention
Pruitis
Limited movement
Increased use of Pitocin, forceps, vacuum
What are the physiologic changes during
pregnancy?
What is the fundal height?
What are the different stages of labor and
their contraction times?
MONITOR FOR HYPOTENSION EVERY 3 MINS
– turn lateral and place wedge under hip,
increase IV fluids, admin O2, notify
anesthesia, admin vasopressor per protocol
(ephedrine or phenylephrine)
WBCs increase to 25,000 – 30,000
Glucose levels decrease
Decreased GI motility and absorption of solid
foods
Backache and joint aches occur as a result of
increased joint laxity at term
Leg cramps are common
Umbilicus at 20 weeks pregnant
By 1 week pp, fundus is half-way between the
umbilicus and the symphysis pubis
Not palpable after 2 weeks pp
Latent - Dilation 0-3; ctx mild-mod, 5-30
minutes apart, lasting 30-45 seconds
Active - Dilation 4-7; ctx mod-strong, 3-5
minutes apart, lasting 40-70 seconds
Transition - Dilation 8-10; ctx strong to very
strong, 2-3 minutes apart, lasting 45-90
seconds
What is the definition of labor?
Change in the cervix
What are the skin changes during pregnancy? Chloasma: Usually disappears at end of
pregnancy (large brown spots on the skin)
Striae: May fade but usually don’t disappear
(stretch marks)
Hyperpigmentation of areola & Linea nigra:
Partial regression or may remain after
pregnancy
Order?
Amenorrhea, Goodell’s sign, Quickening,
then Lightening
What is marfan syndrome?
Autosomal Dominant Disorder. Affects the
connective tissues in the body. Eye problems,
long arms and fingers, abnormal chest, heart,
and lung issues, a short torso, and long legs.
Who most commonly gets Turner’s
Females
Syndrome?
Who gets x linked recessive disorders and
Ricketts - a disorder in which the bones
what are they?
become painfully soft and bend easily, due to
What are ALL of the probable signs of
pregnancy?
What are interventions for a natural birth?
Know ALL pain management! SATA
What is a normal vs. abnormal FHR strip?
low levels of phosphate in the blood. Twice
as common in girls as in boys.
Rett Syndrome - a rare genetic neurological
disorder that occurs almost exclusively in girls
and leads to severe impairments, affecting
nearly every aspect of the child’s life: their
ability to speak, walk, eat, and even breathe
easily
Probable = positive pregnancy test, Goodell’s
sign, Hegar’s sign, Chadwick’s sign,
ballottement, and Braxton hicks
Effleurage
Touch
Massage
Movement
Counterpressure
Water therapy
Application/cold heat
Biofeedback
TENS
Breathing techniques
Accupressure
Acupuncture
Aromatherapy
Hypnosis
Imagery/Focal point
Reflexology
Baseline (110-160 bpm)
Brady or tachy is abnormal (tachy can be
caused by caffeine, cocaine, or
methamphetamines)
Baseline FHR variability: absent, minimal (<5
bpm), moderate (6-25 bpm), marked (>25
bpm)
Absent and minimal are abnormal
Late (Placental insufficiency) or variable (cord
compression) decelerations?
Both abnormal
Early decelerations: either present or absent
Occasional decels: Monitor
Recurrent: indicate repetitive disruption in
fetus’s oxygen supply
Accelerations: either present or absent
All accelerations are considered an indication
of fetal well-being, especially when related to
fetal movement. Their presence is highly
predictive of a normal fetal acid-base
balance.
What happens during different stations? +4?? 0-+4 means that baby is moving down the
pelvis. +5 means baby’s head is crowning
rd
Last from the birth of the baby until the
What is occurring during the 3 stage of
labor and what do you assess?
expulsion of the placenta
Which positioning of baby will be a c section
Transverse
no matter what?
What are the presenting parts of stations?
-5 = 5 cm above ischial spines
-4 = 4 cm above ischial spines
-3 = 3 cm above ischial spines
-2 = 2 cm above ischial spines
-1 = 1 cm above ischial spines
0 = at the ischial spines
+1 = 1 cm below ischial spines
+2 = 2 cm below ischial spines
+3 = 3 cm below ischial spines
+4 = 4 cm below ischial spines (birth is very
close at this point)
+5 = 5 cm below ischial spines
What foods are off limits during pregnancy?
Fish with high mercury content
Caffeine (> 200mg/day)
Artificial Sweeteners
Excessive sodium
Raw meat
What is the position of the fundus 12 hours
Above the umbilicus. If not or has deviated to
pp?
one side have mom pee first, bladder has big
effect on positioning.
All moms that are Rh – get the RhoGAM shot
What is RhoGAM? When does it happen?
at 26-28 weeks. After delivery, if baby was
Rh+, mom will get another RhoGAM shot
within 48 hrs. after delivery.
What is the pt. teaching after a c section?
Use sitz bath, squeeze bottle for cleansing,
What might be things the mom would ask or wipe perineum from front to back, change
say?
peri-pad with each void. Teach signs and
symptoms of infection and to call primary
care provider if they experience these
symptoms.
What should be assessed 2 hours post labor? BUBBLE HEAD!!
What are the medications for this unit?
What is the first line pain relief after an
episiotomy?
Breasts, uterus, bladder, bowel, lochia,
episiotomy, health promotion, educational
needs, affect, and discomfort
C/S specific – assess incision and breath
sounds
Narcan, Nubain, Stadol, Sublimaze, and Ultiva
Ice pack