Induction of labor may be done if continuing the pregnancy is

It is not done if

more hazardous to the maternal and fetal health than the induction.

a maternal or fetal contraindication to labor

and vaginal birth exists.

Oxytocin-stimulated uterine contractions may be _______, decreasing _______?

External cephalic version is done to promote vaginal birth by

. Internal version sometimes is used to

changing the fetal presentation from a breech or transverse lie to

a cephalic presentation

change presentation of a second twin after the birth of the fi rst

Trauma to maternal and fetal tissue is the primary risk associated

with .

Possible trauma to the mother includes

Trauma to the infant may include

use of forceps and vacuum extraction

vaginal wall laceration and hematoma.

 ecchymoses, lacerations, abrasions,

facial nerve injury, and intracranial hemorrhage.

The median episiotomy is less painful but more likely to

extend

into the rectum than the mediolateral episiotomy.

The preferred uterine incision for cesarean birth is the

low transverse

incision

rupture in a subsequent pregnancy.

After childbirth the uterus returns to its nonpregnant size and

condition by  which involves .

involution,

contraction of stretched

muscle fi bers, catabolic processes that reduce enlarged muscle

cells, and regeneration of uterine epithelium

The site of placental attachment heals by a process of

exfoliation,

smooth and without scars.

Involution can be evaluated by measuring

 By about the ________  after childbirth

the fundus should be located in the pelvic cavity and should no

longer be palpable abdominally.

the descent of the

fundus (about 1 cm/day).

14th day

Afterpains, or intermittent uterine contractions, cause discomfort

for many women, particularly

■

Vaginal discharge (lochia) progresses from lochia rubra (mostly

blood) to lochia serosa (serous exudate, erythrocytes, and leukocytes)

to lochia alba (increased amounts of leukocytes and decidual

cells) in a predictable time frame. Lochia should be assessed

. Foul odor suggests

.

Although vaginal mucosa heals within 3 weeks, it takes

for volume, type, and odor

endometrial infection

Although vaginal mucosa heals within 3 weeks, it takes _______ for the vagina to regain its nonpregnant size and contour.

6 to

10 weeks

Hemorrhoids and perineal trauma, including edema, bruising,

episiotomy, and lacerations, can cause a great deal of discomfort

and interfere .

Cardiac output increases when blood from the uterus and placenta

returns to the

central circulation and extracellular fl uid

moves into the vascular compartment

Excess fl uid is excreted

by

Increased levels of clotting factors predispose the postpartum

woman to

Early, frequent ambulation

Constipation may occur as a result of

decreased food and fl uid

intake during labor, reduced activity, decreased muscle tone,

diminished bowel tone, and fear of pain during defecation

Increased bladder capacity and decreased sensitivity to fl uid

pressure may result in 

this allows what and leads to what

urinary retention.

time for bacteria to grow and can lead to urinary tract infection

A distended bladder lifts and displaces what, which does what

the uterus and can interfere

with uterine contraction and cause excessive bleeding

Exercises to strengthen the abdominal muscles and good

musculoskeletal

discomfort.

As hormone levels decline, the skin gradually

reverts to its nonpregnancy

state.

Breastfeeding may delay the return of ovulation and menstruation

but ovulation may occur before .

Breastfeeding mothers are more likely to experience dyspareunia

as a result of

vaginal dryness that results from inadequate

estrogen

Lactation may be suppressed by

wearing a sports bra and

avoiding stimulation of the breasts.

The postpartum woman should be afebrile, but her temperature

may be higher when and why

 during the fi rst 24 hours after delivery because of

dehydration and leukocytosis.

Tachycardia may be caused by .

Additional assessments (for example, lochia, fundus) are required to determine whether

excitement, pain, hypovolemia, infection, and dehydration

excessive bleeding is the cause.

Orthostatic hypotension occurs when the mother moves from a what to what

The postcesarean woman requires postoperative and postpartum

. She is at increased risk for problems

associated with

assessments and care

immobility and discomfort

Early discharge challenges nurses to streamline information and

teaching self-care and infant care in a short

time.

Spontaneous abortion is one of the leading causes of pregnancy

preventing complications, such as

hypovolemic shock and infection, and providing emotional support

for grieving.

The incidence of ectopic pregnancy is increasing in the United

States as a result of .

The goals of therapeutic management

are to prevent .

pelvic infl ammation associated with sexually

transmissible diseases

severe hemorrhage and to preserve the fallopian

tube so that future fertility is retained

Management of gestational trophoblastic disease (hydatidiform

■

 (1) evacuation of the molar pregnancy

and (2) continued follow-up for 1 year to detect malignant

changes in any remaining trophoblastic tissue.

Disorders of the placenta (placenta previa and abruptio placentae)

are responsible for .

hemorrhagic conditions of the last half of

pregnancy

Disseminated intravascular coagulation is a life-threatening complication

of

■

 missed abortion, abruptio placentae, and severe hypertension,

procoagulation and anticoagulation factors

are simultaneously activated.

The cause of hyperemesis gravidarum remains unclear, but the

goals of management are to

prevent dehydration, malnutrition,

excess weight loss, and electrolyte imbalance. Emotional support

is an important responsibility of nurses, in addition to

physical care.

Classifi cations of hypertension during pregnancy include .

preeclampsia,

eclampsia, gestational hypertension, chronic (preexisting

or persistent) hypertension, and preeclampsia superimposed

over existing chronic hypertension

The underlying process

is generalized vasospasm, which decreases

circulation to all organs

of the body, including the placenta. Major maternal organs

affected include the liver, kidneys, and brain.

Treatment of preeclampsia includes

reduced activity, reduction of

environmental stimuli, and administration of medications to prevent

generalized seizures.

Magnesium sulfate, used to prevent preeclampsia from progressing

to generalized eclamptic seizures, may have adverse

effects.

The most serious of these is Adverse effects such as _________________ are more likely to occur if the blood level of magnesium

rises over the therapeutic range.

central nervous system

depression, which includes depression of the respiratory center.

respiratory depression or absent deep

tendon refl exes

Nurses monitor the woman with preeclampsia to determine the

effectiveness of medical therapy and to identify signs that her

condition is worsening, such as

increasing hyperrefl exia. Nurses

also control external stimuli and initiate measures to protect her

in case of eclamptic seizures

Rh incompatibility can occur if an Rh-negative woman conceives

a child who is .

 As a result of exposure to the Rhpositive

antigen, maternal antibodies may develop that cause

Rh-positive

hemolysis of fetal Rh-positive red blood cells in subsequent

pregnancies.

Administration of Rh

o(D) immune globulin (RhoGAM) prevents

production of

 anti-Rh antibodies, thereby preventing destruction

of Rh-positive red blood cells in subsequent pregnancies

ABO incompatibility usually occurs when the mother has type O

blood and naturally occurring anti-A and anti-B antibodies, which

cause hemolysis if the fetus’s blood is not type O. ABO incompatibility

may result in

hyperbilirubinemia of the infant, but it usually

presents no serious threat to the health of the child.

The release of insulin accelerates during early pregnancy, which

may result in episodes of .

The availability

of glucose and insulin favors the development and storage of

maternal hypoglycemia

fat

that the mother will need later.

Placental hormones, which reach their peak during the second

and third trimesters, create resistance to insulin in maternal cells,

resulting in increased insulin needs throughout the rest of pregnancy.

resistance to insulin in maternal cells,

resulting in increased insulin needs throughout the rest of pregnancy.

Diabetes is classifi ed according to

and whether the woman requires the administration of

insulin to prevent .

Type 1 diabetes requires ____ for control.

onset (before or during pregnancy)

ketoacidosis

insulin

require both insulin and diet 

Type 1 diabetes adversely affects the mother in a variety of ways

during pregnancy,

 including increasing her risk of hypertension,

urinary tract infections, and ketosis.

Because maternal hyperglycemia during the fi rst trimester increases

the risk for _______ in the fetus,

a major

goal of management is to establish

congenital anomalies

normal blood glucose levels

before conception

Fetal growth depends on the condition of maternal blood vessels.

If no vascular impairment occurs, placental perfusion is

adequate and the infant is likely to be large if

If vascular impairment does

occur, placental perfusion may be reduced and the fetus may

maternal glucose

levels remain too high (macrosomia).

intrauterine growth restriction.

In addition to having an increased risk for congenital anomalies,

the infant of a mother with preexisting diabetes has an increased

risk for

hypoglycemia, hypocalcemia, hyperbilirubinemia, and

respiratory distress syndrome

Maternal adverse effects of gestational diabetes include

.

increased

urinary tract infections, hydramnios, premature rupture

of membranes, and the development of preeclampsia

Gestational diabetes increases the risk for

fetal macrosomia and

neonatal hypoglycemia

Gestational diabetes usually can be treated by

However, insulin may be required if blood glucose levels remain

diet and exercise.

high.

Cardiovascular changes occurring in normal pregnancy impose

an additional burden that may result in

cardiac decompensation

if the expectant mother has preexisting heart disease.

The primary goal of management of the pregnant woman with

heart disease is to

This may be done by .

prevent the development of congestive heart

failure.

restricting activity, limiting weight

gain, and preventing anemia and infection so that cardiac demand

does not exceed cardiac reserves

Intrapartum and postpartum management of heart disease focuses

on preventing .

fl uid overload, which can cause a sharp rise

in cardiac effort

Iron supplementation often is needed during pregnancy because

most women

 do not have suffi cient iron stores to meet the demands

of pregnancy with diet alone.

Folic acid defi ciency is associated with increased risk of 

Folic acid supplementation of ____ daily is recommended for all women of childbearing age

to reduce the risk for neural tube defects.

spontaneous

abortion, abruptio placentae, and fetal anomalies such as

neural tube defects.

400 mcg

(0.4 mg)

Sickle cell disease often is ______  by pregnancy,

and a primary

goal is to prevent sickle cell   _________ during pregnancy

worsened

 crisis

Laboratory values for thalassemia are similar to those of _______ . However, administration of iron is risky because increased

iron absorption and storage makes the woman susceptible to .

of iron deficiency

iron overload

Although the woman with systemic lupus erythematosus can

have a normal pregnancy and give birth to a normal newborn,

the pregnancy must be treated as high risk because of the increased

incidence of abortion, fetal death during the fi rst trimester,

and possible exacerbation of the disease.

Antiphospholipid syndrome is a cluster of clinical entities and is

associated with an increased risk for 

Preeclampsia has a higher incidence in the

woman with ________ .

thrombosis, fetal loss, and

decreased platelets.

antiphospholipid syndrome

Marked improvement in rheumatoid arthritis often occurs during

pregnancy, possibly as a result of  ______ . However, most women relapse soon after

childbirth

pregnancy-specifi c hormone

and hormonal factors

Management of epilepsy is complex because of the teratogenic

effects of anticonvulsant medications coupled with the importance

of _______. Changes in anticonvulsant therapy

that reduce the risks of adverse effects may be possible for the

woman who wants to become pregnant.

Management of epilepsy is complex because of the ________ of anticonvulsant medications coupled with the importance

of ______________. Changes in anticonvulsant therapy

that reduce the risks of adverse effects may be possible for the

woman who wants to become pregnant.

teratogenic effects

preventing seizures

Although Bell’s palsy usually is temporary, the woman may be

anxious.

what is essential?

Viral infections that occur during pregnancy can be transmitted

to the fetus in two ways: _____________

Although they may be mild or

even subclinical in the mother, viral infections can have serious

effects for the fetus.

across the placental barrier or by exposure

to organisms during birth

The health care team is responsible for teaching how infectious

diseases can be prevented and that early treatment also may

■

Human immunodefi ciency virus (HIV) is a retrovirus that gradually

allows a decline in the effectiveness of the maternal immunity,

often over many years in the treated woman. Maternal treatment

with ______  sometimes with other antiretroviral medications,

can substantially reduce infection of the fetus with HIV.

Specifi c pregnancy and postbirth treatment of nonviral infections

such as ________________ reduce long-term maternal and newborn complications.

toxoplasmosis, group B streptococcus infection,

and tuberculosis

Dysfunctional labor may occur because of abnormalities in the ______ ________  __________   _________

 Combinations

of abnormalities are common.

Nursing care in dysfunctional labor focuses on  ________ and _________ and action to correct additional complications

such as fetal hypoxia, infection, injury to the mother or fetus,

and postpartum hemorrhage

prevention or

prompt identifi cation

Premature rupture of the membranes is associated with  ____________

as both a cause and a complication.

The early indications of preterm labor are often __________

 Prompt

identifi cation of preterm labor enables the most effective therapy

to delay preterm birth.

vague

Nursing care for the woman at risk for a preterm birth before

34 weeks of gestation focuses on helping her delay birth long

enough to provide time for ___________ with ________ ,allow transfer to a facility that has neonatal intensive care,

or reach a gestation at which the infant’s problems with immaturity

are less.

The main risk in prolonged

The main risk in prolonged pregnancy is reduced ____________

This may compromise the fetus during labor and result in

________  in the neonate. Dysfunctional labor may

occur if a fetus continues ________ during the prolonged pregnancy.

placental function.

meconium aspiration

growing

The key intervention for umbilical cord prolapse is to _____

on the umbilical cord and to _____ delivery.

relieve pressure

expedite

Be aware of women at risk for uterine rupture, and observe for

signs and symptoms such as signs of shock, abdominal pain, a

sense of tearing, chest pain, pain between the scapulae, abnormal

fetal heart rate patterns, cessation of contractions, and palpation

of the fetus outside the uterus. However, lesser degrees

of uterine rupture or dehiscence may have ________ symptoms

Uterine inversion can be accompanied by massive blood loss

uterine contraction and

maintenance of adequate circulating volume.

Anaphylactoid syndrome (formerly amniotic fl uid embolism) is

more likely to occur when _____ and _____. The true causes of anaphylactoid syndrome are

not known, because it is uncommon.

 labor is intense and the membranes

have ruptured

The uterus is protected by the maternal pelvis during early pregnancy.

As the uterus enlarges and ascends out of the pelvis, it is

more vulnerable to trauma from direct impact. The fetus may be

injured by what 3 things.

disruption of the placenta, direct trauma, or either fetal

or maternal hemorrhage.

Medical and nursing care of the pregnant trauma victim focuses

on stabilization of the mother fi rst. Management of the fetus

depends on _________ and ________-.

 Abruptio

placentae and uterine rupture are obstetric complications

gestational age and whether the fetus is alive.

direct abdominal trauma.

■

Motor vehicle accidents are a major cause of _________ that may result in premature separation of the placenta, hemor-

rhage, fractures, and internal injuries. Penetrating injuries caused by knife or gunshot wounds are particularly dangerous for the fetus.

Postpartum hemorrhage sometimes can be anticipated and

prevented by careful examination of antepartum and intrapartum

factors that predispose to _________

Overstretching of the muscle fi bers during pregnancy and repeated

stretching during past pregnancies predispose to __________ and ____________ 

uterine

atony and excessive uterine bleeding

Initial management of uterine atony focuses on measures to ___________ and _________

Soft tissue trauma (lacerations, hematomas) can cause rapid

loss of blood even when the uterus is __________

Management of trauma of the reproductive tract involves locating

and repairing the trauma  ____________

Compensatory mechanisms maintain the blood pressure so that

vital organs receive___________. When these mechanisms

fail,  __________ follows.

 adequate oxygen

hypovolemic shock

The process of uterine involution may be delayed (subinvolution)

when ___________are retained or when the uterus is _____________

placental fragments

infected.

Subinvolution of the uterus develops after the mother ________. The nurse teaches the family the process of normal involution

and the signs and symptoms that should be reported to

the health care provider.

Venous stasis that occurs during pregnancy, increased levels of

coagulation factors, and decreased levels of thrombolytic factors

that persist into the postpartum period increase the risk of _______________

Treatment for deep venous thrombosis includes what 3 things .

anticoagulants,

analgesics, and bed rest with the affected leg elevated

Nurses who administer anticoagulant therapy assess the mother

to determine whether her laboratory tests are within the recommended _______ so it doesn't result in ____________ 

therapeutic range so that overmedication with anticoagulants

does not result in unexpected bleeding

Pulmonary embolism occurs when a clot is _________ or _______________, which may be completely or partially occluded

dislodged from the

vein,

or

amniotic fl uid debris is carried by the blood to a pulmonary

vessel

The risk of infection is increased with childbearing because there

is open access to bacteria from the vagina through the fallopian

tubes and into the peritoneal cavity._________ and ____________ further increase the risk of infection

Increased blood supply to

the pelvis and the alkalinization of the vagina by the amniotic fl uid

Any break in the skin or mucous membranes during childbirth

provides a portal of entry for pathogenic organisms and increases

the risk of ___________. Nurses must assess

women with an _________ or ____________for signs of localized wound

infections.

Urinary stasis

puerperal infection

incision or laceration

Urinary stasis and trauma to the urinary tract increase the risk of

____________. Nurses must initiate measures to prevent

_________.

urinary tract infection

urinary stasis

Nurses must provide information about the importance of completely

emptying the breasts at each feeding and about measures

to avoid nipple trauma to prevent _________.

Mood disorders include postpartum blues, postpartum depression,

and postpartum ___________.

Late preterm infants, born between 34 0/7 and 36 6/7 weeks,

are at risk for what 6 things.

respiratory, thermoregulation, and feeding problems

as well as hypoglycemia, hyperbilirubinemia, and sepsis.

Preterm infants differ in appearance from full-term infants. Some

differences include what 7 things

small size, limp posture, red skin, abundant

vernix and lanugo, and immature ears and genitals

The lungs of preterm infants may lack adequate surfactant,

noncompliant,

amount of energy necessary for breathing 

 atelectasis.

Other factors that may increase respiratory problems are what three things

poor

cough refl ex, narrow respiratory passages, and weak muscles

The prone position is used for preterm infants because it decreases _____________ and __________

Preterm infants are subject to cold stress because they have thin

skin with blood vessels ___________, little subcutaneous

white fat or brown fat, a large surface area, a ___________, and

an immature temperature control center

near the surface

limp position

Their kidneys do not

______ or __________ as well as those of full-term infants.

Intake and output must be carefully measured.

Preterm infants are subject to infections because they lack ________ from the mother, have an immature immune

system, have fragile skin, and are subjected to many invasive

procedures

passive

antibodies

Infants demonstrate that they are receiving too much stimulation

by changes in _________ and _________. The nurse should

schedule care to allow what three things

oxygenation and behavior

rest periods, keep noise to a minimum,

and teach parents how to interact with the infant appropriately.

Preterm infants lack nutrient stores and need more nutrients but

do not __________. They lack coordination in sucking and

swallowing and ___________ easily.

absorb them well

fatigue

Common complications of preterm birth are what 5 things

respiratory distress

syndrome, bronchopulmonary dysplasia, periventricular-intraventricular

hemorrhage, retinopathy of prematurity, and necrotizing

enterocolitis

Infants with postmaturity syndrome may appear thin with what three things.

They may have respiratory diffi culties at birth and suffer from whwat two things.

.

loose

skin folds, cracked and peeling skin, and meconium staining.

hypoglycemia and inadequate temperature regulation

Infants with intrauterine growth restriction may be small for gestational

age at birth. In symmetric growth restriction, _______________; in asymmetric growth restriction, the head

and length ____________.

the infant is

proportionately small

are normal and the body is thin

Large-for-gestational-age infants may have birth injuries such as

_____________ what three things as a result of their size. They

may have  what two things

fractures, nerve damage, or bruising

hypoglycemia or polycythemia

Asphyxia before or during birth may cause  what three things.

an

Asphyxia before or during birth may cause  what three things

 Neonatal resuscitation

apnea, acidosis, pulmonary

hypertension,

apnea, acidosis, pulmonary

hypertension, and possible death.

In transient tachypnea of the newborn, respiratory diffi culty in

infants is caused by__________________. It usually resolves spontaneously with supportive

care.

 failure of fetal lung fl uid to be absorbed

completely

In meconium aspiration syndrome, meconium in amniotic fl uid

enters the lungs before birth during gasping movements or is

drawn in during the fi rst breaths after birth, causing  what three things

obstruction,

air trapping, and infl ammation.

The nurse’s role in meconium aspiration is to notify caregivers

when meconium is discovered, prepare equipment, assist with

intubation if necessary, and observe ________________.

for further respiratory diffi -

culty, infection, and other problems

Nonphysiologic jaundice appears in the __________ of life;

bilirubin

levels rise faster and to higher levels than those found in

___________ . If untreated it may result in injury to the__________

fi rst 24 hours

physiologic jaundice

brain.

The nurse’s role in phototherapy is to decrease situations such

as cold stress or hypoglycemia that might further elevate ___________  ensure that lights are used properly, protect the eyes,

observe for excessive __________, ensure adequate

oral intake, and teach parents

bilirubin

levels,

fl uid loss or skin impairment

Infection in neonates is a problem because their immune system

is immature, infection spreads easily, and the _____________is less effective.

The infant of a diabetic mother (IDM) may have congenital

anomalies, .such as (6)

may be large (macrosomia) or small for gestational

age, and may suffer from respiratory distress syndrome, hypoglycemia,

hypocalcemia, and polycythemia

Nursing responsibilities in caring for the IDM include early identifi

cation and follow-up of complications, ____________  and ___________, and support

of parents

monitoring of blood

glucose levels,

and

ensuring early and adequate feedings

Infants with prenatal exposure to drugs may have behavioral and

feeding abnormalities. They may have diffi culty relating to others

and ___________

Nursing care for infants with neonatal abstinence syndrome includes __________________ (4)

decreasing stimuli from lights, noise, and handling; increasing

feeding abilities; and fostering the mother’s attachment

to and ability to care for her infant

____________ include left-to-right shunting defects,

defects with obstruction of blood outfl ow, defects with decreased

pulmonary blood fl ow, and cyanotic defects with increased

pulmonary blood fl ow.