The mother may have manic or depressive episodes. She may suffer from confusion or disorientation, agitation, mood swings, and fear. She may refuse to eat. Onset is rapid, typically within the first week postpartum but rarely before the third day although symptoms may not appear for up to three months.

Dysuria, urgency, and frequency. Overabundance of bacteria.

*perform a clean catch*

Profuse bleeding from 24hrs.-6 weeks.

*commonly between 1-2 weeks*

Bleeding that soaks one sanitary pad in an hour, bleeding is bright red, and blood clots are larger than a golf ball.

infants whose mothers are extremely ill immediately after birth, infants who are premature or of very low birth weight, infants with hypoglycemia that does not improve with breastfeeding, infants with dehydration or inborn errors of metabolism, infants whose mothers are taking medication that is passed through breastmilk and is harmful to the infant

retained remnants of the placenta or membranes in the uterus or a uterus that does not contract sufficiently due to infection or other conditions.

Treatment

includes oxytocic medications, removal of

any placental or membrane fragments,

rest, hydration, and a blood transfusion if

needed.

during prolonged rupture of the  membranes or when many vaginal exams are performed during labor when aseptic technique is not scrupulously followed during or after extensive tissue

 damage during intrauterine manipulation with previous untreated disease

or infection of the reproductive tract with hemorrhage, retention of placental fragments, or poor perineal care

Excessive tissue trauma, tearing, or

suturing occurred.

general malaise, pain, elevated temperature, and lochia with a foul odor. Endometritis, in particular, typically presents with a fever of up to 104 degrees F, chills, tachycardia, pelvic pain during bimanual exam, lateral

uterine tenderness, elevation of the white blood count, and subinvolution.

What is one reason why the tone and position of the cervix may not have returned to normal at 6 weeks?

salpingitis, peritonitis, septic thrombophlebitis, and necrotizing fasciitis may result.

Lochia serosa is more pink than red. It persist for how many days and transitions into what?

 It persists for seven to eight days and transitions to lochia alba, which is a light pink, yellow or white color.

Sudden recurrence of bright red vaginal bleeding p.p. is abnormal and must be assessed. It may be caused by the following.

Uterus: for any continuing enlargement Cervix: for firmness and position, perform Pap smear, Internal muscle tone: exercises

must be continued if tone has not returned, Lacerations or episiotomy: for healing, Abdominal muscle tone: check for gaping at the juncture of the abdominal muscles from umbilicus to pubis, Breasts: tenderness or lumps, Hemoglobin and hematocrit: In

case of exhaustion or if hemorrhage occurred during birth, Diet, Adjustment to parenting 
 

Cord stump: cord clamp removal or removal of cord plus placenta in a lotus birth, Skin for jaundice, Dehydration, Behavior, feeding, crying, Mother’s relationship to breastfeeding: make certain

the baby is not being placed on a schedule, Sleeping arrangements: cosleeping or sleeping in separate bed but in the same room

Breasts: engorgement, cracked nipples, Uterus, perinreum: lochia, color, odor, vol. uterinie: enlargement, tenderness,perineal cystocele or rectocele. Temperature

mother reports sensations of pressure in her vagina,extreme fatigue, continued bleeding, or exhaustion

The mother places her thumb on top of the

breast to be expressed where the areola

and the breast tissue meet. The forefinger

is placed on top in the same position. The

fingers draw the areola back into the

chest wall while gently compressing the

nipple between them

Characteristics-square window, arm recoil, popliteal, scarf, heel to toe,Observations-lanugo on the bk., cartilage in the pinna of the ear, breast tissue and nipples, creases on the bottom of the feet

The gestational age assessment is applied by using it to

 categorize the newborn, (<38wks), (38-42 wks), (>42 wks.)

The breast may feel warm or hot, it may have a shiny

appearance, and it will feel tight and hard to the touch. Engorgement typically occurs when feedings are not given often enough.

Breastfeeding until the baby is full and the breast is empty, ice, warm compresses, or manual expression so the baby can latch, Arnica, Bryonia, Phytolacca, and Belladonna. Echinacea is thought the help prevent the

 progression of engorgement to mastitis. Comfrey leaf compresses or raw cabbage leaves on the breasts also help relieve engorgement.

the infant begins with a wide open mouth and latches on with an asymmetrical latch. The areola is drawn

into the lower portion of the mouth

pain and discomfort will result. Eventually, the nipples will crack and possibly bleed, leading to the inability

to breastfeed until the nipples heal. If this occurs before breastfeeding is wellestablished, the mother’s intentions to continue to breastfeed may fade especially if she lacks a support and education network to encourage her to continue and to educate and assist her in attaining proper positioning.

It is a fallacy that dehydration, poor nutrition, and lack of rest in the mother will decrease milk production unless she is profoundly malnourished. T/F?

 Is it important for the mother to maintain her health by

 eating properly, drinking as needed, and obtaining sufficient rest as much as possible? T/F?

 A sitz bath consisting of comfrey leaf, Yarrow, Rosemary,

Golden Seal, Oak bark, Witch hazel, Sea salt, Grape bark,and Myrrh, are helpful for:

Aloe vera, fresh or gel, and vitamin E are both helpful for

healing as is Slippery Elm bark.

If the uterus is fully contracted, there will be no increased lochial flow during massage? T/F?

If the uterus is relaxed and boggy, the lochial flow will increase, sometimes significantly.T/F?

The mother should be taught to perform light uterine massage and to check her lochia regularly for the first 24 to 48 hours after birth. T/F?

When a steady flow or trickle of bright red blood from the vagina is observed, or if there was rapid labor, cervical manipulation during labor, pushing before dilation was

complete, or a traumatic or instrument delivery.

The lower vagina, periurethral areas, and the perineum are assessed for lacerations and torn blood vessels, including determination of the need to repair; bruising; and hematoma. Episiotomies are assessed for depth and

extensions. The perianal area is assessed for hemorrhoids and skin tears.

decreasing blood pressure, rapid pulse and respirations, and cold, clammy skin

Fundal massage is generally the first response to uterine atony.

Lifting the uterus through the abdominal wall and squeezing it between both hands.

Place one hand inside the vagina, palmar surface up and fisted. The other hand is pushed deeply into the

abdomen and behind the uterus. The uterus is then compressed between the external hand and the internal fist. This compresses internal uterine vessels and

causes the uterus to contract.

What degree of laceration involves the vaginal mucosa, posterior fourchette, and perineal skin?

What degree of tear involves the following tissue:

vagina, mucosa,posterior fourchette, perineal skin and perineal muscles

What degree of tear involves the following tissue:

 vaginal mucosa, posterior fourchette, perineal skin, perineal muscles, and external anal sphincter?

vaginal mucosa, posterior fourchette, perineal skin, perineal muscles, external anal sphincter, and anterior rectal wall

  Vaginal abrasions, some perineal lacerations, or minor tears of the bulbocavernosus wall need repair. T/F?

Uterine assessment by abdominal palpation revealS the uterus above and, typically, to the right of the umbilicus, when the following has occurred.

Catheterization should not be the first

choice due to the following reasons.

The mother should be encouraged to urinate. If she is unable to do so after repeated attempts, what should be done?

The bladder may develop hypotonicity which leads to the loss of the urge to urinate.

Preventing the uterus from contracting and increased bleeding. It is also a risk for bladder infection.

To ensure no clots, retained placental fragments, or membranes are left in the uterus which may be inhibiting

the complete contraction of the uterus or causing bleeding.

A gauze pad is wrapped around the forefinger of a gloved hand. Betadine is poured over the gloved hand and guaze.This hand is placed entirely inside the uterus. The back of the hand is placed against the uterine wall. The other hand is placed on the abdomen at the same area

as the internal hand. The uterus is swept and anything on the gauze pad is identified

Oxytocin and/or Methergine are administered to promote uterine contractions. Herbal remedies such as Shepherd’s Purse and blue Cohosh may also be used. In some cases, the mother can stop the bleeding by focusing on the

problem, tightening the uterus and taking control of her body.

Most immediate postpartum hemorrhages are caused by:

incomplete delivery of the placenta or uterine atony which may be due to an overdistended uterus,

oxytocin induction or augmentation uterine relaxing medications,

grand multiparity, rapid labor and delivery, history of uterine atony or postpartum hemorrhage,

prolonged first or second stage labor

cervical lacerations, extensive vaginal or perineal lacerations, and laceration of the lower uterus/uterine rupture, which is rare.

If a client has two or more risk factors for uterine atony, the birth should be in a hospital.T/F?

The umbilical cord: There should be three cord vessels, two arteries and a vein. The presence of only two vessels may indicate a non-visible fetal anomaly. It should also

be inspected for knots, tumors, cysts, edema and hematomas. The volume of Wharton’s jelly should also be noted along with the location of cord insertion

(eccentric, marginal, or central)

The membranes are inspected for completeness and

succenturiate lobes, blood vessels, or defects.

The placenta is observed for meconium staining and

calcifications. The fetal side is observed for cysts, a determination of extrachorial placenta, and missing or intact succenturiate lobe. The maternal side is observed for infarcts and intactness such as missing colydon.

The placenta is often weighed and the umbilical cord measured, in the following situation:

 especially if they are abnormally small or large.

A quick, firm massage will facilitate the expulsion of any remaining clots.

 If the uterus continues to feel soft or asymmetrical, or

 if excess bleeding is occurring, what should be done?

firm massage, nipple stimulation (especially breastfeeding) and/or administration of Shepherd’s Purseand blue Cohosh tinctures can facilitate further

contractions. The mother’s bladder should be checked for distention as this can also keep the uterus from full

contraction.

A slow trickle bleed may also be caused by retained placental fragments.T/F?

inspection of the placenta for completeness

Neither massage nor pitocin will help in this case. When dealing with a trickle bleed.

used to facilitate uterine contractions for placental delivery “like an angel”. A few drops are placed under the mother’s tongue. It may also be used for partial

placental separation and to ensure complete delivery

Shepherd’s Purse is given after placental delivery to facilitate clotting so it is important the placenta be

completely delivered prior to administration (along with Blue Cohosh) to cause uterine contractions to expel

excess clots and reduce bleeding.

The administration of raspberry leaf infusion during labor is helpful for ensuring uterine contractual efficiency. T/F?

Glechoma hederacea

, or Ground Ivy Herb, administered as a tincture.

 A placenta that delivers with the meaty maternal side presenting.

The placenta that presents the fetal side with shiny membranes upon delivery. This occurs when the placenta begins separation in the center.

 _______  _________ separates along the edges and is often found in placentas that implanted low in the uterus. 

bleeding, increased visible umbilical cord length,

changed uterine shape, and allowing the uterus to rise in the abdomen through uterine displacement. The uterus

becomes globular. Mom feels the placenta or the urge to push. 

The uterus is held in place with the edge of a hand pressing inward and upward just above the pubic bone.

Traction is gently applied to the cord first downward then outward as in the birth of the infant. The mother should push while this it performed. The membranes may not follow immediately and may need to be teased out. When the mother delivers in a squat this is rarely an issue. The placenta should be gently delivered a

short distance into a container otherwise any adherent membranes may tear and separate.

bluish discoloration of not only the oral mucous membranes, but the lips, tongue, and trunk

 Cyanosis is a sign of _______ _______ or compromise.

Cyanosis, along with grunting, nasal flaring, and retractions of the intercostal muscles, are all indicators of ___________   ____________.

Cyanosis, along with _______, ______ _______, and retractions of the intercostal muscles, are all indicators of respiratory compromise.

What does grunting typically indicate?

 Once an airway has been established, give the newborn a few breaths by way of a _______ _______ or

 ___________  ___________ __________.

Once spontaneous respiration is in evidence, what can be done?

If spontaneous respiration does not commence, what needs to be done?

PPV using 5 to 10 L/min of oxygen at the rate

of 40 to 60 respirations per minute through a rescusitation bag and mask should be performed. PPV should pause every 30 seconds to check for spontaneous respiration.

Clear airway by holding the infant so the head is below

the body, wipe the face and head, and clean fluid from the nose and mouth. Suction the nasal and oral cavities. Keep the infant warm, preferably on the mother’s abdomen with a cap placed on its head and covered with a blanket.

Assign the 1 minute APGAR score.

Place the hands on the fetal chest and back as in a typical rotation procedure but the fetus is rotated 180 degrees one direction, then 180 degrees the opposite direction until the baby is “screwed out”.The fetus

should be rotated so the back is rotated anteriorly.

*Three to four complete rotations should be attempted before abandoning this maneuver.*

To fracture the fetal clavicle or use the Zavanelli maneuver.

You place your entire hand into the vagina and follow the fetal arm to the elbow and forearm. Flex the arm by

pressing the antecubital space and bringing it across the fetal abdomen and chest in the normal range of motion until the hand can be grasped and the arm delivered. It is performed after McRoberts has failed.

Do not hook the fingers into the axilla or armpit.

Delivery is completed using McRobert’s maneuver, suprapubic pressure, and downward and outward pressure on the fetal head.

The fetus can be rotated 180 degrees in the corkscrew maneuver and delivery is attempted again.

If the fetus assumes direct mentum posterior position during rotation (face presentation), describe how to deliver.

Notify the consulting physician. To deliver the head, apply pressure to the brow until the chin is born. Once the chin

and the rest of the head are born, complete the delivery normally.

Unless transitory prior to face presentation, will cause the

largest diametrical portion of the head to present which is nearly always too large for the pelvic outlet.

1.Activate EMS, 2.explain to mom, 3.place mom in McRobert's or Gaskin, 4.fetal shoulders are rotated into the oblique angle (

One hand is placed on one side ofthe fetal chest, the other behind the opposite shoulder blade; as much force as necessary is used to rotate the body), 4. apply suprapubic presssure(

press downward and outward on the side of the head)

catheteriize, determine the need for an episiotomy, and perform avaginal exam for short cord, enlarged fetal thorax or abdomen. The baby is then delivered on a renewed attempt from McRobert’s maneuver.

When a cord prolapse occurs:

 You place your entire hand into the vagina to hold the presenting part off the cord at the pelvic inlet, The cord MUST NOT be replaced This may cause cord spasm or further compression,

Summon assistance, inform the mother and secure her cooperation, Send STAT notification to the consulting physician, Have other helpers place the mother in Trendelenberg or knee chest to keep the fetus off the pelvic inlet, Wrap any cord protruding through the vagina in gauze soaked with warm saline

 *emergency caesarian section is performed*

Frank cord prolapse: the cord has protruded through the cervix.

Occult cord prolapse: the cord lays aside the presenting part but does not protrude through the cervix.

Umbilical cord prolapse is at high risk when:

Occasionally the midwife will be asked to see a mother who has “something coming out between her legs”. List the possibilities.

cord, a mucus plug, or a prolapsed foot or arm

If unchanged notify the consulting physician.

A crease will develop just above and parallel to the pubic bone, extending completely across the lower abdomen when dilation is complete.

A dark red line will be seen to extend up towards and between the buttocks. When it reaches the sacrococcygeal joint, dilation is complete.

The fetus is likely passing through the spines if the head is no longer palpable above the pubic bone or if the shoulders seem to be rotating upon palpation.

Any nonreassuring fetal heart tone that cannot be attributed to narcotic administration or fails to resolve with inutero rescusitation efforts, needs to be:?

Stage two labor is usually signaled by an intense

 desire to ____, meaning that the fetal head has descended to the ______  _____.

Delivery is approaching when rectal bulging, perineal bulging, and progressive visibility of the ____ _____at the _______ _______ are observed. The mother may express the desire to ____ ____ _____.

In a situation where the fetusis crashing and must be birthed quickly to be resuscitated, you must have the

mother push to help speed delivery. Episiotomy

Cimicifuga 200C reduces intensity and establishes an

effective rhythm. Caulophyllum 200C encourages regular contractions. Pulsatilla 200C helps inconsistent early

labor and emotional tensions.

Sepia 200C reduces the mother’s fears of the intensity of

contractions.

Gelsimium 200C administration facilitates cervical dilation and effacement

Arnica 200C will prevent cervical swelling. If there is a strong urge to push at 6 or 7 cm dilation, Sepia and

Arnica administered together with repeated administration of Sepia every 10 to 15 minutes reduces swelling and

inhibits tension.

China, Carbo Veg, or Ustilago plus an

enema of warm water and honey, or some royal jelly taken orally. Essence of Chicken may also help.

What homeopathic can help labor continue and reduce the risk of postpartum hemorrhage?

Caulophyllum

What homeopathic helps with pain, uneven contractions, and swelling?

Vaginal examination after the cervix has started to dilate  will confirm definitive diagnoses of the

presentation, position, and variety determined during abdominal palpation.

Breech presentation at the start of labor accounts for about 3 to 3.5 % of mothers. One half percent are

face presentations. The majority of the remaining is  typically transverse and oblique lies. They all require ________ _______.

Disengage the head by placing fingers on either side of the sagittal suture and lightly pressing upward on the

parietal bones. The mother then fully reclines with an assistant next to her on the side of the fetal back, facing the midwife. Steady, even pressure on the bony edge of the anterior fontanelle is used to rotate it to a transverse position. The fontanelle is pressed toward the vaginal side wall. The posterior fontanelle is then caught and rotated to the anterior while the assistant presses the fetal body to the anterior with mother turning in the direction of fontanelle rotation.

sit upright and stand with a forward leaning position to  secure the fetal position. Without an assistant the mother assumes knees-chest position.

Place the mother upright if she has been prone, or lying on one side then the other if she has been upright

Relieve swelling by icing the lip and/or administering

homeopathic Sepia 200C and Arnica 200C

placing the fingers on the lip where it touches the

fetal head and massaging the lip back over the fetal head above the inferior border of the pubic symphysis. The lip

should be held in place until the next contraction when the woman is asked to push down.

half squatting during this maneuver.

Effacement and dilation are the result of __________ ___________ and progressive effacement and dilation are the only indications of ______  _____.

No effacement is _______ effaced”, complete effacement is _________ effaced”.

A primagravida often presents 50 to 60% effaced and up to 1 cm dilation prior to labor due to _______ _______.

A multigravida may present with no effacement and 1-2 cm dilation when entering labor. T/F?

The station of the presenting part is measured in centimeters from above or below the _______ _______.

______ is an unengaged floating presenting part whereas _____ is the presenting part at the vaginal orifice.

The ischial spines represent ____ station.

___________ is the point where the widest portion of the

presenting part has passed through the pelvic inlet, not the point where the presenting part is at station __.

When there is significant fetal skull molding and caput

succedaneum, the ________ may be difficult to determine.

The membranes typically rupture by the ____ of the first stage of labor.

80% of PROM cases, labor begins spontaneously within

______?

24 hours

______ contractions are irregular with short duration, every 20 to 30 minutes lasting 15 to 20 seconds with mild

intensity.

By the end of the first stage of labor, the contractions are regular with longer duration and intensity, every ___ ___minutes and lasting ___ ___ seconds with severe intensity.

develops synchronous activity in which the contraction is longer and harder at the top of the fundus and gradually decreases in duration and intensity through the midportion until it ceases towards the cervix.

China, Carbo Veg, or Ustilago 200C

It has been found that ice chips actually intensify the desire for liquids rather than relieving thirst and

dehydration.  T/F? What is another alternative to dealing with dehydration in labor?

Herbs that have often been used to alleviate nausea and vomiting are:

peppermint, spearmint, or chamomile tea, and ginger capsules or tea. Nausea can also be relieved by pressure on the acupressure point PC-6 on the inner wrist

supine with any or no incline, knee-chest, all-fours, lateral recumbent, sitting, standing, walking or squatting.

Rotation of the fetus to an anterior position may be accomplished by the following:

mother leaning forward, supported by a partner, table, birthing ball, or other 

support. The hands-and-knees or kneeschest position may also accomplish this. Lateral recumbent positions can help rotate a fetus from an occipital posterior position.

performing controlled breathing will serve as a distraction from the pain of contractions and it helps lift the diaphragm off the uterus to relieve pressure and pain.

pant-pant-blow rhythm, if possible, or panting “like a dog”, whichever the mother is capable of.

Post-term pregnancy

• high parity

• maternal obesity

• maternal age over 35

• maternal diabetes

• gestational diabetes

• fetal macrosomia

• oxytocin induction

• prolonged labor

• operative deliveries• prolonged second stage labor

If the delivery is initially uncomplicated but the head birthed slowly with problems in delivering the chin over the perineum, shoulder dystocia may be implicated. The head may appear to be receding back into the vagina as reverse traction ensues. If normal maneuvers to birth the baby fail, shoulder dystocia is diagnosed. Turtle sign

The anterior shoulder is caught behind or on the pubic

symphysis and the posterior shoulder is in the sacral hollow or above the sacralpromontory.

Women who are allowed to remain ambulatory during labor, experienced:

Fewer caesarian sections and episiotomies, Less need for labor augmentation or induction, Shorter labors, Less need for analgesia, Fewer issues with fetal compromise, More effective uterine action

The upright position during labor alleviates problems with the following:

Assess temperature and pulse every 2 hours, Monitor FHR every hour prior to onset of labor. For induction, the FHR is monitored more closely, even constantly with electronic

monitoring, Avoid vaginal exams if possible, If a vaginal exam is performed

observe the temperature of the vaginal walls, and the odor and color of the discharge or fluid, Monitor hydration levels closely

avoid tub baths until advanced

labor,

 use increased vigilance in hygiene,when using the bathroom, using,sterilized toilet paper if desired (toilet paper that has been baked at 200 degrees for 1 hour) avoid hand-to-genitalia contact, underwear, and pads unless flowing heavily, then the pad should be changed frequently, remain hydrated, increase vitamin C consumption to 250 mg every 24 hours, eat non-constipating foods, 

monitor her temperature every 3 to 4 hours

After 24 hours have passed since rupture, what should be done?

A CBC may be necessary, ck FHT's regularly,

supplemental vitamin E along with the vitamin C, ingesting 5 to 10 drops of Echinacea tincture 2 to 3 times a

day to prevent infection, and drinking Nettle, Comfrey, or Violet leaf infusions

for healing.

Management options of PROM include:

1. Ensuring birth within 24 hours of rupture 2. Awaiting spontaneous labor while monitoring for signs of chorioamnionitis

If the membranes rupture more than ____hours prior to the commencement of labor, the condition is called _____ ________ ___ ________.

There is increased risk of PROM with the following:

incompetent cervix, fetal malpresentation, vaginal/cervical

infection, polyhydramios, and multiple gestation. Nulliparous women due to occupational fatigue.

DIC, postpartum hemorrhage, renal failure, and pituitary necrosis.

Placenta previa is more common with:

maternal age over 35, multiparity, history of placenta previa, multiple gestation, smoking, previous uterine surgery

When painless third trimester bleeding is reported, a vaginal exam should ____ be performed until placental position is confirmed.

If the placenta moves away from the os and no other symptoms, such as bleeding, occur, vaginal birth may be attempted with careful observation for ______  _______or other _____  _______.

Fetal movement may become excessive then cease due to hypoxia.

If fetal death has occurred, I should never do what?.

Failure to elicit fetal heart tones with a stethoscope,

fetoscope or dopplar is ______ _______ a sign of fetal demise.

There may be maternal history or symptoms of preeclampsia, headaches, nausea, and vomiting. There may be trauma due to accidents or domestic violence. External cephalic version, birth of a first twin, and loss of large volumes of amniotic fluid can cause placental abruption.

Any unexplained abdominal pain and bleeding early in the pregnancy should alert you to the possibility of an ______ _________. Additional symptoms include gastrointestinal upset, vomiting, and diarrhea.

Cervical pregnancy and abdominal pregnancy, both very rare, can cause ________  ________.

Abdominal pregnancy can also result in infection followed by _______ ___ ______+.

Placental abruption is the separation of a normally implanted placenta after the ____ ____ __ ______

.

A previous caesarian section can increase the risk of

placental abruption by 40%. Cigarette smoking may also be a factor.

STD infections

• trauma from IUDs

• infection after abortion

• progesterone based birth control

• reconstructive surgery from a

prior tube rupture

• DES exposure

• assisted reproduction

Conditions that mimic tubal pregnancy symptoms are:

 pelvic inflammatory disease, appendicitis, and severe

gastrointestinal illness.

When notified of symptoms indicative of tubal pregnancy or rupture, what should be done?

call the consulting physician immediately and instruct the mother to call an ambulance.

Counseling to deal with the impact of nearly dying, losing a baby, and possibly losing her fertility.

EPO taken orally/internally, blue/black cohosh tincture,

Caulophyllum, 30C or 200x, or Cimicifuga30C.Acupuncture, blue cohosh enemas abdominal massage, and visualizing the uterus contracting

Bishop scoring system assigns a point value to the centimeters of _____, the percentage of ________, the ________, the cervical ______, and the cervical  ________.

When a mom reaches 40 weeks I should review the postdate management plan with her and document her

acceptance of the plan.What is that?

Perform nonstress tests and measurements of amniotic fluidvolume twice weekly starting at the 41

st

week and continuing until birth. Perform

a full biophysical profile and contact the

consulting physician if the nonstress test

or amniotic fluid volume is not

reassuring. If labor has not begun by 42

weeks and the dating of the pregnancy is

accurate, notify the consulting physician

and being active management of the

pregnancy.

If labor has not begun by 42 weeks and the dating of the pregnancy is accurate, I should do the following?

Cord compression and meconium aspiration

bladder distension

• position of the fetus

• the length of the cervix

• maternal build

• fibroids

• uterine abnormalities

• placental location

• amniotic fluid volume

• retroflexion or retroversion of the

fetus

• placental location

• examiner experience

• foreknowledge of the last

menstrual period

Fundal assessment is typically most accurate between _____and ____ weeks gestation with a margin of error of up to __ weeks.

Quickening and using the time of uterus at the umbilicus as a benchmark for 20 weeks gestation have significantly wide margins of error as do using signs and symptoms of pregnancy or the date on first noting fetal heart tones by

ultrasound or fetoscope. T/F?

How accurate is first trimester ultrasound in dating a pregnancy and what is the possible inaccuracey?

 accuracy of +/- 3 to 5 days.

gestational age, sonographer’s

skill, fetal position, and available technology.

Serum BhCG of less than 10,000,

using two values obtained 1 week

apart and rising appropriately.

o

Accuracy +/- 3 to 5 days.

Last accurately recorded normal,

regular menstrual period that is

consistent with a first trimester

exam.

o

Accuracy +/- 1 to 2 weeks.

Second trimester ultrasound.is accurate up to how many wks? And it on what?

o

Accuracy +/- 1 to 2 weeks, accurate tech. skills.

Third trimester ultrasound is accurate in dating a preg. up to how many wks.?

o

Accuracy +/- 2 to 3 weeks,

depending on the ultrasound

conditions.

Physical exam after 20 weeks is accurate in dating a pregnancy up to how many weeks?

The menstrual age, the gestational age and the fetal age are all identical. T/F?

The average length of pregnancy is:

280 days (40 weeks or 10 lunar months/9 calendar

months).

Conceptual age and ovulatory age are identical. T/F?

The average length of pregnancy for the conceptual and

ovulatory age is ___ days or ____ weeks.

The average gestational age of a pregnancy allows for estimated birth dates within a ___ ____ range, ___ ____ on either side of the estimated birth date.

A

post date

pregnancy is considered to be any accurately dated pregnancy that is more than _____  days, more than ____ weeks,or more than ____ lunar months.

If there is a predisposition towards preterm labor, what things can be added to the diet for prevention? 

Homeopathic Mag

Phos 30C may be effective at a rate of 7

pellets per 4 oz of hot, but not boiling,

water. The solution is sipped until gone

and the contractions should slow or stop

within the hour. Postural tilting several

times daily has occasionally stopped

preterm labor

An empathetic approach devoid of false reassurances is the best route to take. Trust the mother’s suspicions and her

reports of any important changes; remain available by phone

They are more effective than other agents at inhibiting uterine contractions. They also have fewer of the severe side effects of betamimetics.

better choices for women with heart disease, hyperthyroidism, or diabetes

There are fewer side effects than betamimetics and

magnesium sulfate, and there is little to no adverse effect on fetal outcome. preferable to betamimetics as tocolytics.

postpone birth longer

They appear to have fewer maternal side effects and equal effectiveness in tocolysis but carry greater fetal risk. New on the scene and needs more research.

uterine environment must be assessed, side effects and risk of complications to the mother, time needed to reach an appropriate tertiary care facility or to begin corticosteroid administration for fetal lung maturity issues

Beta-adrenergic drugs are the most commonly used tocolytics for stopping or stalling labor. T/F?

Beta adrenergic drugs typically have maternal side effects of:

tachycardia, pulmonary edema, markedly increased cardiac output, blood pressure effects, and increased blood sugar and insulin

secretion.

fetal side effects are tachycardia, hypoglycemia, and

hyperinsulinism after birth.

preterm labor, dilated to 4cm and gestation <34 weeks gestation

THESE DRUGS ARE

EXTREMELY TOXIC AND MAY

PRODUCE DANGEROUS SIDE EFFECTS

IN MOTHER AND FETUS.

If there is a history of preterm labor,perform the following:

perform increased monitoring starting at 24 weeks with visits every 2 weeks.

Recommend a reduced workload and the

use of condoms.

If the cervix begins to efface, or if preterm labor is

halted, what should be suggested?

 sexual contact should cease and

visits become weekly.

Dealing w/ preterm: If regular contractions begin or the cervix begins to dilate, immediately do the following:

Preterm labor is diagnosed when gestation is between ___ and ___ weeks, uterine contractions are __ to __ minutes apart or there are ____ contractions in twenty minutes or____in sixty minutes, and (5 possibilities).

20-37,5-8, 4 or 8 the membranes are ruptured, OR membranes are intact and there is progressive cervical change OR membranes are intact and the cervix is 2 cm dilated OR membranes are intact and there is a positive fFN test

duration, frequency, physical location, regularity, and progress to stronger, longer or more frequent. You should then palpate the contractions for intensity, duration and frequency.

The followingconditions can result in or contribute to

preterm labor:

 Uterine rupture involves the old incision separating completely, what is it called?

The first sign of catastrophic rupture is ________ _______.

feels a sharp, shooting abdominal pain at the peak of a contraction. The presenting part is now movable, a loss of station or repositioning is apparent, fetal parts are easily palpated, fetal movements are violent and then cease, the contracted uterus is felt beside the fetus. Maternal shock may occur.

 Hx of previous c-section, not a repeat for the same reason, spontaneous labor with normal progression 

A trial of labor may end in a repeat caesarian section if the same reasons for the previous caesarian occur such as:

failure to progress or cephalopelvic disproportion,

the need to induce or augment labor, no prior vaginal delivery, more than one previous, caesarian section,

a non-reassuring fetal heart tone, early in labor

The greatest risk of uterine rupture during VBAC is when the previous caesarian section was performed via a

_______ incision of the _____ contractile uterine segment.

If the caesarian was performed prior to 28 weeks gestation, especially without labor, it indicates the corpus muscular mass was likely incised regardless of type

of incision; the risk of rupture in this case may be significant enough to deny a trial of labor. T/F?