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PLEASE ALSO GO OVER OB FACE 1 EXAM REVIEW ALONG WITH THISOB MIDTERM1. PLACENTAL INSUFFIENCY = LATE FETAL DECELARATION Leopold maneuver: ppg 469-471 (place woman supine position and stand beside her) method for determining presentation, position and lie of the fetus using 4 specific steps/screening a...

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PLEASE ALSO GO OVER OB FACE 1 EXAM REVIEW ALONG WITH THIS OB MIDTERM 1. PLACENTAL INSUFFIENCY = LATE FETAL DECELARATION 2. Leopold maneuver: ppg 469-471 (place woman supine position and stand beside her) method for determining presentation, position and lie of the fetus using 4 specific steps/screening assessment for malpresentation A. The woman is supine and what we can detect is position, presentation, and lie. NOT ATTITUDE. 3. McRoberts: maneuver used for shoulder dystocia- hyperflex maternal hips (knee to chest) and tell pt to stop pushing. 4. Stages of labor o First Stage Dilation o Second Stage Expulsive o Third Stage Placental o Fourth Stage Restorative A. The first stage is the longest: it begins with the first true contraction and ends with full dilation (opening) of the cervix. Because this stage lasts so long, it is divided into 2 phases, each corresponding to the progressive dilation of the cervix. o the 2 phases of Stage One: ▪ Latent Phase 0-6 ▪ Active Phase 6-10 B.

Stage two of labor, or the expulsive stage, begins when the cervix is completely dilated (10 cm) and ends with the birth of the newborn. C. The third stage, or placental expulsion, starts after the newborn is born and ends with the separation and birth of the placenta. Continued uterine contractions typically cause the placenta to be expelled within 5 to 30 minutes. If the newborn is stable, bonding of infant and mother takes place during this stage through touching, holding, and skin-toskin contact. D. The fourth stage, or the restorative stage or immediate postpartum period, lasts from 1 to 4 hours after birth. This period is when the mother’s body begins to stabilize after the hard work of labor and the loss of the products of conception. Close monitoring of both the mother and her newborn are done during this stage 5. Mothers' funds should be firm and well contracted. Located at the midline between the umbilicus and the symphysis, but it rises slowly to the level of the umbilicus during the first hour after birth. IF UTERUS BECOMES BOGGY, MASSAGE TO KEEP FIRM. USE FINGERPADS TO MASSAGE. Lochia is red mixed with small clots and moderate flow. If episiotomy it should be intact with the edges approximated and clean and no redness or edema present. Pg 460 6. Shoulder dystocia: mechanical problem. Requires medical emergency Due to increasing birth weight. Transient Erb or Duchenne brachial plexus palsies and clavicular or humeral fractures are most common fetal injuries. McRoberts maneuver or suprapubic pressure can reduce severity of injuries. TAKE NOTE pg 775 Immediately assess the infant for signs of trauma, Erb palsy, fractured clavicle, neonatal asphyxia, assess mother for excessive vaginal bleeding and blood in urine from bladder trauma.

7. Anaphylactoid Syndrome of Pregnancy ASP: pg 798-799 Often fatal sudden onset of hypotension, cardiopulmonary collapse, hypoxia, and coagulopathy, Amniotic fluid containing particles of debris enters maternal circulation and obstructs pulmonary vessels causing respiratory distress and circulatory collapse. FOUR CARDINAL SIGNS OF ASP: RESPIRATORY FAILURE, ALTERED MENTAL STATUS, HYPOTENSION, AND DIC. 8. Celestrone to give to mother for fetus lung maturity before 36 weeks 2 does intramuscularly 24 hours apart 9. Bishop scoring: used to identify cervical ripening; score over 8 indicates successful vaginal birth. Less than 6 indicates cervical ripening method to be used. ADD PICTURE 787 10. VBAC Vaginal birth after cesarean: complications: hemorrhage, uterine rupture, preeclampsia. Monitor fetal heart rate. Contradiction to prior classical uterine incision, transfundal uterine sx pg 702 11. Vacuum extractor/forceps: apply traction to the fetal head or to provide rotation of the head during birth. Head has to engaged. Indicated for prolonged stage of labor, none reassurance fetal heart rate, limited inability to push, fetal distress, maternal heart disease, risk of trauma to newborn and mother. Laceration, hematoma to the vagina cervix and perineal, Hematoma to baby, facial laceration, facial nerve injury , celfelo hematoma. 12. Fetal Demise intervention: touch on the shoulder, hold hands, stay in the room, active listening, refer to a support group. 13. Priority of any intervention in the labor: AIRWAY first 14. Side Effect of dinoprostone = Headache 15. Mag sulfate- IV respiratory check FHR less than 10 give calcium gluconate 16. Procardia= check BP before administration PICTURE OF A TABLE\ 17. Meconium fluid you do amnioinfusion to dilute the amniotic fluid 18. Precipitate labor p 769 : under 3 hours from the start of contractions to birth. Labor slow but abnormally rapid. 19. Toxoplasmosis: cat litter no changing , no gardening, raw foods veggies and fruits, handwashing important. 20. SLE: Systemic Lupus : Butterfly rash autoimmune dx : p 731 21. Food rich in Iron: spinach 22. Asthma triggers: p 725 Smoke and chemical irritants, air pollution, dust mites, animal dander, seasonal changes with pollen molds and spores, upper Resp infections, GERD, NSAIDs and ASA, exercise, cold air, emotion stress. 23. If pregnant pt has cardiac dx, the least risk is: corrected tetrology of fallot 24. Overweight pregnant client at risk for diabetes, HTN monitor kidney function 25. Review from OB FACE 1 EXAM REVIEW abruptio and preclampsia and ecclampsia 26. Premonitory Signs of Labor Before the onset of labor, a pregnant woman’s body undergoes several changes in preparation for the birth of the newborn. The changes that occur often lead to characteristic signs and symptoms that suggest that labor is near. These premonitory signs and symptoms can vary, and not every woman experiences every one of them. A. Cervical Changes: o Before labor begins, cervical softening and possible cervical dilation with descent of the presenting part into the pelvis occur o As labor approaches, the cervix changes from an elongated structure to a shortened, thinned segment.

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o The ripening and softening of the cervix are essential for effacement and dilation, which reflect the enhanced collagen breakdown that was previously inhibited by progesterone Lightening: o Lightening occurs when the fetal presenting part begins to descend into the true pelvis o The uterus lowers and moves into a more anterior position. o With this descent, the woman usually notes that her breathing is much easier and that there is a decrease in gastric reflux. However, she may complain of increased pelvic pressure, leg cramping, dependent edema in the lower legs, and low back discomfort. She may notice an increase in vaginal discharge and more frequent urination. Increased Energy Level (Nesting): o Some women report a sudden increase in energy before labor. This is referred to as NESTING bcaz many women will focus this toward childbirth preparation such as cleaning, cooking, preparing the nursery, etc. o The increased energy level usually occurs 24 to 48 hours before the onset of labor. It is thought to be the result of an increase in epinephrine release caused by a decrease in progesterone Bloody Show: o At the onset of labor or before, the mucous plug that fills the cervical canal during pregnancy is expelled as a result of cervical softening and increased pressure of the presenting part. o These ruptured cervical capillaries release a small amount of blood that mixes with mucus, resulting in the pink-tinged secretions known as bloody show. ∙ Braxton Hicks Contractions: o Braxton Hicks contractions, which the woman may have been experiencing throughout the pregnancy, may become stronger and more frequent. o Braxton Hicks contractions are typically felt as a tightening or pulling sensation of the top of the uterus. o They occur primarily in the abdomen and groin and gradually spread downward before relaxing. In contrast, true labor contractions are more commonly felt in the lower back. o These contractions aid in moving the cervix from a posterior position to an anterior position. o They also help in ripening and softening the cervix. o However, the contractions are irregular and can be decreased by walking, voiding, eating, increasing fluid intake, or changing position. o Braxton Hicks contractions usually last about 30 seconds but can persist for as long as 2 minutes. As birth draws near and the uterus becomes more sensitive to oxytocin, the frequency and intensity of these contractions increase. Spontaneous Rupture of Membrane: o Rupture of membranes with loss of amniotic fluid prior to the onset of labor is termed prelabor rupture of membranes (PROM). o The rupture of membranes can result in either a sudden gush or a steady leakage of amniotic fluid. o Although much of the amniotic fluid is lost when the rupture occurs, a continuous supply is produced to ensure protection of the fetus until birth. o After the amniotic sac has ruptured, the barrier to infection is gone and an ascending infection is possible.

o In addition, there is a danger of cord prolapse if engagement has not occurred with the sudden release of fluid and pressure with rupture. 27. True Vs False Labor A. False labor is a condition occurring during the latter weeks of some pregnancies in which irregular uterine contractions are felt, but the cervix is not affected. ∙ In contrast, true labor is characterized by contractions occurring at regular intervals that increase in frequency, duration, and intensity. B. True labor contractions bring about progressive cervical dilation and effacement. ∙ False labor, prodromal labor, and Braxton Hicks contractions are all names for contractions that do not contribute in a measurable way toward the goal of birth. ∙ With first pregnancies, the cervix can take up to 20 hours to dilate completely ∙ KNOW THE TABLE BELOW

28. Physical exam of the mother the physiological response of the fetus is increased HR. In labor periodic acceleration of fetal HR is a normal occurrence. 29. Difference between two in first stage of labor Latent is 0-6cm and Active 6-10cm 30. Factors Affecting The Labor Process (5 P’s) Traditionally, the critical factors that affect the process of labor and birth are outlined as the “five P’s”: A. Passageway (birth canal: Pelvis and Soft tissue) B. Passenger (fetus and placenta) C. Powers (contractions) D. Position (maternal) 31. Psychological response: These critical factors are commonly accepted and discussed by health care providers. However, five additional “P’s” can also affect the labor process: A. Philosophy (low tech, high touch) B. Partners (support caregivers) C. Patience (natural timing) D. Patient (client) preparation (childbirth knowledge base) E. Pain management (comfort measures) 32. IF the cervix is halfway dilated 5cm it means labor is in progres 33. Amniotic fluid if you suspect infection there will be a foul odor and cloudy appearance 34. Cultural competence 35. Determining FHR Patterns A. Category I: normal fetal acid-base status at the time of observation and needs no interventions B. Category II: not predictive of abnormal fetal acid-base status and but does require evaluation and continued monitoring C. Category III: predictive of abnormal fetal acid-base status at the time of observation and requires prompt evaluation and interventions such as giving maternal oxygen, changing position, discontinuing labor augmentation medication, and treating maternal hypotension 36. The BPP is a scored test with five components, each worth two points if present. A total score of 10 is possible if the NST is used. Thirty minutes are allotted for testing, though less than 10 minutes are usually needed. The following criteria must be met to obtain a score of 2; anything less is scored as 0. Overall, a score of 8 to 10 is considered normal if the amniotic fluid volume is adequate. A score of 6 or below is suspicious, possibly indicating a compromised fetus; further investigation of fetal well-being is needed. A. Body movements: three or more discrete limb or trunk movements B. Fetal tone: one or more instances of full extension and flexion of a limb or trunk C. Fetal breathing: one or more fetal breathing movements of more than 30 seconds D. Amniotic fluid volume: one or more pockets of fluid measuring 2 cm E. NST: normal NST = 2 points; abnormal NST = 0 points 37.. If the female has HTN prior to pregnancy she will be at an increase risk for gestational HTN and preeclampsia which can lead to eclampsia. (the difference between pre and eclampsia is seizures.) 38. Abortion types 39. Leopold’s maneuvers Method for determining the presentation, position, and lie of the fetus

A. Maneuver 1: What fetal part (head or buttocks) is located in the fundus (top of the uterus) B. Maneuver 2: on which maternal side is the fetal back located? (fetal heart rate tones are best auscultated through the back of the fetus) C. Maneuver 3: what is the presenting part? D. Maneuver 4: Is the fetal head flexed and engaged in the pelvis 40. Nonpharmacological Measures for Pain Management A. Continuous Labor Support o A woman’s family, a midwife, a nurse, a doula, or anyone else close to the woman can provide this continuous presence o They can help with ambulating, repositioning herself, and use breathing techniques o Continuous support has shown to have beneficial effects on the mother and the newborn B. Hydrotherapy o Involve showering or soaking in the regular tub or whirlpool bath o In the shower the women are sitting on a chair allowing the warm water to gently glide over the abdomen and back o Release muscle tension and can impart sense of well-being o Water provides soothing stimulation of nerves in the skin, promoting vasodilation, reversal of sympathetic nervous response, and a reduction in catecholamines o Contractions are less painful in warm water because the warmth and buoyancy of the water have a relaxing effect o Shown to have reduce surgical birth rates, a shorter second stage of labor, reduced analgesic requirements and a lower incidence of perineal trauma o Women should be 5 cm dilated ● Risk: hyperthermia, hypothermia, changes in maternal HR, fetal tachycardia, and unplanned underwater birth C. Ambulation and position changes o Walking and upright positions in the first stage of labor reduce the length of labor do not seem to be associated with increased intervention or negative effects o gravity directs the weight of the fetus and amniotic fluid downwards o causes a successful dilating the cervix (upright position) o uterine contractions have been shown to be better spaced, stronger and more efficient in dilating the cervix when the mother is in an upright position than when she is supine o encourage the women to choose whatever position is comfortable to her (1st stage of labor) o Changing positon frequently (sitting, walking, kneeling, standing, lying down, getting on the hands and knees, and using a birth ball helps relieve pain o Help speed labor o Allowing the woman to obtain a position of comfort frequently o Cause favorable fetal rotation by altering the alignment of the presenting part with the pelvis

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Acupuncture and acupressure o Useful in relieving pain associated with labor and birth (both methods require trained individuals) o Acupressure involves the application of firm finger or massage used in acupuncture to reduce the pain sensation o The amount of pressure is important E. Attention focusing and imagery o The woman can focus on tactile stimuli such as touch, massage, or stroking o She may focus on auditory stimuli such as music, humming, or verbal encouragement o Visual stimuli might be any object in the room or the woman can imagine the beach, a mountain top, a happy memory o These techniques during the contraction from reaching the pain center in the cortex of the brain F. Therapeutic touch and massage o Effleurage is a light, stroking, superficial touch of the abdomen, in the rhythm with breathing during contractions o Used as a relaxation and distraction technique o Massage work as a form of pain relief by increasing the production of endorphins in the body o Endorphins produce the transmission of signals between nerve cells and thus lower the perception of pain o Massage anywhere in the body can block pain message to the brain G. Breathing techniques o The breath affects the lungs, immediately cueing the nervous system o If we alter how we breath, we alter the constellation of messages and reactions in our entire mind-body experience o It produces relaxation and pain relief 41. Cervical Shapes A. Best cervical shape for labor is gynecoid. The gynecoid pelvis is considered the true female pelvis, occurring in about 40% of all women. Vaginal birth is most favorable with this type of pelvis because the inlet is round and the outlet is roomy. (VERY IMPORTANT) ∙ This type of pelvis allows early and complete fetal internal rotation during labor. It occurs in approximately 25% of women. Vaginal birth is more favorable with this pelvic shape compared with the android or platypelloid shape B. The android pelvis is considered the male-shaped pelvis. The prognosis for labor is poor, subsequently leading to cesarean birth. Is the least common type of pelvic structure among men and women, with an approximate incidence of 3%. The pelvic cavity is shallow but widens at the pelvic outlet, making it difficult for the fetus to descend through the mid-pelvis. Labor prognosis is poor with arrest at the inlet occurring frequently. It is not favorable for a vaginal birth unless the fetal head can pass through the inlet. Women with this type of pelvis usually require cesarean birth. 42. Fetal lie refers to the relationship of the spine of the fetus to the spine of the mother. There are three possible lies: A.

Longitudinal (most common) Fetus spine is parallel to mothers ▪ Transverse 🡪 Perpendicular to mothers spine

B. Oblique 🡪 At an angle compared to mothers spine. A fetus in a transverse or oblique lie position cannot be delivered vaginally 43. Fetal Station: refers to the relationship of the presenting part to the level of the maternal pelvic ischial spines. Fetal station is measured in centimeters and is referred to as a minus or plus, depending on its location above or below the ischial spines. Typically, the ischial spines are the narrowest part of the pelvis and are the natural measuring point for the birth progress. o Zero (0) station is designated when the presenting part is at the level of the maternal ischial spines. o When the presenting part is above the ischial spines, the distance is recorded as minus stations. o When the presenting part is below the ischial spines, the distance is recorded as plus stations. o For instance, if the presenting part is above the ischial spines by 1 cm, it is documented as being a –1 station; if the presenting part is below the ischial spines by 1 cm, it is documented as being a +1 station. 44. Cardinal Movements of Labor. The fetus goes through many positional changes as it travels through the passageway. These positional changes are known as the cardinal movements of labor. A. ENGAGEMENT: o Occurs when the greatest transverse diameter of the head in vertex (biparietal diameter) passes through the pelvic inlet (usually 0 station). o The head usually enters the pelvis with the sagittal suture aligned in the transverse diameter. B. DESCENT: o Is the downward movement of the fetal head until it is within the pelvic inlet. C. FLEXION: o Occurs as the vertex meets resistance from the cervix, the walls of the pelvis, or the pelvic floor. o As a result, the chin is brought into contact with the fetal thorax and the presenting diameter is changed from occipitofrontal to suboccipitobregmatic (9.5 cm), which achieves the smallest fetal skull diameter presenting to the maternal pelvic dimensions. E. INTERNAL ROTATION: o After engagement, as the head descends, the lower portion of the head (usually the occiput) meets resistance from one side of the pelvic floor. o As a result, the head rotates about 45 degrees anteriorly to the midline under the symphysis. o This movement is known as internal rotation. o Internal rotation brings the anteroposterior diameter of the head in line with the anteroposterior diameter of the pelvic outlet. o It aligns the long axis of the fetal head ...