Chapter 32

Question 1

Preterm Birth

Answer 1

Any birth that occurs between 20-37 weeks gestation

Question 2

Risk factors for spontaneous preterm labor

Answer 2

hx of spontaneous preterm labor, not white, genital tract infection, multifetal gestation, second trimester bleeding, low prepregnancy weight.

Question 3

what is the only factor show to be definitely associated with preterm labor?

Answer 3

infection

Question 4

common causes of indicated preterm labor

Answer 4

gestational diabetes, chronic HTN, preeclampsia, previous cesarean birth, seizures, thromboembolism, advanced maternal age, HIV or herpes, obesity

Question 5

women whose cervical length is greater than ______ are unlikely to have preterm birth.

Answer 5

30 mm

Question 6

Fetal fibronectin (fFN)

Answer 6

Diagnostic test for preterm labor; collect fluid from the woman’s vagina using a swab; the presence of fFN during the late second and early third trimesters may be indicative of preterm labor coming

Question 7

Signs and Symptoms of Preterm Labor

Answer 7

contractions occurring more than q 10 min for 1 hour or more, lower abdominal cramping, dull lower back pain, suprapubic pain or pressure, urinary frequency, change in character or amount of usual discharge, rupture of amniotic membranes

Question 8

Teaching for Preterm Labor

Answer 8

Empty your bladder. Drink 2-3 glasses of water or juice. Lie down on your side for 1 hour. Palpate for contractions. If sx continue, call pcp or go to hospital. If sx go away then resume light activity.

Question 9

Tocolytics

Answer 9

meds given to stop labor after uterine contractions and cervical change has already occurred.

Question 10

Maternal contraindications to tocolysis

Answer 10

preeclampsia w/ severe features, bleeding, contraindications to specific tocolytic meds

Question 11

Fetal contraindications to tocolysis

Answer 11

intrauterine fetal demise, lethal fetal anomaly, nonreassuring fetal status, chorioamnionitis, PROM

Question 12

Magnesium Sulfate Safety Alert

Answer 12

frequently assess respiratory status, DTR’s, and LOC to monitor for toxic levels; depresses the CNS

Question 13

Don’t give Nifedipine with

Answer 13

Magnesium sulfate or Terbutaline

Question 14

Nifedipine (Calcium Channel Blocker) Safety Alert

Answer 14

Change positions slowly!!

Question 15

Magnesium Sulfate Antidote

Answer 15

Calcium gluconate

Question 16

When should Indomethacin be given

Answer 16

at less than 32 weeks gestation

Question 17

Indomethacin

Answer 17

monitor for hemorrhage or signs of bleeding

Question 18

Terbutaline

Answer 18

monitor blood glucose and potassium levels

Question 19

Magnesium sulfate therapeutic range

Answer 19

4-7.5 mEq/L

Question 20

Antenatal glucocorticoids

Answer 20

given IM to accelerate fetal lung maturity by stimulating fetal surfactant production

Question 21

Antenatal glucocorticoids should be given when

Answer 21

between 24-34 weeks gestation

Question 22

Where to give antenatal glucocorticoids

Answer 22

deep IM: vastus lateralis or ventral gluteal

Question 23

The most important function of tocolytics

Answer 23

to give time to administer antenatal glucocorticoids and get them working to accelerate fetal lung maturity

Question 24

Risk factors for preterm PROM

Answer 24

hx of cervical cerclage, UTI, short cervical length, uterine overdistention, preterm labor, second and third trimester bleeding, low BMI, pulmonary disease, low socioeconomic status, cigarette smoking, nutritional deficiencies

Question 25

The most common maternal complication of preterm PROM

Answer 25

Chorioamnionitis

Question 26

Chorioamnionitis

Answer 26

bacterial infection of the amniotic cavity

Question 27

postterm pregnancy

Answer 27

42 or more weeks gestation

Question 28

teaching for postterm pregnancy

Answer 28

perform daily fetal movement counts (4 an hour). assess for sx of labor. call pcp if membranes rupture or there is a decrease in or no fetal movement. keep appointments

Question 29

Dysfunctional Labor (dystocia)

Answer 29

a long, difficult or abnormal labor

Question 30

Hypertonic uterine dysfunction

Answer 30

frequent and painful contractions that are ineffective in causing cervical dilation or effacement to progress

Question 31

Hypotonic uterine dysfunction

Answer 31

most common type; woman initially makes progress into active phase of labor but then contractions become weak and inefficient or stop altogether.

Question 32

prolonged latent phase in the nulliparas woman

Answer 32

more than 20 hours

Question 33

prolonged latent phase in the multiparas woman

Answer 33

more than 14 hours

Question 34

protracted active phase dilation in the nulliparas woman

Answer 34

less than 1.2 cm in an hour

Question 35

protracted active phase dilation in the multiparas woman

Answer 35

less than 1.5 cm in an hour

Question 36

protracted descent in the nulliparas woman

Answer 36

less than 1 cm in an hour

Question 37

protracted descent in the multiparas woman

Answer 37

less than 2 cm in an hour

Question 38

arrest of descent in the nulliparas woman

Answer 38

greater than or equal to 1 hour

Question 39

arrest of descent in the multiparas woman

Answer 39

greater than or equal to 1/2 hour

Question 40

failure of descent for both nulliparas and multiparas women

Answer 40

no change during deceleration phase and second stage

Question 41

precipitous labor in the nulliparas woman

Answer 41

greater than 5 cm an hour

Question 42

precipitous labor in the multiparas woman

Answer 42

10 cm in an hour

Question 43

cephalopelvic disproportion (CPD)

Answer 43

disproportion between the size of the fetus and the size of the mother's pelvis

Question 44

external cephalic version (ECV)

Answer 44

used in an attempt to turn the fetus from a breech or should presentation to a vertex presentation for birth

Question 45

internal version

Answer 45

when the hcp puts a hand into the uterus and changes the fetus position for birth

Question 46

What is the bishop score used for

Answer 46

to evaluate inducibility