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Maternity Final
Pregnancy/ labor/ delivery: (chapters 10-14, 19-21)
| Question | Answer |
|---|---|
| Stage 1: Normal vaginal delivery - Latent phase | 1. Description: Stage 1 is the longest. A labor curve, such as the Friedman curve, may be used to identify whether a woman’s cervical dilation is progressing at the expected rate |
| Stage 1: Normal vaginal delivery - Latent phase Assessment | Assessment a. Cervical dilation is 1 to 4 cm. b. Uterine contractions occur every 15 to 30 minutes, are 15 to 30 seconds in duration, and are of mild intensity. |
| Stage 1: Normal vaginal delivery - Latent phase Intervention | Interventions a. Encourage mother and partner to participate in care. b. Assist with comfort measures, changes of position, and ambulation. c. Keep mother and partner informed of progress. d. Offer fluids and ice chips. e. Encourage voiding every 1 to 2 hours. |
| Stage 1: Normal vaginal delivery - Active phase Assessment | a. Cervical dilation is 4 to 7 cm. b. Uterine contractions occur every 3 to 5 minutes, are 30 to 60 seconds in duration, and are of moderate intensity |
| Stage 1: Normal vaginal delivery - Active phase Interventions | a. Encourage maintenance of effective breathing patterns. b. Provide a quiet environment. c. Keep mother and partner informed of progress. d. Promote comfort with back rubs, sacral pressure, pillow support, and position changes. e. Instruct partner in effleurage (light stroking of abdomen). f. Offer fluids and ice chips and ointment for dry lips. g. Encourage voiding every 1 to 2 hours. |
| Stage 1: Normal vaginal delivery - Transition phase Assessment | a. Cervical dilation is 8 to 10 cm. b. Uterine contractions occur every 2 to 3 minutes, are 45 to 90 seconds in duration, and are of strong intensity. |
| Stage 1: Normal vaginal delivery - Transition phase Intervention | a. Encourage rest between contractions. b. Wake mother at beginning of contraction so she can begin breathing pattern. c. Keep mother and partner informed of progress. d. Provide privacy. e. Offer fluids and ice chips and ointment for dry lips. f. Encourage voiding every 1 to 2 hours. |
| Interventions throughout stage 1 | 1. Monitor maternal vital signs. 2. Monitor FHR via ultrasound Doppler, fetoscope, or electronic fetal monitor. 3. Assess FHR before, during, and after a contraction, noting that the normal FHR is 110 to 160 beats per minute. 4. Monitor uterine contractions by palpation or tocodynamometer, determining frequency, duration, and intensity. 5. Assess status of cervical dilation and effacement. 6. Assess fetal station presentation and position by Leopold’s maneuvers. 7. Assist with pelvic examination and p |
| Stage 2: Normal vaginal delivery Assessment | a. Cervical dilation is complete. b. Progress of labor is measured by descent of fetal head through the birth canal (change in fetal station). c. Uterine contractions occur every 2 to 3 minutes, lasting 60 to 75 seconds, and are of strong |
| Stage 2: Normal vaginal delivery Intervention | a. Perform assessments every 5 minutes. b. Monitor maternal vital signs. c. Monitor FHR via ultrasound Doppler, fetoscope, or electronic fetal monitor. d. Assess FHR before, during, and after a contraction, noting that the normal FHR is 110 to 160 beats per minute. e. Monitor uterine contractions by palpation or tocodynamometer, determining frequency, duration, and intensity. f. Provide mother with encouragement and praise and provide for rest between contractions. g. Keep mother and partner informed |
| Stage 3: Normal vaginal delivery Assessment | a. Contractions occur until the placenta is expelled. b. Placental separation and expulsion occur. c. Expulsion of the placenta occurs 5 to 30 minutes after the birth of the infant. d. Schultze mechanism: Center portion of the placenta separates first, and its shiny fetal surface emerges from the vagina. e. Duncan mechanism: Margin of the placenta separates, and the dull, red, rough maternal surface emerges from the vagina first. f. Method of placental presentation is of no clinical significance. |
| Stage 3: Normal vaginal delivery Intervention | a. Assess maternal vital signs. b. Assess uterine status. c. Provide parents with an explanation regarding expulsion of the placenta. d. After expulsion of the placenta, uterine fundus remains firm and is located 2 fingerbreadths below the umbilicus. e. Examine placenta for cotyledons and membranes to verify that it is intact. f. Assess mother for shivering and provide warmth. g. Promote parental-neonatal attachment. |
| Stage 4: Normal vaginal delivery: Assessment | Period 1 to 4 hours after birth a. Blood pressure returns to prelabor level. b. Pulse is slightly lower than during labor. c. Fundus remains contracted, in the midline, 1 or 2 fingerbreadths below the umbilicus. Monitor lochia discharge. Lochia may be moderate in amount and red in color in stage 4. |
| Stage 4: Normal vaginal delivery: Interventions | a. Perform maternal assessments every 15 minutes for 1 hour, every 30 minutes for 1 hour, and hourly for 2 hours (or as per agency policy). b. Provide warm blankets. c. Apply ice packs to the perineum. d. Massage the uterus if needed and teach the mother to massage the uterus. e. Provide breast-feeding support as needed. f. See Chapter 27 for information on caring for the newborn. |
| Forceps delivery | 1. Two double-crossed, spoon-like articulated blades are used to assist in the delivery of the fetal head. 2. Reassure the mother and explain the need for forceps. 3. Monitor the mother and fetus during delivery. 4. Check the neonate and mother after delivery for any possible injury. 5. Assist with repair of any lacerations. |
| Vacuum extraction | 1. A cap-like suction device is applied to the fetal head to facilitate extraction. 2. Suction is used to assist in delivery of the fetal head. 3. Traction is applied during uterine contractions until descent of the fetal head is achieved. 4. The suction device should not be kept in place any longer than 25 minutes. 5. Monitor FHR frequently; fetal monitoring should be used. 6. Assess infant at birth and throughout the postpartum period for signs of cerebral trauma. 7. Monitor for developing cephalhem |
| Cesarean delivery | 1. Cesarean section is delivery of the fetus usually through a transabdominal, low-segment incision of the uterus. |
| Cesarean delivery - Pre-op | a. If planned, prepare the mother and partner. b. If an emergency, quickly explain the need and procedure to the mother and partner. c. Obtain informed consent. d. Ensure that the preoperative diagnostic tests are done, including Rh factor determination. e. Prepare to insert an IV line and an indwelling urinary catheter. f. Prepare the abdomen as prescribed. g. Monitor the mother and fetus continuously. h. Provide emotional support. i. Administer preoperative medications as prescribed. |
| Cesarean delivery - Post-op | a. Monitor vital signs. b. Perform a fundal assessment; evaluate incision. c. Provide pain relief. d. Encourage turning, coughing, and deep breathing. e. Encourage ambulation. f. Encourage bonding and attachment with newborn. g. Provide psychological support. h. Monitor for signs of infection and bleeding. i. Burning and pain on urination may indicate a bladder infection. j. A tender uterus and foul-smelling lochia may indicate endometritis. k. A productive cough or chills may indicate pneumonia. |
| Trial of labor after cesarean birth (TOLAC) | Trial of labor after cesarean birth (TOLAC) refers to a planned attempt to give birth vaginally by a woman who has had a previous surgical birth, regardless of the outcome. However, although TOLAC is appropriate for some women, several risk factors increase the incidence of a failed TOLAC, which may increase maternal and fetal morbidity and mortality |
| Vaginal birth after cesarean (VBAC) | Vaginal birth after cesarean (VBAC) describes giving birth vaginally after having at least one previous cesarean birth. Despite evidence that some women who have had a cesarean birth are candidates for vaginal birth, some women who have had a cesarean birth once undergo cesareans for subsequent pregnancies. |
| Vaginal birth after cesarean (VBAC) Contraindications | Contraindications to VBAC include a prior classic uterine incision, prior transfundal uterine surgery (myomectomy), uterine scar other than low-transverse cesarean scar, obesity, short maternal stature, macrosomia, maternal age (over 40 years), gestational diabetes, contracted pelvis, and inadequate staff or facility if an emergency cesarean birth in the event of uterine rupture is required |
| Cerclage | Incompetent Cervix 1. Incompetent cervix refers to premature dilation of the cervix, which occurs most often in the fourth or fifth month of pregnancy and is associated with structural or functional defects of the cervix. 2. Treatment involves surgical placement of a cervical cerclage. |
| Cerclage Assessment | 1. Vaginal bleeding 2. Fetal membranes visible through the cervix |
| Cerclage Interventions | 1. Provide bed rest, hydration, and tocolysis, as prescribed, to inhibit uterine contractions. 2. Prepare for cervical cerclage (at 10 to 14 weeks of gestation as prescribed), in which a band of fascia or nonabsorbable ribbon is placed around the cervix beneath the mucosa to constrict the internal os. 3. After cervical cerclage, the client is told to refrain from intercourse and to avoid prolonged standing and heavy lifting. 4. The cervical cerclage is removed at 37 weeks of gestation or left in place an |
| Adolescents : effects on maternal health | |
| Older women: effects on maternal health | |
| Obesity & vulnerable: effects on maternal health |
Created by:
bonitasoul
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