Prenatal Care
What are the phases of pregnancy?
Antepartum- before birth
Intrapartum- during labor and delivery
Postpartum- after birth
(Preconception)- before pregnancy
Explain the difference between Placenta Previa and Placenta Abruptio.
Placenta Previa- the placenta covers the cervix
S/Sx: painless bleeding
Preferred Delivery- C/S
Placenta Abruptio- the placenta detaches from the uterine wall, causing bleeding into the uterus.
S/Sx: firm/tender abdomen, bright red bleeding, hypotension, NRFHT
Preferred Delivery- Emergency C/S
What does the acronym TORCH represent?
Toxoplasmosis
Other infections
Rubella
Cytomegalovirus
Herpesvirus
These infections can cause significant fetal or neonatal complications.
What are the Stages and Phases of Labor?
First stage --> Dilation and Effacement
- Latent Phase
- Active Phase
- Transitional Phase
Second stage --> Expulsion of fetus
Third stage --> Expulsion of placenta
Fourth stage --> Rest and Recovery
A laboring patient reports moderate lower back pain with each contraction. Which nonpharmacological intervention would be particularly appropriate?
Sacral pressure can be used to help relieve back discomfort during contractions (counterpressure)
What is the difference between dysfunctional labor and dystocia?
Dysfunctional labor is labor that does not progress normally.
Dystocia means difficult labor and can result from problems with the powers, passenger, passage, or psyche.
What is the difference between gravida and para?
Gravida = the total number of times a woman has been pregnant, regardless of the outcome.
Para = the number of pregnancies that resulted in delivery at 20 weeks or beyond.
Explain the difference between an Uncomplicated UTI and Complicated UTI
Uncomplicated UTI: Infection is limited to the lower urinary tract (bladder/cystitis) → burning with urination, frequency, urgency, usually no high fever.
Complicated UTI: Infection has progressed to the kidneys (pyelonephritis) → high fever, chills, flank pain/tenderness, nausea/vomiting.
A pregnant patient tests positive for Group B Streptococcus (GBS) at 36 weeks. What treatment should the nurse anticipate during labor?
IV antibiotics, typically penicillin, during labor to reduce transmission of GBS to the newborn.
Screening is performed at approximately 35–37 weeks.
If a woman gets admitted to the L&D and we have limited or no PNC for them, PCN may be given prophylactically throughout labor and extend into the postpartum period as well.
Powers- uterine contractions, maternal pushing
Passage- maternal pelvis, soft tissue
Passenger- Fetus
Psyche- mother's mental/emotional state and its effect on labor
What is the basic principle behind the Gate Control Theory of pain, and name two interventions that utilize this theory.
Stimulation of large nerve fibers can temporarily interfere with pain transmission through smaller nerve fibers. Examples include massage, effleurage, sacral pressure, and hot/cold applications.
A laboring patient initially progresses normally but then contractions become weak and less frequent during the active phase of labor.
What type of labor dysfunction is occurring, and what can contribute to it?
Hypotonic labor dysfunction. It occurs when labor begins normally but contractions become ineffective during the active phase.
Uterine overdistention, such as from hydramnios or multiple fetuses, can contribute by stretching the uterine muscle and reducing its ability to contract effectively.
A patient at 30 weeks' gestation has a routine prenatal visit. Name four assessments the nurse should anticipate performing at the visit.
A patient with Pre-E is started on Mag Sulfate. What signs and symptoms would the nurse be watching out for that indicate Mag Sulfate Toxicity?
What is the intervention that would be warranted if the patient starts to show Mag Sulfate Tox?
Respiratory depression, loss of DTRs, and decreased urine output. NRFHT/Fetal Bradycardia/ Loss of Variability is another sign of Mag Sulfate Tox but for the baby.
Calcium gluconate is the antidote.
A pregnant patient with sickle cell disease develops a sickle cell crisis. Why is this particularly dangerous for the fetus?
Sickling can cause vascular occlusion, including vessels supplying the placenta. Reduced placental blood flow can lead to preterm birth, fetal growth restriction, or fetal demise.
Immediately after a patient's membranes rupture, the nurse notes a sudden fetal heart rate decrease.
What complication should the nurse suspect?
Umbilical cord prolapse or cord compression. Rupture of the membranes can allow the cord to descend ahead of the presenting part, potentially compromising fetal blood flow and oxygenation. The fetal heart rate should be assessed immediately after rupture of membranes.
A laboring patient requests an opioid analgesic. The nurse determines that birth is expected within approximately 30 minutes.
What should the nurse do?
Question the administration of the opioid at this time.
Opioid analgesics should generally be avoided when birth is expected within 1 hour because they can cross the placenta and cause newborn respiratory depression.
During delivery, the fetal head delivers but then retracts against the maternal perineum and the shoulders do not deliver.
What complication should the nurse suspect, and what emergency maneuvers may be performed?
Shoulder dystocia.
This is an obstetric emergency. McRoberts maneuver (performed by the nurse) and suprapubic pressure (performed by the provider) may be used to help release the shoulders.
NO FUNDAL PRESSURE
A pregnant patient tells the nurse, “I've been eating almost twice as much because I'm eating for two now.” She reports that most of her additional calories are coming from sugary snacks and drinks.
What should the nurse teach the patient?
The patient should focus on nutrient-dense, well-balanced foods rather than simply increasing calories. Pregnancy does not mean literally “eating for two”; nutritional quality is important for both maternal health and fetal development.
A pregnant patient with gestational diabetes asks why her newborn will need blood glucose monitoring after birth even though the mother is no longer pregnant.
What should the nurse explain?
Infants of mothers with GDM are at increased risk for neonatal hypoglycemia. During pregnancy, maternal hyperglycemia can result in increased fetal insulin production. After birth, the maternal glucose supply suddenly stops while the infant's insulin may remain elevated, placing the newborn at risk for hypoglycemia. The newborn's glucose should be monitored closely, particularly during the first 24 hours.
A pregnant patient has a positive tuberculosis screening test. What additional testing should the nurse anticipate?
The patient should have a chest radiograph and possibly sputum specimens to determine whether active pulmonary TB is present.
A patient at 34 weeks gestation reports to the L&D unit stating that she has been experiencing painful contractions that feel very regular but she has not timed them yet.
On her walk up from ED to OBED, her contractions subsided.
How should the nurse interpret this?
The patient was experiencing False Labor (Braxton Hicks), contractions were relieved with walking.
A patient is being considered for an epidural,which findings would cause the nurse to question whether the patient should receive an epidural?
Platelet count of less than 100,000/mm³
S/Sx of Infection
S/Sx of Hypovolemia
A patient's labor begins abruptly and intensifies extremely quickly. She delivers the infant less than 3 hours after labor began.
What complication occurred, and what maternal and fetal complications should the nurse assess for?
This is a precipitate birth.
The nurse should assess for maternal uterine rupture, cervical lacerations, and hematoma and for fetal complications such as impaired oxygenation, intracranial hemorrhage, and nerve injury.
A patient at 34 weeks' gestation presents for a routine prenatal visit. Her vital signs are stable, and she reports no new symptoms. During the visit, the nurse performs Leopold maneuvers, measures fundal height, assesses fetal heart rate, checks urine, and reviews the patient's nutrition.
The patient asks:
“Why do I need all of these assessments when I feel completely fine?”
How should the nurse explain the purpose of these assessments?
Routine prenatal assessments help identify deviations from expected pregnancy patterns and detect maternal or fetal problems early. Fundal height helps assess fetal growth and amniotic fluid volume, Leopold maneuvers assess fetal presentation and position, fetal heart rate assesses fetal well-being, and urine testing can identify findings such as protein, glucose, or ketones.
A pregnant patient presents with sudden severe lower abdominal pain, vaginal bleeding, shoulder pain, tachycardia, and hypotension. The patient reports that she is approximately 8 weeks pregnant.
What complication should the nurse suspect, and what is the priority concern?
Ruptured ectopic pregnancy with hypovolemic shock. An ectopic pregnancy most commonly occurs in the fallopian tube. Rupture can cause significant internal hemorrhage, producing severe pain, vaginal bleeding, shoulder pain, tachycardia, and hypotension. The priority is controlling hemorrhage and stabilizing the patient.
A pregnant patient is involved in a motor vehicle collision but initially reports feeling fine. What assessments should the nurse prioritize during the observation period?
The nurse should monitor maternal vital signs, fetal heart rate, and urine output and observe the patient for evidence of complications. A small pillow under one hip can help move the uterus off the inferior vena cava and improve placental blood flow.
What are the cardinal movements of labor and why are they important?
Cardinal movements: Descent --> Flexion --> Internal Rotation --> Extension --> External Rotation/Restitution --> Expulsion
They describe changes in fetal position and movement that allow the fetus to navigate through the maternal pelvis during vaginal birth
Explain what type of Analgesia/Anesthesia these produce:
Pudendal block → _____________________
Epidural → __________________________
Spinal → ____________________________
General → ___________________________
Perineum relief, can still feel contractions
Lower body/Regional analgesia
Rapid, dense, regional analgesia
Unconsciousness
A term patient's membranes rupture spontaneously, but contractions do not begin for several hours.
What complication should the nurse recognize, and what major complication becomes increasingly concerning as the time since rupture increases?
This is premature rupture of membranes (PROM) because the membranes ruptured before labor began. Infection becomes an important concern as the duration of membrane rupture increases, which is why maternal temperature is monitored after rupture.
A pregnant patient at 30 weeks' gestation reports increased urinary frequency, occasional heartburn, and mild shortness of breath. She is concerned that these symptoms indicate that something is wrong with her pregnancy.
Which explanation by the nurse best connects these symptoms to normal physiological adaptations of pregnancy?
The symptoms can result from normal anatomical and physiological changes of pregnancy. The enlarging uterus places pressure on the bladder, contributing to urinary frequency; displacement of the stomach and slower gastrointestinal emptying can contribute to heartburn; and the growing uterus elevates the diaphragm while oxygen consumption increases, contributing to dyspnea.
A patient is 11 weeks pregnant and has:
The nurse should suspect which condition?
Hydatidiform mole (molar pregnancy/gestational trophoblastic disease).
The combination of rapid uterine growth, hyperemesis, unusually high hCG, bleeding, and inability to detect fetal heart activity is characteristic.
A pregnant patient presents with bruises in various stages of healing. The nurse suspects intimate partner violence.
What is the nurse's priority approach?
Question the patient privately and maintain confidentiality. The nurse should assess safety and provide appropriate resources/referrals while recognizing that the decision to leave the abuser belongs to the patient.
How would one describe Effective Contractions?
Contractions that are regular in Frequency, Duration, and Intensity, consistently increasing in the three, and cause change to the cervix --> Dilation and Effacement
A laboring patient has received an epidural and now reports that she cannot tell when her bladder is full. The nurse notes that she has not voided for several hours.
Why is this finding particularly important, and what should the nurse do?
Epidural anesthesia can decrease sensation and contribute to urinary retention. The nurse should monitor bladder function and assess/empty the bladder as needed, with bladder assessment occurring approximately every 2 hours.
A full bladder can interfere with labor progress.
A pregnant patient with a history of a classic cesarean incision is being considered for labor induction.
Why should the nurse recognize this as a major concern?
A previous classic uterine incision carries a higher risk of uterine rupture during a subsequent pregnancy/labor. The PPT identifies previous classic cesarean incision as a contraindication to labor induction.
A patient who is 30 weeks pregnant reports that she has been sitting in a hot tub for 30–45 minutes every evening because it helps relieve her back discomfort.
She asks the nurse whether she can continue doing this.
What is the nurse's best response?
The nurse should discourage use of the hot tub because maternal temperature should not exceed 100.4°F, and exposure to elevated temperatures during pregnancy has been associated with miscarriage and neural tube defects. The nurse should discuss safer approaches to managing pregnancy-related discomfort.
A pregnant patient with beta-thalassemia minor is mildly anemic. She asks why the nurse hasn't simply increased her iron supplementation.
What should the nurse recognize?
Iron supplementation may be inappropriate because patients with beta-thalassemia minor can absorb and store excessive amounts of iron, creating a risk for iron overload.
A patient experiences a pregnancy loss. She asks whether she can hold the infant and requests time alone with her partner.
What should the nurse do?
Support the parents' choices by providing privacy and allowing them to hold the infant if they wish. The nurse should accept their grieving behaviors, offer appropriate mementos, provide emotional and educational support, and consider their religious and cultural rituals when developing the plan of care.
A patient in active labor has contractions every 90 seconds, lasting 100 seconds, with only 30 seconds of relaxation between contractions. The fetal heart rate begins showing recurrent late decelerations.
What two problems should the nurse identify, and what is the priority nursing response?
Uterine tachysystole/hyperstimulation — contractions are too frequent and prolonged with inadequate relaxation.
Late decelerations — suggest uteroplacental insufficiency and fetal compromise.
A patient requires an emergency cesarean birth under general anesthesia.
What two major complications should the nurse anticipate, one involving the mother and one involving the newborn?
Mother: Regurgitation with aspiration of gastric contents, potentially causing chemical lung injury.
Newborn: Respiratory depression, potentially requiring aggressive resuscitation.
A patient requires vacuum-assisted birth because birth needs to be expedited. After birth, what complications would the nurse expect to find on the mother and the newborn?
Mother: Vaginal lacerations, hematomas
Newborn: Bruising, Scalp Lacerations, Cephalohematoma, Intracranial Hemorrhage