ANATOMY PHYSIOLOGY OF REPRODUCTION:

OB-MATERNITY

ANATOMY & PHYSIOLOGY OF REPRODUCTION:

• State the objective signs that signify ovulation
• abundant, thin, clear cervical mucus; open cervical os; slight drop in BBT and then

0.5-1.0 F rise; ferning under the microscope

• Ovulation occurs how many days before the next menstrual period?
• 14 days.

• State three ways to identify the chronological age of a pregnancy (gestation)?
• 10 lunar months, 9 calendar months consisting of 3 trimesters of 3 months each, 40

weeks, 280 days.

• What maternal position provides optimum fetal maternal/placental perfusion

during pregnancy?

• The knee-chest position, but the ideal position of COMFORT for the mother which

supports fetal/maternal/placental perfusion is the side-lying position off the abdominal vessels (vena cava, aorta)

• Name the major discomforts of the first trimester and one suggestion for

amelioration of each.

• Nausea and vomiting: crackers before rising. Fatigue: teach the need for rest

periods/naps and 7-8 hours sleep at night.

• If the first day of a woman’s last normal menstrual period was May 28, what is

the estimated delivery date (EDD) using Nagele’s rule?

- Count back 3 months and add 7 days: March 7 (always give February 28 days).

• At twenty weeks gestation, the fundal height would be ______ , the fetus would

weigh approximately _______ and look like _____ .

• At the umbilicus; 300-400 grams; a baby with hair, lanugo and verniz, but without

subcutaneous fat.

• State the normal psychosocial responses to pregnancy in the 2

nd trimester

• Ambivalence wanes and acceptance of pregnancy occurs; pregnancy becomes “real;”

signs of maternal-fetal bonding occur.

• Hemodilution of pregnancy peaks at ______ weeks and results in a/an ______ in

a women’s Hct.

• 28-32 weeks; increase in Hct

• State three principles relative to the PATTERN of weight gain in pregnancy.

• Total gain should average 24-30 lbs. Gain should be consistent throughout

pregnancy. An average of 0.9 lb/week should be gained in the 2 nd & 3 rd trimester.

• During pregnancy a woman should add ____ calories to her diet, and drink ____

of milk/day.

• 300 calories; 1 quart of milk

• Fetal heart rate can be auscultated by Doppler at ____ weeks gestation.
• 10-12 weeks

• Describe the schedule for prenatal visits for a low-risk pregnant woman.
• Once a month until 28 weeks, then once every week until delivery.

FETAL-MATERNAL ASSE SSMENT TECHNIQUES:

• Name 5 maternal variables associated with diagnosis of a high risk pregnancy
• Age (under 17 years or over 34 years of age), parity (over 5), <3 months between

pregnancies, diagnosis of PIH, diabetes mellitus, or cardiac disease.

• Is one ultrasound examination useful in determining the presence of intrauterine

growth retardation (IUGR)?

• no, serial measurements are needed to determine IUGR.

• What does the biophysical profile (BPP) determine?
• Fetal well-being

• List 3 necessary nursing actions prior to an ultrasound exam for a woman in the

first trimester of pregnancy.

• Have client fill bladder. Do not allow client to void. Position supine with uterine

wedge.

• State the advantage of CVS over amniocentesis.
• Can be done between 8-12 weeks gestation with results returned within one week,

which allows for decision about termination while still in 1 st trimester.

• Why are serum or amniotic AFP levels done prenatally?
• To determine if alpha-fetoprotein levels are elevated which may indicate the presence

of neural tube defects; or low levels, which may indicate trisomy 21.

• What is the most important determinant of fetal maturity for extrauterine

survival?

• L/S ratio (lung maturity, lung surfactant development)

• Name the 3 most common complications of amniocentesis.

• Spontaneous abortion, fetal injury, infection.

• Name the 4 periodic changes of the fetal heart rate, their causes, and one nursing

treatment for each.

• Acceleration: caused by burst of sympathetic activity; they are reassuring and require

no treatment. Early decelerations: caused by head compression, are benign and

caution the nurse to monitor for labor progress and fetal descent. Variable decelerations: caused by cord compression; change of position should be tried first.Late decelerations: are caused by UPI (uteroplacental insufficiency) and should be treated by placing client on her side and administering O2.

• What is the most important indicator of fetal autonomic nervous system

integrity/health?

• Fetal heart rate variability

• Name 4 causes of decreased FHR variability.
• Hypoxia, acidosis, drugs, fetal sleep

• State the most important action to take when a cord prolapse is determined.
• Examiner should position mother to relieve pressure on the cord with fingers until

emergency delivery is accomplished.

• What is a “reactive” non-stress test?
• FHR acceleration of 15 beats per minute for 15 seconds in response to fetal

movement.

• What are the dangers of nipple-stimulation stress test?
• The inability to control “oxytocin” dosage and the chance of tetany/hyperstimulation.

• Normal fetal scalp pH in labor is ____ and values below ____ indicate true

acidosis.

• 7.25-7.35 normal pH; 7.2 indicates true acidosis.

INTRAPARTUM:

• List five prodromal signs of labor the nurse might teach the client.
• lightening, braxton-hicks contractions increase, bloody show, loss of mucous plug,

burst of energy, and nesting behaviors.

• How is true labor discriminated from false labor?
• true labor: regular, rhythmic contractions that intensify with ambulation, pain in the

abdomen sweeping around from the back, and cervical changes. False labor: irregular rhythm, abdominal pain (not in back) that decreases with ambulation.

• State 2 ways to determine if the membranes have truly ruptured (ROM).

• Nitrazine testing: paper turns dark blue or black. Demonstration of fluid “ferning”

under microscope.

• Are psychoprophylactic breathing techniques prescribed for use by the stage

and phase of labor?

• No, clients should use these techniques according to their discomfort level and

change techniques when one is no longer working for relaxation.

• Identify two reasons to withhold anesthesia and analgesia until the mid-active

phase of Stage 1 labor.

• if given too early, can retard labor; if given too late, can cause fetal distress

• Hyperventilation often occurs to the laboring client. What results from

hyperventilation and what actions should the nurse take to relieve the condition?

• Respiratory alkalosis occurs which is caused by blowing off CO2 and is relieved by

breathing into a paper bag or cupped hands.

• Describe maternal changes that characterize the transition phase of labor.
• irritability, unwillingness to be touched but does not want to be left alone, nausea and

vomiting, and hiccupping.

• When should a laboring client be examined vaginally?
• Vaginal exams should be done prior to analgesia/anesthesia, to rule out cord prolapse,

to determine labor progress if it is questioned, and to determine when pushing can begin.

• Define cervical effacement.
• the taking up of the lower cervical segment into the upper segment; shortening of the

cervix expressed in percent from 0-100% or complete effacement.

• Where is the fetal heart rate best heard?
• through the fetal back in vertex, OA positions.

• Normal fetal heart rate in labor is _____ = 110-160 bpm

Normal maternal BP in labor is _____ = <140/90 Normal maternal pulse in labor is _____ = <100 bpm Normal maternal temperature in labor is _____ = <100.4 F

• List four nursing actions for the 2

nd stage of labor.

• make sure cervix is completely dilated before pushing is allowed. Assess FHR with

each contraction. Teach woman to hold breath for no longer than 5 seconds. Teach pushing technique.

• List 3 signs of placental separation.