Labor&delivery Questions
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AQUINAS COLLEGE ASN PROGRAM MATERNAL-NEWBORN NURSING LABOR AND DELIVERY QUESTIONS PRENATAL LABS 1. What might the patient need if blood type is RH negative? Rhogham 2. What is RPR test for? Screening for syphilis; the patient with a history of Treponema Pallidum infection (syphilis causing bacteria) will have a + result regardless of adequate treatment. A confirmation test with a history or a false + in the RPR test then causes the patient to have a FTA-ABS test done which detects antibodies to the bacteria. The FTA-ABS test is more accurate in testing the presence of syphilis infections than the RPR test. Detection is important due to it’s affect on the fetus. 3. What will be done if the patient’s rubella test is nonimmune? Vaccination should be prearranged to be given following delivery, along with the mother avoiding children showing signs of fever or rash during pregnancy. The vaccine is not given to the woman while pregnant due to the possibility of causing a low grade infection. 4. Why is it important to test for rubella immunity? It is important to test for Rubella infection as it can cause serious complications with the fetus. 5. What is Hepatitis B surface antigen a test for? Hepatitis B surface antigen tests for infectious potential. If positive, regardless of whether prior vaccination was completed, the patient is potentially infectious. 6. What will be done if Hepatitis B is positive? If positive, the fetus will receive normal the hepatitis B vaccination, in addition to hepatitis B immunoglobulin (HBIG) to prevent active hepatitis. 7. What is a GBS test? The GBS test stands for Group B streptococcus, which is tested by culturing the vagina and rectum of the mother at approximately 34 weeks. GBS can also be detected through a urine culture. 8. What is done if the GBS test is positive? If the MD speculates the possibility of GBS due to presence of risk factors (i.e. prolonged rupture of the membrane or preterm labor) the patient will be treated. During labor, treatment with antibiotics prevents the rare occurrence of pneumonia and overwhelming infection of the newborn. LABOR
1. Define true labor. True laboring is seen with contractions occurring every five minutes for at least one hour, which are often preceded by the gush of amniotic fluid. The contractions are felt over the fundus, radiating to the back and lower abdomen. The pain experienced is not relived with ambulation, and sedation does not stop contractions. 2. Define false labor. “Braxton-Hicks” contractions, or false labor, are contractions often felt in less intensity with shorter duration. The pain is lower in the abdomen and to the groin, and ambulation often stops contractions. 3. Name 2 tests to check for ruptured membranes. The pH and Nitrazine are tested using vaginal fluid collected during the speculum exam. The pH is tested to obtain levels determining acidity/alkalinity, with a high alkalinity of vaginal fluid indicating a greater likelihood of membrane rupture. This alkaline level additionally results in amniotic fluid leakage into the vagina as a possibility. 4. What is the recommended weight gain for pregnancy? 2-4 lbs. total during the 1st trimester, 3-4 lbs/month during the 2nd/3rd trimesters. This approximation is based on the fact that the patient is at a healthy weight prior to pregnancy, allowing a total gain of 25-35 pounds. 5. What problems may occur with excessive weight gain? Excessive weight gain during pregnancy can increase the risk of birth defects and problems such as LGA, gestational diabetes, shoulder dystocia, and a increase in need for C-section delivery. 6. What problems may occur with too little weight gain? Too little weight gain may result in a fetus with SGA. A lack of adequate nutrition may not only affect the fetal growth, but negative long term outcomes may result including effects on brain growth/development. 7. What might the RN be concerned with if the fluid is: red? Green? If green fluid is present, depending on the shade, the RN will be concerned that the presence of meconium is possible. The green fluid can be seen if the passage of meconium occurs within the uterus prior to birth, it is also can be a sign of fetal distress. If the fluid is red, or wine-colored the RN should associate this with early interamniotic bleeding. The hemoglobin breakdown products are what is attributed to the red pigmentation. 8. What might the RN be concerned about if the fluid has been ruptured greater than 24 hours? If it has been greater than 24 hours since the rupture occurred, the RN should be worried about the possibility of
infection. A sepsis screen should be done or the neonate should be started on broad spectrum antibiotics. 9. What is normal blood loss for a vaginal delivery? Less than 500 mL of blood loss after vaginal delivery is normal, but up to one pint is not uncommon. 10. What is normal blood loss for a cesarean section? 1000 mL to 1499 mL of blood loss is normal for a cesarean section delivery. STAGES OF LABOR • 1ST stage from onset of true contractions to full dilation and effacement of cervix • 2nd stage from complete dilation and effacement to birth • 3rd stage from birth to expulsion of placenta DEFINE G –gravida, the # of times pregnant EDC – estimated date of completion T –term, the # of full term infants born >37 wks LMP – last menstrual period P-preterm, # of preterm infants born <37 wks EGA – estimated gestational age A-abortions, # of spontaneous/induced abortions L-living, the # of living children patient has given birth to DRUG CLASSIFICATION SYSTEM FOR PREGNANCY A – Adequate, well controlled studies in pregnant women show no increased risk to fetal abnormalities. B – Animal studies show no harm to fetus, but no adequate studies of pregnant women are reported OR animal studies have shown adverse effects to the fetus but well-controlled studies in pregnant women reveal no risk to the fetus. C – Animal studies show an adverse effect on fetus but no wellcontrolled studies in pregnant women have been reported OR no animal studies have been conducted and no adequate/wellcontrolled studies in pregnant women have been reported. D – Studies being adequate, well-controlled and observational in pregnant women demonstrate a risk to the fetus, although the benefits may outweigh the risks. X – Studies being adequate, well-controlled and observational show a positive confirmation of fetal abnormalities, contraindicating the use of the product in women who are, or may become pregnant. NR/UK – abbreviation used when the pregnancy category is unknown.
1. Define true labor. True laboring is seen with contractions occurring every five minutes for at least one hour, which are often preceded by the gush of amniotic fluid. The contractions are felt over the fundus, radiating to the back and lower abdomen. The pain experienced is not relived with ambulation, and sedation does not stop contractions. 2. Define false labor. “Braxton-Hicks” contractions, or false labor, are contractions often felt in less intensity with shorter duration. The pain is lower in the abdomen and to the groin, and ambulation often stops contractions. 3. Name 2 tests to check for ruptured membranes. The pH and Nitrazine are tested using vaginal fluid collected during the speculum exam. The pH is tested to obtain levels determining acidity/alkalinity, with a high alkalinity of vaginal fluid indicating a greater likelihood of membrane rupture. This alkaline level additionally results in amniotic fluid leakage into the vagina as a possibility. 4. What is the recommended weight gain for pregnancy? 2-4 lbs. total during the 1st trimester, 3-4 lbs/month during the 2nd/3rd trimesters. This approximation is based on the fact that the patient is at a healthy weight prior to pregnancy, allowing a total gain of 25-35 pounds. 5. What problems may occur with excessive weight gain? Excessive weight gain during pregnancy can increase the risk of birth defects and problems such as LGA, gestational diabetes, shoulder dystocia, and a increase in need for C-section delivery. 6. What problems may occur with too little weight gain? Too little weight gain may result in a fetus with SGA. A lack of adequate nutrition may not only affect the fetal growth, but negative long term outcomes may result including effects on brain growth/development. 7. What might the RN be concerned with if the fluid is: red? Green? If green fluid is present, depending on the shade, the RN will be concerned that the presence of meconium is possible. The green fluid can be seen if the passage of meconium occurs within the uterus prior to birth, it is also can be a sign of fetal distress. If the fluid is red, or wine-colored the RN should associate this with early interamniotic bleeding. The hemoglobin breakdown products are what is attributed to the red pigmentation. 8. What might the RN be concerned about if the fluid has been ruptured greater than 24 hours? If it has been greater than 24 hours since the rupture occurred, the RN should be worried about the possibility of
infection. A sepsis screen should be done or the neonate should be started on broad spectrum antibiotics. 9. What is normal blood loss for a vaginal delivery? Less than 500 mL of blood loss after vaginal delivery is normal, but up to one pint is not uncommon. 10. What is normal blood loss for a cesarean section? 1000 mL to 1499 mL of blood loss is normal for a cesarean section delivery. STAGES OF LABOR • 1ST stage from onset of true contractions to full dilation and effacement of cervix • 2nd stage from complete dilation and effacement to birth • 3rd stage from birth to expulsion of placenta DEFINE G –gravida, the # of times pregnant EDC – estimated date of completion T –term, the # of full term infants born >37 wks LMP – last menstrual period P-preterm, # of preterm infants born <37 wks EGA – estimated gestational age A-abortions, # of spontaneous/induced abortions L-living, the # of living children patient has given birth to DRUG CLASSIFICATION SYSTEM FOR PREGNANCY A – Adequate, well controlled studies in pregnant women show no increased risk to fetal abnormalities. B – Animal studies show no harm to fetus, but no adequate studies of pregnant women are reported OR animal studies have shown adverse effects to the fetus but well-controlled studies in pregnant women reveal no risk to the fetus. C – Animal studies show an adverse effect on fetus but no wellcontrolled studies in pregnant women have been reported OR no animal studies have been conducted and no adequate/wellcontrolled studies in pregnant women have been reported. D – Studies being adequate, well-controlled and observational in pregnant women demonstrate a risk to the fetus, although the benefits may outweigh the risks. X – Studies being adequate, well-controlled and observational show a positive confirmation of fetal abnormalities, contraindicating the use of the product in women who are, or may become pregnant. NR/UK – abbreviation used when the pregnancy category is unknown.
