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OB Clinical Preparation PacketNUR 350

BSNObstetrical (OB) Nursing

OB clinical preparation packet – LKS 3/2020

This part of the OB Preparation Packet will require you to view the 3 OB Video’s on myDSN.net (in NUR350) or in the Simulation Google classroom. You must view the videos and use your book Maternity & Women’s Health Care book by Lowdermilk to complete this clinical preparation packet. If you have clinical starting the 1 week of the quarter (April 4 th ) your OB clinical preparation packet needs to be completed before attending clinical including medications logs.

The OB preparation packet will be available Monday week 11, to view and download at mydesn.net (NUR350), Google Classroom, then on black board the first day of the quarter. In addition, after completing the med sheets some clinical instructor’s want your completed medication list to be on a 3x5 card, preferably with a ring place through the cards to make it easier to flip through the medications at the clinical site.

All students need to upload to the completed clinical preparation packet by the end of the first week of OB didactic class by Friday 4/10. Failure to upload the completed clinical preparation packet including medications logs will lead to a failure for clinical. Plus note: Students do not need to up load the “how to read fetal monitoring” it is for your reference at your clinical site. The clinical preparation packet will be graded by your OB didactic instructor. A student must meet 78% on the clinical preparation packet. Failure to meet 78% wills results in Clinical failure.

All students must take the completed clinical preparation packet to their individual clinical site.

Grading Rubric for Clinical Preparation Packet

Competency 25 points 15 points 10 points Points Earned

Labor and Delivery

Completely answers all questions to show understanding of concepts with

fewer than 3 mistakes

Answers all questions with

more than 3 mistakes

Does not answer all questions, or shows minimal understanding

of materialPostpartum Completely answers all questions to

show understanding of concepts with fewer than 3 mistakes




of materialNewborn Completely answers all questions to

show understanding of concepts with fewer than 3 mistakes




of materialMedication

CardsMedication log is complete with

action/use, dosage/route of administration, side

effects/contraindications/precautions, nursing considerations, and patient

teaching for all medications

All medications on log are

filled out but with 3 or

fewer missing areas

Not all medications on

log are completed or

with more than 3 missing areas


NUR 350 OB

Check list for the Clinical Instructor:

First day of clinical students have their finished clinical prep packets for L&D, postpartum and the newborn and completed medication sheets.

Yes Comments

Students are present at Clinical early, 7minutes late leeway and stay through the required end time. After 7 minutes late the student may not attend clinical and sent home.

Students adherence to Denver college of Nursing dress code including name badge at the clinical site

Student maintains academic integrity and adheres to Student Standards of conduct.

Students maintain HIPAA and includes PHI for electronic, written or oral information about the patient

Have calculations checked by the faculty member prior to administering any medications.

Seek help from faculty member as needed. Does not perform new skills/additional skills without consent or supervision of the faculty member

It is the student’s responsibility to notify the clinical office and the instructor if they will be absent

Clinical instructor will be present when the students perform the newborn assessment.


NURS 350 Clinical Preparation LABOR AND DELIVERY

Use your book Maternity and Women’s Health Care by Lowdermik, et al. and three video’s viewed from my DSN.net to answer the questions below.

Betty Moreno just arrived in Labor and delivery triage. She is a 27-y/o Gravida 2, Para 1, currently at 39, with routine Pre Natal Care, GBS negative, blood type A positive, rubella immune . She stated that she had been having contractions at 5 to 10 minute intervals since 4 p.m. and now stronger at 6:30 pm. They lasted 50 seconds.” She also stated that she had been having "a lot of false labor" and hoped that this was "the real thing". She reports active fetal movement and denies any leakage of fluid but has some pink tinged vaginal discharge. When asked to rate her pain, she replies that her current pain level is 7 on a scale of 1 to 10. Betty’s temperature, pulse and respirations were normal and her blood pressure was 120/76. The fetal heart tones were 130 with moderate viability and accels. Her contractions palpate moderate. The nurse did a Sterile vaginal exam (SVE) and recorded the cervix was 4 cm. dilated, 80 percent effaced baby's head was at +1 station, (4/80/+1) with intact membranes. Her DTR’s are 2+, 1+edma in her lower extremities and not clonus. She gave a urine specimen in triage and state she had a BM yesterday. She reported her findings to the Provider and received to admit to L&D.

1. Fetus is showing and average FHT of 130 beats per minute with Accels over a 10-minute period. Is this fetus well oxygenated? (Video)

2. What is the normal fetal heart range? (Video)

3. The BUBBLE LE is an Acronym for labor and postpartum Focused Assessment is taught at DCN. What would be Betty’s BUBBLE LE Assessment? (Video)

4. Using VEAL CHOP what is the likely cause of these decelerations below: (Video)

a) Early decelerationb) Late decelerationc) Variable deceleration


5. What 4 measures should the nurse implement to provide intrauterine resuscitation? (Video)

The Provider arrives and at 9:05 p.m. Betty gave birth to 7 lbs., 5 oz. (3.317 gm.) boy in the O.A. position. The baby was place on skin-to-skin on Mom’s chest and wiped dry. At 9:10 p.m. the placenta was expelled. Betty is now bonding with her baby boy.

Please rate the Apgar score for the following:

At one minute of age the baby’s has:Heart rate: over 100, Respiratory: effort Good, cryingMuscle tone: active motionReflex: Cough or sneeze, Color: Blue, Pale

1 minute Apgar Score_____

At five minutes of age has:Heart rate: over 100 Respiratory: effort Good, cryingMuscle tone: active motionReflex: Cough or sneeze, Color: Body pink, Extremities blue

5 minute Apgar score ______


NUR 350 Clinical Preparation Postpartum

Use your book: Maternity & women’s Health Care by Lowdermilk, et al. (2016) and watching the three OB videos you watched to answer questions pertaining to postpartum nursing Care.

Case Study:

You have just received Abigail Rice a 32-year-old biracial female, Gravida 1 now Para 1, who delivered a baby girl three hours ago, at 38 weeks gestation and the newborn weighs 7 lbs. 3 oz. on the postpartum unit after and uneventful fourth stage recovery period. She is GBS negative, and blood type AB positive and had her T-Dap shot during her pregnancy and is rubella non-immune. Your first assessment vital signs are temperature 99.0, pulse 88, respiration 20, and blood pressure 108/68. Fundal assessments boggy, at 2 fingers above and to the right of the umbilicus, with moderate amount of lochia with clots, perineal edema apparent and vaginal lacerations were repaired, with hemorrhoids present.

1. What is a boggy uterus? (Pg. 425- 428, & 772-724, [fig.724]) What interventions are needed firm up the uterus, decrease the lochia and help

stop the vaginal clots?

Please list your interventions by priority.

2. What would be the intervention for the uterus deviated to the right of the umbilicus? What if she was unable to void? (Pg. 428)


NUR 350 clinical preparation Newborn

Use your book: Maternity & women’s Health Care by Lowdermilk, et al. (2016) Chapter 24 (Pg. 486-530) and watching the three OB videos.

Before doing a newborn assessment you need to know and look up the following:

1. What it the newborn average length and range?

2. What is the newborn average weight in grams? 1 kg = 2.2 lbs. 1 lb. = 453.59 grams

3. Average newborn head circumference?

4. Fill in acronyms below and give the potential risks AGA SGA LGA

5. What is the normal newborn temperature range?

6. What is the newborn apical pulse range?

7. What is the respirations range?

8. What is the normal newborn blood sugar?

9. What is the most critical physiologic change required of the newborn after birth? (Video)

10. Infant’s head has overriding sutures with some molding, why does this occur?

11. What assessment should be done concerning baby Colby’s anterior and posterior fontanel?

12. Hypoglycemia of the infant (pg. 468- 470, 510 & 757) What signs and symptoms does the infant display when hypoglycemic?


What is the treatment for hypoglycemic infant?

13. Thermoregulation of the infant. Please identify 4-heat loss mechanisms for the newborn and interventions for each. (pg. 464-466, & 735)

1.

2.

3.

4


Select Glossary of Important Obstetrical Terms

AABO incompatibility Hemolytic disease that occurs when the mother’s blood type is O and the newborn’s is A, B, or

AB.

abortion Termination of pregnancy before the fetus is viable and capable of extrauterine existence, usually less than 20 weeks of gestation (or when the fetus weighs less than 500 g); miscarriage.

abruptio placentae (placental abruption) Premature separation of the placenta; the detachment of part or all of a normally implanted placenta from the uterus before the birth of the infant. Related to: Hypertensive disorders, high gravidity, abdominal trauma, short umbilical cord, cocaine abuse.

acute bilirubin encephalopathy Acute manifestations of bilirubin toxicity that occur during the first weeks after birth.

amnioinfusion Infusion of room-temperature isotonic fluid (usually normal saline or lactated Ringer’s solution) into the uterine cavity if the volume of amniotic fluid is low, in an attempt to increase the fluid around the umbilical cord and prevent compression during uterine contractions.

amniotic fluid embolus (AFE) Rare but devastating complication of pregnancy characterized by the sudden, acute onset of hypoxia, hypotension, cardiovascular collapse, and coagulopathy. AFE occurs during labor, during birth, or within 30 minutes after birth. Also known as anaphylactoid syndrome of pregnancy.

anencephaly Congenital deformity characterized by the absence of both cerebral hemispheres (cerebrum and cerebellum) and the flat bones of the overlying skull.

asphyxia Term used when fetal hypoxia results in metabolic acidosis.

Bbiophysical profile (BPP) Noninvasive assessment of a fetus using ultrasound and the nonstress test. It includes the

following components: fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate (FHR), and qualitative amniotic fluid volume.

brachial plexus injury Paralysis caused by physical injury to the upper brachial plexus, occurring most often in childbirth from forcible traction during birth.

bradycardia Baseline fetal heart rate (FHR) of fewer than 110 beats/minute for 10 minutes or longer. True bradycardia occurs rarely and is not specifically related to fetal oxygenation.

Braxton Hicks contractions Mild, intermittent, painless uterine contractions that occur during pregnancy. These contractions occur more frequently as pregnancy advances but do not represent true labor.

bronchopulmonary dysplasia (BPD) Pulmonary condition affecting preterm infants who have experienced respiratory failure and have been oxygen dependent for more than 28 days.

C


caput succedaneum Swelling of the tissue over the presenting part of the fetal head caused by pressure during labor.

cephalhematoma NOTE: This is spelled cephalohematoma in some sources. Extravasation of blood from ruptured vessels between a skull bone and its external covering, the periosteum. Swelling is limited by the margins of the cranial bone affected (usually parietals).

cephalopelvic disproportion (CPD) Condition in which the infant’s head is of such a shape, size, or position that it cannot pass through the mother’s pelvis; can also be caused by maternal pelvic problems. Also called fetopelvic disproportion (FPD).

cerclage Use of nonabsorbable suture to constrict the internal os of a cervix that is dilating prematurely because of cervical weakness. The suture can be placed vaginally or abdominally. A cerclage can be placed either prophylactically or as a rescue procedure.

cesarean Delivery of a fetus or fetuses through the abdomen. Whether planned (elective) or unplanned (emergency),

such a client is prone to complications. Anesthesia complications, Usual abdominal surgery complications, Sepsis, Thromboembolism, Injury to the urinary tract, The rate of cesarean-section births is more than 30% in the United States and is increasing, Vaginal birth after cesarean (VBAC) rate is decreasing due to the complications associated with the procedure.

chorioamnionitis Bacterial infection of the amniotic cavity; usually diagnosed by the clinical findings of maternal fever, maternal and fetal tachycardia, uterine tenderness, and foul odor of amniotic fluid. Other terms for this condition include clinical chorioamnionitis, amnionitis, intrapartum infection, amniotic fluid infection, and intraamniotic infection.

chronic hypertension Hypertension that is present before pregnancy or that is initially diagnosed during pregnancy and persists longer than 12 weeks postpartum.

clonus Hyperactive reflexes.

contraction stress test (CST) Test to stimulate uterine contractions for the purpose of assessing fetal response to stress; it identifies a fetus that is stable at rest but shows evidence of compromise after stress. This test is also known as the oxytocin challenge test (OCT).

Coombs’ test Indirect: determination of Rh-positive antibodies in maternal blood. Direct: determination of maternal Rh-positive antibodies in fetal cord blood. A positive test result indicates the presence of antibodies or titer.

corrected age Taking into account the gestational age and the postnatal age of a preterm infant when determining expectations for development.

Ddiabetes mellitus A group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The current classification system includes four groups: type 1 diabetes, type 2 diabetes, other specific types (e.g., diabetes caused by genetic defects in beta cell function or insulin action, disease or injury of the pancreas, or drug-induced diabetes), and gestational diabetes mellitus.

dilation and curettage (D&C) Surgical procedure in which the cervix is dilated if necessary and a curette is inserted to scrape the uterine walls and remove uterine contents. Uterine contents may also be removed by suction curettage, using a catheter attached to an electric-powered vacuum source.

disseminated intravascular coagulation (DIC) Pathologic form of clotting that is diffuse and consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both, and clotting. In obstetrics it is most often associated with placental abruption, amniotic fluid embolism, preeclampsia, HELLP syndrome, and gram-negative sepsis. Also called consumptive coagulopathy.


Doppler blood flow analysis Method for measuring blood flow noninvasively in the fetus and placenta using ultrasound to detect intrauterine growth restriction.

dysfunctional labor Long, difficult, or abnormal labor, caused by various conditions associated with the five factors affecting labor; also called dystocia.

Eectopic pregnancy Pregnancy in which the fertilized ovum is implanted outside of its normal

place in the uterine cavity. Locations include the abdomen, uterine tubes, and ovaries. Ectopic pregnancies are often called tubal pregnancies because at least 90% are located in the uterine tube.

emergency delivery (rapid, uncontrolled delivery) A n nonsterile or an unassisted delivery that can be managed without complications to mother or fetus.

exstrophy of the bladder Results from the abnormal development of the bladder, abdominal wall, and pubic symphysis that causes the bladder, the urethra, and the ureteral orifices to be exposed; rare and males affected twice as often as females.

external cephalic version (ECV) Turning the fetus to a vertex position by exertion of pressure on the fetus externally through the maternal abdomen.

extremely low birth weight (ELBW) A newborn birth weight of 1000 g (2.2 lb) or less.

Ffetal fibronectin (fFN) Glycoprotein “glue” found in plasma and produced during fetal life. It normally appears in

cervical and vaginal secretions early in pregnancy and again in late pregnancy. Assessing for the presence or absence of fFN in vaginal secretions is used as a diagnostic test for preterm labor.

fetal hydrops The most severe form of erythroblastosis fetalis, in which the fetus has marked anemia, cardiac decompensation, cardiomegaly, hepatosplenomegaly, and hypoxia.

forceps-assisted birth Birth in which forceps are used to assist in delivery of the fetal head.

Ggestational diabetes mellitus (GDM) Traditionally defined as carbohydrate intolerance with the onset or first

recognition occurring during pregnancy. The American Diabetes Association defines GDM as diabetes diagnosed during pregnancy that is clearly not overt (preexisting) diabetes.

gestational hypertension Onset of hypertension without proteinuria or other systemic findings diagnostic for preeclampsia after week 20 of pregnancy. Gestational hypertension does not persist longer than 12 weeks postpartum and usually resolves during the first postpartum week.

glycosylated hemoglobin A1c Test done to assess recent glycemic control. Hemoglobin A1c levels greater than 6 indicate elevated glucose levels during the previous 4 to 6 weeks.

gestational trophoblastic disease Chorionic villi degenerate into a bunch of clear vesicles in grapelike clusters. Hydatidiform mole is a developmental anomaly. An embryo is rarely present. It predisposes the client to choriocarcinoma.

HHELLP syndrome A laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction,

characterized by hemolysis (H), elevated liver enzymes (EL), and low platelet count (LP); it is not a separate illness.


hemorrhagic shock Clinical condition in which the peripheral blood flow is inadequate to return sufficient blood to the heart for normal function, particularly oxygen transport to the organs or tissue. Also called hypovolemic shock.

hydramnios A condition characterized by too much amniotic fluid (aka Polyhydramnios)

hydatidiform mole Benign proliferative growth of the placental trophoblast in which the chorionic villi develop into edematous, cystic, avascular transparent vesicles that hang in a grapelike cluster. Hydatidiform mole is caused by abnormal fertilization, so there is no viable fetus. Also called a molar pregnancy

hyperbilirubinemia Condition in which the total unconjugated serum bilirubin concentration in the blood is elevated. Values are abnormal based on gestational age, days of life, and the baby’s general physical condition. Hyperbilirubinemia is characterized by a yellow discoloration of the skin, mucous membranes, sclera, and various organs.

hyperemesis gravidarum Abnormal condition of pregnancy characterized by vomiting excessive enough to cause weight loss, electrolyte imbalance, nutritional deficiencies, and ketonuria

hypoxia Inadequate supply of oxygen at the cellular level that can cause metabolic acidosis.

I induction of labor Chemical or mechanical initiation of uterine contractions before their spontaneous onset for the

purpose of bringing about birth.

intrauterine growth restriction (IUGR) Term for slowed growth of the fetus during pregnancy.

intrahepatic cholestasis of pregnancy (ICP) Disorder unique to pregnancy that is characterized by generalized pruritus caused by elevated serum bile acids. The itching commonly affects the palms and soles but can occur on any part of the body and is usually worse at night. No skin lesions are present.

intrauterine growth restriction (IUGR) Fetal undergrowth of any cause, such as deficient nutrient supply or intrauterine infection, or associated with congenital malformation; birth weight below population 10th percentile corrected for gestational age.

intrauterine pressure catheter (IUPC) Catheter inserted into uterine cavity to assess uterine activity and pressure by electronic means.

inversion of the uterus (1) Turning end for end, upside down, or inside out. (2) Deviation in which a portion of the chromosome has been rearranged in reverse order.

isoimmunization Production of antibodies by one member of a species against something that is commonly found within that species (e.g., development of anti-Rh antibodies in an Rh-negative person; also called Rh incompatibility).

Jjaundice Yellow discoloration of the body tissues caused by the deposit of bile pigments (unconjugated bilirubin); also

called icterus. See also hyperbilirubinemia.

Kkernicterus Bilirubin encephalopathy involving the deposit of unconjugated bilirubin in brain cells, resulting in death

or impaired intellectual, perceptive, or motor function and adaptive behavior.

ketoacidosis The accumulation of ketone bodies in the blood as a consequence of hyperglycemia; leads to metabolic acidosis.


Llarge for gestational age (LGA) Exhibiting excessive growth for gestational age; an infant whose birth weight falls

above the 90th percentile on intrauterine growth curves.

lecithin/sphingomyelin ratio (L/S ratio) Ratio of lecithin to sphingomyelin in the amniotic fluid. It is used to assess maturity of the fetal lung.

lochia Uterine/vaginal discharge after childbirth (during the puerperium) consisting of blood, tissue, and mucus.

low birth weight (LBW) A newborn birth weight less than 2500 g (5.5 lb).

Mmacrosomia Birth weight more than 4000 to 4500 g or greater than the 90th percentile.

meconium aspiration syndrome (MAS) Function of fetal hypoxia: with hypoxia, the anal sphincter relaxes and meconium is released; reflex gasping movements draw meconium and other particulate matter in the amniotic fluid into the infant’s bronchial tree, obstructing the airflow after birth.

meconium-stained amniotic fluid Presence of green amniotic fluid that is either thin (light) or thick (heavy) in consistency; indicates that the fetus has passed meconium (first stool) before birth.

Montevideo units (MVUs) A method for evaluating the adequacy of uterine activity for achieving progress in labor.

MVUs are calculated by subtracting the baseline uterine pressure from the peak contraction pressure for each contraction that occurs in a 10-minute window, and then adding together the pressures generated by each contraction that occurs during that period of time. MVUs can only be calculated using an intrauterine pressure catheter (IUPC).

multigravida A woman who has had two or more pregnancies

multipara A woman who has completed two or more pregnancies to 20 weeks of gestation or more

Nnecrotizing enterocolitis (NEC) Acute inflammatory bowel disorder that occurs primarily in preterm or low-birth-

weight neonates. It is characterized by ischemic necrosis (death) of the gastrointestinal mucosa, which may lead to perforation and peritonitis; formula-fed infants are at higher risk for this disease.

neonatal abstinence syndrome Signs and symptoms associated with drug withdrawal in the neonate.

nonstress test (NST) Evaluation of fetal response (fetal heart rate) to fetal movement, uterine contractions, or stimulation.

nuchal cord Encircling of fetal neck by one or more loops of umbilical cord.

nullipara A woman who has not completed a pregnancy beyond 20 weeks of gestation.

nulligravida A woman who has never been pregnant and is not currently pregnant.

Ooligohydramnios Decreased amount of amniotic fluid; usually objectively diagnosed when the deepest vertical pocket

of fluid measured in two perpendicular planes is less than 2 cm.

ophthalmia neonatorum Infection in the neonate’s eyes usually resulting from gonorrheal or other infection contracted when the fetus passes through the birth canal (vagina).


oxytocin Hormone produced by the posterior pituitary that stimulates uterine contractions and the release of milk in the mammary gland (let-down reflex). Synthetic oxytocin (Pitocin) may be used to either induce or augment labor.

Ppatent ductus arteriosus (PDA) Condition that occurs when the fetal ductus arteriosus fails to close after birth.

pathologic jaundice Jaundice usually first noticeable within 24 hours after birth; caused by some abnormal condition such as an Rh or ABO incompatibility and resulting in bilirubin toxicity (e.g., kernicterus); unconjugated hyperbilirubinemia that is either pathologic in origin or severe enough to warrant further evaluation and treatment. Also called nonphysiologic jaundice.

persistent pulmonary hypertension of the newborn (PPHN) Combined findings of pulmonary hypertension, right-to-left shunting, and a structurally normal heart.

phenylketonuria (PKU) Inborn error of metabolism caused by a deficiency in the enzyme phenylalanine hydrolase. Absence of this enzyme impairs the body’s ability to metabolize the amino acid phenylalanine found in all protein foods. Consequently, toxic accumulation of phenylalanine in the blood occurs, which interferes with brain development and function.

phototherapy Using lights to reduce serum bilirubin levels by oxidating bilirubin into water-soluble compounds that are then processed in the liver and excreted into bile and urine. placenta accreta Unusual placental adherence; accreta is a slight penetration of the myometrium.

placenta increta Unusual placental adherence; increta is deep penetration of the myometrium.

placenta percreta unusual placental adherence; perceta is perforation of the myometrium.

placenta previa Placenta is implanted in the lower uterine segment such that it completely or partially covers the cervix or is close enough to the cervix to cause bleeding when the cervix dilates or the lower uterine segment effaces. Placenta previa can be further classified as complete, marginal, or low-lying.

placental abruption See abruptio placentae.

postpartum hemorrhage (PPH) Excessive bleeding after childbirth; defined as a loss of 1000 ml birth or signs of hypovolemia in the first 24 hours.

postpartum infection Any clinical infection of the genital canal that occurs within 28 days after miscarriage, induced abortion, or childbirth; in the United States, the presence of a fever of 38° C or more on 2 successive days of the first 10 postpartum days (not counting the first 24 hours after birth). Also called puerperal infection.

postpartum psychosis Postpartum depression with psychotic features, including auditory or visual hallucinations, paranoid or grandiose delusions, elements of delirium or disorientation, and extreme deficits in judgment accompanied by high levels of impulsivity that can contribute to increased risks of suicide or infanticide.

postterm pregnancy Pregnancy that extends past 42 completed weeks of gestation (294 days or more from the first day of the last menstrual period). Sometimes also referred to as a postdates or prolonged pregnancy.

preeclampsia Pregnancy-specific condition in which hypertension and proteinuria develop after 20 weeks of gestation in a woman who previously had neither condition. In the absence of proteinuria preeclampsia may be defined as hypertension along with either thrombocytopenia, impaired liver function, the new development of renal insufficiency, pulmonary edema, or new-onset cerebral or visual disturbances.

pregestational diabetes Type 1 or type 2 diabetes that existed before pregnancy.


premature rupture of membranes (PROM) Spontaneous rupture of the amniotic sac and leakage of amniotic fluid beginning before the onset of labor at any gestational age.

prolapse of the umbilical cord Umbilical cord lies below the presenting part of the fetus; may be frank (visible) or occult (hidden, rather than visible).

Rrespiratory distress syndrome (RDS) Condition resulting from decreased pulmonary gas exchange, leading to

retention of carbon dioxide (increase in arterial PCO2). Most common neonatal causes are prematurity, perinatal asphyxia, and maternal diabetes mellitus; hyaline membrane disease (HMD).

retinopathy of prematurity (ROP) Associated with hyperoxemia, resulting in eye injury and blindness in premature infants.

Rh immune globulin a solution of gamma globulin that contains Rh antibodies; administered to prevent sensitization in an Rh negative woman who has had a fetomaternal transfusion of Rh positive fetal red blood cells.

Ssecond stage of labor Begins with full cervical dilation (10 cm) and complete effacement (100%) and ends with the

baby’s birth. It is composed of two phases: the latent (“laboring down”) phase and the active pushing (descent) phase.

shoulder dystocia Condition in which the head is born but the anterior shoulder cannot pass under the pubic arch to complete the birth of the entire fetus.

small for gestational age (SGA) Inadequate growth for gestational age; an infant whose rate of intrauterine growth was restricted and whose birth weight falls below the 10th percentile on intrauterine growth curves.

spina bifida The most common defect of the central nervous system (CNS); results from failure of the neural tube to close at some point.

spinal anesthesia (block) Regional anesthesia induced by injection of a local anesthetic medication alone or in combination with an opioid agonist analgesic into the subarachnoid space at the level of the third, fourth, or fifth lumbar interspace.

spiral electrode A small electrode attached to the presenting fetal part (usually the head) to assess the fetal heart rate using the internal mode of monitoring.

spontaneous abortion Pregnancy that ends as a result of natural causes before 20 weeks of gestation. A fetal weight less than 500 g also may be used to define an abortion. Miscarriage is the lay term for a spontaneous abortion.

spontaneous rupture of membranes (SROM) Rupture of membranes by natural means.

station Relationship of the presenting fetal part to an imaginary line drawn between the ischial spines of the pelvis. It is a measure of the degree of descent of the presenting part of the fetus through the birth canal.

subinvolution Failure of a part (e.g., the uterus) to reduce to its normal size and condition after enlargement from functional activity (e.g., pregnancy).

supine hypotension Fall in blood pressure caused by impaired venous return when gravid uterus presses on ascending vena cava, when woman is lying flat on her back; vena cava syndrome.


surfactant Phosphoprotein necessary for normal respiratory function that prevents the alveolar collapse (atelectasis). See also lecithin and L/S ratio.

Tteratogens Nongenetic factors that cause malformations and disorders in utero.

term Birth after 37 weeks gestation; early term—37 0/7 through 38 6/7 weeks; full term—39 0/7 through 40 6/7 weeks; late term—41 0/7 through 41 6/7 weeks; postterm (postmature)—after 42 weeks. tocolytics Medications given to arrest labor after uterine contractions and cervical change have occurred. Also used to treat uterine tachysystole.

tocotransducer Electronic device for measuring uterine contractions using the external mode of monitoring. Also called a tocodynamometer.

TORCH infections (this term no longer referred to in the 12th ed of Lowdermilk) Collective name for toxoplasmosis, other infections (e.g., hepatitis), rubella virus, cytomegalovirus (CMV), and herpes simplex virus, a group of organisms capable of crossing the placenta; these infections can affect a pregnant woman and her fetus.

trial of labor (TOL) Period of observation to determine if a laboring woman is likely to be successful in progressing to a vaginal birth.

trimester One of three periods of about 13 weeks each into which pregnancy is divided.

Uuterine prolapse Falling, sinking, or sliding of the uterus from its normal location in the body. The degree of prolapse

can vary from mild to complete. In complete prolapse the cervix and body of the uterus protrude through the vagina, and the vagina is inverted.

uterine resting tone Degree of tension in the uterine muscle between contractions; relaxation of the uterus between contractions.

uterine rupture Rare but life-threatening obstetric injury in which there is complete nonsurgical disruption of all uterine layers. The major risk factor for uterine rupture is a scarred uterus as a result of previous cesarean birth or other uterine surgery. uterine tachysystole More than five contractions in 10 minutes, averaged over a 30-minute window, regardless of the presence of an abnormal fetal heart rate or pattern or the woman’s perception of pain. The term tachysystole applies to both spontaneous and stimulated labor.

uteroplacental insufficiency (UPI) Decline in placental function—exchange of gases, nutrients, and wastes—leading to fetal hypoxia and acidosis; evidenced by late fetal heart rate decelerations in response to uterine contractions.

Vvacuum-assisted birth Birth involving attachment of vacuum cup to fetal head and using negative pressure to assist in

birth of the fetus. Also called vacuum extraction.

vaginal birth after cesarean (VBAC) Giving birth vaginally after having had a previous cesarean birth.

Valsalva maneuver Any forced expiratory effort against a closed airway such as holding one’s breath and tightening the abdominal muscles (e.g., pushing during the second stage of labor).

very low birth weight an infant whose birth weight is less than 1500 g (3.3 lb)

Taken from Lowdermilk “Materni ty and Women’s Healthcare” (11 t h ed) and “HESI Comprehensive Review for the NCLEX RN Examination” (5 t h ed), 3-12-2020



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