The nurse knows that a pregnant person who TRIES to have a vaginal birth after a Cesarean
Section is considered to be a ____ (acronym only). - TOLAC (trial of labor after cesarean)
The nurse knows that a pregnant person who has successfully had a vaginal birth after a
Cesarean Section is considered to be a ___ (acronym only). - VBAC (vaginal birth after
cesarean)
The nurse knows that the main risk with TOLAC is the risk of uterine ____. Risk is higher for
those with no prior vaginal delivery (C/S only). S/Sx of this complication are abdominal pain,
absent contractions, hypovolemic shock (hemorrhage), and variable decelerations. - rupture
Pregnant persons who have had a ____ (two words) uterine incision are good candidates for a
TOLAC. - low transverse
The umbilical cord slips down after the patient's membranes rupture and before the baby's
head engages. The pressure of the fetus compresses the cord against the pelvis. The nurse
knows that the pregnant person is experiencing a ____ umbilical cord and encourages the
patient to assume a KNEES to CHEST (child's pose) position. - prolapsed
The pregnant person's placenta is MALPOSITIONED in the lower uterine segment and it totally
or partially occludes the internal cervical os or is in close proximity to the cervical opening. The
nurse recognizes this complication as ____ (two words). S/Sx: sudden onset of painless, bright
red bleeding. Avoid doing a vaginal exam with hands or devices to avoid infection. - placenta
previa
Placenta previa is typically less of a concern when it is diagnosed [early / late] in the pregnancy.
- early
When a pregnant person experiences a partial or total DETACHMENT of the placenta from a site
of normal implantation in the uterine wall any time before the delivery of the fetus, the nurse
understands this is ____ (two words). S/Sx: varies but with bleeding (usually darker) and pain -
placental abruption
During placenta abruptio, the amount of bleeding, pain and abdominal discomfort vary with the
amount of ____. - separation
The nurse knows that an important precaution against infection during 2nd or 3rd trimester
bleeding (i.e. indications of placenta previa or placental abruption) is to avoid performing ____
(two words). - vaginal exams
,The nurse observes the placenta and notices that the cord separates into small vessels that
reach the placenta across the amnion. The nurse recognizes this pattern of cord insertion as
____ insertion, which involves increased risk of broken vessels. - velamentous
The nurse observes the placenta and notices that the cord is inserted marginally rather than
centrally on the placenta. The nurse recognizes this placental variation as ____ placenta, and
knows that the entire placenta is not getting optimal perfusion. - battledore
The nurse observes the placenta and notices one or more accessory lobes that are attached to
the main placenta by blood vessels. The nurse recognizes this placental variation as ____
placenta, which can increase the risk of not knowing that remnants of the placenta have not
been delivered. - succenturiata
Three variations of placental attachment to the uterus exist. The LEAST SEVERE occurs when
chorionic villi pass through the endometrium and attach onto the myometrium of the uterus.
The nurse recognizes this as placenta ____ and is the most common variation of attachment. -
accreta
Three variations of placental attachment to the uterus exist. The MODERATELY SEVERE version
occurs when the chorionic villi penetrate deeply into the myometrium and attach. The nurse
recognizes this as placenta ___. - increta
Three variations of placental attachment to the uterus exist. The MOST SEVERE version occurs
when the chorionic villi of the placenta dig through the endometrium, the myometrium, the
perimetrium and sometimes the bladder wall. The nurse recognizes this as placenta ___, which
dramatically increases the risk of poor detachment of the placenta during birth. - percreta
Placental attachment typically occurs directly to the [ endometrium / myometrium /
perimetrium ]. - endometrium
Placenta Previa, when diagnosed [ early / late ] in pregnancy via ultrasound, is very serious and
the patient needs to plan for a C/S birth by at least 37 weeks whether they experience bleeding
or not during the pregnancy. - late
A patient presenting with vaginal bleeding, no pain, no contractions is likely experiencing
placenta [ previa / abruptio ]. - previa
A patient who presents (usually after 20 weeks) with vaginal bleeding, uterine pain, and
contractions is likely experiencing placenta [ previa / abruptio ]. Non-reassuring fetal heart
tracing is also common. - abruptio
Yes or No? A patient with a placental abruption will always have vaginal bleeding. - No
,Concealed or complete are two types of placental ____. HTN, smoking, cocaine use and
trauma/mechanical event are typical causes. - abruption
Placenta percreta is often discovered at birth because the placenta does not come out. The
nurse understands that in these situations the pregnant person will likely undergo an
abdominal ____ to avoid putting the pregnant person at risk. - hysterectomy
Prior C-section or placenta previa, prior D&C (dilation and curettage), and myomectomy
(removal of fibroids) increase the risk of poor placental ____. - attachment
Uterine contractions occurring from the 20th week of gestation through the 37th WITH cervical
changes is known as ____ labor. S/Sx: icky, yucky, leaking, nausea, diarrhea, pelvic pressure,
painful or painless contractions (6/hr). - preterm
A prior ____ (two words) is the biggest risk factor for a preterm birth. - preterm birth
The nurse knows that the nausea, vomiting and DIARRHEA that presents with preterm labor is
likely due to the rise in ____. - prostaglandins
Nifedipine and Indomethacin are tocolytics that help to slow labor and reduce ____ muscle
irritation and thereby help to inhibit uterine contractions. Commonly used with preterm labor. -
smooth
Postponement of preterm labor is essential, even for 48 - 72 hours. The nurse might have time
to administer a steroid like Betamethasone (23-37 weeks) for improved lung function and
Magnesium Sulfate (>34 weeks) for ____. - neuroprotection
Postponement of preterm labor is essential, even for 48 - 72 hours. The nurse might have time
to administer a steroid like Betamethasone (23-37 weeks) for improved ____ function and
Magnesium Sulfate (=<34 weeks) for neuroprotection against cerebral palsy. - lung
When the cervix dilates prematurely, and cannot feasibly hold the fetus until term, cervical
____ may be performed to maintain the pregnancy and close the cervix mechanically. - cerclage
A transvaginal ultrasound is often conducted at 20 weeks to measure the ____ of the cervix. -
length
ROM that occurs anytime prior to the onset of labor in a term birth is ____ (acronym only). -
PROM (premature rupture of membranes)
ROM that occurs anytime prior to the onset of labor in a preterm birth is ____ (acronym only).
INFECTION is the most common cause due to bacteria eating holes in the membranes. - PPROM
(preterm premature rupture of membranes)
, The nurse knows that when using a Nitrozene strip to determine if PPROM has occurred, the
nurse will immediately see the strip color change to ____ (two words). - dark blue (pH 7.5)
Vaginal fluid and urine tend to be [ acidic / basic ]. - acidic (vaginal pH 4.5, urine pH 6.0)
The nurse knows that examination of dried amniotic fluid collected from a STERILE speculum
examination will reveal a pattern of crystallization that looks like a ____. - fern
[ Hypertonic / hypotonic ] dysfunction. See the top line. - Hypotonic
[ Hypertonic / hypotonic ] dysfunction - hypertonic
Multiple gestation and polyhydramnios, sometimes accompanied by cervical insufficiency, are
common causes of uterine ____, which can lead to preterm labor. - distension
Stress, inflammation, placental abruption and uterine distension are the four major causes of
____ (two words). - preterm labor
Postpartum hemorrhage care phases include:
1. Preparation: evaluate labs Hct, Hgb, and Platelets and assess for RISKS
2. Standard Preventative: given to ALL women @ deliv.
3. On Alert: bleeding > ____ (#) mL - 350
4. Activation of PPH Protocol: bleeding > 500mL vaginal delivery and bleeding > 1000ml C-
section
5: Rescue: bleeding > 1500 mL AND activation of massive hemorrhage protocol
Postpartum hemorrhage care phases include:
1. Preparation: evaluate labs Hct, Hgb, and Platelets and assess for RISKS
2. Standard Preventative: given to ALL women @ deliv.
3. On Alert: bleeding > 350mL
4. Activation of PPH Protocol: bleeding > ____ (#)mL vaginal delivery and bleeding > 1000ml C-
section - 500
5: Rescue: bleeding > 1500 mL AND activation of massive hemorrhage protocol
Postpartum hemorrhage care phases include:
1. Preparation: evaluate labs Hct, Hgb, and Platelets and assess for RISKS
2. Standard Preventative: given to ALL women @ deliv.
3. On Alert: bleeding > 350mL
4. Activation of PPH Protocol: bleeding > 500mL vaginal delivery and bleeding > 1000ml C-
section
5: Rescue: bleeding > ____ (#) mL AND activation of massive hemorrhage protocol - 1500
Yes or No? Postpartum hemorrhage can happen in absence of risk factors. - Yes
