📚 Reading: Exam 3 — confirmed by the recording; week split inferred
💡 The one idea
When labor stalls, ask which of the 5 Ps failed — and when the uterus suddenly
stops hurting during strong labor, think rupture, not relief.
🖼️ Preterm labor.Swipe it sideways if it is cut off, or tap to open it full size.
🚨 Uterine rupture — the paradox
The classic sign is a sudden loss of contractions and a report that the pain
“stopped”, together with fetal bradycardia, loss of station, and signs of shock.
Pain that suddenly stops in strong labor is an emergency, not progress.
In shoulder dystocia, never apply fundal pressure. It drives the shoulder harder into the pelvis. Suprapubic pressure only.
🖼️ Oxytocin, tachysystole and cesarean care.Swipe it sideways if it is cut off, or tap to open it full size.
⭐ Oxytocin — when to stop it
Contractions more often than every 2 minutes
Contractions lasting longer than 90 seconds
Resting tone that does not return between contractions
Any late decelerations or non-reassuring pattern
Tachysystole starves the placenta - the uterus must relax to perfuse.
⭐ High-yield — what the exam actually asks
Show 5 moreHide these 5
Hypertonic contractions — frequent, painful, uncoordinated, in the latent phase, e.g. every 60 seconds → fetal hypoxia is the priority, because there is no relaxation interval for placental perfusion. Monitor FHR, oxygen, reposition, anticipate tocolytics or cesarean.
Cephalopelvic disproportion: 41 weeks, 13 hours of active labor, adequate contractions, no cervical change and the head still at 0 station → notify the provider, anticipate cesarean.
Forceps/vacuum prerequisites: cervix fully dilated, membranes ruptured, presenting part engaged, bladder empty. Main indication is a prolonged second stage.
Cesarean indications: CPD, breech or transverse lie, multiples, failure to progress, active STI, fetal distress. Post-dates alone is not one.
Conversion to memorize: 1 unit = 1,000 milliunits.
Calc — Pitocin: order 2 milliunits/min; bag 10 units/1,000 mL = 0.01 units/mL. 2 mU = 0.002 units/min → 0.002 ÷ 0.01 = 0.2 mL/min × 60 = 12 mL/hr.
The ×60 at the end is the most commonly missed step in every one of her infusion problems.
🖼️ Umbilical cord prolapse.Swipe it sideways if it is cut off, or tap to open it full size.
Oxytocin titration targets: contractions q2–3 min, lasting 40–70 sec and never over 90, strong to palpation, soft resting uterus at least 60 sec between, dilation ~0.5–1 cm/hr in active labor, FHR 110–160.
STOP the oxytocin for: more than 5 contractions in 10 min · any contraction over 90 sec · contractions within 1 min of each other · resting tone above 15 mmHg · no relaxation between.
Monitor with EVERY dose change — FHR, contractions and vital signs. q15 min first stage, q5 min second stage.
Uterine rupture: she reports "ripping" or "tearing," contractions stop, station is lost, fetal parts become palpable, bradycardia with absent variability, then shock. Rupture involves all three layers; dehiscence does not.
Prolapsed cord, in order: call for help and do not leave her → gloved hand in, hold the presenting part off the cord and stay there until birth → knee-chest / Trendelenburg / modified Sims → continuous monitoring → oxygen → IV bolus → immediate birth. Cover a visible cord with warm sterile saline gauze. Never push it back in.
Show 5 moreHide these 5
Precipitous labor = under 3 hours. Do not leave her, keep her side-lying, deliver between contractions, check for a nuchal cord, anterior shoulder first.
Amniotic fluid embolism: abrupt dyspnea, cyanosis, circulatory collapse, then coagulopathy with bleeding from every puncture site. Can occur up to 30 min after birth.
Meconium-stained fluid: have the resuscitation team at the birth. If the newborn is vigorous — skin-to-skin and observe, no routine suctioning.
Betamethasone 12 mg IM ×2, 24 h apart, deep into ventrogluteal or vastus lateralis. It needs 24 h to work. Watch maternal hyperglycemia and pulmonary edema.
Hold terbutaline for HR over 120, chest pain, dysrhythmia, BP under 90/60, or pulmonary edema.
Show 2 moreHide these 2
Preterm labor = contractions plus cervical change, 20 to 36 6/7 weeks. Cervical length ≤25 mm and a positive fetal fibronectin (22–34 6/7 wk) predict risk. Hydration matters because dehydration triggers oxytocin release.
Cerclage in at 13–14 weeks, out at 36–37 or when labor starts.
📚 From your Maternal & Child textbook
Pillitteri, Maternal and Child Health Nursing — ch. 23 (complications of labor) · ch. 24 (surgical birth).
Cord prolapse: relieve the pressure first — knee-chest or Trendelenburg, and a gloved hand holding the presenting part off the cord until birth. Never push the cord back in. Keep it moist, give oxygen, prepare for cesarean.
⚠️ Exam traps
Hypertonic labor is a latent-phase problem. If the stem says active phase and uncoordinated contractions, re-read it.
Contractions stopping is not relief — with a prior cesarean it is rupture until proven otherwise.
🧠 Mind maps 2
One per disorder, built from the structure of your ATI chapter.
Early Onset of Labor
🎯 Who gets it
Genitourinary or intrauterine infection raises preterm labor risk
Prior preterm birth
Multifetal pregnancy
Smoking or substance use
👀 What you see
Uterine contractions
Pelvic pressure with menstrual-like cramping
Persistent low backache
GI cramping, sometimes with diarrhea
🧪 What confirms it
Fetal fibronectin testing
Cervical cultures
CBC
Urinalysis
🩺 What you do
Preterm labor management focuses on stopping contractions
Modified bed rest with bathroom privileges preferred; avoid strict bed rest
Left lateral positioning boosts uterine blood flow and lowers contraction activity
Avoid sexual intercourse during preterm labor
💊 Drugs
Nifedipine: calcium channel blocker; blocks calcium entry into smooth muscle to suppress contractions
Ampicillin: antibiotic used to treat intrauterine infection
Obtain vaginal, urine, and blood cultures before starting ampicillin
Betamethasone: glucocorticoid that boosts fetal lung maturity/surfactant in fetuses 24-34 weeks gestation; takes 24 hr to work
💬 What you teach
Change positions slowly, supine to upright; sit until dizziness resolves (nifedipine)
Keep well hydrated to offset nifedipine-related hypotension
Magnesium sulfate is a CNS-depressant tocolytic; may add fetal neuroprotection if given before 32 weeks gestation
⚠️ What goes wrong
Major risk: intrauterine infection or sepsis
Other risks: placental abruption, cord compression/prolapse, fetal pulmonary hypoplasia, death
Management is often conservative; hospitalization may prolong pregnancy while monitoring risk signs
Restrict activity to bathroom privileges only
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
ATI Active Learning Template — System DisorderEarly Onset of Labor
Filled from ATI chapter 10, row by row from that chapter’s own sections — 12 of 12 rows have content.
3 rows came from outside your ATI chapter — 3 cite a source, 0 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Preterm labor — contractions with cervical change between 20 and 36 6/7 weeks — together with membrane rupture before labor starts (PROM) and the preterm form (PPROM). Focus: spotting who is at risk, what to monitor, and what protects mother and fetus.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from StatPearls, 2024.
Vaginal progesterone is recommended for patients with a shortened cervix under 25 mm, even without a prior preterm birth.
Standard progesterone dosing is a single daily 90 mg8% intravaginal gel, or a 200 mg micronized vaginal capsule.
Combining cerclage with vaginal progesterone appears more effective at preventing preterm birth than either intervention alone.
StatPearls (NCBI Bookshelf) · Cervical Insufficiency · open the source →
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Genitourinary or intrauterine infection raises preterm labor risk
Prior preterm birth
Multifetal pregnancy
Smoking or substance use
History of violence or abuse
Uterine abnormalities or a short/shortening cervix
Low prepregnancy weight or low BMI
Advanced maternal age
Assessment — Expected Findings
Uterine contractions
Pelvic pressure with menstrual-like cramping
Persistent low backache
GI cramping, sometimes with diarrhea
Increased vaginal discharge
Change in discharge amount, odor, or blood tinge
Cervical dilation change on exam
Regular contraction pattern
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Fetal fibronectin testing
Cervical cultures
CBC
Urinalysis
Nitrazine test (blue, pH 6.5-7.5) or ferning pattern confirms membrane rupture
Diagnostic Procedures
Fetal fibronectin swab positive between 22 and 34 6/7 weeks signals higher preterm labor risk
Transvaginal ultrasound measures cervical length; 25 mm or less strongly predicts preterm labor
Cervical culture and sensitivity results guide antibiotic choice if infection found
Biophysical profile or nonstress test assesses fetal wellbeing
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Preterm labor management focuses on stopping contractions
Modified bed rest with bathroom privileges preferred; avoid strict bed rest
Left lateral positioning boosts uterine blood flow and lowers contraction activity
Report changes in vaginal discharge amount, color, consistency, or odor
Monitor vitals/temperature; fever plus tachycardia suggests intrauterine infection
Fetal tachycardia over 160/min can signal infection with preterm labor
PROM care depends on gestational age and signs of infection or fetal/maternal compromise
Medications
Nifedipine: calcium channel blocker; blocks calcium entry into smooth muscle to suppress contractions
Ampicillin: antibiotic used to treat intrauterine infection
Obtain vaginal, urine, and blood cultures before starting ampicillin
Betamethasone: glucocorticoid that boosts fetal lung maturity/surfactant in fetuses 24-34 weeks gestation; takes 24 hr to work
Therapeutic Procedures
Not in your ATI chapter — filled from StatPearls, 2024.
For a history-indicated cerclage, clinicians usually place the stitch around 12 to 14 weeks gestation, before problems arise.
Exam-indicated cerclage is considered before 28 weeks when the cervix is dilated 1 to 4 cm without labor.
The McDonald technique, a purse-string suture around the cervix, is generally preferred for its simpler placement and removal.
The stitch is usually taken out around 36 to 37 weeks gestation once the pregnancy nears term.
StatPearls (NCBI Bookshelf) · Cervical Insufficiency · open the source →
💬 Around the patientClient Education · Interprofessional Care
Client Education
Change positions slowly, supine to upright; sit until dizziness resolves (nifedipine)
Keep well hydrated to offset nifedipine-related hypotension
Magnesium sulfate is a CNS-depressant tocolytic; may add fetal neuroprotection if given before 32 weeks gestation
Perform daily fetal kick counts; report contractions to the nurse
Stay on bed rest with bathroom privileges only
Interprofessional Care
Not in your ATI chapter — filled from StatPearls, 2024.
Cervical insufficiency management involves obstetricians or maternal-fetal medicine specialists coordinating diagnosis and ongoing care.
Anesthesia clinicians and operating room staff support the cervical cerclage placement procedure itself.
Radiology technicians perform the ultrasound cervical-length screening used to guide cerclage and progesterone decisions.
Pharmacists and nurses provide medication education and safety monitoring for patients on progesterone therapy.
StatPearls (NCBI Bookshelf) · Cervical Insufficiency · open the source →
⚠️ What goes wrongComplications
Complications
Major risk: intrauterine infection or sepsis
Other risks: placental abruption, cord compression/prolapse, fetal pulmonary hypoplasia, death
Management is often conservative; hospitalization may prolong pregnancy while monitoring risk signs
Restrict activity to bathroom privileges only
Maintain hydration
Self-monitor for uterine contractions
Track daily fetal kick counts
📋 Therapeutic Procedures for Labor and Birth6 parts
ATI Active Learning Template — System DisorderTherapeutic Procedures for Labor and Birth
Filled from ATI chapter 15, row by row from that chapter’s own sections — 12 of 12 rows have content.
9 rows came from outside your ATI chapter — 4 cite a source, 5 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Surveys procedures used to assist labor and birth: version to turn a breech fetus, cervical-readiness scoring, ripening agents, oxytocin induction/augmentation, artificial rupture of membranes, fluid infusion for cord compression, vacuum or forceps delivery, perineal incision, cesarean surgery, and trial of labor after a prior cesarean.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Explain why an intervention is being offered and what happens without it — consent in labor is easily assumed rather than obtained.
A Bishop score guides whether induction is likely to succeed; a favorable cervix scores higher.
Elective induction before 39 weeks is not recommended without a medical indication.
Discuss the possibility of cesarean in advance, so it is not the first time she hears it.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Not in your ATI chapter — filled from StatPearls, 2024.
Common indications for labor induction include oligohydramnios, fetal growth restriction, hypertensive disorders, and post-term pregnancy.
Absolute contraindications to induction include vasa previa, placenta previa, transverse fetal lie, and umbilical cord prolapse.
A prior classical cesarean incision is a contraindication to labor induction due to uterine rupture risk.
Operative vaginal delivery (vacuum or forceps) is considered for maternal exhaustion, a nonreassuring fetal heart rate tracing, or a prolonged second stage.
StatPearls (NCBI Bookshelf) · Induction of Labor; Vacuum Extraction · open the source →
Assessment — Expected Findings
From this module — built from the notes above on this page, not a section of the ATI chapter.
After amniotomy: fluid clear, and the fetal heart rate unchanged.
After a ripening agent: gradual cervical change without tachysystole.
On oxytocin, an adequate pattern is contractions about 2–3 minutes apart lasting 60–90 seconds, with the uterus relaxing fully in between.
After a vacuum or forceps birth: expect a caput or bruising on the newborn.
A uterus that does not relax between contractions is not an expected finding — the fetus is only perfused during the rest.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
Type and screen or crossmatch before cesarean.
CBC before an operative birth.
Coagulation studies where hemorrhage or abruption is suspected.
Cord blood gases after an operative birth for a non-reassuring tracing.
Diagnostic Procedures
Not in your ATI chapter — filled from StatPearls, 2024.
A Bishop score of 8 or higher predicts a favorable cervix and a likely successful vaginal delivery after induction.
A Bishop score of 3 or lower predicts a low chance of successful induction, favoring cervical ripening first.
StatPearls (NCBI Bookshelf) · Induction of Labor · open the source →
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Monitor FHR continuously during external cephalic version and for 1 hr afterward for bradycardia or variable decels.
Give Rh-negative clients Rho(D) immune globulin after version unless birth is expected within 72 hr.
Bishop score of 8 or higher at term means the cervix is favorable for induction.
Bishop scoring rates 5 cervical/station factors, each scored 0 to 3 points.
Misoprostol (prostaglandin E1) and dinoprostone (prostaglandin E2) are used to ripen the cervix.
After a vaginal ripening insert, keep client side-lying for 30 min to 2 hr.
Remove any vaginal ripening insert before starting oxytocin.
Watch for ripening-agent adverse effects: nausea, vomiting, diarrhea, fever, or tachysystole.
Use cervical ripening agents cautiously with glaucoma, asthma, or cardiovascular/renal disease.
Medications
Not in your ATI chapter — filled from StatPearls, 2024.
IV oxytocin for induction is titrated to produce contractions about 2 to 3 minutes apart to achieve cervical dilation.
Misoprostol for cervical ripening is typically dosed between 25 and 50 micrograms.
Uterine tachysystole, more than five contractions inside a 10-minute window, is a recognized risk of pharmacologic induction.
StatPearls (NCBI Bookshelf) · Induction of Labor · open the source →
Therapeutic Procedures
Not in your ATI chapter — filled from StatPearls, 2024.
Vacuum extraction requires a fully dilated cervix, ruptured membranes, an engaged fetal head, and a known fetal head position.
Emptying the bladder and obtaining informed consent are also prerequisites before attempting operative vaginal delivery.
A cervical ripening Foley balloon is inflated with 30 to 80 mL of saline and generally removed once the cervix dilates 3 to 4 cm.
Vacuum cup traction is applied only during contractions and maternal pushing, limited to two to three attempts.
Clinicians are advised to keep the whole vacuum procedure under roughly 20 to 30 minutes from start to finish.
StatPearls (NCBI Bookshelf) · Vacuum Extraction; Induction of Labor · open the source →
💬 Around the patientClient Education · Interprofessional Care
Client Education
From this module — built from the notes above on this page, not a section of the ATI chapter.
Explain what she will feel with each procedure — pressure, not usually pain, with a vacuum.
After cesarean: splinting the incision to cough, early ambulation, incision care, and what to report.
Report to the provider: fever, foul discharge, a wound that opens or drains, calf pain, heavy bleeding.
Explain that a vacuum or forceps birth does not mean the next birth will need one.
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Anesthesia for regional or general; surgical team for cesarean.
Neonatal team present for every operative birth.
Blood bank on standby where hemorrhage risk is raised.
Physiotherapy for recovery after cesarean where mobility is slow.
⚠️ What goes wrongComplications
Complications
Stop oxytocin for tachysystole: more than 5 contractions per 10 min, duration over 90 seconds, or resting tone over 15 mmHg.
Target oxytocin contraction pattern: every 2 to 3 min, lasting 40-70 seconds, with FHR staying 110-160/min.
For tachysystole with nonreassuring FHR, give terbutaline0.25 mg subcutaneously.
Elective induction should wait until at least 39 weeks gestation to limit infection, preterm birth, and cesarean risk.
Amniotomy raises risk of cord prolapse and infection; labor usually starts within 12 hr of rupture.
Amnioinfusion (saline or lactated Ringer's) eases variable decelerations caused by cord compression.
Vacuum-assisted birth risks include neonatal scalp laceration, cephalohematoma, or subdural hematoma.
📋 Complications Related to the Labor Process6 parts
ATI Active Learning Template — System DisorderComplications Related to the Labor Process
Filled from ATI chapter 16, row by row from that chapter’s own sections — 12 of 12 rows have content.
7 rows came from outside your ATI chapter — 5 cite a source, 2 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
This chapter covers emergent labor complications -- cord prolapse, meconium-stained fluid, non-reassuring fetal status, dystocia, precipitous birth, uterine rupture, and amniotic fluid embolism -- all requiring rapid recognition and intervention to protect maternal and fetal outcomes.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Identify risk before labor: previous cesarean, malpresentation, macrosomia, polyhydramnios, grand multiparity.
Avoid elective induction of an unfavorable cervix, which raises the cesarean rate.
Recognize and treat tachysystole early — it precedes several of these complications.
Rehearse obstetric emergencies as a unit; the response is a team skill, not an individual one.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Not in your ATI chapter — filled from StatPearls, 2024.
McRoberts maneuver, hyperflexing the mother's thighs onto her abdomen, is the recommended first maneuver for shoulder dystocia.
Suprapubic pressure is applied concurrently with McRoberts as an initial shoulder dystocia maneuver.
If first-line measures fail, delivering the posterior arm or performing a rotational maneuver is attempted next.
For cord prolapse, the examiner's fingers gently elevate the presenting part off the cord without directly compressing the cord itself.
Trendelenburg or knee-chest positioning is used with cord prolapse to let gravity help relieve pressure on the cord.
StatPearls (NCBI Bookshelf) · Shoulder Dystocia; Umbilical Cord Prolapse · open the source →
💬 Around the patientClient Education · Interprofessional Care
Client Education
Not in your ATI chapter — filled from StatPearls, 2024.
During shoulder dystocia maneuvers, instruct the patient to stop pushing so the team can reposition safely.
Patients considering trial of labor after cesarean should be counseled that rupture risk is about 15 to 30 times higher than with a scheduled repeat cesarean.
A prior classical or inverted-T/J uterine incision carries two to three times higher rupture risk during TOLAC than a low transverse incision.
StatPearls (NCBI Bookshelf) · Shoulder Dystocia; Uterine Rupture · open the source →
Interprofessional Care
Not in your ATI chapter — filled from StatPearls, 2024.
Shoulder dystocia response requires obstetric clinicians and nurses, anesthesia personnel, and a neonatal resuscitation team on standby.
Additional support from operating room technicians, blood bank and laboratory staff, and a functioning paging system is recommended for shoulder dystocia readiness.
Cord prolapse management requires immediate coordination between the bedside team maintaining cord decompression and the surgical team performing emergency cesarean.
StatPearls (NCBI Bookshelf) · Shoulder Dystocia; Umbilical Cord Prolapse · open the source →
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2024.
Neonatal traumatic injury, such as brachial plexus injury or clavicle fracture, follows shoulder dystocia in about 5.2% of deliveries.
About 10% of neonates with a shoulder-dystocia-related brachial plexus injury have persistent deficits beyond the newborn period.
Uterine rupture in an unscarred uterus carries roughly a 10% maternal mortality rate, versus about 0.1% in a previously scarred uterus.
Fetal mortality after uterine rupture ranges from about 6% to 25% overall, higher with an unscarred than a scarred uterus.
StatPearls (NCBI Bookshelf) · Shoulder Dystocia; Uterine Rupture · open the source →
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Hypertonic contractions — frequent, painful, uncoordinated, in the latent phase, e.g. every 60 seconds → fetal hypoxia is the priority, because there is no relaxation interval for placental perfusion. Monitor FHR, oxygen, reposition, anticipate tocolytics or cesarean.
Cephalopelvic disproportion: 41 weeks, 13 hours of active labor, adequate contractions, no cervical change and the head still at 0 station → notify the provider, anticipate cesarean.
Conversion to memorize: 1 unit = 1,000 milliunits.
Calc — Pitocin: order 2 milliunits/min; bag 10 units/1,000 mL = 0.01 units/mL. 2 mU = 0.002 units/min → 0.002 ÷ 0.01 = 0.2 mL/min × 60 = 12 mL/hr.
The ×60 at the end is the most commonly missed step in every one of her infusion problems.
Oxytocin titration targets: contractions q2–3 min, lasting 40–70 sec and never over 90, strong to palpation, soft resting uterus at least 60 sec between, dilation ~0.5–1 cm/hr in active labor, FHR 110–160.
STOP the oxytocin for: more than 5 contractions in 10 min · any contraction over 90 sec · contractions within 1 min of each other · resting tone above 15 mmHg · no relaxation between.
Monitor with EVERY dose change — FHR, contractions and vital signs. q15 min first stage, q5 min second stage.
Prolapsed cord, in order: call for help and do not leave her → gloved hand in, hold the presenting part off the cord and stay there until birth → knee-chest / Trendelenburg / modified Sims → continuous monitoring → oxygen → IV bolus → immediate birth. Cover a visible cord with warm sterile saline gauze. Never push it back in.
Precipitous labor = under 3 hours. Do not leave her, keep her side-lying, deliver between contractions, check for a nuchal cord, anterior shoulder first.
Amniotic fluid embolism: abrupt dyspnea, cyanosis, circulatory collapse, then coagulopathy with bleeding from every puncture site. Can occur up to 30 min after birth.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
