Nursing Care for Women with Complications during pregnancy – Flashcards

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Ectopic Pregnancy
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development of the fetus outside the uterus
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Hyperemesis gravidarum
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excessive nausea and vomiting during pregnancy
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Incompetent cervix
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failure of the cervix to remain closed until the fetus is mature enough to survivie outside the uterus
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Spontaneous abortion
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spontaneous loss of a pregnancy before 20 weeks (often called miscarriage)
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Nursing interventions with woman with hyperemesis gravidarum
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avoid food odors, I and O monitoring, frequent small amount food, taking fluids between meals
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Threatened abortion
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vaginal bleeding without dilation of the cervix or passage of tissue
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Incomplete abortion
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bleeding and cramping with passage of some tissue
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Inevitable abortion
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bleeding and cramping with cervical dilation but no passage of tissue
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Complete abortion
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passage of all products of conception
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Missed abortion
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retention of the dead fetus in the uterus
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Recurrent abortion
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two or more consecutive spontaneous abotions
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Therapeutic abortion
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passage of all products of conception
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Elective abortion
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intentional termination of pregnancy for reasons unrelated to health
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An ectopic pregnancy usually occurs in the
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follopian tube
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The purpose of the biophysical profile is to
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determine if the placenta is functioning well enough to support fetal life
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What fetal or neonatal problems should the nurse anticipate if a woman has persistent hyperemesis gravidarum
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smaller than expected birth weight
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Amniotic Fluid volume
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this ultrasound scan measure teh amniotic fluid pockets in all four quandrants. 5 to 19cm is normal
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Kick Count
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fewer than three fetal kicks within an hour or cessation of fetal movement for 12 hours indicates the need for evaluation
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Alpha-fetoprotein testing
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determines the level of this fetal protein in the pregnant woman's serum
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Amniocentesis
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insertion of a thin needle through the abdominal and uterine walls to obtain a sample of amniotic fluid
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Abortion
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miscarriage
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What is the purpose of magnesium sulfate in the treatment of hypertension
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it reduces it
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What observations are needed for a woman who is receiving magnesium sulfate as treatment for hypertension
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watch for hypotension
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What drug should be on hand if a woman is receiving magnesium sulfate
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calcium gluconate
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Rh blood incompatibility can only occur if the mother is Rh ___ and the fetus is Rh ___
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negative , positive
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The drug given to prevent Rh incompatibility is
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RhoGAM
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The preferred rug used to control the blood glucose during pregnancy is ___ because it ___
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insulin, does not cross the placenta
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Why is glucose monitored by blood testing during pregnancy
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insulin requirements fluctuate
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How do labor and the postpartum period change the demands on the heart
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each contraction temporarily shifts 300 to 500 ml of blood from the uterus and placenta to the woman's circulation, overloading the heart
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Three reasons why a pregnant woman needs increased iron
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increased blood volume, transfer to the fetus, a cushion against the blood loss expected at birth
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Iron foods
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meats, chicken, fish, liver, legumes
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Folic Acid foods
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green leafy vegetables, asparagus
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Vitamin C foods
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strawberries, cantalope
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What foods are good to take with an iron supplement
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vitamin C, because it enhances the absorption of iron
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What foods or durgs should be avoided at the time an iron supplement is taken and why
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calcium or antacids, because it impairs absorption
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Cytomegalovirus
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no effective prevention or treatment
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Rubella
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immunize children to avoid infecting pregnant women, immunize nonimmune woman after birth
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Herpesvirus
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deliver infants by cesarean birth if the woman has genital lesions when labor begins
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Hepatitis B
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give immune globulin immediately after birth followed by vaccine
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Three ways an infant may be infected with human immunodeficiency virus
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transplacentally, through contact with infected maternal secretions at birth, through breast milk
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If a woman has cardiac disease, the main risks tot he fetus are related to
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poor oxygenation
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Toxoplasmosis
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wash hands and surface after handling raw meat, cook meat thoroughly, avoid cat litter
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Group B streptococcus
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treat culture positive woman and her infant with penicillin
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Why is a pregnant woman more likely to have a urinary tract infection
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alters the self-cleaning action because pressure on urinary structures keeps the bladder from emptying completely
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Three things the nurse can teach a woman about avoiding a urinary tract infection
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front to back direction, adequate fluid intake, reduce sexual intercoarse
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General approaches tot he care of pregnant women related to bioterrorist attacks
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safe food and water supply, safe air, available vaccines
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Manifestations of fetal alcohol syndrome
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growth restrictions, mental retardation and facial abnormalities
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ACE inhibitors
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fetal kidney anbormalities, growth restircition and insufficient amniotic fluid
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Cigarette smoking
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infant may be smaller than expected for gestation
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Cocaine
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severe vasoconstriction may cause preterm labor, hypertension with reduced placental circulation and maternal stroke
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Folic acid antagonists
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causes spontaneous abortion and other serious fetal anomalies
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Heroin
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abstinence syndrome may develop in woman or infant if drug is stopped suddenly
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Lithium
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associated with congenital heart disease and toxicity to fetal thyroid and kidneys
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Tetracycline
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infant may have discolored teeth
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Vitamin A preparations
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reliable birth control is needed for three months after treatment with this drug
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Warfarin
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crosses placenta, possibly causing spontaneous abortion, growth restriction and central nervous system and faical defects
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If a woma needs a potentially teratongenic therapeutic drug during pregnancy, how will the health care provider make a decision about what to prescribe
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drug is weighed against the potential for fetal harm it may cause and the fetal or maternal harm that may occur
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Risks for a woman and her infant is she is a victim of abuse
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miscarriages, still births and low-birthweight
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Common manifestations of batterin
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bruises or laceration in various stages of healing
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Characteristic causes of high-risk pregnancies
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can relate to the pregnancy itself, can occur because the woman has a medical condition or injury that complicates the pregnancy, can result from environmental hazards that affect the mother or her fetus, can arise from maternal behaviros or lifestyles that have a negative effect on the mother or fetus
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Assessment of Fetal healh
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done at any age, amniotic fluid index, biophsical profile
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Amniotic fluid index
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normal 5cm-19cm
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<5cm
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oligohydramnios
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>19cm
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polyhydramnios
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Biophysical Profile
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group of 5 fetal assessments, score 0-10
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Nursing responsibilities for biophsyical profile
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preparing the patient properly, explaining the reason for teh test, clarifying and interpreting results in collaboration with other health care providers
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Danger signs in pregnancy
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suddne gush of lfuid from the vagina, vaginal bleeding abdominal pain, persistent vomiting, epigastric pain, edema of face and hands, severe, persistent headache, blurred vision or dizziness, chills with fever over 100.4, painful urination or reduced urine output
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Hyperemesis gravidarum
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excessive nausea and vomiting, dehydration, reduced delivery of blood, oxygen and nutrietns to the fetus, can effect growth
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Treatment of hyperemesis gravidarum
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correct dehydration and electrolyte or acid-base imbalance, antiemetic drugs may be prescribed, TPN may be required nad/or hospitalization
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Ectopic Pregnancy
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95% occur in fallopian tube, scarring or tubal deformity
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Scarring or tubal deformity may result from
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hormonal abnormalities, inflammation, infection, adhesions, congenital defects, endometriosis
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Ectopic pregnancy manifestations
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lower abdominal pain, may have light vaginal bleeding, if tube ruptures may have sudden severe lower abdominal pain, signs of hypovolemic shock, shoulder pain
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Ectopic pregnancy treatment
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pregnancy test, transvagiannl ultrasound, priority is to control bleeding, no action, treatment with methotrexate, surgery to remove pregnancy from the tube
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Signs and Symptoms of Hypovolemic Shock
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changes in fetal heart rate, risking weak pulse, risking respiratory rate, shallow, irregular respirations, air hunger, falling blood pressure, decreased or absent urinary output, pale skin or pale mucous membranes, col, clomammy skin, faintlness, thirst
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Hydatidiform Mole
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occurs when chorionic villi abnormally increase and develop vesicles, may cause hemorrhage, clotting abnormalities hypertension and later development of cancer, more likely to occur in women at age extremes of the reproductive life
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Hydatidiform Mole manifestations
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bleeding, rapid uterine growth, failure to detect fetal heart activity, signs of hyperemesis gravidarum, unusally early development of GH, higher than expected levels of hCG, a distinct snowsotrm pattern on ultrasound with no evidence of a developing fetus
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Treatment for hydatidiform mole
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uterine evacuation, dilation and evacualtion
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Bleeding disorders
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placenta previa, albruptio placentae
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Placenta previa
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abnormal implantation of placenta, bright bleeding occurs when cervix dilates, resulting in painless bleeding
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Albruptio placentae
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normal implantation of placenta, dark bleeding with pain and enlarging uterus suggest blood its accumulating within the cavity
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Placenta previa risks
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infection, because of vaginal organisms, postpartum hemorrhage, because if lower segment of uterus was site of attachment, then there are frew muscle fibers so weaker contractions may occur
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Abruptio placentae risks
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hypertension, cocaine or alcohol use, cigarette smoking and poor nutrition, blows to the abdomen, prior history of abruptio placentae, folate deficiency
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Care of the pregnant woman with excessive bleeding
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document blood loss, closely monitor vs, including I and O, observe for pain, verify orders for blood typing and cross-match have been carried out, monitor intravenous infusion, prepare for surgery, if indicated, monitor fetal heart rate and contractions, monitor laboratory results, inclduing coagulation studies, administer oxygen by mask, prepare for newborn resuscitation
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