This course provides an overview about the safety of patients undergoing a trial of labor after cesarean (TOLAC) to attempt a vaginal birth after cesarean delivery (VBAC). Research evidence has influenced where VBACs are performed, which women are eligible and how the practice is conducted, including the safe use of induction/augmentation medications. The safety of VBAC for mother and newborn always remains the primary underlying principle that guides care.

The Certified Emergency Nurse (CEN®) is required to demonstrate competency in the domain of emergency nursing which includes knowledge of gynecological and obstetrical conditions and diseases, their signs and symptoms, management, and applicable nursing interventions.

Three different obstetrical scenarios, complicated by a Category II Fetal Heart Rate pattern, are presented to illustrate the importance of clinical context when formulating management plans. Emphasis, characteristics, and potential etiologies of Category II fetal heart rate tracings are reviewed. Management of the patient with a Category II fetal heart rate pattern is discussed, with special emphasis on the importance of the clinical context and fetal heart rate pattern evolution.

The National Institute of Child Health and Human Development (NICHD) workgroup standard for fetal heart rate monitoring assessment and categorization, first proposed in 1997 and subsequently updated in 2008 was meant to promote commonality of FHR tracing nomenclature and interpretation. Based on these recommendations, a three-tiered categorization pattern based on the visual assessment of the fetal heart rate pattern was adopted. This module aims to review and apply essential FHR content in several clinical scenarios to highlight an important Clinical Pearl: The Category III tracing is a rare intrapartum FHR pattern that is highly associated with fetal acidemia and adverse neonatal outcomes.

A case of obstetrical hemorrhage due to uterine atony, requiring medical and surgical interventions and blood component replacement therapy is presented. Emphasis: A review of obstetrical hemorrhage, etiologies, and treatments is provided. The importance of early recognition and response to excessive blood loss is stressed. Medical and surgical interventions for uterine atony are reviewed. Current recommendations for blood component replacement therapy for massive hemorrhage are discussed.

As the population of the U.S. soars in diversity, healthcare professionals must be prepared to care for childbearing families from many different cultures. All cultures and families should be given the same respect, be assured of the highest quality of care, have their religious, ethnic, and cultural values respected and integrated into their care, and have their physical and educational needs met in a way that honors their spiritual beliefs and individuality. Knowledge of the cultures one is serving and the influence they have on women’s perceptions of childbirth are important for achieving positive outcomes. Equally and perhaps more important is applying the principles of cultural humility to nursing care.

The goal of this continuing education course is to improve the ability of nurses and health educators in acute care settings to assess and meet the sociocultural needs of childbearing families of diverse cultural and social groups. 

The management of the female who presents to the emergency department (ED) in active labor is stressful and overwhelming. Ideally, the ED has a plan in place, based on hospital resources, for the imminent delivery of a newborn. Decisions regarding delivery in the ED or transferring the patient to labor and delivery are based on a variety of factors. Knowledge of the possible complications of delivery will provide anticipatory guidance to improve maternal and fetal outcomes.

This course is intended to review the identification and management of various fetal heart rate patterns in a clinical context to prevent or address potential physiologic stress imposed on the fetus during labor, as evidenced by the fetal heart rate tracing. 

This course provides an introductory overview of intrapartum fetal monitoring, including the maternal-fetal oxygenation pathway, assessing uterine activity, and recognizing, interpreting, and managing FHR patterns.

This is a brief review of how nurses and providers should address maternal hemorrhage in the ED. All emergency departments must be prepared for obstetric hemorrhage, which can cause severe issues or death. 

This is a brief review of how nurses and providers should address maternal hemorrhage in the ED. All emergency departments must be prepared for obstetric hemorrhage, which can cause severe issues or death. 

Maternal obesity has significant implications for both the parent and fetus. This course discusses the risks associated with maternal obesity, updated care guidelines regarding BMI, and maternal, fetal, and neonatal complications associated with increased morbidity and mortality risk. You will also learn about how biases and perceptions related to BMI can affect the quality of care that patients receive and patient outcomes. Strategies to mitigate these risks through interprofessional care involving providers, nurses, and RDNs will also be reviewed.

Almost 95% of all maternal mortalities happen in low and lower middle-income countries (World Health Organization, 2023). However, the U.S. has the highest maternal mortality rate among all developed countries. Approximately 700 patients die each year in the U.S. due to pregnancy complications and nearly 85% of those deaths are preventable (Hill et al., 2022). Furthermore, the AMA and CDC state that Black and AIAN patients are 3 to 5 times more likely to die from maternal complications than White patients (AMA, 2023). Indigenous, immigrant, refugee, and low-income populations are also at significantly greater risk of poorer maternal outcomes. However, in the past few years, global and national advocacy initiatives have set their philanthropic and financial radar on improving maternal outcomes in these vulnerable communities.