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z OB > ob emergencies > Flashcards

ob emergencies Flashcards

1
Q

grand multipara

A

> = 5 births

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2
Q

subinvolution

A

uterus does not return to normal size

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3
Q

prolapsed umbilical cord definition

A

protrusion of the umbilical cord past the presenting part through the cervical os

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4
Q

prolapsed umbilical cord presentation

A
  • persistent variable decelerations- OR bradycardia (compression doesn’t let up)- felt on cervical exam (keep fetal pulse > 100!)
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5
Q

umbilical cord prolapse nursing interventions

A
  • maternal positioning (trendelenberg, knee chest, lateral = depends on cord. RELIEVE PRESSURE)- oxygen- increase IV fluids to maximize baby perfusion- prep for delivery- educate and support
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6
Q

shoulder dystocia

A

impaction of fetal shoulders within maternal pelvisno breath + compressed cord = unhappy babbyno reliable risk identifiers, predictors, tools (ok a few)

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7
Q

fetal macrosomia non-diabetic vs diabetic moms

A

nondiabetic 5000 gdiabetic 4000 g

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8
Q

shoulder dystocia anticipatory management

A
  • assess labor pattern (slow progress in second stage, caput)- squatting- empty bladder- anaesthesia, peds @ delivery- newborn assessment- prepare for pph- documentation ESSENTIAL
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9
Q

caput succedaneum

A

swelling of the scalp in a newborn- most often brought on by pressure from the uterus or vaginal wall during vertex delivery- more likely to form during a long or hard delivery

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10
Q

turtle sign

A

shoulder dystocia indication - head out then in

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11
Q

mcroberts maneuver

A

position maternal thighs up onto abdomen (straightens sacrum, decreases angle of incline of syphysis pubis)for shoulder dystocia

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12
Q

suprapubic pressure

A

NEVER FUNDAL PRESSUREpressure is hand over anterior fetal shoulder with downward and lateral motion

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13
Q

gaskin maneuver

A

roll the patient onto all fourssafe, rapid, effective,

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14
Q

amniotic fluid embolus

A

aka anaphylactoid syndrome of pregnancyrare (1/40000)immunologic response (anaphylaxis, septic shock-ish)- sudden maternal hypoxia- cardiovascular collapse- coagulopathmom’s circulation collapses - shunting happens to brain/heart NOT UTERUSonly 15% survive neurologically intact

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15
Q

anaphylactoid syndrome of pregnancy supportive therapy

A

CALL FOR HELP (rapid response team)- high O2 concentrations- CPR, intubate, ventilate, crystalloid solutions- blood product replacement- monitor fetus- perimortem c-section: ASAP 4 minutes after cardiac arrest

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16
Q

CPR in pregnant women: TRICK!

A

tilt to get pressure off aorta - use a wedge

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17
Q

single most significant cause of maternal mortality worldwide

A

obstetric hemmorhage

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18
Q

obstetric hemorrhage

A

serious morbidity: ARDS, DIC, AKI29-93% of deaths are PREVENTABLE

19
Q

obstetric hemorrhage: class I

A

EBL 1000 mls/s: none, dizzy, palpitations, minimal BP changes

20
Q

obstetric hemorrhage: class II

A

EBL 1500 mls/s: orthostatic hypotension, tachycardia, tachypnea, narrowing pulse pressure, weakness, delayed cap refill

21
Q

obstetric hemorrhage: class III

A

EBL 2000 mls/s: hypotension, marked tachycardia (120 - 160), tachypnea (30-50), cold, clammy, palor, restless

22
Q

obstetric hemorrhage: class IV

A

EBL > 2500 mls/s: cardiogenic shock (BP absent, peripheral pulses very week, air hunger, oliguria/anuria)

23
Q

estimating blood loss nota bene

A

hypotension, dizziness, pallor, oliguria do not occur until blood loss is SUBSTANTIALpregnant women especially lose more before showing signs of compromise

24
Q

physical adaptations to hemorrhage nota bene

A

pH lowered, hyperventilation to compensate for metabolic acidosis (not enough O2)

25
Q

ob hemorrhage management goals

A
  • maintain systolic >90- maintain adequate uop- maintain normal mental statusTREAT SOURCE OF HEMORRHAGE
26
Q

ob hemorrhage nursing considerations

A
  • rapid response team- foley ( I/O q 1’, > 30 ml/hr, NO LASIX)- cumulative blood loss totals- IV access (large bore + crystalloid solutions to support CO)- blood typing- maternal positioning to optimize CO (lateral, elevate LE)- monitor VS frequently (O2 > 95%)- monitor fetal status (emergent delivery)- monitor maternal pain
27
Q

abruptio placentae is

A

premature separation of normally implanted placenta; IT HURTS (uterus contracts when placenta separates)revealed: external, darkconcealed: internal, clot forming inside1 to 3 levels (3 worst)

28
Q

abruptio placentae risk factors

A
  • previous abruption- cocaine, smoking- grand multip- chronic htn, preeclamp- sudden uterine decompression (trauma)- pprom - maternal thrombophilias (clotting disorder)- uterine malformation
29
Q

abruptio placenta presentation

A

varies widely- uterine tenderness- backache, shoulder pain, abdominal pain- vaginal bleeding DARK, PORT WINE - increased uterine tone BOARDLIKE- uterine irritability, hypertonus- maternal tachycardia- fetal compromise –> fetal death

30
Q

placenta previa is

A

implantation of placenta over cervical os; will bleed as cervix softens PAINLESS BRIGHT REDtotal: internal ospartial: implants near, partially covers internal osmarginal: implants near/doesn’t cover any oslow-lying: near region of osendometrial scarring: 50% riskimpeded vascularization: htn, dm, smoking

31
Q

placenta accreta

A

chorionic villi adhere to myometrium; not an issue until delivery- 75% of placenta previa

32
Q

placenta increta

A

invasion of chorionic villi into myometrium, but not across serosa- 15 to 20% of placenta previa- dramatic increase of risk with increased # c sections

33
Q

placenta percreta

A

growth of chorionic villi through myometrium- 5 to 10% of placenta previa

34
Q

abruption vs previa

A

abruption: painful and darkprevia: painless and bright

35
Q

uterine rupture is

A

symptomatic disruption, separation of layers of uterus or previous scarrisk: VBAC because c-section scar tissue contracting, grand multiparity, polyhydramnios

36
Q

uterine rupture s/s

A

abnormal FHR- uterine activity change- abdominal pain- loss of fetal station- palpable fetal parts- vaginal bleeding- suddenly anxiety, restlessness- maternal shock (hypotension, tachycardia)CAN BE ASYMPTOMATIC

37
Q

uterine rupture management

A
  • rapid response team, notify PCP, anaesthesia, neonatal- oxygen, positioning- monitor fetus- emergency c section- volume resuscitation, blood replacement
38
Q

postpartum hemorrhage is

A

blood loss > 500 ml (vaginal birth)> 1000 (cesarean)be prepared: in late pregnancy, blood flow to placenta is ~750-1000ml/minuterine atony 80%

39
Q

pph: early (when and why)

A
  • within first 24 hoursdue to lacerations, trauma, placental fragments, inversion, rupture, invasive placentation, coagulation disorders
40
Q

pph: late (when and why)

A
  • 24 hours to 6 weeks postpartumdue to infection, placental fragments, placental site subinvolution, coagulation disorders
41
Q

uterine involution

A

placenta does not detach from uterus and pulls uterus inside out as it exits omfg

42
Q

pph management (manipulative)

A

bladder drainageuterine massageuterine exploration

43
Q

pph management (pharm)

A

oxytocin, methergine, prostaglandin, misoprostol

z OB (10 decks)

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