Alterations In Intrapartal Flashcards Preview

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Flashcards in Alterations In Intrapartal Deck (51):
0

Who gets RhoGAM ? When do they get it?

Rh - mom, 28 week and within 72 hours of delivery

1

Uterus doesn't contract keeps becoming boggy

Uterine atomy

2

What is dystocia

Things that could cause difficult labor

3

What are operative obstetrics techniques

Help facilitate fetus to be brought to the outside

4

What part of uterus is where there is very little contacting done

Lower uterus

5

Where is placenta normally?

Upper front part if uterus

6

Placenta previa is improperly implanted placenta in the _________ with ____________

In lower uterine segment with painless bright red bleeding

7

Risk factors for placenta previa

Maternal age and number of C/S
Scaring in upper uterine segment
Smoking, cocaine
HTN, diabetes

8

Concerns with placenta previa

Bleeding, hemorrhage.. "Afterbirth comes first"

9

What is a medication to stop contractions and calm uterus? When would you use it?

Tocolytics, placenta previa

10

Why should there be no nipple stimulation or vaginal exam with placenta previa?

Release oxytocin which stimulate contractions. We do nothing to stimulate contractions. But if vaginal exam had to be done you have to have a double set up.

11

Premature separation or NORMALLY implanted placenta from uterine wall

Abruptio placenta

12

What kind of bleeding would you see with a marginal Abruptio placenta

Bright red bleeding

13

What's important about central Abruptio placenta

May not know she has it until she delivers the baby. There will be fast bleeding which will cause the uterus to swell up and there will be a big clot behind placenta which can be painful for mom

14

What is important about fundal height with the complete Abruptio placenta

Fundal height will be much bigger than expected

15

What is a concern with severe central Abruptio placentae?

May observe Couvelaire uterus (blue uterus, abnormal fundal height, mother c/o of lots of pain) and risk of DIC ( disseminated intravascular clotting)

16

What is DIC

disseminated intravascular clotting- excessive activation of clotting factors and then they run out and bleeding occurs. insult that occurs in relation to something else it is not a disease by itself.

17

If there is vaginal bleeding should you do a vaginal or rectal exam?

Not without a double set up!!

18

What color bleeding with Abruptio placenta? Why?

Dark red bleeding because it is behind placenta

19

Symptoms of Abruptio placenta

Dark red bleeding, shock, severe abdominal pain

20

What is somebody with Abruptio placemat at a increased risk for

Hemorrhage, fetal distress, preterm labor/delivery depending on placenta problem

21

What is Cryoprecipitate

Anti-hemorrhage medication
Used with Abruptio placenta

22

Is the clot usually visible on the ultrasound with Abruptio placenta?

Less than 50% of cases

23

Where should cord normally attach

More towards the center

24

What are the three different ways of placental adherence?

*Accreta - (most common) superficially into myometrium
*Increta- myometrium invaded
*Percreta- myometrium penetrated

25

What is the most common type of placental adherence where the chronic villi attach directly to myometrium of uterus

Accreta

26

Type of placental adherence where myometrium is invaded, attached deep into myometrium

Increta

27

Type of placental adherence where myometrium is penetrated, attached through the myometrium

Percreta

28

Concerns with placental problems & umbilical cord variations

Hemorrhage failure of placenta to separate; abnormal separation of placenta

29

What is a person at increased risk for if they have placental problems and umbilical cord variations

Hemorrhage, fetal distress, preterm labor/delivery depending on problem

30

Most common types of twins

Fraternal (dizygotic) ---67%

31

Two separate ovums? Single ovum?

Two separate- dizygotic
Single- monozygotic

32

With twins, triplets, or more the risk is increasing with ____________

Infertility treatment

33

What things are multifetal pregnancy at risk for

Pulmonary embolism, PROM, preterm labor, increased risk of maternal physical discomfort, increase risk fetal problems, increased risk or postpartum bleeding

34

Why could a multifetal pregnant mother be at risk for postpartum bleeding

Because of stretching

35

Do you just use one fetal monitor on a mom with multi fetus pregnancy

No- If the mom is expecting twins you do a dual external fetal monitor using 2 sets of belts

36

Most common procedure in OB

Amniotomy

37

What is amniotomy

Artificial rupture of membranes "strip membranes"

38

What do you use for amniotomy

Amnihook; sterile vaginal exam

39

When is amniotomy done

After engagement occurs--which is when head is in brim and not popping back out

40

What are some reasons for amniotomy

Induction or to facilitate labor contractions, gain access to fetus, at least 2 cm dilated cervix required

41

When should births occur after an amniotomy?

Must occur within 24 hours because of risk of infection

42

What risks increase if amniotomy is used

Cord prolapse, Abruptio placenta, fluid embolism

43

What is fluid embolism

Bolus of amniotic fluid enters maternal circulation & then the lungs. It is a rare occurrence but it is a obstetric emergency ( hypotension, hypoxia, coagulopathy, respiratory distress, circulatory collapse

44

What color does amniotic fluid turn?

Blue because it is alkaline

45

Is vagninal fluid acidic/basic

Acidic

46

For amniotomy...check temperature every ____ hours, _______ if no engagement, keep _____ and ________

Temperature every 2 hours, bed rest if no engagement, keep clean and dry

47

Forceps are a stainless steel instrument with two steel parts, _____&______, used to apply traction to fetal head

Cross and lock

48

If trial of labor is followed by failed forceps what is likely

C/S

49

What is outlet when talking about forceps

Most often used. Head on perineum, crowning

50

Are the forcep blades put on at the same time

No. Each blade put on separately brought together and locked