Exam 3 Flashcards
(138 cards)
1
Q
oxytocics
A
agents that stimulate uterine contractions to promote labor
2
Q
tocolytics
A
uterine relaxants
3
Q
agents used for cervical ripening
A
cervadil and cytotec
4
Q
misoprostol
A
- most widely used agent for cervical ripening
- preferred agent for controlling postpartum hemorrhage
- can cause uterine contractions
5
Q
what does oxytocin target?
A
the uterus
6
Q
does oxytocin ripen the cervix?
A
no; don’t give to someone with an unripened cervix
7
Q
when should we not use pitocin?
A
- fetal lungs have not matured
- patient has had previous c-section or uterine surgery
- patient has active genital herpes
- cephalo-pelvic disproportion
8
Q
betamethasone
A
steroids given to accelerate fetal lung maturity
9
Q
main purpose of magnesium sulfate
A
used to prevent seizures
10
Q
signs of magnesium toxicity
A
- respirations < 12 per minute
- significant drop in maternal pulse/BP
- hyporeflexia or absent reflexes
- urine output < 30 mL/hr
- serum mag levels > 9.6
- fetal tachycardia or bradycardia
11
Q
interventions for mag toxicity
A
- discontinue mag sulfate
- call provider
- administer calcium gluconate (antidote)
- monitor maternal and fetal status
12
Q
signs of impeding labor
A
- lightening: fetus settles into pelvis (10-14 days prior to labor for nulliparas and unpredictable for multiparas)
- braxton hicks contractions
- cervical changes: softening of cervix
- bloody show: pink tinged mucus secretion when mucus plug is expelled (occurs when cervix ripens and starts to dilate)
- nesting: occurs 24-48 hours before labor starts
13
Q
do braxton hicks contractions cause cervical changes?
A
no
14
Q
what is important to remind women about nesting?
A
forewarn them not to over-exert ~ trauma can lead to abruption
15
Q
true labor
A
- regular contractions, increase in frequency, intensity, and duration
- cause cervical dilation and effacement
- does not decrease with walking, showering, etc.
16
Q
what kind of assessment is cervical dilation?
A
subjective
17
Q
what are the 5 P’s of labor?
A
- passageway
- passenger
- power
- position of mother
- psychological factors
18
Q
what does the passageway include?
A
- pelvis
- cervix
- vagina
- external perineum
19
Q
who is the passenger during labor?
A
the fetus
20
Q
open suture lines
A
- membranous space between bones
- sagittal suture line: between parietal bones on top of head
- coronal suture line: between frontal bone and two parietal bones on front of head
- lamdoidal suture line: between parietal bones and occipital bone on the back of head
21
Q
anterior fontanel
A
- junction of coronal and sagittal suture line
- also called “bregma”
- diamond in shape
22
Q
posterior fontanel
A
- junction of sagittal and lamdoidal sutures
- triangular in shape
23
Q
landmarks of fetal skull entering the pelvis
A
- occiput: area over occipital bone
- sinciput: area over frontal bone
- mentum: chin
24
Q
best position for fetal skull to enter pelvis
A
occiput
25
what part is the widest diameter of the skull?
anterior posterior diameter
26
transverse diameter
- also called biparietal diameter
- approximately 9.25 cm across
27
attitude of fetal presentation
describes degree of flexion fetus assumes as well as position of body parts in relation to each other
28
best attitude for fetus to be delivered
full flexion
29
moderate flexion
- military style
- chin is not flexed forward
- not usually a problem for delivery
30
partial extension
- brown presentation
- head is in partial extension
31
complete extension
- face presentation
- back is arched
- neck is extended
- not successful vaginal delivery, cervix won't dilate since not a lot of pressure
32
three types of fetal presentation
cephalic, breech, shoulder
33
cephalic fetal presentation
"vertex" ~ head down first
34
breech fetal presentation
a bunch of parts presenting first
35
how are breech presentations delivered?
via c-section
36
engagement
presenting part is settled into pelvis and is at level of ischial spines (zero station); determined during vaginal exam
37
what are the 3 numbers obtained during a SVE?
cm dilated, % effaced, station
38
Station
relationship of presenting part of fetus to level of ischial spines, when presenting part is at level of ischial spine = 0 station
39
how do we chart fetal presentation and position?
- maternal pelvis: right or left
- landmark of fetal presenting part: occiput (O), mentum (M), sacrum (S), scapula (Sc)
- maternal pelvis: anterior, posterior, transverse
40
what will we always see O in for the fetal presentation?
vaginal deliveries
41
what does LOA mean?
occiput on maternal left, pointing anterior
42
fastest type of deliveries have what fetal presentation?
ROA or LOA
43
what kind of deliveries are longer and more painful?
posterior deliveries ~ ROP or LOP (sunny-side up)
44
four methods to determine fetal position
- abdominal inspection and palpation (leopold's)
- vaginal exam
- auscultation of FHT (over spine is best way to hear)
- U/S (most accurate)
45
labor assessment acronym
B - bladder (keep empty)
U - uterine contractions
R - rupture of membranes (causes stronger and harders contractions)
T - temperature (portal of entry from rupture
H - heart tones (fetal)
S - sterile vaginal exam
46
where does the power come from in uterine contractions?
the fundus of the uterus
47
how long should uterine contractions occur and last?
- every 2-5 minutes
- should last less than 90 seconds
- should have at least 30 seconds of rest from end of one to beginning of next
48
frequency of uterine contractions
time between beginning of one contraction to beginning of next
49
duration of uterine contractions
measured from beginning of contraction to completion
50
intensity of uterine contractions
strength of contraction
51
how is intensity of uterine contractions determined?
- by IUPC or by palpating
- palpating fundus can show "indentability" (mild are easily indented and strong cannot be indented)
52
what must occur for IUPC to be placed?
membranes must be ruptured ~ risk of infetion
53
what is the only accurate to determine true intensity of contractions?
IUPC
54
what are uterine contractions responsible for?
- effacement of cervix
- dilation of cervix
- descent of fetus
55
stages of labor and birth
- first stage: from onset of true labor to complete dilation
- second stage: from complete cervical dilation to birth of baby (pushing stage)
- third stage: from birth of baby to birth of placenta
- fourth stage: postpartum
56
three phases in the first stage of labor
- latent
- active
- transitional
57
latent phase
- begins with onset of regular contractions
- mild and short contractions: last about 30-45 seconds
- effacement occurs
- dilation 3-4 cm
- can still walk and talk
- avoid giving analgesia at this time because it can slow or stop contractions
58
active phase
- dilation progresses form 4-8 cm
- stronger and longer contractions lasting 60 seconds
- frequency of contractions is usually every 3-5 minutes
- painful
- cannot talk through
- good time to give analgesics IV or IM
59
goals of pharmacologic treatment during labor
- relax and relieve discomfort
- minimal effect on uterine contractions
- minimal effect on ability to push
- minimal effect on fetus
60
anesthesia
loss of feeling
61
analgesia
pain control
62
how far can an epidural be given?
through stage 2
63
epidural
- blocks nerve pathways
- temporary loss of sensation
- women are not aware of their contractions, or may just feel slight pressure
- will not alter uterine contractions
- may effect urge to push
64
most common complication from an epidural
maternal hypotension
65
transitional phase
- dilation from 8-10 cm
- strong and long (60-90 seconds)
- frequency every 2-3 minutes
- usually a rapid phase of labor
- full dilation and complete effacement occur
- very emotional, very moody
- may begin to feel urge to push (say they feel like they have to have a BM)
66
what phase of labor is usually not a good time for analgesia?
transitional phase
67
assessments once membranes rupture
- color, odor, time, amount, fetal respose
- fetal HR and temperature every 2 hours
68
how fast should we try to deliver after ROM?
within 24 hours ~ if not, she will be induced
69
SROM
spontaneous rupture of membranes
70
AROM
artificial rupture of membranes
71
PROM
premature rupture of membranes ~ may occur before onset of contractions
72
main concerns of ROM
- infection
- prolapsed cord
73
what do we look for with fetal heart monitoring?
fetal well-being
74
what can we use to determine fetal position?
leopolds maneuver
75
where is the best place to listen for fetal heart sounds?
the back
76
baseline FHR range
110-160 BPM
77
causes of fetal tachycardia
- early fetal hypoxia
- fetal anemia
- maternal dehydration
- beta sympathomimetic drugs (terbutaline)
- intrauterine infection
- maternal hyperthyroidism
78
causes of fetal bradycardia
- late fetal hypoxia
- maternal hypothermia
- maternal hypotension
- prolonged umbilical cord compression
- fetal arrhythmia
79
variability
irregular waves or fluctuations in baseline FHR
80
no variability
amplitude range undetectable
81
minimal variability
< 5 BPM
82
moderate variability
6 - 25 BPM
83
marked variability
> 25 BPM
84
short term variability
- beat to beat
- only accurately measured with internal electrode
85
long term variability
rhythmic fluctuations
86
causes of decreased variability
- hypoxia and acidosis
- drugs such as demerol, valium, vistaril
- fetal sleep cycle
- fetus less than 32 weeks gestation
87
causes of increased variability
- early mild hypoxia (compensation)
- fetal stimulation
88
VEAL CHOP
Variable Decelerations -> Cord Compression
Early Decelerations -> Head Compression
Accelerations -> Okay!
Late Decelerations -> Placental Utero Insufficiency
89
interventions of early decelerations
- does not require intervention
- benign
- may indicate CPD if they occur early in labor
- peak of contraction and deceleration match up
90
are late decelerations concerning?
yes! you need to notify HCP
91
interventions for late decelerations
- does not necessarily warrant immediate delivery
- does warrant close observation
92
TTOIV
Turn of Pitocin
Turn patient on her side to increase perfusion to placenta
Oxygen to mom: 10-15 L
IV fluids wide open
93
varibale decelerations
sharp drop from baseline and sharp return to baseline
94
interventions for variable decelerations
- continue monitoring (usually benign)
- change maternal position
- administer oxygen
- administer amnioinfusion if ordered (LR or NS)
95
if there are prolonged decelerations, what should you do?
TTOIV
96
what do we check for with a SVE?
dilation, effacement, station
97
when should we not do SVE?
if there is significant vaginal bleeding
98
effacement
thinning and shortening of cervix
99
second stage of labor
full dilation to birth of baby ~ verified with SVE
100
crowning
when you start to see baby's head with pushes
101
episiotomy
- surgical incision made to prevent a tear
- incision can be a midline episiotomy (straight up and down) or mediolateral episiotomy (out towards legs)
102
advantages of midline episiotomy
- heals more quickly
- less blood loss
- less discomfort
103
mediolateral episiotomy
- if it tears, it won't tear into rectum
104
modified ritgen maneuver
used to control birth of head using hands
105
third stage of labor
begins at time baby is born and ends with delivery of placenta
106
how long does placenta take to deliver after birth of baby?
about 5 minutes
107
signs of placental separation
- lengthening of umbilical cord
- slight gush of vaginal blood
- change in shape of uterus
108
expulsion of placenta
- mom starts to gently push
- provider tugs gently
109
2nd leading cause of infant mortality
preterm labor and birth
110
initial instructions to prevent preterm labor
- empty bladder
- drink 2-3 glasses of fluid
- lie down on side for 1 hr
- if ctxs q10 minutes or less after 1 hr. call Dr.
111
when should you call the doctor in any preterm labor?
- any vaginal bleeding
- leaking of fluid
- malodorous discharge
112
tocolytics
only fairly effective at preventing PT birth; works directly on uterus
113
why do we prevent birth for 24-48 hours?
- transfer to facility with NICU
- treat an infection/medical condition
- administer corticosteroids to stimulate
- fetal lung maturation
- betamethasone
114
what does magnesium sulfate do for preterm labor?
- CNS depressant
- relaxes smooth muscles
- decreases calcium in cells
115
nifedipine (procardia)
- calcium channel blocker ~ decreases calcium in cells
- commonly used as antihypertensive agent ~ may cause hypotension
116
terbutaline
- relaxes smooth muscles
- bronchodilation
117
goal to promote fetal lunch maturity
administer at least 24 hours before delivery
118
what cervix dilation shows inevitable preterm birth?
> 4 cm ~ transfer to high risk hospital
119
care during inevitable preterm labor and birth
- little or no systemic analgesia
- left side, continuous monitoring
- delay AROM until >= 6cm
- low dose pitocin
- generous episiotomies or C/S delivery
- neonatologist/peds present
- third stage longer ~ small placenta does not readily separate
120
PPROM
rupture of membranes before labor starts - at least 1 hours
121
risks of PPROM
- chorioamnionitis
- cord prolapse
122
induction of labor acronym
Cooks balloon
Oxytocin (pitocin)
Misoprostol (cytotec)
Membrance stripping
AROM
Nipple stimulation
Dinoprostone (cervidil)
123
amniotomy
- AROM
- only used to induce if cervix is ripe and head is engaged
124
greatest risk of AROM
infection
125
contraindications to oxytocin administration
- CPD
- prolapsed cord
- transverse lie
- placenta previa
- prior classic uterine incision
- active genital herpes
- invasive caner of cervix
126
if concerned about pitocin, what should we do?
stop it and TTOIV
127
when should a forceps delivery never be used?
on a fetus that is unengaged
128
dystocia
long, difficult, or abnormal labor
129
causes of dystocia
- too much pitocin
- maternal fatigue, dehydration, fear
- analgesics/anesthetics
- uterine abnormalities
130
management of hypertonic dystocia
- reduce anxiety
- comfort measures
- analgesics for sedation
- IV fluids and I/O
- if pattern continues or fetal distress -> C/S
131
main cause of hypotonic dystocia
excessive narcotics, analgesics, anesthetics in early labor, especially before 3-4 cm dilation
132
preciptuous labor
labor that lasts < 3 hours
133
if fetal hypoxia is >5 minutes in a prolapsed umbilical cord, what can happen?
can cause CNS damage or fetal death
134
if prolapse of umbilical cord an emergency?
yest
135
how to manage a prolapsed umbilical cord
relieve pressure on cord!
- place fingers on presenting part and push forward
- position mom in knee-chest or extreme trendelenburg position
- if cord is evident, cover with warm, wet sterile towel (if not in hospital)
136
shoulder dystocia
head is born, but shoulder cannot pass under pubic arch
137
effects of aging placenta
- 800 mL by 40 weeks
- 400 mL by 42 weeks
- can lead to cord compression/fetal hypoxia
- placental starts to hard/calcify
138
if there is meconium fluid and oligo, what can be done?
amnioinfusion
