Interventions

Question 1

What are examples of intrauterine Resuscitation Techniques?

Answer 1

Maternal repositioning
Reduction of uterine activity
IV fluid bolus
Correction of maternal hypotension
Amnioinfusion during the first stage of labor
Modification of maternal pushing efforts during the second-stage of labor.

Question 2

Lateral Positioning or Change of Position

Answer 2

-This alters the relationship between the umbilical cord, fetal parts, and the uterine wall, and decreases the frequency of uterine contractions
-In the lateral position, the uterus does not compress the vena cava or aorta; thus maternal cardiac return and cardiac output are maximized, and blood flow to the uterus is optimal

Question 3

Reduction of Uterine Activity

Answer 3

Uterine contractions cause an intermittent decrease in blood flow to the intervillous space where oxygen exchange occurs.
-if this intermittent interruption of blood flow reaches an abnormal level as a result of too-frequent contractions, the fetus is at risk for hypoxemia
-As fetal deterioration progresses, the fetus will likely respond with late decelerations and the fetal heart rate will lose variability and reactivity.
-Oxytocin discontinuation, IV fluid bolus, and change to lateral position.

Question 4

How long after the discontinuation of Oxytocin is it similar to a person who has not received in the first place?

Answer 4

30-40 minutes

Question 5

IV Fluid Administration

Answer 5

Increasing IV fluids will positively affect uterine blood flow and thus fetal oxygenation

Question 6

Amnioinfusion

Answer 6

This is the transcervical instillation of fluid into the amniotic activity.
-this is a therapeutic option to attempt to resolve recurrent variable fetal heart rate decelerations by correcting umbilical cord compression

Question 7

Modification of Maternal Pushing Efforts

Answer 7

-Discourage prolonged breath-holding- instead instruct the woman to bear down and allow her to choose whether or not to hold her breath while pushing
-Discouraging more than three pushing efforts with each contraction and more than 6-8 seconds

Question 8

What are the suggested interventions for STABLE tachysystole?

Answer 8

1. Lateral position change
2. 500 mL fluid bolus
3. Wait 15 minutes
4. Decrease the Pitocin by half
5. Wait another 15 minutes
6. Turn the Pitocin off

Question 9

What are the suggested interventions for UNSTABLE tachysystole?

Answer 9

1. Turn the Pitocin off
2. Lateral position change
3. 500 mL fluid bolus

Question 10

What are the three positions for forceps?

Answer 10

1. Outlet- scalp is visible at the vaginal opening
2. Low- fetal head is at +2
3. Mid- +2 and above head engaged

Question 11

What is the name of the forceps used for breech deliveries?

Answer 11

Piper forceps

Question 12

What is an important intervention prior to an operative delivery?

Answer 12

Empty the bladder

Question 13

What are fetal/ Neonatal Complications from vacuum deliveries?

Answer 13

Retinal hemorrhage, Cephalohematoma (does not cross the suture lines), intracranial hemorrhage, abrasion/ lacerations, fractures, Erb’s Palsy, jaundice, infection

Question 14

What are the limitations with a vacuum delivery?

Answer 14

up to 3 attempts/ pulls, maximum amount of pop-offs, no more than 600 mmHg, must make descent with pulls, time applied should not exceed 15-20 seconds, a maximum of 20 minutes

Question 15

What is a genetic side effect of general anesthesia?

Answer 15

Malignant Hyperthermia Syndrome

Question 16

What are major symptoms of Malignant Hyperthermia?

Answer 16

Muscle rigidity, extremely dark urine, fever (late sign), jaw clench (1st sign), hyperkalemia, arrhythmia, hypoxia

Question 17

What is the medication to give in Malignant Hyperthamia?

Answer 17

Dantroline

Question 18

What is a common side effect of epidurals?

Answer 18

Hypotension

Question 19

What is a dural puncture?

Answer 19

This is where the dura has been punctured and there is a loss of spinal fluid where there is less fluid around the brain, therefore there is pressure of the brain from the skull

Question 20

What is a hallmark sign of a dural puncture?

Answer 20

Severe headache. This gets worse when sitting up and immediately better when laying flat.

Question 21

What are some conservative treatments for a dural puncture?

Answer 21

Fluids, caffeine, and pain medications

Question 22

What is another treatment for a dural puncture?

Answer 22

An epidural blood patch
This is where the patient’s blood is injected into the epidural space and seals the hole.

Question 23

What is the use for glucocorticoids in preterm labor?

Answer 23

This increases the surfactant production for the alveoli to stay open

Question 24

What are three side effects of giving glucocorticoids?

Answer 24

Decrease in variability, decreased in the number of accelerations, and increase in the fetal heart rate.

Question 25

What are side effects of giving Terbutaline?

Answer 25

Increase in blood pressure, chest pain, nervousness, hypokalemia, anxiety, tremors, hypotension, tachycardia

Question 26

How does Procardia work to help with preterm labor?

Answer 26

Decreases contractility of smooth muscles

Question 27

What are side effects of indomethacin administration?

Answer 27

Oligo

Question 28

What is a side effect in the neonate that can happen if indomethacin is given after 32 weeks?

Answer 28

Premature closure of the ductus arteriosus- this is blood that goes to the baby’s brain

Question 29

How does Magnesium Sulfate used for neuroprotection in preterm fetuses?

Answer 29

This causes the brain to vasodilate which increases blood flow (which has more O2), this decreases the risk for CP.