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OB TEST 3 > Intrapartum > Flashcards

Intrapartum Flashcards

1
Q

Precipitous Delivery

A

Rapid intense contractions

Labor less than 3 hrs

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2
Q

Dystocia

A

Long, difficult, or abnormal labor

As a result of
Powers
Passenger
Passageway

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3
Q

Dysfunctional Labor Pattern

Hypertonic

A

Hypertonic

Strong, painful, ineffective contractions
Contributing factor: maternal anxiety
Occiput-posterior malposition of fetus

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4
Q

Dysfunctional Labor Pattern

Hypotonic

A

Hypotonic

Contractions decrease in frequency, intensity
Maternal and fetal factors that produce excessive uterine stretching

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5
Q

Structural Dystocia (4)

A

Shoulder Dystocia McRoberts Maneuver

Cephalo-Pelvic Disproportion (CPD)

Fetal Anomalies

IDM or LGA

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6
Q

Uterus Complications

A

Uterine inversion – uterus follows the placenta out
Surgical repair

Uterine rupture - complete separation vs. small tear
Obstetric emergency
Sharp referred pain -> between scapula

Increased risk during VBAC = vaginal birth after C-section

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7
Q

Umbilical Cord

A

Umbilical cord complications
Nuchal cord
“loose vs. tight” “knots”
“how many loops”

Umbilical cord prolapse
Obstetric emergency
-> c/s

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8
Q

Placenta Complications

5

A

Placenta irregularities:

Implantation
Circumvellate,Succenturiate

Adherence
Accreta, Increta, Percreta

Insertion of cord
Battledore, Velamentous

Infarcts
Substances – cocaine

Insufficiency
Smoking

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9
Q

Amniotic Fluid Complications (5)

A

Oligohydramnios -> less amniotic fluid, amniofusion, kidney problems of baby not urinating

Polyhydramnios –> too much amniotic fluid, tracheoesophageal atresia

Amniotic Fluid Emboli –> amniotic fluid and fetal tissue in moms blood supply, fast death

Meconium –> Meconium-stained; seizure, stress on baby
Pea soup – thick and under a lot of stress –> aspiration and pneumonia

Infection – Chorioamnionitis

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10
Q

Intrapartal Infections
Chorioamnionitis “chorio”
7 symptoms

A

Maternal fever (100.4 F)

Plus
WBC > 15,000
Maternal tachycardia (> 100 bpm)
Fetal tachycardia (> 160 bpm)
Foul or strong-smelling amniotic fluid
Cloudy or yellow amniotic fluid
Tender uterus

Tocolytics are contraindicated in the presence of symptomatic Amniotic Fluid Infection.

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11
Q

Perineal Trauma (8)

A

Lacerations
1st degree to 4th degree

Birth weight > 4 kg
Persistent occipitoposterior position
Nulliparity
Induction of labor
Epidural analgesia
Prolonged second stage > 1 hr
Midline episiotomy
Forceps delivery
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12
Q

Intrapartum Assessment

A

Maternal and fetal well-being

Analyze labor status
Monitor for symptoms of complications
Facilitate progression of labor
Ensure safety of patient and fetus/newborn

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13
Q

Fetal Assessment
Changes in Fetal HR

Tachycardia (9)

Bradycardia (8)

A

Changes in Fetal Heart Rate

Tachycardia   > 160 bpm
maternal fever or infection
maternal dehydration
maternal anemia
maternal anxiety
maternal medications or illicit drugs
prolonged fetal stimulation
compensatory response to transient fetal hypoxemia
chorioamnionitis
fetal anemia
Bradycardia 
maternal supine positioning
mom hypotension
mom meds/illicit drugs
mom hypothermia
mom hypoglycemia
umbilical cord prolapse
decompensating fetus
prolonged PSNS
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14
Q

Fetal Assessment

–> C-Section HR STATS

A

Fetal heart rate

Baseline FHR
Tachycardia
> 160 bpm x 10 mins
Bradycardia

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15
Q

Interpret FHR, EFM Tracing

What are you looking for

A

Contractions
Frequency and Intensity

FHR Pattern
Reassuring
Non-reassuring

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16
Q

EFM Assessment

A 
Baseline FHR
Presence of...
Variability
Accelerations
Decelerations
Early
Variable
Late
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17
Q

Acceleration

A

Abrupt increase in HR from baseline
Can occur at any time during labor
Reassuring sign of fetal well being

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18
Q

Variable deceleration

A

Abrupt decrease in HR from baseline
Onset varies with contractions
Extremely common, present in 83% of labors

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19
Q

Late Decelerations

A

Gradual, symmetrical, decrease in HR
HR returns to baseline after contraction ends
Onset occurs at peak of contraction

May indicate fetal distress if repetitive or severe

20
Q

Early vs. Late Decelerations

And Variable

A

Early decelerations caused by head compression

Late decelerations caused by uteroplacental Insufficiency

Variable decelerations caused by cord compression

21
Q

VEAL CHOP

A

variable - cord
early - head
acceleration - ok
late - placenta

22
Q

Nursing Interventions
FHR decelerations
Early vs. variable and late (6)

A

Early: no action

Variable and Late
Discontinue oxytocin
Lateral position change
Increase IVF rate
Oxygen per face mask
Palpate for hyperstimulation
Notify HCP
23
Q

Obstetric interventions (4) for labor

A

Induction of Labor
Labor is started artificially

Labor Augmentation
Assisting labor which has started spontaneously but is ineffective

Instrument Assisted Labor
Vacuum Extraction
Forceps

Cesarean Section

24
Q

Post term pregnancy
Time
Management

A

Post-term—extends beyond 42 wks
Risk for fetal/neonatal problems
Increased maternal risk
Management—labor induction

25
Indications for induction (6)
Post term pregnancy Premature Rupture of Membranes (PROM) Chorioamnionitis HTN: Chronic, Gestational, or Preeclampsia (mild) Maternal co-morbidities Diabetes Cardiac or Respiratory Psychosocial (including hx precipitous or rapid labor & distance to hospital ) ``` Fetal compromise Intrauterine growth restriction (IUGR) Oligohydramnios Isoimmunization Fetal demise ```
26
Induction and the Cervix | Mechanical vs. Medication
Mechanical Amniotomy = AROM Membrane Stripping ``` Medication Cervical Ripening dinoprostone insert or gel misoprostol (off-label) laminaria Synthetic Oxytocin IV ```
27
Augmentation of Labor Mechanical Medication
Prolonged labor “failure to progress” Mechanical AROM Membrane Stripping Medication Synthetic Oxytocin IV
28
Indications for Vacuum extraction
Maternal fatigue, ineffective pushing, vacuum
29
C-Section STAT Indications (5)
``` Fetal distress (prolonged deceleration without recovery) Umbilical cord prolapse Placenta Abruptio Uterine rupture Hemorrhage ```
30
C-Section Scheduled (6)
``` Scheduled Repeat Multiples Infection: HIV, active herpes lesions Previous 4th degree perineal laceration ``` Scheduled during last weeks Placenta previa Presentation: breech, transverse
31
``` C-Section Not emergent (5) ```
Not emergent Failure to progress – prolonged labor Failed labor induction Macrosomia / CPD Complications: Preeclampsia and HELLP Preterm labor (if progressing and 22-28 wks)
32
Surgical Procedure | Major Risks
Respiratory Depression Anesthetic gases or medications (epi/spinal) Maternal or Newborn respiratory depression Infection -> Pre-operative prevention Surgical Care Improvement Project Measure
33
General Anesthesia for C/S
Though an increased risk for post-op complications Respiratory Preferred if Platelet count is less than 100,000 Epidural/spinal is not effective “STAT” emergency section for fetal or maternal distress
34
Perinatal Fetal Loss
``` Communication and care techniques Actualize the loss Provide time to grieve Interpret normal feelings Allow for individual differences Cultural and spiritual needs of parents Physical comfort ```
35
High Risk Newborns | Birth weight
Birth Weight Low birth weight (LBW) 2500 Very low 1500 Extremely low 1000
36
High Risk newborns IUGR SGA
Intrauterine Growth Restriction Lack of intrauterine fetal growth may also be SGA Small for Gestational Age Infants born at any gestational age, birth weight is below the 10th percentile on the growth charts
37
High Risk Newborns Risk Factors Physiology
Risk Factors Intrauterine development Intrapartum processes Extrauterine adaptation Physiology Lung immaturity Circulatory immaturity Neurological immaturity
38
Lung Immaturity Lower airway characteristics (3)
At 24-28 wks gestation, surfactant begins to line the alveoli Inhibits alveolar collapse at end of expiration Increases area available for gas exchange
39
Premature newborn | Severe vs. Moderate
Severe prematurity 22 to 26 weeks Moderate prematurity 26 to 30 weeks
40
Apnea of Prematurity Treatment
Apnea – not breathing >15 to 20 secs accompanied by pallor, hypotonia, cyanosis, and bradycardia Apnea Periodic breathing Central apnea Reflux Caffiene Apnea Monitor CPR training for parents and caregivers before D/C
41
Respiratory Distress Syndrome
Premature newborn –> Underdeveloped alveoli, lack of surfactant Atelectasis, congestion, edema in lung spaces GFR = grunting, flaring, retractions
42
Preterm Newborn Challenges
Hypoglycemia Hypothermia Hyperbilirubinemia
43
Transient tacypnea of the newborn
Fetal lung fluid not fully absorbed
44
Meconium aspiration syndrome
Meconium-stained amniotic fluid Light Moderate Pea Soup -> Suctioning before first breath to prevent aspiration pneumonia
45
Post term newborn
Newborns remain in utero after the optimal growth Skin is parchment-like Fingers are long and peeling Muscle wasting is present
46
``` Infections of Newborn Bacterial --4 Fungal -- 1 TORCH -- 3 _______ ```
``` Bacterial infections Group B strep Escherichia coli Tuberculosis Chlamydia ``` Fungal infections Candida TORCH Cytomegalovirus Toxoplasmosis Herpes HIV
47
Symptoms of Sepsis
``` Temperature Instability Feeding Poor suck Feeding intolerance Hypoglycemia Respiratory - “GFR” Hypotonia ``` GFR

OB TEST 3 (2 decks)

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