OB Flashcards by Jordan Elliff

OB Physiological Changes

Up to 50% increase in blood volume “Anemia of pregnancy”
Decreased Tidal Volumes
HR increased by 10-20 bpm

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Report Info

Gravida - Number of pregnancies
Para - Number of live births
Number of abortions under 20 weeks
Gestational Age

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Fetal Assessment

Fundal Height

20 wks: Fundus should be at umbilicus.
36 wks: Sternum

Station: Measured -3-+3 - “dropping”

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FHR Variability

Healthy fetal heart rate variability reflects a healthy CNS and cardiac function.

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Decreased FHR Variability

Fetal hypoxia
Prematurity
Congenital heart problems

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Increased FHR Variability

Fetal Hypoxia
Mechanical compression of umbilical cord

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Fetal Bradycardia

<120 bmp >5-10m

Cord compression
Cord prolapse
Anesth esia to spinal cord
Maternal seizures

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Fetal Tachycardia

> 160bpm >5-10m

Fetal Hypoxia
Maternal Fever
Anemia
Hyperthyroidism

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Accelerations

Increased roughly 15 bpm for roughly 10-15 seconds.

Reflective of fetal well-being.

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Early decelerations

Mirrors contractions

Head is compressed.
Going to canal.

NOT HARMFUL

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Late Decelerations

At peak of contraction
returns to baseline after contraction

Smooth/shallow dips
WORRISOME - Fetal Hypoxia

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Sinusoidal

EMERGENCY
No changes in contractions
Sine wave appearance
Fetal anemia/hypoxia

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Interventions for fetal distress

Oxygen
IV Bolus
Rule out cord prolapse
Lateral Positioning

DC infusion of oxytocin if having tetanic contractions

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Pre-Term Labor

20-37 wks gestation

Increased Vaginal Discharge
Increased pelvic pressure
Lower backache

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Tocolytics

CCB, Mg, NSAIDS, NTG, Terbutaline

Contraindications:

Fetal Demise
Lethal fetal anomalies
Severe Pre-eclampsia
Maternal Bleeding
Intraamniotic Infection

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Nifedipine

> 32 Weeks Gestation CCB

Indomethacin

NSAID
Cyclooxygenase Inhibitor
<32 weeks gestation

Contraindications:

Platelet dysfunction
Hepatic/renal dysfunction
Hypersensativity to ASA

Terbutaline

Beta Andrenergic Receptor Agonist
-Off Label for preterm labor
FDA Warning against prolonged use

Contraindications:

Tachycardia Sensitive cardiac disease
Poorly controlled hyperthyroidism/Diabetes
It does cross placenta lines. Can cause tachycardia in fetus.

OB Magnesium Sulfate

Relatively weak tocolytic effects

Neuroprotection of fetus.

Monitor BP, Respiratory Status, and DTR

Contraindications: Myasthenia Gravis
Cardiac Compromise

Antidote: Calcium Gluconate

OB Nitroglycerin

Smooth muscle relation.
Monitor blood pressures

OB Corticosteroids

Betamethasone

Boost development of fetal lung, brain, and digestive systems.
Takes up to 48 hours for full effect

Decreases risk of intraventricular hemorrhage.

OB Antibiotics

Group B Strep.
Usually given >35 weeks gestation. If less than 35 wks gestation, consider giving antibiotics.

Premature Rupture of Membranes

Risk to fetus:

Infection
Pre-term delivery
Umbilical cord prolapse/compression

Signs of Imminent Delivery

1-2 minute contractions
Bloody Show
Urge to bear down
Crowing
ITS COMING

Pregnancy Induced Hypertension

>140/90 Weight Gain Headache Visual Disturbances Edema Oliguria NO PROTEINURIA Treatment: Hydralazine Labetalol Nifedipine

Preeclampsia

Typically diagnosed >20 weeks gestation or <4 weeks post-partum Hypertension Weight Gain/Edema PROTEINURIA Usually acute onset. Treatment: Hydralazine/Labetalol Mag Sulfate Valium/Ativan

Eclampsia

SEIZURES Immediate delivery of fetus. Hypertension weight gain/edema PROTEINURIA Manage seizures, hypertension, and deliver baby.

HELLP Syndrome

Hemolysis, Elevated Liver Enzymes, Low Platelets RUQ epigastric pain Headache N/V Myalgia Immediate delivery if >34 weeks.

Placenta Previa

Placental attachment over opening of cervix Pain BRIGHT RED bleeding C section Supportive Treatment DEFER VAGINAL EXAM

Placental Abruption

Premature separation of placenta from uterine wall Risk of fetal hypoxia and death Uterine tenderness, board-like abdomen, DARK RED VAGINAL BLEEDING

Uterine Rupture

Baby is typically outside of the uterus. Signs of previous C-section? Watch fundal height or palpable uterine defects. LOSS OF FETAL STATION Support Care: Blood Oxytocin DELIVERY

Nuchal Cord

Variable Decelerations Somersault Maneuver Clamp and cut before shoulder delivery

Post-Partum Hemorrhage

>500ml in vaginal >1000ml in Cesarean Causes: 4 T's Tone - atony Trauma - tears, rupture Tissue - retained placenta? Trombosis - coagulopathy Fluid/Blood External Uterine Massage Oxytocin for uretal atony Pitocin, Methergine, Cytotec Blood Bimanual Uterine Compression

Uterine Inversion

Supportive Care DO NOT REMOVE THE PLACENTA - Stop uterotonic medications (johnson maneauver)

Anaphylactoid Syndrome

Antibody response to amniotic fluid and fetal components entering maternal circulation Hypoxia, hemodynamic compromise/instability, coagulopathy (petichae, contusion) Supportive Care: Corticosteroids Epinephrine PRBC's, FFP, Cryopreceipitate