OB and Neonatal Care Flashcards by Matti Nowery

Approximately how many cells does the embryo contain when it implants into the uterine wall?

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Function of placenta

Synthesis of glycogen and cholesterol.
Metabolizes fatty acid.
Transfer of certain antibodies.
Performs respiratory gas exchange, transport of nutrients, excretion of wastes, and heat transfer.
Produces necessary hormones and serves as a barrier against harmful substance in woman’s circulation.

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Premature rupture of membranes

Rupture of amniotic sac prior to the onset of labor.

Increasing risk of fetal infection or injury.

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What is considered preterm?

Less than 37 weeks

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Cardiovascular changes during pregnancy

HR elevates by 10-20 beats
CO increases by 30-50%
BP decreases by 10-15

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Blood changes during pregnancy

Blood volume increases by 50%
RBC increase by 30#
Elevated RBC increases the need for iron

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Respiratory changes during pregnancy

Respiratory minute volume increases by 40%

Increased CO2 during exhalation

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GI changes during pregnancy

Morning sickness
Heartburn
Peristalsis decreases resulting in constipation

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Musculoskeletal changes during pregnancy

Edema in LE

Approximately 27 lb weight gain

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Most common cause of vaginal bleeding during the first nd second trimester?

Spontaneous abortion

Miscarriage

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Causes of abortions.

Chronic illness in mother
Maternal exposure to toxic substances or illicit drugs
Fetal abnormalities
Abnormal attachment of placenta

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Threatened abortion

Abortion that is impending or potentially occurring

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Treatment for threatened abortion

Best rest to avoid activity or fluctuations in vital signs

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Imminent abortion

Impending or threatened spontaneous abortion that cannot be prevented

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Treatment for imminent abortion

Administering 250 mL bolus - repeat PRN
NRB at 15L
Emotional support
Rapid transport
Be alert for signs of shock

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Incomplete abortion

Part of the products of conception is expelled, but some remain in the uterus.

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s/s ectopic pregnancy

Sudden onset of lower abdominal pain and cramping

May or may not have vaginal bleeding

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abruptio placenta

Premature separation of normally planted placenta from the wall.

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s/s abruptio placenta

Sudden onset of severe abdominal pain
Decreased fetal movement
Decreased fetal hart tones
Minimal vaginal bleeding or none

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placenta previa

Placenta is implanted low in the uterus and partially or fully obscures cervical canal

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s/s placenta previa

Painless vaginal bleeding

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Chronic HTN in pregnancy can cause

Retard growth and development of the fetus
Impaired liver and renal function
Pulmonary edema
Progress to life-threatening tonic-clonic seizures

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Preeclampsia

HTN

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s/s preeclampsia

Severe headache
N/V
Agitation
Rapid weight gain
Visual disturbances

pulmonary embolus
SOB
AMS
Upper abd pain
Myoclonus

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Eclampsia

HTN | Seizure

Postpartum eclampsia

24 hours - 4 weeks after birth

Supine hypotensive syndrome

vena cava compression

s/s supine hypotensive syndrome

``` Nausea Dizziness Tachycardia Claustrophobia SOB Syncopal episodes ```

Gestational diabetes mellitus

Inability to process carbohydrates during pregnancy

Treatment for hyperemesis gravidarum

``` NRB 100% Blood glucose levels IV access Saline bolus Transport ```

Deceleration forces may cause :

abruptio placenta | uterine rupture

XABCDE

``` eXsanguinating hemorrhage Airway Breathing Circulation Disability Exposure ``` Assessment for trauma in pregnancy

Questions to ask during hx taking

``` If the patient is pregnant G/P/A Length of gestation Estimated due date or date of confinement Fetal movements present Complications w/ past pregnancies C-section Under physician's care Taking prenatal vitamins Last OB visit Contractions? How far apart? ```

When would you consider delivering a newborn on scene?

Delivery is expected in minutes Natural disaster, bad weather or other catastrophe making it impossible to reach the hospital No transportation is available

What BP would you consider preeclampsia?

140/90

First stage of labor

Onset of contractions and ends when the cervix is fully dilated

Second stage of labor

Full cervical effacement and dilation until fetus is delivered

Third stage of labor

Delivery of newborn and ends with delivery of placenta

Emergency situations after delivery

Placenta has not delivered after 30 minutes More than 500 mL of bleeding occurs before delivery of placenta Substantial bleeding occurs after the delivery of the placenta

When is labor considered preterm?

20th week, but before 37th week

When is a newborn considered a premi?

Born before 36 weeks or weighs less than 5 lbs

Physical findings of uterine rupture.

Diaphoretic Tachycardia Falling BP May or may not have substantial vaginal bleeding Possible sign: palpate fetal body parts through abdominal wall

Symptoms of uterine rupture

``` Weakness Dizziness Thirst Strong, painful contractions that are now slackened off Severe abdominal pain ```

Factors increasing the chance of amniotic fluid embolism.

``` Maternal age greater than 35 Eclampsia Abruptio placenta Placenta previa Uterine rupture Fetal distress ```

s/s amniotic fluid embolism

``` Sudden onset of respiratory distress Hypotension Cyanosis Seizures Cardiogenic shock Unresponsiveness Cardiac arrest ```

Breech presentation

Buttocks or both feet

Frank breech presentation

Hips flexed Knees extended Buttocks present

Incomplete breech presentation

One or both hips and knees extended | One or both feet presenting

Complete breech presentation

Hips and knees are flexed with buttocks presenting

Two goals in the situation of a limb presentation

Prevent further trauma to newborn | Transport patient rapidly and safely

What position should the mother be placed in during transport of a limp presentation?

On her back w/ head down and hips elevated

McRoberts manuever

Used in cases of shoulder dystocia. | Have mother hyperflex her knees tightly to her abdomen. Apply suprapubic pressure and gently pull on fetus's head

What is the major concern after a newborn is born with a shoulder dystocia complication?

Damage to brachial nerve plexus

Examples of potential embolic processes during pregnancy.

Amniotic embolism Pregnancy-related venous thromboembolism Air embolism

Treatment for spina bifida?

Place a sterile, moist dressing over opening. Maintain body temperature.

In which instances should you insert your fingers into your pregnant patient's vagina?

Umbilical cord prolapses | Breech birth

Causes of delayed transition in newborns

``` Hypoxia Meconium staining Blood aspiration Acidosis Hypothermia Pneumonia Hypotension Sepsis Birth asphyxia Pulmonary hypoplasia Respiratory distress syndrome ```

What does "Do What Probably Seems Simple" stand for?

``` Drying Warming Positioning Suctioning Stimulation ```

When should you provided positive pressure ventilations on a newborn?

HR below 100

Tactile stimulations acceptable and safe for newbown.

Slapping or flicking the soles of the feet | Gently rubbing the back, trunk, or extremities

Appearance APGAR Score

Completely pink : 2 Body pink, extremities cyanotic : 1 Centrally cyanotic, pale : 0

Pulse rate APGAR score

>100 : 2 <100, >0 : 1 Absent : 0

Grimace APGAR Score

Cries : 2 Grimaces : 1 No response: 0

Activity APGAR Score

Active motion : 2 Some flexion of extremities : 1 Limp : 0

Respiratory APGAR Score

Strong cry : 2 Slow and irregular : 1 Absent : 0

Indications for artificial ventilation of newborn

Apnea HR <100 Persistent despite breathing 100% oxygen

When should you d/c chest compressions and continue ventilations during a neonatal resuscitation? When do you stop ventilations?

HR is above 60 but below 100. | Stop ventilations once HR is more than 100.

When do you administer free-flow oxygen?

Central cyanosis present

When do you perform positive pressure ventilations w/ 100% oxygen when newborn has central cyanosis?

If the newborn remains cyanotic after 30 minutes of free-flow oxygen

Signs of respiratory distress that suggest a need for BVM?

Periodic breathing Intercostal retractions Nasal flaring Grunting on expiration

How much of the BVM bag are you going to compress?

1/10th

Ventilation rate for newborn

40 to 60 breaths

Count for ventilation of newborn

Breath-two-three, breath-two-three

Delivery of compressions and ventilations ratio of neonate

3:1

Apnea of prematurity is a result of _____.

Underdeveloped CNS

Primary apnea vs secondary apnea

Primary: caused by oxygen deprivation Secondary: period of gasping respirations, falling HR, and falling BP

Tx for primary apnea

Attempt drying and stimulation

Tx for secondary apnea

Positive pressure ventilation by BVM

Where should you asses HR in newborn?

Auscultation | Palpating base of umbilical cord

Blood glucose levels 12 hours after birth

30-45

Tx of hypovolemia in newborn

Administer 10 mL/kg isotonic solution over 5-10 minutes

OB and Neonatal Care Flashcards

(81 cards)