OB Mod IV Review Flashcards
1
Q
The passage, the fetus, the relationship between the passage and the fetus, the physiologic forces of labor, and the psychosocial considerations.
A
Five factors of critical importance in the process of labor and birth.
2
Q
Four types of pelvis as classified by the Caldwell-Moloy system
A
gynecoid (most common)
android
anthropoid
platypelloid
3
Q
The true pelvis consists of….
A
the inlet, pelvic cavity, and the outlet
4
Q
Frontal suture
A
located between the two frontal bones, becomes the anterior continuation of the sagittal suture
5
Q
Sagittal suture
A
located between the parietal bones, divides the skull into left and right halves
6
Q
coronal sutures
A
located between the frontal and parietal bones, extend transversely left and right from the anterior fontanelle
7
Q
lambdoidal suture
A
located between the two parietal bones and occipital bone, extends transversely left and right from the posterior fontanelle
8
Q
2 pelvic types favorable for vaginal birth
A
gynecoid, anthropoid
9
Q
2 pelvic types not favorable for vaginal birth
A
android, platypelloid
10
Q
Skull landmark Mentum
A
fetal chin (face presentation; head is hyperextended)
11
Q
Skull landmark Sinciput
A
anterior area known as the brow (brow presentation)
12
Q
Skull landmark Bregma
A
diamond-shaped anterior fontanelle (sinciput presentation; no head extension or flexion)
13
Q
Skull landmark Vertex
A
area between anterior and posterior fontanelles
14
Q
Skull landmark Occiput
A
occipital bone (vertex presentation; most common type)
15
Q
Primary physiologic force of labor
A
uterine muscular contractions
16
Q
Secondary physiologic force of labor
A
use of abdominal muscles to push
17
Q
Each contraction has three phases progressively:
A
increment, acme, decrement
18
Q
Progesterone relaxes smooth muscle tissue, estrogen stimulates uterine muscle contractions, connective tissue loosens
A
identified factors at the onset of labor
19
Q
Three phases of the first stage of birth
A
Latent, active, transition
20
Q
Cardinal movements of labor
A
- descent
- flexion
- internal rotation
- extension
- restitution
- external rotation
- expulsion
21
Q
Two phases of the third stage of birth
A
placental separation, placental delivery
22
Q
Two presentations of the placenta
A
shiny Schultze, dirty Duncan
23
Q
Under what circumstances should the mother come to the birthing unit?
A
ROM, regular and frequent uterine contractions, vaginal bleeding, decreased fetal movement
24
Q
Contraction frequency 2-5 minutes, duration 40-60 seconds, moderate to strong intensity.
A
Active phase
25
Contraction frequency 1.5-2 minutes, duration 60-90 seconds, intensity strong.
Transition phase
26
Systemic medication considerations
1. cross the placental barrier by simple diffusion
2. action depends on liver enzyme metabolism
3. high doses remain in fetus for long periods (fetal liver enzymes and kidney function insufficient)
27
Maternal assessment with medication administration
1. willing to receive
2. vital signs stable
3. contraindications not present
28
Fetal assessment with medication administration
1. FHR between 110 and 160
2. Variability present
3. fetal movement/ accelerations present
4. fetus is at term
29
Labor assessment with medication administration
1. documentation of contraction pattern
| 2. cervical status (position, consistency, effacement, dilatation, station)
30
Butorphanol tartrate (Stadol)
Synthetic agonist-antagonist opioid analgesic agent.
1. respiratory depression, mother and fetus
2. drowsiness, dizziness, fainting, hypotension
3. urinary retention; not common
4. protect med from light/ store at room temp
5. has a ceiling effect
31
nalbuphine hydrochloride (Nubian)
Synthetic agonist-antagonist opioid analgesic
1. crosses placenta/ nonreassuring fetal heart rate & respiratory depression
2. IV infusion/ 10 mg over 3-5 minutes
3. Has a ceiling effect
4. choice over Stadol/ less nausea & vomiting and increased maternal sedation
32
Fentanyl (Sublimaze)
Short-acting opiate
1. relives pain/ induces sedation
2. 50-100 more potent than morphine
3. does not cross placenta (less neonatal neurobehavioral depression than Demerol)
4. less sedation, nausea, vomiting, pruritus compared with Demerol
33
Potentiate the effects of opioid analgesics permitting lower doses of opioids
analgesic potentiators: promethazine (Phenergan), hydroxyzine (Vistaril), propiomazine (Largon), and promazine (Sparine)
34
Used to counter opioids; reverse respiratory depression
Naloxone (Narcan)
| 1. if unresponsive to treatment may be readministered every 2-3 minutes
35
Two types of local anesthetic agents
1. esters [procaine hydrochloride (Novocain), chloroprocaine hydrochloride (Nesacaine), Ropivacaine (Naropin), and tetracaine hydrochloride (Pontocaine)]
2. amides [lidocaine hydrochloride (Xylocaine), mepivacaine hydrochloride (Carbocaine), and bupivacaine hydrochloride (Marcaine)]. More powerful than esters
36
Preferred treatment for mild toxic reaction to anesthetics
oxygen and IV injection of a short-acting barbiturate to diminish anxiety
37
Given to counter hypotension of 1-2 minutes after epidural regional block (after initial repositioning efforts to counter hypotension)
ephedrine 5-10 mg IV
38
Pruritus associated with an epidural infusion is treated with administration of what
diphenhydramine hydrochloride (Benadryl)
39
Given at 30-32 weeks gestation to facilitate growth of alveoli
corticosteroids
40
Cyclooxygenase (prostaglandin synthetase) inhibitors, calcium channel blockers such as nifedipine (Procardia), terbutaline sulfate (Brethine), and magnesium sulfate are used for what?
Tocolytics
41
These tocolytics should not be used concurrently due to their calcium blockage potential
Nifedipine/ magnesium
42
Five "P's" of labor
```
Powers: contractions
Passageway: birth canal
Passenger: fetus and placenta
Position of the Mother
Psyche: psychologic response
```
43
Percent increase in circulating blood volume when pregnant
40-50%
44
Normal placental implantation
Upper part of the uterus (1st stage of development)
45
Infectious agents (teratogens) and possible effects on pregnancy
Rubella
Parovirus-chance of miscarriage or hydropsfetalis
Toxoplasmosis-cat feces
STD
46
Cervical cerclage
Treatment for cervical incompetence (purse-string stitch)
47
2 types of maternal fetal monitoring
Intrauterine pressure catheter
| Internal fetal scalp monitor
48
Premonitory signs of labor
```
Braxton Hicks contractions
Lighteining (2-3 weeks b4 labor)
Increased vaginal mucous secretion
Bloody show
Energy spurt
Weight loss
```
49
Theories of the causes of labor
Primarily hormonal changes
Increase in oxytocin receptors
Fetal production of oxytocin, cortisol, prostins
Increase stretching, pressure, irritation of uterus cervix
50
Primary hormone changes during labor
estrogen to progesterone ratio increases
progesterone decreases
prostaglandins increase
oxytocin increases
51
True Vs. False labor contractions
consistent pattern increasing frequency, duration, and intensity/ inconsistent change in activity
52
True Vs. False labor discomfort
begins lower back and moves anterior/ annoying not painful
53
True Vs. False labor cervix changes
effacement and dilation/ no change
54
Uterine rupture (causes, S&S, nursing management, treatment)
Hemorrhage/ fetal anoxia/ fetal hemorrhage/ neonatal morbidity and mortality/ increased risk of maternal death
C-section birth/ hysterectomy
55
Placenta previa (causes, S&S, nursing management, treatment)
Hemorrhage/ uterine atony
| increase incidence of C-section/ fetal hypoxia/ acidosis/ fetal exsanguination/ increased prenatal mortality
56
Chorioamnionitis (causes, S&S, nursing management, treatment)
Intra-amniotic infection resulting from bacterial invasion before birth/ PROM/ retained placenta and hemorrhage/ maternal sepsis/ maternal death
57
First stage of labor
onset of true labor until full effacement and dilation of cervix (15-20 hours)
58
First phase (latent)/ First stage of labor
0-3 cm dilated
Uterine contractions 5-20 min/ 30-45 sec
Mild tone
Nose
59
Second phase (active)/ First stage of labor
4-7 cm dilated (Dr. will tell mom to come in)
Uterine contractions 2-5 min/ 45-60 sec
Moderate tone
Chin
60
Third phase (transition)/ First stage of labor
8-10 cm dilated
Uterine contractions 1.5-2.5 min/ 60-90 sec
Firm tone
Forehead
61
Nursing care interventions First Stage of Labor
I/O; Temperature; Vital Signs
62
HCL
nuccal; cord around neck
63
Nursing diagnoses during first stage of labor
dehydration
| risk for falls
64
Second stage of labor
Full effacement and dilation until birth
65
Second stage of labor nursing responsibilities
```
Blood pressure q15min/ FHR q15min
Comfort measures (positioning is important, rest, prepare for delivery, reassure, significant other or self involvement/ present to coach)
```
66
Second stage of labor concerns
Pushing efforts
Descent
Birth of baby
Amniotic fluid appearance
67
Third stage of labor
From birth of baby to birth of placenta
68
Third stage of labor nursing responsibilities
```
Prevent fluid loss/ maintain safety/ prevent trauma/ basic care and comfort
Prevent trauma (do not pull on cord: hemorrhage/ cramping before placental delivery)
```
69
Fourth stage of labor
1-4 hours after birth for physiological and psychological stabilization and family attachment
70
Fourth stage of labor nursing responsibilities
Teach about baby care (i.e. cord care, etc.)
Monitor HR, cardiac output, respiratory rate)
Gastrointestinal and urinary systems are affected
71
Importance of relaxation between contractions
Tense muscles increase resistance to the descent of the fetus and contribute to maternal fatigue.
72
Positional changes during labor (very important)
Encourage mom to move
| Walking, rocking, chair, birthing ball, toilet assistance, moving side-to-side
73
Most common type pelvis (50%) that is favorable for vaginal childbirth; wide and deep
Gynecoid
74
Type of pelvis favorable for vaginal childbirth (25% white, 50% non-white); narrow and deep
Anthropoid
75
Type of pelvis not favorable for vaginal childbirth (30%); heart shaped
Android
76
Type of pelvis not favorable for vaginal childbirth (3%); wide and shallow
Platypelloid
77
Consists of the inlet, mid (pelvic cavity measured in the U.S.), and outlet.
True pelvis
78
True pelvis
Portion of the pelvis below the line terminalis (consists of the inlet, midpelvis, and outlet)
79
The flared upper portion of the bony pelvis
False pelvis
80
Soft tissue of the cervix and vagina
Birth canal
81
Released by the placenta, this hormone influences pelvic relaxation
Relaxin
82
How to increase pelvic diameter to facilitate the birth process
during labor squat and lie in a lateral Sims position
83
Most common risks of VBAC
Hemorrhage/ uterine scar separation/ uterine rupture/ surgical injuries/ fetal death/ neurologic complications
84
Aspects to consider with VBAC
Debate regarding safety
ACOG guidelines
Common risks
85
ACOG guidelines
American College of Obstetricians and Gynecologists
The College guidelines state that women with two previous low-transverse cesarean incisions and women carrying twins may be considered
appropriate candidates for a TOLAC
86
Injection of anesthetic into the epidural space between dura and spinal cord.
Epidural block; all drugs injected into epidural or subarachnoid space are preservative free
87
Performed to determine placement of an epidural block
3 mL test
88
Should be monitored before injection through an epidural block
Platelets should be high/ watch vitals/ 3 mL test/ I&O/ **always monitor BP every 15 min.
89
Possible side effect of maternal narcotic analgesia
Newborn respiratory depression
90
Adverse effects of an epidural block
Maternal hypotension/ bladder distension/ prolonged 2nd stage/ nausea and vomiting/ pruritus/ decreased RR for up to 24 hrs dura puncture (headache, fluid leakage)/ contraindicated if allergic to anesthetics.
91
Intrathecal injection (spinal anesthesia)
Injection of preservative free opioid analgesic into subarachnoid space. May have to re-inject.
92
Advantages of spinal anesthesia (intrathecal)
small doses, reduces pain, less sedation, no motor block, no hypotensive effects
93
Disadvantages of spinal anesthesia (intrathecal)
Limited duration of action, inadequate relief for late labor and birth, has to be timed "right" for maximum effect
94
Adverse effects of spinal anesthesia (intrathecal)
Nausea and Vomiting (N/V)/ pruritus (itching)
95
Three types of C-section
Scheduled/ emergent (not a true emergency but must be done)/ emergency
96
Indications for a C-section delivery
PIH (pregnancy induced hypertension), maternal disease, active genital herpes, HIV positive mom, previous uterine surgical procedure, fetal distress, prolapsed umbilical cord, fetal malpresentation, hemorrhagic conditions
97
Contraindications for a C-section delivery
Conditions that are not desirable, intrauterine fetal demise (IUFD), preterm fetus (that wont survive), maternal coagulation defects
98
Three types of breech presentation
Frank breech: bottom first, feet crossed
Complete breech: bottom first, feet crossed in front of the face
Single footing breech: one foot delivering first, second foot over abdomen
