OB procedures (unit 3) Flashcards Preview

OB > OB procedures (unit 3) > Flashcards

Flashcards in OB procedures (unit 3) Deck (39)
1

external cephalic version (ECV)

•manually change fetal position using abdominal manipulation
•37-39 wks
•used to prevent C/S d/t breech

2

contraindications for ECV

•previous C/S
•placenta previa (can't deliver vag anyway)
•twins
•oligohydramnios
•uterine anomalies
•abruption/UPI

3

risks r/t ECV

•umbilical tangle
•fetal hypoxia
•placental abruption
•Rh iso-immunization
•SROM

4

labor induction

•artificial stimulation of labor when pt is not in labor
•medical OR elective

5

labor augmentation

•artificial stimulation of labor when pt is IN labor, but not progressing appropriately

6

indications for induction

•pre-eclampsia/PIH
•SROM at term
•maternal medical problems
•chorioamnionitis
•IUGR, post term, incompatibility
•IUFD
*NOT convenience

7

elective induction for convenience

•not recommended, but done
•should be considered if
-hx of rapid labor & far from hospital
-specialized neonatal care needed
-41 wks PG

8

39 week rule

•no elective inductions prior to 39 wks GA b/c too many risks

9

risks r/t induction

•hypertonic ctx
•placental abruption
•uterine rupture
•postpartum hemorrhage
•C/S

10

natural induction

•breast/nipple stimulation
•sex
•acupuncture/pressure

11

mechanical induction (cervical ripening)

•balloon cath
•laminaria tent
•osmotic dilators
•membrane stripping
•amniotomy (AROM)

12

chemical induction

•nonhormonal
-herbs/oils
-enemas
•hormonal
-oxy
-prostaglandins
-misoprostol, mifepristone if goal is to soften cervix first

13

pitocin

•synthetic form of oxytocin
•causes uterine ctx
•short t1/2
•lower dose needed in augmentation

14

pitocin admin

•always mix IVPB
•always use pump
•attach as close to insertion site as possible
•start low and slow
-titrate until desired result

15

tachysystole

•hyper stimulation of uterus
•ctx > 90 sec
• > 5 U ctx in 10 min
*causes late decel, abnormal FHR, loss of variability

16

intrauterine resuscitation for tachystytole

•pt on side
•stop pit
•open main fld. line
•O2 @ 10L
•vag exam (r/o prolapse)
•have Brethine 0.25 mg SQ ready

17

Brethine (Terbutaline)

•muscle relaxer
•relaxes uterus

18

hemorrhage r/t Pitocin

•PP risk
•all receptors saturated so uterus can't clamp down anymore
*uterine atony from Pit

19

Bishop score

•estimates how successfully woman's labor can be induced by determining if her cervix is favorable
•based on dilation, effacement, station, consistency, & postion

20

readiness for induction

•Bishop score of 9+ for nullips
•5+ for multip

21

cervical ripening

•chemically/mechanically softened day before labor
•thins, allowing for successful induction
*do before inducing if have low Bishop score

22

mechanical cervical ripening

•hydrophobic insertion
•attracts liquid, swelling and dilating cervix
•Laminaria/Lamicel
•takes 8-12 hrs

23

chemical cervical ripening

•Cervidil (Dinoprostone)
•Cytotec

24

amniotomy

•AROM
•induce/augment labor
•done only if fetal station low and cephalic fetus
*labor w/in 12-24 hr
*WONT shorten labor

25

RN role amniotomy

•FHR
•assess amniotic fld. (color, odor, amnt)
•bedpan if have to urinate
*excessive fld indicates poly and high station

26

risks r/t amniotomy

•cord prolapse
•infection (fetal tachy)
•abruptio placenta

27

DONT let woman ambulate if...

•ROM and high fetal station
*should not perform amniotomy if head not well-applied to cervix

28

forceps/vacuum extraction

•operative vaginal delivery that provides traction and aids in descent/rotation of fetus in 2nd stage
*can't use for preterm

29

indications for operative vaginal delivery

•maternal exhaustion
•inadequate pushing
•cardiac/pulmonary dz
•fetal HRN abnormality if can't do C/S fast enough
•breech (get head out)

30

maternal risks r/t operative vaginal delivery

•bladder injury
•cervical laceration
•vaginal laceration/hematoma

31

fetal risks r/t operative vaginal delivery

•facial/scalp abrasion/asymm
•nerve injury
•cephalohematoma
•intracranial hemorrhage
•scalp edema (caput)
•shoulder dystocia

32

RN role episiotomy

•ice
•monitor infection
•NEVER give enema/suppository
•PO stool softeners

33

indications for C/S

•placental abnormality
•PIH
•dysfxnl labor
•herpes/HIV
•IDDM
•previous C/S
•cord prolapse
•fetal distress
•breech presentation
•multip

34

C/S contraindications

*if risk to mom > than baby
•IUFD
•clotting dz
•fetal dz incompatible w/ life

35

maternal risks r/t C/S

•infection
•hemorrhage
•bladder/organ damage
•DVT
•paralytic ileus
•psychological

36

fetal risks r/t C/S

•TTN r/t retaining lung fld.
•injury
•respiratory distress

37

C/S incision types

•low transverse (preferred)
•low vertical
•classical (high vertical)

38

when is classical C/S incision employed

•very premature
•placenta previa
•emergency birth
•morbid obesity
*shouldn't labor in subsequent PG

39

vaginal birth after C/S

•only if was LTCS
•only if 1 prior C/S
•induce w/ Pit
•have anesthesia and MD ready