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Flashcards in OB Test 2: High Risk Intrapartum Deck (46)
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0

What is preterm?

Between 20-37 weeks

1

What is late preterm?

34-36 week

2

What is low birth weight?

Less then 2500 grams
5.5 pounds

3

What is vlbw?

Less then 1500 grams
3.51 pounds

4

What is PROM?

Premature rupture of membranes

5

What are preterm risk factors?

African American
Previous preterm birth
Multiple gestation
Uterine anomalies
Socio economic disadvantage
Smoking
GU dysfunction
No prenatal care

6

What are preterm labor symptoms?

Backache
Cramping
Pressure
Increased vaginal discharge

7

What are preterm labor assessments?

Cervix 4cm
Rupture of membranes
Infection: urinalysis
Ffn: fetofkbronectin kndicates at risk. Iran
Cervical length: >30mm less likely to deliver

8

What is treatment of preterm labor?

Hold off as long enough to get I. The betsmethasone because helps mature fetal lungs
Glucosteriods of bethmethasone 12mg IM twice a day, 12 hours a part
Tocolytics: stop labor

9

What are tocolytics?

Terbutaline (Brethine) beta adrenergic agonist
- mimic SNS, relax smooth muscle
- decrees blood pressure, increase heart rate
- risk for pulmonary edema and hyperglycemia
- 0.25 mg SC or IV titration

Magnesium sulfate
- fewer side effects
- 4 gram loading dose IV
- antidote: calcium gluconate
- toxicity: CNS depression, rate <12

10

What is PROM?

Unknown causes associated with infection and Inflammation
Preterm premature rupture of membrane

11

What are the risks with PPROM.

Chorioamnionitis: infection going to the amniotic fluid
Neonatal sepsis

12

What is the treatment of PPROM.

Expected management
Wait, monitor infection, no vaginal exams, antibiotic

13

What are labor complications?

Dystocia: ineffective labor pattern, give sedatives and encourage rest
- hypertonic contractions: uterine tachsystole, to fast, stop pitosin
- hypotonic contractions: not strong enough, augment labor

Precipitous labor: labor beginning to end is less then 3 hours big pelvis
- risk: meconium stained amniotic fluid, low APGAR, mom risk hemorrhage

Precipitous birth: sudden and doctor was not there

14

What is version?

External cephalic version: turn breech cephalic position, done in hospital, pt and monitor and non stress test. Ultrasound used to visualize baby and turned
- risks ROM, placental rupture, monitor 1 hour

Internal podalic version: reach into uterus, grab feet and pull out

15

What are the indications for labor induction?

Post maturity: over 42 weeks
Preeclampsia: only cure is delivery
Prolonged ROM
Maternal diabetes: increase stillbirth
Fetal demise: mom risk for DIC
IUGR: intrauterine growth restriction
History of rapid labor

16

What are labor induction contraindications?

Abnormal presentation
Uterine tachsystole
Fetal distress
Placenta previa: massive hemorrhage
Prior classical uterine incision: vertical incision into fundus. Scar in part of active fundus in labor
Active genital herpes: if active heroes lesion you need c-section

17

What is induction and augmentation?

Induction: stimulation of labor contractions before they begin
Augmentation: labor Dystocia (not strong enough)

18

What are the different elements of bishop score?
What bishops score do you want?

Dilation: cervix >4 good indication
Efface net: good sign
Station: baby moving down and engaged
Cervical consistency: softness
Cervical position: starts out firm and posterior and during labor it softens up and goes anterior

0-10 score and if 10 good indicator that induction will work

19

What are cervical ripening agents?

Prostaglandins
-PGE2 inert (cervidil)
-PGE2 gel (prepidil)
-PGE1 (cytotec)

20

What are prostaglandins insert?
Gel?
PGE1?

Left in place 12 hours on side
Gell, squirt into cervical oz but cannot be removed
PGe1: tablet orally or placed around cervix

21

What's re the risks of cervical ripening agents?

Uterine tachsystole
Fetal distress

22

How do you fix cervical ripening agents?

Pull out cervidil and get terbutaline

23

How can you stimulate labor?

Stripping membranes: in doctor office, strip fetal membranes from uterine wall and irritate causes uterus to soften
Sexual intercourse: semun contains prostaglandins
Nipple stimulation: cause oxytocin release
Herbal preparation
Castor oil: mom gets rain diarrhea
Balloon catheters: foley inserted cervix to stretch out, irritate and ripen

24

What is amniotomy (AROM) advantages? Disadvantages?

Advantage: rupture membranes stimulate labor and evaluate color
Disadvantage: risk of infection, pre-mature labor, prolapsed cord

25

What is important about Pitocin medications?

Continuous EFM
Position: on side for good uterine blood flow
Maintain IV fluid:!balance salt solution, lactated ringers with glucose

Mis pitosin per protocol
-20 units of pitosin in 1000ml LR
-3 ml/hr = 1 mU/min

IVPB to maintain IV via pump so you can take pitosin out and keep fluids going
-start at 0.5-1 mU/min

26

What are complications of Pitocin?

Uterine tachsystole:
-more then 5 contractions In 10 minutes
- contraction duration is over 2 minutes
- less then 1 minute between contractions

Pitosin has water retention quality so can cause water intoxication

If these occur discontinue pitosin

27

What is the advantage of forceps-assisted birth?

Good if mom is exhausted or if have heart disease, baby OP and not coming down.

Strong epidural or spinal. Decrease need for Caesarian

28

Why are the disadvantages of a forceps assisted birth?

Metal (cause tissue damage to vagina)
Skull injury to fetus
Bruising
Lacerations
Facial palsy (droops)

29

What is the nursing care to do deal with forceps-assisted birth?

Explain why is going to happen
Needs good anesthesia
Assess and document fetal heart tones before applied and during the use
Assess for injury