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OB Test 2: High Risk Intrapartum Flashcards

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0
Q

What is late preterm?

A

34-36 week

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1
Q

What is preterm?

A

Between 20-37 weeks

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2
Q

What is low birth weight?

A

Less then 2500 grams

5.5 pounds

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3
Q

What is vlbw?

A

Less then 1500 grams

3.51 pounds

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4
Q

What is PROM?

A

Premature rupture of membranes

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5
Q

What are preterm risk factors?

A 
African American
Previous preterm birth
Multiple gestation
Uterine anomalies
Socio economic disadvantage
Smoking
 GU dysfunction
No prenatal care
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6
Q

What are preterm labor symptoms?

A

Backache
Cramping
Pressure
Increased vaginal discharge

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7
Q

What are preterm labor assessments?

A

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

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8
Q

What is treatment of preterm labor?

A

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

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9
Q

What are tocolytics?

A

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
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10
Q

What is PROM?

A

Unknown causes associated with infection and Inflammation

Preterm premature rupture of membrane

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11
Q

What are the risks with PPROM.

A

Chorioamnionitis: infection going to the amniotic fluid

Neonatal sepsis

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12
Q

What is the treatment of PPROM.

A

Expected management

Wait, monitor infection, no vaginal exams, antibiotic

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13
Q

What are labor complications?

A

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

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14
Q

What is version?

A

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

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15
Q

What are the indications for labor induction?

A 
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
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16
Q

What are labor induction contraindications?

A

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

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17
Q

What is induction and augmentation?

A

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

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18
Q

What are the different elements of bishop score?

What bishops score do you want?

Study These Flashcards
A 
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
Q

What are cervical ripening agents?

Study These Flashcards
A

Prostaglandins

  • PGE2 inert (cervidil)
  • PGE2 gel (prepidil)
  • PGE1 (cytotec)
20
Q

What are prostaglandins insert?
Gel?
PGE1?

Study These Flashcards
A

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

21
Q

What’s re the risks of cervical ripening agents?

Study These Flashcards
A

Uterine tachsystole

Fetal distress

22
Q

How do you fix cervical ripening agents?

Study These Flashcards
A

Pull out cervidil and get terbutaline

23
Q

How can you stimulate labor?

Study These Flashcards
A

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
30
What is vacuum extraction?
Same idea as forceps Soft suction cup applied at vertex of head and suction applied. Suction no more then 40-60 mm/Hg Cookie cutter scalp injury results from the cut of skin via suction cup
31
What are the indications of cesarean birth?
Preserve life and health of mom and baby
32
What are the complications of Caesarian birth?
Increase maternal mortality Hemorrhage Bladder dysfunction With c section only have 3 children
33
What are the cuts for c-sections?
Classical: cut uterine fundus. Used for placenta previa and severe fetal distress. Fastest. Low transverse Low vertical
34
What is the nursing care for Caesarian?
Teach and support: amount time, feeling, acknowledge feeling, no activan or Valium Informed consent ID band and allergies Lab work: HgB, Hct, postassiu Surgical team: surgeon, 1st assist, pediatrician, anesthesia, circulating nurse, scrub nurse, baby nurse Equipment: all working, must have ground pad for cotorize IV: risk for hemorrhage Medication: acid neutralizer, no anxiety meds Foley: empty bladder Shave Positioning: tilt bed, legs strapped and arms strapped on arm board Immediate care of newborn Post operative care: PACU or unit recovery Postpartum care
35
What's re the indications for VBAC?
Want experience Traumatized by previous c section No other uterine scar, first one was low transverse OB and anesthesia present in case of crash c sectio. Within 39 minutes
36
What is the cause if shoulder Dystocia?
Should impacted and caught behind symphysis
37
What are the signs of shoulder Dystocia?
Head goes out and comes back in "turtle"
38
What is the treatment of shoulder Dystocia?
McRoberts maneuver: pull legs up and out to open pelvis wider Supra pubic pressure: physicians will push shoulder down
39
What do you never do in labor?
Give fundal pressure during birth because rupture wounds and kill baby
40
What I juri occur with shoulder Dystocia?
Break clavicle Petechia: bruise face Brachial pelvis injury
41
What is a prolapsed could and it's risk factors?
OB emergency Cord in front of baby will come down and baby compresses it This is what we worry about when water breaks Do emergency c-section and hold baby off cord until the surgery is done Once water breaks check to e if head is engaged and if it is not they need to stay in bed Risk factor: adverse fetal lie & abnormal fetal presence
42
What is the nursing care for a prolapsed cord?
Prevention: watch multigravida Relieve cord compression C section
43
What is an amniotic fluid embolus?
Bolts amniotic fluid, blocks blood vessels and body acts with I flammatory response to shock and die,
44
What's re the symptoms of amniotic fluid embolus?
``` Dyspnea Chest pain Dry cough Hemopoesis Cyanosis Tachycardia Syncope Hypertension Cardiac arrest ```
45
What is the treatment of amniotic fluid embolus?
``` Be supportive Give O2 Elevate head of bed Cheat x ray IV Heprin Emboliectomy (pull out clot) ```

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