OB test 4 Flashcards
(125 cards)
1
Q
When is it considered preterm labor?
A
20-37 weeks
2
Q
How many contractions is a sign of preterm labor?
A
4 or more in one hour
3
Q
2 s/s of premature labor
A
change/increase of vaginal discharge, intestine cramps/diarrhea
4
Q
what is the protein and the rule with PTL
A
Fetal fibronectin ; if found 22-34 weeks, strong indicator that you will deliver in the next 2 weeks. does not work after 34 weeks.
5
Q
what is normal length of a cervix?
A
3-4 cm
6
Q
fibronectin
A
relax uterus
7
Q
PTL treatment 2 non pharm
A
Empty bladder, hydration
8
Q
4 meds for preterm labor
A
Terbutaline, Nifedipine, magnesium sulfate, betamethasone
9
Q
Terbutaline M/A one thing Route Adverse effects 2 Complications 5
A
Smooth mm relax
Not first line
SQ/IV/PO
Epi respiratory edema
arrhythmias, hypotension, hypokalemia, hyperglycemia, ketoacidosis
10
Q
Nifedipine MA SE 4 one thing route
A
ca channel blocker decreases contractions
Hypotension, HA, Tachy, flushing
can use with terbutalin not with mag
PO
11
Q
Magnesium sulfate MA and why that works SE 2 One good thing when to use? route
A
Calcium antagonist (Needed to produce prostaglandin) Depressant, decrease urine output and Neuro protection for babe prior to 32 weeks IV
12
Q
betamethosone
MA and how that helps?
route
When to use 3 things
A
Glucocorticoid
IM-Increases surfactant
up to 37 weeks, at least 24 hours before delivery, 2 doses 24 hours apart.
13
Q
What is something to remember about preterm delivery and pharm intervention
A
Avoid opioids.
14
Q
Contraindications to arresting PTL 7
A
o Fetal infection o Chronic fetal distress o IUGR o Intrauterine death o Pulmonary maturity o Maternal distress o Placental abruption
15
Q
5 ps
A
powers, passageway, passenger, psyche, position
16
Q
Contraction rule
A
Every 2-5 mins lasting at least a min but less than 2
17
Q
What is hypertonic labor?
A
High frequency, low amplitude UC in first stage in early phase
18
Q
How do we assess hypertonic labor?
A
Cervix and fundus Very painful
19
Q
What is hypotonic labor?
A
• Etiology: weak, irregular, ineffective UC’s
20
Q
3 causes of hypotonic labor
A
o Over distended uterus, bowel, bladder
o Secondary inertia
o Excessive analgesia
21
Q
4 ways to help hypotonic labor
A
o IV fluids
o I&O
o Augmentation
o Assess P’s
22
Q
3 Passageway issues
A
Cephalo-pellvic disproportion
placental previa
bowl bladder distention
23
Q
tx of passageway obstruction
4
A
pelvimetry trial of error delivery route positioning empty bowl/bladder
24
Q
Passanger dystocia causes 7
A
Multi-fetal preg mal presentation occiput post macrosomia shoulder dystocia hydramnios chorioamnionitits
25
What do we document with FHR
baseline
variability
accelerations
decelerations
26
What do we document with UC?
Frequency, strength, duration
27
What is a normal fetal heart rate?
110-160
28
what might bradycardia on a fetal monitor mean? 3
o Congenital heart defects, maternal medication, prolonged hypoxia
29
What would tachy mean on a fetal monitor 4
Maternal fever, dehydration, drugs, early fetal hypoxia
30
What is variability?
Irregular fluctuations in the baseline FHR which is measured in beat/minute (bpm)
31
One thing about variability
Indicates absence of metabolic acidosis.
32
How is variability measured? give numbers
Absent
minimal-1-5 bpm
Moderate 6-25bpm
Marked- >25bpm q
33
Acceleration
Greater than or equal to 15 bmp for 15 seconds but less than 2 mins
34
What kinds of deceleration can you have
Early
variable
late
prolonged
35
What is an early deceleration? 2
Smooth dip in baseline FHR greater than or equal to 30 seconds to the nadir.
returns before or with UC
36
What does early deceleration mean? 5
Fetal head compression, SVE, Pushing, FSE application, ROM
37
what is a early late and variable deceleration mean?
E-Normal
L-placenta
v-umbilical cord
38
What is Variable deceleration 2
sudden drop greater than or equal to 15 seconds but less than 2min
less than 30 seconds to nadir
39
Veal Chop
Variable Cord compression
early head compression
accel Okay
late Placental insu
40
what do we do for uterine resuscitation 5
Change position, give o2 at 10lt pr min with non-rebreather mask, turn of oxy
IV fluids
Call provider
41
late deceleration
Smooth dip greater than 30 seconds to the nadir begins at or after the peak of the contraction
42
2 things to remember with late decelerations
Beats don't matter
| they always go with contractions
43
prolonged deceleration
Decrease of at least 15 bpm
| lasts 2 mins but less than 10
44
How to measure frequency of a contraction
beginning of one contraction until the beginning of the next
45
Frequency at the beginning and end of labor
10-20mins
| 2-3 mins
46
Duration of contraction is measured
beg and end of same contraction
47
Values for frequency beginning and end of labor
15-25 seconds
| 45-90 seconds
48
What is tachysystole give value
Greater than 5 UC in 10mins or contraction lasting longer than 2 mins.
49
How is frequency measured?
Beginning of one contraction until the beginning of the next. measured in mins ranging from sm to larg in 10 min window
50
documentation of frequency for low risk and high risk
LR-1st stage-30mins
2nd stage-15 mins
HR-1-15min
2-5mins
51
physical considerations to teen moms 4
PreE
cephalopelvic disporportion
nutrition
anemia
52
How does an mother abused infant respond? 5
irritable, easily startles, lack of responsiveness, failure to thrive, developmental delays.
53
3 reasons why we dont need to report abuse
if they are 18 and say no
if it is not something we already need to report
the injury is not a serious bodily injury
54
Four things about reporting abuse
we need to document the clients request
always refer to victim services
If reported to authorities we must make an effort to let the victim know first
55
When do we do chronic villus sampling
8-12 weeks
56
What is the risk for chronic villus sampling percent
1-2 percent fetal damage, limb defects
57
What do we test for chronic villus sampling
1-3
and 1 it does not
chromosomal defects, hemophilia, sickle cel, sex link disorders
no nerotube defects
58
What is chronic villus sampling?
Removal of small tissue specimen from the fetal portion of the placenta, which reflects the fetal genetic makeup;
59
procedure for Alpha fetoprotein
A sample of the woman’s blood is drawn to evaluate plasma protein that is produced by the fetal liver, yolk sac, and GI tract, and crosses from the amniotic fluid into the maternal blood
60
What if alphafetoprotein in high? 7
Increased levels might indicate a neural tube defect, Turner syndrome, tetralogy of Fallot, multiple gestation, omphalocele gastroschisis, or hydrocephaly.
61
What if alpha fetoprotein is low?
downs
62
when can we get serum from mom to test for alphfetoprotein?
15-18 weeks
63
When is amniocentesis done
| give three and why
15-20 weeks-AFP chrom
20+ fetal surveillance
3rd tri for maconium-stress
64
How is amniocentesis done? 3 things
Ultrasound guides a needle and 20ml of fluid local anesthesia is used
65
Two more things that amniocentesis can be used for
Asses fetal lung maturity
| levels of bilirubin
66
Biophysical profile
uses US over 30 min determines fetal well being
67
Where do we put fetal monitoring over 2
Toco over fundus and ultrasound over back
68
What are the two internal monitors
Fetal scalp electrode and intra-uterine pressure catheter
69
When is a Non-stress test reccomended?
Currently, an NST is recommended twice weekly (after 28 weeks’ gestation) for clients with diabetes and other high-risk conditions, such as intrauterine growth restriction (IUGR), preeclampsia, post-term pregnancy, renal disease, and multifetal pregnancies
70
How do we document a fetal non-stress test and what is good?
Reactive/nonreactive
| reactive is good
71
What is the criteria for a non-stress test?
Needs to be 32 weeks
| 2 movements with accelerations over 15 beats above baseline for 15 at least seconds
72
What is the contraction stress test
Tests for 2
how is it done
02 reserves and utero/placental insufficiency
| Mom is hooked up to fetal monitor and given oxytocin until we get 3 contractions in 10 mins
73
Interpretation of contraction stress test
What is good?
What indicates bad?
Can we retest?
Negative is good
Late decelerations with 50 percent is positive and c section is likely
can be repeated in 24 hours if inconclusive.
74
Occult prolapse
Hidden can't be seen or felt by SVE
75
Cord prolapsed in front of head
Can't be seen but can be felt
76
Complete cord prolapse
Can be seen
77
Umbilical cord prolapse associated with 6
ROM, PROM, long umbilical cord, breech births, post dates, multiples
78
FHR monitoring with cord prolapse 4 things that would show up.
Bradycardia, variable decelerations possible late decelerations, SVE
79
What position for cord prolapse
Trendelenburg
80
What statute do we use for abuse
HB171322
81
Earliest day to get elective induction
not before 39 weeks
82
4 contraindications of induction
Over distended uterus, placenta previa, fetal distress, previous vertical incision
83
What is bishop score? what is a high score indicative of?
cervix readiness for Induction
| higher is more favorable.
84
what criteria is in the bishop score? 5
| and ranked
Dilation, effacement, station, consistency, position
| 0-3
85
What do we do if there is a low bishop score?
use ripening agents
86
What are the two pharm interventions used as ripening agents.
Cytotec prostaglandin
87
What are the 2 risks associated with pharm interventions for ripening
tachysytole and post part hem
88
What do we use for mechanical methods for ripening 2
Cervical ripening baloon
| lar seeweed
89
2 things to know about cervical ripening balloon
how long?
when removed?
One thing about it
For 12-24 hours
removed 4-5cm
have to be dilated to get in but not ROM
90
What is amniotomy?
Breaking membranes with amni hook
91
What are the risk/considerations of aminotomy 3
Prolapsed cord, stress on babe, need IV
92
Big consideration for amniotomy
Head engaged
93
Risks for oxytocin
HypoTN, water intoxication, tachy, edema, pulm edema, uterine rupture.
94
Four reasons for obstetric hem in first half of preg
SAB, Ectopic preg, Gestational trophoblastic disease, cervical insufficiency
95
2 reasons for obstetric hem for second half of preg
Placenta previa, placental abruption
96
What are the biggest causes of obstetric hem? 2
Denial and delay
97
Maternal diseases that can be a problem with Obstetric hem 5
Hypothyroidism, diabetes, thrombophilia's PCOs. hypertension
98
3 reasons fetal demise in 1st trimester
Genetic abnormalities, faulty implantation, endocrine imbalances
99
2nd and 3rd trimester fetal demise
Uterine anomalies, infections, maternal disease, substance abuse.
100
SAB classifications with detail
Threatened bleeding cramping low back pain but cervix is closed
imminent.inevitable- increased but with dilation
incomplete not all tissue out
habitual greater than or equal to 3
101
What is cytotech used for
Ending a pregnancy
102
When do we have symptoms for ectopic preg?
6-8 weeks
103
ectopic pregnancy statistics
1-100
104
s/s of ectopic preg 3
Amenorrhea, ab pain, with or without bleeding
105
What happens with hCG in ectopic preg
If it won't double may indicate ectopic
106
What drug do they use with ectopic pregnancy?
mathotrexate
107
Stats for gestational trophoblastic disease
1 in 1500
108
How to diagnose gestational trophoblastic disease 3
no fetal heart tones at 12 weeks and high hCG levels, high fundal height
109
How do we diagnose Gestational trophoblastic disease?
| How do we treat it 2 and what to watch for 2
Ultrasound
Oxy and cytotech
DIC and hemorrhage
110
When do we notice cervical insufficiency
16-24 weeks
111
What is cervical insufficiency
Premature dilation of the cervix in the absence of uterine contractions
112
rate of cervical insufficiency
500 in 1000
113
How do we treat cervical insufficiency?
Cerclage
114
when do we do a cerclage when do we clip
up to 28 weeks
| 36 weeks
115
what is placenta previa and 3 things it can cause
abnormal placement of placenta
| Abruption, hemorrhage, accreta
116
What is accreta?
Placenta growing into the uterine mm
117
placenta previa stats
1-200
118
placenta previa risk factors 5
Previous c section, multi-parity, smoking, infertility treatment, AMA
119
S/s of placenta previa 5
Thin, bright red vaginal bleeding, painless, with or without contraction, soft non-tender abdomen, FHR WNL
120
Placenta previa management 6
bed rest, NPO, Fetal monitoring, NO SVE, tocolytics, csection
121
What is placental abruption?'
when?
One big risk
Premature separation of placenta
greater than 20 weeks
Having had it before
122
Causes of placental abruption 6
```
HyperTN
PreE
DM
short umbilical cord
decompression of uterus
AMA
```
123
Symptoms of placental abruption
Dark red thick blood (if any)
Stron contractions
Ridged tender ab
Shock symptoms
124
placental abruption complications 2
Renal fail, DIC
125
What kinds of placental abruptions are there
Marginal, partial, complete
