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CARE OF MOTHER, CHILD, AND AT RISK (ACUTE AND CHRONIC) > OPERATIVE OBSTETRICS PART 1 > Flashcards

OPERATIVE OBSTETRICS PART 1 Flashcards

(70 cards)

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1
Q

A number of special procedures which the physician may use to assist the mother in labor & delivery

A

operative obstetrics

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2
Q
  • Turning the fetus, is a procedure used to change the fetal
    presentation by abdominal or intrauterine manipulation.
A

version

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3
Q

2 types of version

A

external / external cephalic version
internal podalic version

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4
Q
  • the presentation of the fetus is changed from a breech, shoulder,
    or oblique to a cephalic presentation by external manipulation of
    the maternal abdomen
A

ECV

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5
Q

criteria for ECV

A
  • atleast 37 weeks
  • reactive nonstress test
  • fetal breech not engaged
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6
Q

___ is used to locate the placenta and to confirm fetal presentation and gestational age and determine the adequacy of amniotic fluid

A

UTZ

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7
Q

A ___ agent may be administered to help relax uterus

A

tocolytic

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8
Q

risks for ECV

A
  • FHR changes
  • entangle or compress cord
  • abruptio placenta
  • mixing of fetal and maternal blood
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9
Q

*Used only w/ the 2
nd twin during a vaginal birth
and only if the twin does not descend readily or if
the heart rate is non-reassuring

A

internal podalic version

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10
Q

OB places a hand into the uterus, and with the other hand on the maternal abdomen, maneuver
the fetus into a longitudinal lie (cephalic or breech)
to allow delivery

A

internal podalic version

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11
Q

*an artificial rupture of the amniotic
membranes (AROM)
*Most common operative procedure

A

amniotomy

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12
Q

amniotomy - Instrument is inserted through the cervix at least ___ of cervical dilatation

A

3 cm

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13
Q

risks of amniotomy

A
  • cord prolapse
  • infection
  • abruptio placenta
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14
Q

instrument used for amniotomy

A

amniohook

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15
Q

in which case is amniotomy deferred?

A

presenting part is high in the pelvis OR presenting part not cephalic

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16
Q

amniotomy - temp is monitored every ___

A

2 hours

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17
Q

After birth, if meconium is present = ??

A

baby’s vocal cord is visualized and deep suctioning is done

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18
Q

If labor is not established within 2 to 4 hours after AROM, ___ may be administered as ordered

A

oxytocin

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19
Q

*refers to softening and effacing of the cervix
*may be used for the pregnant woman at or near term when there is a medical or obstetric indication for induction of labor

A

cervical ripening

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20
Q

simplest method of cervical ripening

A

stripping the membrane

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21
Q
  • A nonpharmacologic method of
    induction frequently used by
    physicians/CNMs (or sweeping the
    amniotic membranes)
  • The practitioner inserts a gloved
    finger into the internal os and
    rotates it 360 degrees twice,
    separating the amniotic membranes that are lying against the lower uterine segment.
A

stripping the membranes

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22
Q

stripping the membranes releases ___ to stimulate ___

A

prostaglandins; uterine contractions

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23
Q

suppositories of seaweed that swell on contact with cervical secretions which gradually and gently urge dilatation.

A

hygroscopic suppositories

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24
Q

pharmacologic methods of cervical ripening

A

prostaglandin agents
misoprostol

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25
* shorten labor, and to lower requirements for Pitocin during labor induction
prostaglandin agents
26
is used in a hospital birthing unit, and it is recommended that an obstetrician be available in case of emergency caesarean birth is needed
prostaglandin gel
27
major adverse reaction of prostaglandin
tachysystole
28
administered in a setting in which fetal monitoring and emergency care, including immediate caesarean birth are readily available
prostaglandin agents
29
is a synthetic PGE1 analogue that some healthcare agencies use to ripen the cervix and induce labor
misprostol
30
* available as a tablet that is inserted vaginally
misprostol
31
cytotec - Use only during the ___ trimester for cervical ripening or labor induction
3rd
32
initial dose of cytotec
1/4 tablet or 25 mcg
33
misoprostol - * Recurrent administration should not exceed dosing intervals of ___
less than 3-6 hours
34
* ___ should be administered at least 4 hours after the last Cytotec dose
pitocin
35
cytotec C/I
- 3x contractions in 10 mins - asthma - previous c/s birth - bleeding - placenta previa - non-reassuring fetal heart rate
36
Is taken to prevent stomach ulcers in patients taking anti-inflammatory drugs, including aspirin off label use for cervical ripening
misoprostol
37
- balloon-tipped foley catheter in the cervix with possible saline infusion through the catheter into the space between the internal os and intact membranes
Transcervical catheter
38
another method mechanical ripening of cervix is Placement of ___ into the cervical canal
hydrophillic inserts
39
position recommended for usually one our after using cervical ripener
supine with a right hip wedge
40
Monitor the woman for uterine ____ and ___ for at least 2 hours following insertion
hyperstimulation and FHR abnormalities
41
If ___ are present or contractions occur more frequently than every ___, the gel is removed.
nausea and vomiting 2 minutes
42
*Use of artificial methods to stimulate uterine contractions before the spontaneous onset of labor, with or without ruptured fetal membranes, for the purpose of accomplishing birth
induction of labor
43
induction of labor indications
- 39 wks - ges/chronic HTN - preeclampsia - eclampsia - DM - PROM - IUFD - IUGR - post term
44
induction of labor C/I
- transverse position - cord prolapse - active genital herpes - placenta previa - previous myomectomy
45
pre-requisites of induction of labor
- fetus in longitudianal lie - ripe cervix - engaged presenting part - no CPD - fetal maturity
46
*A primary line of 1L of electrolyte solution (e.g. Lactated Ringer’s solution) is started IV. * 10 “u” of Oxytocin (Pitocin) are added to secondary line of 1L IVF (D5LR); the mixture will contain 10 mU of oxy/ml (1mU/min=6ml/hr)
pitocin infusion
47
After the primary infusion is started, the Pitocin solution is ___ into the primary tubing port closest to the catheter insertion
piggybacked
48
* The goal for induction is to achieve stable contractions every ___ that last ___
2-3 minutes 40-60 seconds
49
The uterus should relax to ____ between each contraction.
full baseline resting tone
50
natural, non-invasive complementary methods of induction of labor
nipple stimulation exercise sex homeopathy and herbs castor oil
51
If ____, then drugs or mechanical cervical dilators should be used to ripen the cervix before labor is induced.
cervix is not sufficiently dilated
52
Inducing labor with misoprostol should be avoided in women who have had even one prior cesarean delivery due to the possibility of ___.
uterine rupture
53
A ____ should be readily available any time induction is used in the event that induction is not successful.
physician capable of performing CS
54
* a technique by which warmed, sterile normal saline or Ringer’s lactate solution is introduced into the uterus through an intrauterine pressure catheter (IUPC)
amnioinfusion
55
uses of amnioinfusion
- increase volume during oligohydramnios - extra cushion to relieve pressure on cord - to dilute moderate to heavy meconium - indicated for PTL with PROM
56
* w/ suspected cord compression, the immediate intervention is to ___
assist to another position
57
after positioning If not successful in restoring the FHR, an ____ may be considered.
amnioinfusion
58
 A surgical incision of the perineal body to enlarge the outlet.  The second most common procedure in maternal-child care.
episiotomy
59
is made with blunt-tipped scissors in the midline of the perineum or is begun in the midline but directed laterally away from the rectum
episiotomy
60
advantages of episiotomy
- substitute a clean cut for a ragged tear - minimize pressure on fetal head - shorten the second stage of labor
61
preventive measures for episiotomy
- kegels - perineal masssage - natural pushing, avoiding lithotomy - side-lying position - warm / hot compress on perineum - gradual expulsion
62
types of episiotomy
median/midline mediolateral
63
At the time of an episiotomy incision, there is a slight loss of blood, but ___ immediately seals the cut edges and minimizes bleeding.
pressure of presenting part
64
*midline of the perineum *minimal blood loss *neat healing w/ little scarring
median
65
* result in less postpartal discomfort * added laceration may extend into the anal sphincter * limited enlargement of the vaginal opening because perineal length is limited
median
66
* is begun in the midline but directed laterally away from the rectum * more enlargement of the vaginal opening
mediolateral
67
* little risk that it will extend into the anus * more blood loss * increased postpartum pain
mediolateral
68
* more scarring and irregularity in the healed scar * prolonged dyspareunia
mediolateral
69
episiotomy - Apply an ice pack to the perineum for ___ and removed for at least 30 minutes before being reapplied.
20-30 minutes
70
Episiotomy site should be inspected every ___ during the first hour after birth for redness, swelling, tenderness, bruising, and hematomas.
15 minutes

CARE OF MOTHER, CHILD, AND AT RISK (ACUTE AND CHRONIC) (77 decks)

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