Partner Violence and Obs Emergencies Flashcards
(35 cards)
Abuse in pregnancy?
May begin, escalate, or diminish in pregnancy (less common). Most begins during pregnancy but the rates are likely underreported.
Impact of IPV on pregnancy and fetus?
P- delayed/less PN care, increased stress/depression, may have no access to money, inadequate weight gain, increase substance use, increased physical/sexual health complaints
F- physical trauma causing injury/miscarriage, negative effects of behaviours, preterm labour/birth, LBW or SGA
Impact of DV postnatal? on mom and child
Decreased BF, maternal mental health issues associated with difficulties in parenting/mother-child bonding, increased risk of child abuse=risk taking behaviours in teens, and increase risk of aggression/emotional disorder/hyperactivity in child
How to assess/screen for IPV?
Providers include questions about violence in assessing patients as part of prenatal care but the nature of clinician-patient relationship/how questions are asked are more important than the screening tool
How can HCP build trust?
Know resources, be supportive, provide info, recognize diversity/avoid stereotypes, find private moment to talk alone, have resources available in offices/bathroom, believe in them/help them, be aware of ACEs, and be trauma informed
What is dystocia? what can it be caused by under problem with powers vs problems with passengers
Abnormal or difficult labour.
- Problems with powers- hypo or hypertonic uterine contractions, arrested labour (no progress), precipitous labour (contractions start and within 3 hrs baby is out)
- Problems with passenger- breech, cord prolapse, shoulder dystocia, POP (persistent occipital posterior- aims toward back of hip), CPD (pelvic too small for head or baby too big for normal pelvis)
What can dystocia result in?
Operative delivery- use of forceps, vacuum, C-section
3 types of breech?
- Frank- most common, legs up by ears
- Footling- one or both feet hanging down or coming out of cervix
- Complete- baby sites cross legged on the cervix
How do we dx breech?
Maternal perception of movement (is baby kicking lower), leopoldo’s maneuver (hard moveable part in fundus aka the head), FH auscultated above umbilicus (usually in lower quadrants, preterm/small fetus may still be below umbilicus), vag exam (don’t feel head but bum, maybe get mec on fingers), U/S (only real way to confirm), and passage of meconium if ROM (could mean maybe breech)
Fetal risk for breech?
Cord prolapse common with ROM, injury to aftercoming head could cause ICH or anoxia, preterm breech could cause footling/body delivery before full dilation so head is trapped
Recommendations for breech deliveries? set of criteria?
Try external cephalic version and if unsuccessful: vag birth if OBGYN is skilled in vag breech birth, uncomplicated/term/frank or complete breech/single baby >2800 and <4000 g with flexed head
Plan C section if above criteria not met or if client chooses
What is external cephalic version? and risks
If baby is breech then trained HCP with use hands to move baby/flip it. Need a normal NST and presenting parts can’t be engaged. Give tocolytic to relax uterus before. Risk of nuchal cord (cord around neck because you’re spinning the baby around)
C-section indications?
Active genital herpes, abnormal FHR findings, multiple gestation (3+), cord prolapse, pelvic size (CPD), lack of progression/failed induction, maternal infection, previous C-section (sometimes), fetal anomalies or extremes in size, and placenta problems
Different incisions for C-section?
- Transverse lower uterine segment (most common, horizontal incision)
- Vertical lower segment (seen in very preterm babies)
- Classical incision (in body of uterus, vertical incision, do in severe cases)
Skin incision are different than uterus incisions
What does C-section increase risk for intra and post-op?
I- aspiration, difficult airways management (general anesthesia), PPH >1000 mLs
PO- hemorrhage, infection, poor bladder emptying, paralytic ileus (rare), thrombophlebitis
What does a C-section require and teaching?
Require- establish IV lines, insert in dwelling cath, abdominal prep, ranitidine/sodium citrate (to reduce risk of reflex), NICU present
Teaching- what to expect before/during/after, why its being done, expected sensations, role of significant others
Post op/PP for C section?
AMBULATION!, comfort measure, assess for hemorrhage/infection, what’s their pain, bonding/feeding, and pay attention to fatigue
What is trial of labour after C-section (TOLAC)? common risks
Planning on doing a vag birth after having a previous C/S but depend on indication/type of 1st section (like if you have CPD then cant have another vag delivery). Common risks- hemorrhage, uterine rupture, infant death/neuro complications
What uterine incision qualifies for TOLAC?
Transverse lower uterine segment
TOLAC care?
On continuous EFM, montior contractions, avoid oxytocin (it increase risk of uterine rupture), avoid cervical ripening methods (increase risk for rupturex4), support, be prepped for urgent C-section, and complete pre op work
What does an operative delivery involve and indications for it?
Use of vacuum or forceps when fully dilated/ROM. Indications- fetal indications, maternal (exhaustion, inability to push, lack of rotation- head gets stuck, maternal disease- like having heart condition where HR can’t go above certain rate)
How to prevent operative delivery?
Support throughout labour, mobility, position changes, rest, keep bladder emptying, well hydrated/nourished
considerations for forceps/vacuum use?
Need to be fully dilated/ROM, empty bladder before, know fetal position/pelvis adequacy, give pain meds if able, and be prepared for plan B if it doesn’t work (C/S)
How is vaccum used?
Suction applied to fetal head and doctor pulls with contractions
