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maternal child health RN > Powerpoints Test 2 module 3 > Flashcards

Powerpoints Test 2 module 3 Flashcards

1
Q

stages of labor

Stage 1:

A

0-10 cm dilation

Phase 1-3= latent , active, and transition dilation

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2
Q

Stage 2 of labor

A

10 cm dilated (complete) to the delivery of the infant

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3
Q

Stage 3 of labor

A

Delivery of infant to delivery of the placenta

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4
Q

Stage 4 of labor

A

First hour to four hours after placental delivery

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5
Q

Phase 1 of delivery

A

Latent phase - dilation of 0-3 cm

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6
Q

Phase 2 of delivery

A

Active dilation 4 to 7 cm

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7
Q

Phase 3 of delivery

A

Transition phase

Dilation is 8 to 10 cm

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8
Q

What are the Ps of labor

Woman/fetus-

A 
Power
Passageway
Passenger
Position
Psyche
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9
Q

What are the Ps of labor

for providers support persons

A

Patients
Persistence
Practice/pain relief
Psyche

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10
Q

power-

The uterus is stretched to threshold point leading to what?

A

Synthesis and release of prostaglandin

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11
Q

Pressure on the cervix causes what?

A

The release of oxytocin

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12
Q

Oxytocin stimulation in blood Does what during pregnancy?

A

Increases

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13
Q

Estrogen in progesterone ratio does what during pregnancy?

A

The ratio changes and estrogen increases

And progesterone decreases

and excites her uterine response

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14
Q

Placental aging and deterioration triggers what?

A

Contractions

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15
Q

during pregnancy Fetal cortisol concentration rises and causes the placenta to do what?

A

Reduce progesterone

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16
Q

Prostaglandin is produced by fetal membrane during pregnancy and stimulates what

A

Contractions

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17
Q

Power -contractions move downward over the uterus, which portion is contracted for the longest time ?

A

Upper part of uterus

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18
Q

What is responsible for effacement and dilation of the first stage of labor ?

A

Myometrial Activity -The myometrium is the middle layer of the uterine wall, consisting mainly of uterine smooth muscle cells (also called uterine myocytes), but also of supporting stromal and vascular tissue.

Its main function is to induce uterine contractions.

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19
Q

Myometrial activity increases with what?

A

Good blood flow to the uterus (walking/activity and relaxation to eliminate fight or flight response)

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20
Q

How to assess contractions?

A

Duration - (length beginning to end)

Frequency- time between start of one contraction to the start of the next )

Intensity - palpate uterus

Resting tone- palpate uterus

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21
Q

When manually palpating the uterus, for a contraction assessment, what does

Mild
Moderate
Strong

look/feel like?

A

Mild- uterine wall is easily indented

Moderate-Uterine wall demonstrates resistance to pressure, some indention

Strong- uterine wall can not be indented

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22
Q

What is the external machine monitoring contractions called?

And what does it do?

Risks?

A

Tocotransducer

It measures increased intraabdominal pressure
(Not intrauterine pressure)

No known risks

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23
Q

Internal machine monitoring such as FSE (fetal scalp electrolode)-heart monitor or iucp Intrauterine pressure catheter does what ?

Risks

A

Direct measurement of intrauterine pressure

Include infection and uterine rupture

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24
Q

What do Montevideo units do in a contraction assessment

A

Measurement and quantify uterine work

Expressed by the number of contractions in 10 minutes multiplied by their intensity

**Measures Intensity of contractions

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25
Q

How to measure intensity of contractions in montevideo units ?

A

Review 10 minutes of the contractions strip

Count each contraction peek from baseline, total all contraction peak values in 10 minute period

This total peak value equals the MVU

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26
Q

What is a normal range of contraction/intensity Montevideo units ?

A

180-300 = Adequate contractions

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27
Q

Passageway-

Normal female pelvis

Labor progresses good

Most common

Rounded

A

Gynecoid

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28
Q

Labor progresses poor

Flat-oval side to side

Uncommon

A

Platypelloid

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29
Q

Male pelvis shape

Labor progress is poor

Higher among Caucasian women

Heart shaped

A

Android

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30
Q

Higher among non-Caucasian women

Pelvis that has increased OP delivery

Labor progresses good

Up and down oval shape

A

Anthropoid

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31
Q

Effacement -(Thinning r shortening of the cervix) how thin?

What is
Palpable with 100% effacement?

A

2cm- paper thin

A thin edge

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32
Q

Nulliparas (a woman who has never given birth) - when does effacement Of cervix begin?

A

Begins before the onset of labor

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33
Q

Multiparas (a women who has given birth to two or more babies) - when does effacement of cervix begin?

A

May it begin until the onset of labor

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34
Q

Opening of the external OS

A

Dilation

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35
Q

Dilation of the cervix is caused by what

A

Pressure of presenting part

Contraction and retraction of uterine muscles

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36
Q

Diameter of cervix increases to how many cm during labor?

When is it not palpable?

A

10cm

At 10cm dilated

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37
Q

During labor, the cervix of who remains thicker?

A

Multipara women remain thicker than women who have never birthed before

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38
Q

What to asses for in the passenger (baby)

A 
Fetal lie - transverse, longitude 
Fetal altitude , neck flexion 
Presentation- brow, breech etc
Station - out of pelvis - 0, +1
Position- loa
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39
Q

Longitudinal position of baby vs transverse

A

Longitudinal- baby’s head in down by cervix

Transverse- head and butt are side to side angling head angling down to cervix

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40
Q

Relationship of fetal parts to each other and degree of flexion or extension of the fetal head

A

Attitude

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41
Q

What is normal attitude?

A

Moderate flexion with chin flexed

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42
Q

Presentation determines what?

A

How the baby is presented to come out of the cervix first

Brow, breech , etc

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43
Q

Cephalic presentation

A

Head first - most common - 95%

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44
Q

Breech presentation

A

Pelvis first - 3% term deliveries

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45
Q

Shoulder presentation

A

Shoulder first - 2%

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46
Q

Relationship of presenting part to ischial spines of moms pelvis

How far the baby is out of pelvis

-3 to +4

What number is at ischial spine

Ballotable head moves when gentle pushed against

A

passenger station-

0

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47
Q

Relationship between the fetal presenting part and four quadrants of the mothers pelvis

A

Fetal position

Posterior fontanel,Anterior fontanel, sagittal suture, lamboid suture, coronal suture, Parietal

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48
Q

What is the most common and Best birth position for the fetus

A

LOA

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49
Q

False labor s/s

A

Regular contractions ?

Decrease in frequency and intensity

Disappear with sleep

No change in cervix

Sedation decreases or stops contractions

Show usually not present

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50
Q

True labor s/s

A

Regular contractions

Increase in frequency and intensity

Discomfort begins in back and radiates to abdomen

Activities such as walking increases contractions and continues with rest

Cervix dilate and effaces

Sedation does not stop contractions

Show is present

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51
Q

Labor assessment information

A

Labor symptoms

Pregnancy hx

Allergies

Cultural needs

Support persons

Medications

Smoking drugs alcohol

Last meal and time

Group b strep status

Vitals

Frequency and duration of uterine contractions

Well being

Urinary protein

Cervical dilation

Fetal presentation and station

Status of membranes

Date and time of arrival and notification of provider

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52
Q

Latent stage of labor duration

A

Multi gravida - 5.3 hours

Primigravida- 8.6 hours

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53
Q

Contraction frequency in latent stage of labor

A

every 3-30 minutes , may be irregular

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54
Q

Contraction duration in latent Stage of labor

A

30 to 40 seconds

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55
Q

Contraction intensity and latent stage of labor

A

Mild to palpation, 25 to 40mmhg

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56
Q

What do you contractions attempt to do to the cervix?

A

Soften, efface, dialate

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57
Q

What’s involved in psyche: labor support

A

Emotional support
Physical support
Advocacy
Support of partner

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58
Q

The physical presence of someone during labor as well as offering words of encouragement

A

Emotional support

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59
Q

Comfort measures in pain relief, hygiene, reassurance touch, application of heat or cold, calm environment, information and advice during labor

A

Physical support

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60
Q

Ways one can assess the fetus

A

Leopold’s
Auscultation
Vaginal exam
Ultrasound

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61
Q

FHR are incomplete without what?

The clinician should recognize and respond to both palpated and electronically obtained what?

A

Uterine activity assessment

Uterine activity data

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62
Q

Requires attention to audible characteristics of fetal heart rate

A

Auscultation

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63
Q

Methods of auscultation of FHR

A

Fetoscope and Doppler

Intermittent auscultation IA

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64
Q

Advantages of external FHM

A 
Continuous information 
Noninvasive 
Antepartum and during labor 
Permanent record 
Assess LTV
Can assess contractions 
Can detect some variable and periodic change
65
Q

Disadvantages of FHR monitoring

A 
Expensive equipment 
Subject to artifact 
Cannot assess STV Variability 
Belts can be uncomfortable 
Subject to double or half count 
Less than 70 bpm double count 
Greater than 180 bpm half count
66
Q

Internal FHR monitoring advantages

A

Accurate continuous information

Information not subject to artifact

67
Q

Internal FHR monitoring disadvantages

A

Expensive
Need to have ROM and 2-3 cm
Slight risk of infection to mom and baby

68
Q

Transfer of oxygen and carbon dioxide between the maternal and fetal circulation

A

Utero placenta unit

69
Q

Primarily mediated by the Vagus nerve innervating the SA and the AV node’s in the heart

Decreases the heart rate **

Develops around 28-30 weeks of gestation

A

Parasympathetic nervous system

70
Q

Stimulation increases the FHR

Stimulation of nerves is responsible for long term baseline variability

Action occurs through the release of norepinephrine

May be stimulated during periods of fetal hypoxemia

A

Sympathetic nervous system

71
Q

Stretch receptors present in the aortic arch and the carotid arch

Detect pressure changes *

Maintains homeostasis - regulate the heart rate

A

Baroreceptors

72
Q

Located in the aortic arch and the CNS

Respond to changes in fetal O2 CO2 and ph levels

A

Chemoreceptors

73
Q

How to determine the FHR baseline rate?

A

Best straight line image

Need at least 10 min monitor strip to determine baseline rate

FHR between patterns and contractions

74
Q

Causes of tachycardia in pregnancy

A 
Maternal fever
Prematurity 
Fetal infection 
Fetal and maternal anemia 
Early fetal hypoxia 
Maternal dehydration 
Tocolytic therapy 
Maternal anxiety 
Excessive fetal activity
75
Q

Management of tachycardia in pregnancy

A 
R/o maternal fever or drug effect 
Hydrate 
Decreased maternal anxiety 
O2 8-10L
R/O Underlying medical history
Notify Dr. and team 
Determine if associated with late or variable decelerations and anticipate interventions
76
Q

Causes of bradycardia in pregnancy

A 
Fetal hypoxia 
Fetal asphyxia 
Fetal arrhythmia
Drugs 
Maternal hypotension 
Prolong compression of cord 
Maternal hypothermia 
Mild bradycardia May be associated with post term infant
77
Q

Presence of variability suggests what in a monitor strip?

A

good central nervous system control over FHR

78
Q

An irregular FHR baseline on strip demonstrates what?

A

Normal healthy fetus

79
Q

If baseline is flat on external monitor, how will it look on the internal monitor?

A

Even flatter

80
Q

Defined range, fluctuations, oscillations in a fetal monitor strip

Rate change in heart rate over many seconds to minutes - 2-6 changes per minute

Amplitude up /down from baseline

Increases with fetal movement

Decreases when fetus is asleep

A

Variability

81
Q

Amplitude greater than 25 per min

6-25 bpm

Less than 5 bpm

Amplitude range undetectable

A

Marked

Moderate

Minimal

Absent

82
Q

Causes of decreased variability

A

Congenital

Tachycardia

Deep sleep

Drugs

Prematurity

83
Q

Increases in FHR above baseline

A

Accelerations

84
Q

Clauses of accelerations

A

Fetal movement

Stimulation

Contractions

Can be periodic or episodic

If everySingle contraction has an acceleration maybe breech presentation

85
Q

Different decelerations

Veal Chop:

A

Veal chop :

Variable decelerations

Early decelerations

Accelerations

Late accelerations

Cord compression

Head compression

Okay

Placental insufficiency

86
Q

Nadir means ?

A

The lowest point

87
Q

Gradual vs abrupt ?

A

Ask what is the shape

88
Q

Abrupt decreases in fetal heart rate may occur with or without What?

They may also vary in?

A

Contractions

shape, depth, duration, and timing with contractions

89
Q

Most common cause of variable decelerations

How long does the deceleration have to last to be considered variable?

If less than 15 seconds long what is it?

A

Occlusion of the umbilical blood flow

90
Q

These decelerations are believed to represent a vagal response to a cerebral re distribution of blood flow caused by compression of the fetal head

When contractions occur the fetal heart is subjected to pressure which stimulates the Vagus nerve

Mirror the contraction causing them

Can be present in the normal FHR pattern. Benign

A

Early decelerations

91
Q

This deceleration reaches its lowest point (nadir) after the peak of contraction

Typically symmetrical and returns to baseline once contraction resolves

If moderate - adequately oxygenated

If they reoccur with absent or minimal variability they may represent what?

A

Late decelerations

Heart hypoxic depression and risk of acidemia/acidosis

92
Q

Blood cord gases in the newborn

Why is it taken?

A

Determines their metabolic condition at birth

Recommended I’m high risk deliveries such as fever, cesarean section compromise , Growth restriction , abnormal FHR , apgar score less than 7 , multifetal gestation

93
Q

Target new born cord blood gas ranges

PH

Pco2

Bicarb

Po2

BE

A

7.10 or greater
60 or less
22 or higher

20 Or greater

-12 or greater

94
Q

Interval between full cervical dilation and delivery of the infant

Bloody show

Maternal desire to bear down with each contraction

Onset nausea and vomiting

Increased maternal shaking

A

Second stage of labor

95
Q

Operative vaginal birth should be considered to who?

A

First time birth women - when there is lack of progress for 3 hours with regional anesthesia or for 2 hours with out anesthesia

Multiparous women after lack of continuous progress for 2 hours with regional anesthesia or for 1 hour without anesthesia

96
Q

Stage of laceration/episiotomy:

involves the perineal skin and vagina mucus membrane

A

First degree

97
Q

Stage of laceration/episiotomy:

Involve the skin, mucus membrane and fascia (superficial) of the perineal body

A

2nd degree

98
Q

Stage of laceration/episiotomy:

Involve the skin, mucus membrane and muscle of the perineal body and extend to the rectal sphincter

A

Third degree

99
Q

Stage of laceration/episiotomy:

Extends into the rectal mucosa and expose the lumen of the rectum

A

Fourth degree

100
Q

Delivery of the baby to the separation of expulsion of the placenta

Mild uterine contractions and fullness in vagina as placenta is released -mom feels relief

A

Third stage of labor

101
Q

Duration of third stage of labor

A

5-30 minutes

102
Q

Physical findings in third stage of labor

A

Gush of blood
cord lengthens
Fundus rises
Uterine shape changes from flat to firm and globular

103
Q

Nursing interventions for third stage of labor

A

If further assessment, stimulation, or resuscitations are needed after birth explain procedure and infant status as needed

Early infant contact

  • skin to skin until first feeding is completed
  • encourage touching infant
  • initiate breastfeeding if possible
104
Q

Fourth stage of labor

  • encourage what?
  • how often fundal checks and vitals?
  • assess what? And where?
A

Close observation of maternal and newborn for 2-3 hours

Continue to encourage bonding

Maternal vs and fundal checks every
15 minutes for the first hour and then
Every 30 minutes during the 2nd hour

Newborn vs- at 30 minutes, 1 hour, 1.5 hours, 2hours of age

Assessment of bladder function, palpate above symphysis pubis

105
Q

Education about pain is necessary. Educate on what?

A

Contractions

Vaginal exams

Labor progress

Comfort measures

Plan of Care

Help then support person feel comfortable

Your role as the nurse

106
Q

Maternal response to pain

Physical factors-

Pathology-

Psychological-

Cascade of events-

A

Speed, OP position, fatigue

Endorphins are opioids

Fear and anxiety

Labor outcome

107
Q

How to provide basic nursing psychology comfort

A

Apply cool wash cloths

Back rubs

Body massage

Keep patient dry and clean

Lip balm

Keep linens dry and clean

108
Q

Psychology test and relaxation

Nursing interventions

A

provide Calming stimuli - because it affects the thalamus in the brain and controls emotional response

And increases pain tolerance and decreases anxiety

Decreases catecholamines and muscle tension

109
Q

Physical movement -

Patient should be able to move around unless what?

Avoid what?

How to support joints?

Experiment with what during contractions

Change what frequently

A

Unless continuous electronic fetal monitoring

Avoid laying flat on back

Use pillows to support joints

Experiment with walking, rocking back and forth, or swaying during contractions.

Change positions frequently

110
Q

What aids in release of endorphins

This decreases hyperventilation-

A

Moaning - encourage

Decreases in carbon dioxide

111
Q

Psychological-

Visualization and affirmation nursing interventions

A

Guided imagery- Visualize creating mental images of the body letting go, the cervix thinning an opening, the baby moving down in the pelvis

Encourage the patient to talk to their body as part of the visualization and talk to the baby. Use familiar pictures of openings such as a flower or butterfly emerging from a cocoon

Imagine the baby smell, touch, noises

112
Q

Effleurage

A

Gentle massage used during or between contractions

113
Q

Use of prana (breath) the body’s energy fields

the body’s energy fields

A

Therapeutic touch

Healing energy

114
Q

consists of steady, strong force applied to one spot on the lower back during contractions using the heel of the hand, or pressure on the side of each hip using both hands.

helps alleviate back pain during labor, especially in women experiencing “back labor.”

A

Counter pressure

115
Q

A warm bath, Jacuzzi or shower is comforting

This does not increase chances of infection

A sponge bath maybe soothing in bed or soaking your feet

A

Hydrotherapy

116
Q

Soothing scents of essential oils

A

Aromatherapy

117
Q

Ice pack to lower back or heat pack on lower abdomen

  • May alternate
  • don’t apply heat to skin covered in what? Why?
A

Heat and cold packs

Lotion or ointment - it might burn

118
Q

The inability to feel pain while still conscious

A

Analgesia

119
Q

Total or partial loss of sensation, especially tactile sensibility, induced by disease, injury, acupuncture, or anesthetic, such as chloroform or nitrous oxide

A

Anesthesia

120
Q

Parental analgesia meds?

A

Fenanyl
Morphine
Stadol
Nubain

121
Q

Local anesthetic

A

Lidocaine

122
Q

Regional analgesia techniques

A 
Epidural 
Intra spinal narcotic 
Spinal
Combined spinal epidural
Pudendal block
123
Q

Does not eliminate pain- blunting effect

Should not be given until labor is well established

Exception is made with morphine to allow an early laboring patient to sleep in preparation for active labor

Administration- peak of a contraction

A

Parental analgesia

124
Q

Parenteral Analgesia:
Side Effects

What should be available for resp depression?

A

Maternal Sedation

Maternal respiratory depression

Transient decreased fetal heart rate variability or psuedosinusiodal pattern

Fetal respiratory depression

Neonatal sedation, decreased tone, altered suck reflex

Naloxone hydrochloride (Narcan) should be available to treat respiratory depression, but should not be used on infants whose mothers are addicted or suspected of being addicted to narcotics or who are in a methadone treatment program.

125
Q

Regional Analgesia Techniques

A

Pudendal
Lumbar Epidural
Spinal
Intraspinal Narcotic (ISN)

126
Q

Lidocaine can be injected into the perineum and posterior vagina before an episiotomy is performed and after delivery of the placenta for perineal repair.

Duration of action is approximately 20-40 minutes.

A

Pudendal nerve block

127
Q

Great potential to provide pain relief in 1st and 2nd stage of labor

Test Dose: local anesthetic mixed with epinephrine may be injected to determine proper placement.

◦Vein placement causes?

◦Subarachnoid placement causes ?

Loading Dose: local anesthetic, ropivicaine

A

Epidural

tachycardia, palpitations, increased BP, numbness of tongue and mouth, metallic oral taste, slurred speech, tinnitus

immediate upper thoracic sensory loss, initiates severe lower extremity motor blockade, and potentially causes respiratory arrest.

128
Q

Epidural advantages

A

Superior pain relief throughout delivery

Placement of epidural catheter means that emergency c-section delivery can occur more quickly

Entire pelvis and lower extremities are affected so that the client perceives touch but not pain

129
Q

Epidural disadvantages

A

Increased chances of Maternal fever

Increased need for episiotomy, forceps and/or vacuum extraction

Increases need for oxytocin

Decreases bear down reflex

Increases first and second stage of labor

Increases your ability, inconsolable, uncoordinated suck and decreased responsiveness, interfering with the newborns response to breast-feed

130
Q

Epidural Nursing Care

Pre-procedure:

A 
◦Lactated Ringers Bolus
◦Patient empty bladder
◦Obtain baseline vital signs
◦Resuscitative equipment in room
◦Emergency equipment
◦Collect appropriate paper work
131
Q

Epidural Nursing Care

Procedure-

A

◦Position patient with head and hips flexed and shoulders and hips squared to facilitate the insertion of the epidural needle
◦Provide ongoing emotional support and information.
◦Support person to take a seated position
◦Continuous pulse oximeter if needed

132
Q

Epidural Nursing Care

Post Procedure:

A

◦Continue to monitor Vital Signs q 5 minutes x3, q 15 minutes x 4, q 1 hr x 4, q2 hrs x2, q4 hrs x duration of epidural
◦Fetal heart tones every 15 minutes for remainder of labor
◦Check Derms with every VS assessment.
◦Monitor lower extremities
◦Foley catheter insertion
◦Monitor Temperature

133
Q

Fentanyl (6 hour pain relief), essential for longer duration.
Bupivicaine
Morphine

A

Intraspinal Narcotic (Intrathecal)

134
Q

Used for Cesarean Delivery
Combination of Bupivicaine and Morphine
Local injection of lidocaine followed by needle placement with administration of medications.

A

Spinal

135
Q

regional anesthesia side effects

A

Hypotension, change in FHT, nausea, vomiting, puritis with opiates added, urinary retention, poster all headache, maternal temperature elevation, epidural hematoma, intravascular injection of local anesthetic agents

136
Q

Regional Anesthesia: Contraindications

A

Coagulation disorders
Local infection at the site of injection
Maternal hypotension and shock
Non-reassuring FHT pattern requiring immediate birth
Maternal inability to cooperate
Allergy to local anesthetics
Last dose of low-molecular-weight heparin within 12 hours.

137
Q

DYSFUNCTIONAL LABOR PATTERNS

A 
Hypertonic Labor (tachysystole)
◦Fetus malposition
◦CPD
◦BMI
◦Oxytocin
Hypertonic Labor (2-3 cx/10 minutes)
138
Q

Precipitous Labor and Birth

A 
3 hours around….
Think of vital supplies
Stay Calm
Call for assistance
Notify provider or other provider who may be in house
139
Q

is a method in which isotonic fluid is instilled into the uterine cavity. It is primarily used as a treatment in order to correct fetal heart rate changes caused by umbilical cord compression, indicated by variable decelerations seen on cardiotocography.

A

Amniofusion

140
Q

artificial rupture of membranes (AROM) and by the lay description “breaking the water,” is the intentional rupture of the amniotic sac by an obstetrical provider.

A

Amniotomy

141
Q

Indications for Induction

A 
Postterm pregnancy
• Maternal medical conditions
• Gestational hypertension
• Fetal demise
• Chorioamnionitis
• Premature rupture of membranes
• Fetal compromise
• Preeclampsia, eclampsia
142
Q

pre-labor scoring system to assist in predicting whether induction of labor will be required. It has also been used to assess the likelihood of spontaneous preterm delivery.

Scores dilation, length , consistency, position, head station

A

Bishop score

143
Q

Cervical ripening refers to the softening of the cervix that typically begins prior to the onset of labor contractions and is necessary for cervical dilation and the passage of the fetus

What to use to help this occur?

A

MISOPROSTOL (Cytotec)

Foley Bulb ~ Mechanical

DINOPROSTOL (Cervidil)

Laminaria Tents

144
Q

Pituitary hormone

Intravenous Oxytocin used for induction

Requirements for induction

Elective induction before 39 weeks

A

Oxytocin

145
Q

Assisted operative vaginal delivery

What they use ?

A

Forceps

Vacuum extraction

146
Q

Clinician externally or internally rotates a breach or transverse plane fetus to a vertex position

A

Internal/external version

147
Q

Delivery in which the anterior shoulder of the baby is impacted against the maternal symphysis pubis

A

Shoulder dystocia

148
Q

Dangers of Shoulder dystocia to child?

Risk factors In mother ?

A

Entrapment of cord

Inability of child’s chest to expand properly

Severe brain damage or death if not delivered in minutes

Risks :

Diabetes 
Prolonged gestation 
Prior shoulder dystocia 
Macrosomnia of fetus 
Maternal obesity 
Instrument assisted in delivery 
Precipitous delivery
149
Q

Prevention of Shoulder dystocia

A

Maintenance of good glycemic control in diabetic patients helps decrease fetal macrosomia

C-section for any hx of it or diabetes

150
Q

Shoulder dystocia tx

HELPERR

A 
Call for help 
Evaluate for episiotomy 
Legs mcroberts maneuver- what is this?
External pressure - suprapubic ??
Enter: rotational maneuvers 
Remove the posterior arm 
Roll the patient to her hands and knees
151
Q

SD treatment

Internal Maneuvers

First line tx?

Last respite maneuvers ?

A

Internal Maneuvers

◦Rotate anterior shoulder –Rubin’s
Apply pressure to the posterior aspect of the shoulder

◦Wood’s screw maneuver
Apply pressure to the anterior aspect of the posterior shoulder while trying to rotate the anterior shoulder also

◦Reverse Wood’s screw maneuver

Delivery of posterior arm-Now being encourage as first line treatment

Gaskin maneuver
◦Moving patient to hands/knees position

Last resort measures
◦Fracture clavicle
◦Zavanelli maneuver
◦Symphysiotomy

152
Q

when your baby has their umbilical cord wrapped around their neck

A

Nuchal cord

153
Q

the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. The cord can then become trapped against the baby’s body during delivery.

Causes what on fetal strip?

Tx?

A

Cord prolapse

Variable and prolonged decelerations

Alpha- c-section

154
Q

Placental abnormalities

A

Battedore -normal

Succent uriate lobe - small price separates from the main disc of placenta

Vasa previa -blood vessels lie across the opening of cervix

155
Q

Abnormal implantation definitions

1.Firm attachment to the myometrium
◦Found in 4% of previas

◦2.Invasion of myometrium

◦3.Invades through myometrium
◦Can invade into bladder/bowel

A

Placenta accreta

Placenta increta

◦Placenta percreta

156
Q

Now Known as:
Anaphylactiod Syndrome of Pregnancy

Typically seen in labor or just after delivery
Difficult to determine incidence 2-6 per 100,000

Mortality rate exceeds 60%
◦If sustained cardiac arrest survival rate is less than 10%

A

Amniotic Fluid Embolism

157
Q

Amniotic Fluid Embolism

S/s?

A 
◦Hypotension
◦Dyspnea
◦Cyanosis
◦Frothing from mouth
◦Fetal heart rate abnormalities
◦Loss of consciousness
◦Cardiac arrest
◦Bleeding from uterus, incisions, or IV sites
◦Uterine atony
◦Seizure-like activity
158
Q

If you have had a cesarean delivery (also called a C-section) before, you may be able to deliver your next baby vaginally. This is called vaginal birth after cesarean, or VBAC. Most women, whether they deliver vaginally or by C-section, don’t have serious problems from childbirth.

Risks?

A

VBAC

Uterine rupture

159
Q

What is cord prolapse related to?

A

Amntiotomy

High fetal station

Polyhydramnios

maternal child health RN (15 decks)

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