theresa maurer Flashcards
(354 cards)
1
Q
When is the first time fetal heart tones are heard by the doppler?
A
10-12 weeks
2
Q
Molly is newly pregnant. She has two children living at home. A third child died of birth defects at 4 days of age. She has never had an abortion or miscarriage. Which of the following accurately describes her now?
A
Gravida 4 para 3 AB 0
3
Q
Excessive use of antibiotics may result in a vaginal infection with
A
Candida albicans
4
Q
study of anatomy
A
the study of the structure and shape of the body and the body parts, and their relationship to one another
5
Q
study of physiology
A
the study of how the body and its parts work or function
6
Q
Immediately following fertilization, the fertilized egg is called a
A
zygote
7
Q
During what period of pregnancy is the baby most susceptible to teratogens (from conception)
A
2-12 weeks
8
Q
A typical human gestation from conception is:
A
266 days
9
Q
typical human gestation from LMP
A
280
10
Q
low lying placenta may result in
A
labor induction
11
Q
TPAL
A
Term births -Preterm births - Abortions - Living children
12
Q
FPAL
A
full term, pre-term, aborted, living
13
Q
fetal presentation
A
presenting part
cephalic, breech, shoulder
14
Q
cephalic
A
vertex, sinciput, brow, face
15
Q
attitude characteristic
A
well flexed, extended
16
Q
straight sinciput with straight attitude aka
A
military attitude
17
Q
fetal lie
A
relationship of long axis of fetus to long axis of mother
longitudinal, transverse, oblique
18
Q
position of fetus
A
ROA, LOA, RST…
19
Q
variety of fetus
A
same arbitrarily chosen point on the fetus in relation to mothers pelvic
anterior
posterior
transverse
20
Q
vertex
A
head down
most popular is the occipital bone as leading part
21
Q
breech types
A
frank- legs up near head
complete- both legs crossed
incomplete- one leg crossed
footling- one foot down
22
Q
complete breech
A
both legs crossed
23
Q
frank breech
A
legs at or near to head
24
Q
incomplete
A
one leg crossed
25
kneeling breech
This is a very rare position in which the baby is in a kneeling position, with one or both legs extended at the hips and flexed at the knees.
26
ventouse
vacuum extraction in 2nd stage of labor alt. to forceps or csection
27
uterine souffle
A blowing sound, synchronous with the cardiac systole of the mother
28
placental souffle
a hissing souffle synchronous with fetal heart sounds, probably from the umbilical cord.
29
engagement
station 0 level of ischial spines
30
synclitism
sagittal sutures is midway between the symphysis pubis and sacral promontory
31
asynclitism
sagittal suture is directly toward the symphysis pubis or or sacral promontory
anterior or posterior
32
woods maneuver
screw maneuver
33
lightening
```
two weeks before labor, descent of present part in true pelvis
decrease in dysnpea
increased urination
pelvic pressure
leg cramps
venous stasis causing edema
position is similar to 8 months
```
34
proteinuria
1+ 2+ on stick, .1 or higher in urine culture
35
glucosuria
2+ to 4+ glucose, diabetes
36
supine hypotension
when women lay on back it puts pressure on vena cava and thoracic aorta shutting blood flow to heart, fainting
37
chloasma
pregnancy mask, coloration from extra hormones
38
asepsis
no bacteria present
39
antisepsis
the practice of using antiseptics to eliminate the microorganisms that cause disease
40
sterile
free from bacteria or other living microorganisms
41
sequelae
condition that is the consequence of a previous disease or injury
42
Iatrogenic complication
caused by a medication or physician.
43
Cranial sutures
saggital suture, coronal, lambdoidal
44
Fontanelles
ossification is not complete and the sutures not fully formed
anterior - Diamond
posterior-Triangle
"Id rather be holy then have diamonds" 1
45
bandls right
A pathological retraction ring of the uterus is a constriction located at the junction of the thinned lower uterine segment and the thick retracted upper uterine associated with obstructed labor.
46
contraction
muscle shortens and stays short
47
retraction
muscle lengthens
| muscles in between ribs pull upward signaling trouble breathing
48
Leukorrhea
a profuse, thin or thick vaginal secretion that begins in the first trimester
49
what percent of women have PROM?
12%
50
what percent of women start labor in 24 hrs after PROM?
80 %
51
blood show is a sign of labor within
24-48 hours
52
when does an energy spurt happen before labro
24-48 hours before
53
best way to listen to a ctx
start midpoint between two ctx listen through to midpoint after the next
listen in 5 second intervals
54
when do you listen to contractions to establish a baseline
in between ctx
55
1st stage : latent phase
start of labor to progressive dilation
3-4 cm
every 10-20 minutes lasting 20 seconds
56
1st stage : active phase
active progression of dilation to complete dilation
ctx every 5-7 minutes lasting 40 secs or every 5 minutes lasting 60 sec 411, 511
3/4 cm to 10 cm
57
progressive descent occurs in what stages
end of active labor and 2nd stage
58
primigravida entering labor V/E
50-60% effaced, 1 cm dilated (paper thin active)
59
multipara entering labor V/E
1-2 cm dilated no effacement
60
acceleration phase of labor
starts at active phase of labor
61
true labor can be intensified by walking T or F
true
62
walking will calm a false labor T or F
true
63
maximum slope phase of labor
stage 1 most rapid dilation from 3/4 cm to 8 cm
64
decleration phase of labor
end of the active phase, transitional phase, ctx 2-3 mintues lasting 60 seconds
8-10cm
constant dilatin, average 3 cm an hour
65
triple gradient pattern
40-50 mmHg at acme and return to rest of 10 mmHg
66
transition s/s
shaking legs, belching, burping, nausea, vomit, restless, cant comprehend directions, decreased modesty, toes curl, severe low back pain
67
hydrocephaly palpation
breech presentation
68
to determine base FHR listen when?
in between ctx
69
3 phases of uterine ctx
increment- longer
acme-strongest
decrement
70
contractions constrict placenta blood flow T or F
true
71
contractions of muscle fiber
muscle fibers contract and shorten an dont return to original lenght, the fundus gets thicker to expel fetus
72
retraction of uterine fibers
lengthen and dont return to original shape, lower segment of uterus, thins and becomes part of upper segment
73
effacement
shortening of cervical length
74
dilation
enlargement of the external os, amniotic fluid hydrostatic pressure as dilating wedge
75
engagement
widest part of the fetal head has passed through the pelvic inlet
76
station 0
ischial spines
77
widest diameter of fetal head
biparietal 9.5 cm
78
largest diameter of fetal head
occipitomental brow presentation 13.5cm
79
most common diameter presenting
suboccipitobregma- vertex presentation 9.5cm
80
military or siniciput presentation diameter
occipitofrontal- 11.5cm
81
face presenation
submentalbregma 9.5 cm
82
percent of breech presentations
3 - 3.5%
83
% of breech before 32 weeks
50%
84
molding
change in the shape of head-bones overriding and overlapping
85
caput
dilating wedge, edemateous swelling CROSSING suture lines
86
cephalhematoma
bleeding beneath periosteam over more than one bone DOES NOT CROSS sutures
87
FHT eval based on
combo of rate and pattern
88
periodic fetal heart rate
changes in FHR associated with uterine contractions
89
baseline fetal heart rate
HR between contractions
90
FHR 161-180
tachycardia
91
Bradycardia
FHR 110-119
92
normal FHR
120-160 bpm
93
baseline change if
must be at new level for at least 10 minutes
94
marked bradycardia
below 100 bpm
95
abormal FHR
no variablity
marked variabilty
brady/tachy
periodic fetal heart rate changes
96
internal fetal monitor
most reliable comprehensive data of all methods
97
maternal changes stage 1 labor
```
increase metabolic activity that:
increases temp 1-2 degrees (max at delivery)
increase BP 10-20+/5-10 mmHg
increase respiration- hyper = alkalosis
polyuria- empty every 2 hours
decrease gast motility
increase WBC
decrease blood sugars
```
98
short term variability
beat to beat
99
long term variabilty
rhythmic waves in cycles - 5 min readings
100
Friedman
acceleration- start of dilation
max slope- 4-8 cm active labor
deceleration- 8-10 cm transition
101
pulse rate through contaction
increment- increase
acme- decrease
decrement- increase
102
IV indication
gravida 5, overdistended uterus, multip, polyhydraminos, SGA, induction, Hx PPM hemorrhage, dehydration, meds
125 cc per hour, or 300cc initial for dehydration then 125 cc per hour
103
positions for risk of cord prolapse
supine, lateral recumbent(left side lying), knee chest
104
stadol
sedating with pain relief, active labor
105
risk of prolapse cord
SGA, polyhydraminos, transverse lie, PROM
106
demoral
pain relief, active labor
107
nubain
pain relief, active labor
108
phenergan
| vistaril
atartic, anti anxiety, early and active labor
109
reasons for enema
stim labor, clean field, womens desire
110
vitals in Active labor frequency
FHT - every 30 minutes
BP- every 1 hour
Temp/pulse/resp- every 2 hours
Bladder- void every 2 hours
111
distention of bladder signs of
needing to void, posterior baby
| bulge above symphysis pubis
112
risks of AROM
indications
management
inc risk of infection, cord prolapse, cord compression, head compression, limited mobility
indications: active labor, 4-5 cm, cephalic vertex
management: leave fingers in til next ctx to see effect, check for cord prolapse, FHT, get mother standing to apply head
113
VE indications
initial for baseline, verify pushing, after ROM w/suspected cord prolapse, if decels and suspected prolapse
114
progressive relaxation
tighten muscles group let go and relax-promotes sleep
115
controlled relaxation
keep one muscle group relaxed while other group is contracted
116
what happens between 1st and 2nd stage
a lull
1. lull
2. bearing down until head does not retract
3. perineal crown to birth
117
early decel cause
head compression, cord compression
118
late decel cause
uteroplacental deficiency
119
FHT eval frequency in 2nd stage
every 5-15 minutes
120
position for extreme varicosities
dorsal (on back slight knees bent)
121
mechanisms of labor 8
engagement biparietal diameter passes inlet
descent- forces
flexion-meets resistance-cervix, sidewalls, pelvic floor
internal rotation- 45 degrees to anterioposterior position of midplane pelvis-shoulders in oblique
birth of head- by extension curve of carus
restitution-45 degrees right angle to shoulders
external rotation
birth of shoulders
122
internal rotation 45 degrees to the ______position
anterioposterior
123
birth of the head by______________
extension
124
restitution 45 degrees to the ___________position
OA, occiput anterior postion, L or R,
| sagittal suture oblique, shoulders other oblique
125
external rotation 45 degrees to the
LOT, ROT position, bisacromial aligns with anteroposterior diameter of outlet
126
birth of the shoulders by____________
curve of carus and lateral flexion
127
PICA can indicate deficiency in
iron
128
when do braxton hx begin
6 weeks gestation
129
station of a well flexed cephalic baby landmark
occipital bone
130
most positive sign of ROM
visualizing amniotic fluid escaping os
131
majority of progressive descent take place
(deceleration phase)end of 1st stage and 2nd stage labor
132
impending 2nd stage s/s
increase bloody show, rectal pressure, bear down, ROM, rectal bulging, expulsive grunt at exhale
133
most common position at onset of labor
LOT
134
exam ROT and sagittal suture is tilted toward the symphysis pubis
posterior asynclitic
135
normal labor the head usually enters inlet with moderate
posterior synclitic
136
changes in FHR associated with ctx
periodic changes
137
fetal scalp ph for immediate delivery
second reading of pH less than < 7.2
138
no VE following
prolonged walk or period in shower
139
how much water daily in pregnancy
2 quarts daily
140
sims position
lie on their left side, left hip
141
variable decels thought to be from
cord compression
142
innominate bones of pelvis
ischium, illeum, pubis
143
attitude
```
relationship of head to trunk
how flexed or extended compared to body
straight body sinciput
curved body vertex
arched body face
```
144
The lithotomy position is when the mother
flat back in stirrups
145
When performing an emergency episiotomy, the midwife must cut
during a contraction as head crowns
146
Respiratory distress in a newborn is evidenced by
fever
147
If the client continues to hemorrhage in third stage, the most important thing is to
get placenta out
148
If a baby is delivering in face presentation, he must rotate to:
mentum anterior position
149
abrupt persistent bradycardia is a sign of
uterine rupture
150
VBAC's at risk for what placenta complication
placenta accreta
151
preterm/premature labor how many weeks
any labor after 20th weeks before 37 weeks
152
preterm birth accounts for what percent of perinatal deaths
70%
153
preterm birth predisposing factors
non white, low status, poor nutrition, previous hx, hx of baby less than 2500, 1+ SAB 2nd trimester, multip, drugs, no prenatal care, uterine anomalies, DES, incompetent cervix, UTI, GBS. STD's, chorioamnionitis, palcenta previa/abrupto, polyhydraminos
154
previous preterm has a % chance of recurring preterm
20-40 % chance
155
diagnosis of preterm labor
between 20-36 weeks
| ROM, ctx 5-8 mins apart, 4 ctx in 20 minutes, 8 ctx in 60 minutes.cervical progressive change, 80% effaced.
156
tocolytics may be used for preterm labor when ?
the women is less then 34 weeks
| less then 4 cm dilated
157
tocolytics may stall labor for how long
24-48 hours or
| 3-7 days
158
contraindications to tocolytics
chorionamnionitis, fetal maturity, fetal distress, cervix more then 5 cm
159
tocolytic agents
magnesium sulfate
deta adrenergic
extremely toxic w side affects
160
PROM
2- 17% incidence
ferning is from protein in amniotic fluid
if term: 12 hours start induction
if preterm: repeat, weekly GBS screening and 2 x a week BPP and NST
161
FHR in chorioamnionitis
| s/s
tachy above 160
high WBC
foul, tinged waters
progressing fever
162
febrile morbidity
100.4 degrees
163
amnionitis & chorioamnionitis
s/s
treatment
amnion-inflammation of the amnion and sac
chorio- inflammation of chorion, amnion and sac
highest risk of developing A or C is PROM over 24 hours
fever, tachycardia maternal and fetal, tender uterus, vag walls hot to touch, foul smell, WBC increased
treatment- IV antibiotics unless delivery is 1-2 hours away, otherwise IV antibiotic after delivery, baby is cultured.
164
infection rate of PROM
within 24 hours- 1.6 to 29 %
| increases when more then 24 -72 hours
165
management of PROM
```
assess temp every 4 hours
fhr every 1 hour
no V/E unless prolapse or induction
hydration
color/odor of fluid
```
166
cesection rate for women at term induced to deliver in 24 hrs from PROM
30-50%
167
frank cord prolapse
through cervix
168
occult
alongside presenting part but not out cervix
169
ROM immediate action
FHR, and vag exam to rule out cord prolapse
170
cord prolapse immediate action
put whole hand in vag and hold presenting part up off cord
get mom into knee chest- trendleburg
call transfer STAT
FHT
if cord is out wrap with warm, sterile saline
do NOT remove hand until csection
171
fetal sleep cycle average
80 minutes
172
fetal distress
fetus is intermittently experiencing hypoxemia
definition reserved for hypoxic fetus
intermittent late decels
variable decels with average variability and normal baseline
173
chronic fetal stress
secondary to uteroplacenta insufficiency
| late decels and prolonged decels
174
acute fetal distress
variable decelerations with:
with ctx
cord compression, decreased AFI
rapid descent
175
when fetal distress occurs in 2nd stage management depends on anticipated delivery which should be...and...
30 minutes
color of fluid (mec)
fhr (baseline, variability, progressive decels)
176
management of fetal distress
```
transfer
IV
oxygen
left side lying
FHT
csection
```
177
depression of the autonomic nervous system can be identified by what kind of FHR
```
marked variability or
absent variability(hypoxia, acidosis)
```
178
acceleration FHR
fetal movement, stimulation, partial cord occlusion,
179
deceleration patterns
periodic fetal heart rate changes associated with uterine contractions
180
type of decelerations
early, late and intermittent decels
181
early decels
head compression 4-7cm -uniform shape-ends when ctx end
not under 100 bpm
normal baseline of 120-160
no intervention
182
late decels
uteroplacental insufficiency
uniform shape with ctx
occurs in acme or decrement
intervention
183
causes of uteroplacental insufficiency
```
fetal anemia Rh sensitized
maternal sickle cell
IUGR, maternal hypertension,
abnormal placenta, previe, vasa previa, infection
PIH
hypotension
postmaturity
hypertonic uterus
placental abruption
```
184
management of late decels
```
prepare transfer
IV
oxygen
assess length of delivery
correct hypotension, elevate legs
terbutaline to quiet uterus
```
185
variable decels caused
caused by cord compression
186
seriousness of variable decels depends on
frequency, depth, rate of return to baseline, effect on baseline, and variability
187
shape of variable decels
V, U , W
variable shape
different times in ctx
188
characteristics of variable decels
shoulders- small accelerations come before decel and right after decel- reassuring
overshoot-blunt acceleration at end of decel with slow return to baseline- immediate delivery nonreassuring
189
FHR during decels
decreases to below 100 and as low as 50-60 bpm
190
management of variable decels
change position
VE check for cord prolapse, rapid descent
IV
oxygen
191
prolonged deceleration pattern
decels lasting longer then 60-90 seconds
| if it does not recover transfer
192
factors of prolonged decelerations
cord compression, profound uteroplacental insuff, hypertonic ctx, maternal hypoxia, maternal shock, maternal valsalva, rapid head descent.
193
Valsalva pushing
When this technique is used, a woman is instructed to take a deep breath at the beginning of the contraction, to hold her breath and push as long and hard as she can in synchrony with her contractions.
can cause prolonged decels
194
sinusoidal pattern
```
undulating repetitive uniform fhr equally distributed and below baseline for more then 10 minutes, no relationship to ctx or fetal movement
ominous sign, immediate transfer
Rh sensitizion
fetal anemia
fetal hypoxia
placenta abruption
```
195
lambda pattern
immediate acceleration followed by a decel, benign, risk is confusing with other FHR
196
wandering baseline
late development of progression of fetal distress
within in normal 120-160 but NO short term variability
ominous right before fetal demise
immediate delivery
197
CPD body types
```
shoulders wider than hips,
short square
short broad hands and feet
history of pelvic injury
spinal deformity
large fetus
malpresentation
malposition
only TRUE test is labor
dysfunctional labor pattern
deep transverse arrest, poor flexed head, caput, asynclitic, molding
```
198
CPD management of
| risks of
position change, ROM, walking, IV hydration, increase uterine activity, epidural,
may cause fetal damage, brain damage, death, infection, uterine rupture, maternal death
199
deep transverse arrest
s/s
management
platypelloid and android pelvis
sagittal suture of the fetus in transverse diameter
2nd stage hypotonic dysfunction
extendsive molding, caput
leopolds 4th maneuver for presentation
maternal hydration, position change, left side lying, improved ctx, good pushing positions, squat, kneel
200
uterine dysfunction
a prolonged stage of labor beyond expected length
201
progression measurements
dilation, effacement, descent
| efficacy of ctx
202
hypotonic uterine dysfunction
follows gradient patter with no pain, or intensity or tone
stalled labor
infrequent short mild ctx
lack of progress in dilation or descent
203
limits of normality of labor
primi- latent phase 20 hrs, active-less than 1 cm an hours, second stage- 2 hours
multip- latent 14 hrs active- less than 1.5 cm an hour
second stage 1 hour
204
management of hypotonic
environment and stress factors
correct maternal exhaustion, hydration
fears, concerns, walking, bath, enema(improves 1 hrs)
ROM-(effective if ctx increase within 2 hours)
nipple stim
pitocin
epidural
205
hypertonic uterine dysfunction
distorted gradient pattern, midpoint of uterus contracts most, exhaustion!, cause uteroplacental problems leading to fetal problems
occurs in primips, latent phase, freq irregular ctx, lack of progress.
slow ctx, with induced rest period, terbutaline
206
uterine rupture
predisposed risks
% of mortality
s/s
uterine surger of fundus or corpus, classical cesarean, removal of fibroids, too much pitocin,
5% maternal mortality, 50% fetal mortality
s/s cry out, sharp shooting pain, sudden cessatoin of uterine ctx, slight bleed or hemorrhage
fetus outside uterus, dramatic fetal position change, head unengages, parts easily palpated, violent movement to cessation of fhr.
shock
207
shock
| s/s
elevated pulse, rapid, thready, hypotension, pallor, cold clammy, short breath, restless, visual disturbance
208
quiet uterine rupture
hematuria, tender ab, pain, hypotonic, lack of progress, faint, bledding, rapid pulse
209
uterine rupture management
IV 16 gauge two routes-electrolytes (ringers), blood transfusion
oxygen
immediate surgery, hysterectomy
aortic compression and pitocin
210
diagnostic of shoulder dystocia
anterior shoulder wedge above symphysis pubis
posterior shoulder jammed at sacral promontory or jammed on sacrum.
key to defining is anterior shoulder
211
fosters shoulder dystocia
if shoulders attempt to enter the true pelvis with shoulders in anteroposterior of the pelvic inlet instead of the oblique diameter which is larger then the AP diameter in the inlet
212
the oblique diameter is the roomiest diameter in the outlet.
true
213
the anterior posterior diameter is roomiest in the pelvic inlet
true
214
baby usually enters the inlet in ROT LOT position then turns to oblique in true pelvis/outlet
true
215
differential diagnosis of shoulder dystocia
true, snug shoulder, or bed dystocia
216
turtle sign
retraction of the head snug on perineum
217
exaggerated lithotomy
legs elevated and knees drastically bent with mom on her back
218
snug shoulders
```
slow to birth head, no turtle sign, restitution present, external rotation present,
make sure shoulders are oblique
light suprapubic pressure
ex lithotomy position
hands and knees
```
219
fowlers postion
propped upright lying in bed
220
bed dystocia
baby being born down
soft bed
elevated hips, reduce upright angle, bring buttocks to edge of bed, hands and knees
221
erbs palsy
brachialplexus damage from delivery of SD
222
Shoulder dystocia incidence
1% .1-.6%
223
shoulder dystocia increases when what is present
increased fetal weight, prolonged 2nd stage, midpelvic delivery (forcepts, venthouse extract)
224
delivery times of shoulder dystocia
3 minutes best outcome
| 5 minutes to 10 depending how compromised
225
management of shoulder dystocia
have someone call for immed transfer
request full newborn resus
request immediaton ppm hemorrhage support
tell the mother NOT to push!
McRoberts maneuver
rotate shoulders to oblique with 2 hands on both sides
suprapubic pressure
--- 45 SECONDS TO
catheterize, episotomy,
VE- short cord, enlarged fetal ab, twins, bandl ring,
Attempts-
Woods Corkscrew- 180
Deliver posterior arm
Suprapubic pressure and downward outward
pressure on head
still no delivery- rotate 180 degrees again
NO delivery
break clavicle
Zavanelli Maneuver- replace head!- csection
snug shoulders= side lying, hands and knees to deliver posterior arm
226
McRoberts
mother on back, knees to chest, close together widens the outlet, pushes pubis back and horizontal to free anterior shoulder, straightens sacrum
227
Woods corkscrew (Rubin)
degrees two hands, only back up. clockwise. hands on back pushing forward, hand on chest pushing back toward posterior shoulder
posterior shoulder substituted for anterior shoulder, baby rotated, 180 degrees
not delivered go counter clockwise 180 degrees
228
Delivery of posterior arm
find arm, if extended press cubital space to cause flexion
| if extended and jammed splint lower arm and sweep across the babys abdomen, grasp hand, deliver arm
229
flip FLOP Gaskin Maneuver
Flip into hands and knees knees in, Lift leg to running start, rotate to Oblique, remove posterior arm
230
Face presentation
occipital bone prominent! head feels large
no fontanelles and face
anterior fontanelle and face
231
brow presentation VE landmarks
feel brow only and maybe anterior fontanelle
232
movements of face presentation and delivery
Mentum leads the way!
LOP or ROP converts to RMA or LMA as it deflexes
70% enter true pelvis as MA or MT
30% enage as MP
Mentum in posterior CANNOT be delivered
Mentum in anterior can be delivered with extension and flexion of the birth of the head
233
before delivery of breech
```
complete dilation
empty bladder
effective pushing
prep for resus
position mom at edge of bed
hands off until umbilicus
```
234
Pinard Maneuver for breech
follow posterior thigh
press on in the popliteal fossa causing leg to flex at knee
draw leg down sweeping across ab for delivery
235
% of Frank breech
70 %
236
movements of breach delivering head
head HAS to be in occiput anterior to deliver
keep head flexed-supra pubic pressure or Smellie Veit manuever
apply downward outward traction on body until occiput
the upward traction to deliver chin
237
Twins
```
deliver baby as presentation and position
quickly clamp and cut cord
determine presentation of 2nd baby
extreme FHR, signs of bleeding
optimal time for 2nd is 3-15 minutes
deliver 2nd baby before placenta separates
rule out cord prolapse
ROM with no pressure from ctx or fundal
maternal pushing
```
Hemorrhage likely
238
monozygotic twins
one placenta, one chorion and two amnions
239
3rd Stage of Labor - 2 parts
first phase- placental separation
| 2nd phase- placenta expulsion
240
retroplacental hematoma
forms behind placenta when uterine size decreases along with placenta site
241
placental separation
happens as result of decrease in size of uterine cavity
242
signs of placental separation
sudden trickle
cord lengthens
discoid to globular shape uterus
uterus displaced upward
243
schultz mechanism
separations begins central
| fetal side up, majority of bleeding is not seen until after delivery because of inverted placenta
244
duncan
eparations begins margin
blood escapes between membranes
maternal side up
245
mismanagment of 3rd stages is biggest cause of hemorrhage
true
246
management of 3rd stage
evaluate progress of labor and mothers condition
guard uterus so not to massage
do not massage before placenta separation
do not pull cord before separation
do not attempt delivery before complete separation
collect cord blood-
247
Brandt Andrews
to check placenta separation
hold cord taut with other hand put fingers close together and push straight down into low ab of mother just about pubis sym,
if cord recedes= not separated
if cord elongates spearated
OR follow cord with hand to placenta, if it extends into cervix it is not separated, if it is at external os or upper vault it is separated
248
facilitating placenta birth
place one hand palm surface on uterus above sym pubis and press down and up towards umbilcus check it is contracted
exert cord traction
ask mom to push
follow carus downward and upward
249
never exert cord traction if uterus is not contracted
true
250
methergine IM can be given to a mother PPM
false
251
retained placenta definition
not separated and no visible bleeding
| not delivered after 30 minutes
252
3rd stage placenta timing
average 5-10 minutes, normal for longer
253
gestational age and placenta separation
lower gestational ages longer 3rd stage
| most preterm delivery= manual removal
254
management of retained placenta
baby to breast, nipple stim, squatting, privacy for oxytocin effects, empty bladder
intraumbilical oxytocin injection with solution of 10 IU diluted with 20cc of normal saline
255
third stage hemorrhage
```
from partially separated placenta
call for transfer
thoroughly massage- only with hemorrhage cause by non separation
uterine ctx combined with cord contraction usually releases
IV
position for shock- check pulse and BP
catheterize
10 IU of Pitocin
```
256
Pitocin causes
intermittent contractions, upper segment
257
methergine
sustained contraction, lower segment
258
placenta accreta
abnormal or partial or total adherence of the placenta to uterin wall. adhered to myometrium with little to no decidua in between.
definitive diagnosis- microscopic
259
placenta increta
chorionic villi goes farther than myometrium to uterine wall
260
placenta precreta
chorionic vill go through all the way to the uterine wall and to the serosa layer
261
placenta acreta increased incidence with
placenta accreta, previa, previous csection, or unexplained elevated MSAFP
262
second stage is known as
expulsion stage
263
average length of second stage for primip according to Friedmans curve
1 hour
264
which cephalic presentations means that the largest diameter will be presenting
brow
265
which mechanism occurs without
descent
266
external rotation accomplishes what?
brings the bisacromial diameter of the fetus into alignment with the anteroposterior diameter of the pelvic outlet
267
internal rotation accomplishes what
brings the anteoposterior fetal head into alignment with the anteroposterior diameter of maternal pelvis
268
if the baby enters in the ROP position how many degrees does it have to rotate for internal rotation to be occiput anterior?
135 degrees
269
generally an accepted frequency of blood pressure checks in 2nd labor is
every 15 minutes
270
lithotomy for delivery is contraindicated for which condition
varicositites
271
Ritgen maneuver
to control fetal head at birth
272
the best gauge for the perineal body
22 gauge
273
primary disadvantage of local lidocain
distorts local tissue
274
Which one of the following is the most important nutrient of the pregnant and lactating woman by helping to build strong muscles, adequate blood volume, and healthy skin?uter
protein
275
A rubella titer of <1:10 indicates:
non immunity
276
What is the most frequent reason for seizures in the neonatal period?
hypoxic-ischemic encephalopathy
277
Which of the following findings of fetal heart assessment is most ominous
repeated late decelerations with loss of short-term fetal heart variability
278
The basic shape of the android pelvis is:
heart
279
uterine atony is the major cause of immediate ppm hemorrhage
true
280
immediate ppm size of uterus
2/3 3/4 between pubis and umbilicus
281
uterus above the umbilicus
clots need to be expelled
282
above umbilicus and to one side after immediate ppm
full bladder
283
hard to pee after birth
trauma caused by pressure and compression on bladder and urethra
284
vital signs after birth
every 15 minutes or more until stable at prelabor levels
BP=- prelabor
Temp-slightly elevated
pulse- prelabor
285
average blood loss of vag delivery
500ml
286
average blood loss of csection
1000ml
287
PPM hemorrage definition
500ml +
288
80-90% of immediate PPM hemorrhage cause
uterine atony from incomplete placenta
289
80-90% of immediate PPM hemorrhage cause
uterine atony from incomplete placenta
cervical lacerations
vag perineum lacerations
290
methergine
ergot prep of methylergonovine
tetanic sustained ctx
increase in blood pressure -vaso constrict peripheral
acts directly on myometrium
0.2 mg oral, 0.2 injection
repeat in 2-4 hours if needed
291
pitocin
synthetic oxytocin no inc in blood pressure IM
| 10 USP units
292
hembate
contracts smooth muscle of uterus and other parts of body-increasesBP
contraindicated for PID, asthma, cardiac,hepatic disease
may work if others havent
293
before 1900 what percent of women gave birth in hospital?
5%
294
Postpartum assessments after leaving
24hours, check pediatrician appt, 2 weeks, 6 weeks
295
60-70% women will give vag birth after cesection and or CPD diagnosis
true
296
The cord is wrapped around the baby's neck approximately 1 out of every 3 births
true
297
A respiratory rate consistently higher than 60 breathes per minute wth or without flaring grunting or retractions is abormal at 2 hours of life
true
298
clamping the cord or (dave clarke) :) physiological occlusion of the cord shuts down the low pressure system, the newborn circ is now freestandingand is a....
closed, high pressure system, with a rise in resistance. The foreman ovale shuts ductus arteriosus shuts, blood now goes to the lungs and travels to all tissues
299
fetal circluation is defined as a .....
low pressure system
300
thermoregulation in a newborn is not completely stable until?
2 days
| subcutaneous fat helps insulate
301
neonate generates heat 3 ways
shivering, voluntary muscle activity, non shivering thermogenesis
302
non shivering thermogenesis
utilizing brown fat for heat production
303
brown fat energy resource
glucose and glycogen help cells produce energy that converts fat into heat
304
hypoglycemia thermoregulation
doesnt happen because of inadequate glucose to convert fat into heat
305
heat loss in newborns, sequelae
hypoglycemia, hypoxia, acidosis
306
normla newborn temp
97.7-99.5
307
glucose levels for newborn
60-70 mgdL
| from 4-72 hours
308
signs of hypoglycemia in newborn
jittery, apnea, cyanosis, weak cry, lethargy, limp, not feeding
309
low glucose blood level
< 40-45 and should be followed up with blood draw check
310
rbc lifespan of newborn
8o days
311
6% of newborns will need some form of resuscitation
true
312
asphyxia the most common reason for resus
true
313
adequate ventilation is the most important part of resuscitation of the newborn
true
314
ABC of resuscitation
Airway, Breathing, Circulations
315
common reasons for resuscitation
TAMM
| trauma, asphyxia, medications, malformations
316
atleast 30 seconds of effective PPV is given before chest compressions
true
317
heart rate above 100 bpm
no PPV
318
heart rate below 100 bpm
PPV
319
gasping with labored breather or lack of
PPV
320
compressions are postitioned where on the newborn
Xiphoid
321
PPV count
breath, 2, 3 breath 2, 3
| assess HR every 15 seconds
322
chest compressions
90 compressions + 30 PPV += 120 events
90 compressions per minute
one and two and three and BREATHE AND one and two and three and BREATHE AND
3:1
323
reassess after 60 seconds of effective compressions to check HR
true! dont pause
324
stop chest compressions when HR is 60pm or above and continue PPV
true
325
ET tube
3.5-4 mm, 13 inches long
326
% of babies that pass meconium before birth
10-30%
327
healthy newborns spend 60% time sleeping
true
328
healthy newborns gain 1 oz a day and 1 inch per motnh
true
329
breastfed babies may gain less than 1 oz a day
true
330
during the first 3-5 days newborns may lose 5-10% of their birth weight
true
331
By 10 days after birth the baby should be atleast at birth weight
true
332
physiological jaundice
not in 24 hours
seen 3-4 days at peak at 13 mg
not seen after 10 days
333
pathological jaundice
visible in first 24 hours
rises quickly > 13 mgdL
visible after 7 days
334
tachynpea
> 60 respirations per min
nasal flare
retraction
335
respiratory disease
mec aspiration, pneumonia, pneumothorax, tachypnea
336
signs of mec aspiration
uneven breath sound, barrel chest, rales cyanosis,
337
TTN transient Tachy newborn
inadequate fluid lung absorption 48-72 hours
| rales, tachy, nasal flare, intercostal retract
338
late onset bacterial infection
after a few days, problems sucking, lethary, color apnea, abnormal temps
339
most common sign of neurological disease
seizure
340
hernias
unilateral, decreased left side breath sounds, heart sounds on right, resp distress
341
IDM infants of Diabetic Mothers
increased birth weight, hypoglycemia, jitters, early jaundice, resp distress
342
maternal ppm pulse rate above 100 bpm
abnormal
343
postpartum blues occur
3- 5 days ppm,
344
B12 deficiency in what diet
vegetarian
345
peurperal morbidity
100.4 temp in first 10 days or 24 hours
346
endometritis diagnosis
urine and lochia cultures
347
postpartum depression
can start within a year after birth
348
Placenta succenturiate
lobes extending from main area of placenta
349
Placenta circumvallata
a ring from amnion and chorion around placenta
350
battledore
cord insertion on margin
351
velamentous
blood vessels separate and leave the cord
352
vasa previa
unprotected blood vessels covered only covered with amnion and chorion
353
1/3 rd of babies born with one um artery have malformation
true
354
largest muscle of pelvic floor
levator ani
