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Flashcards in Week 6 Day 7 Deck (62):
1

Pharmacological pain management conciderations

Any drug taken may affect fetus

Drugs may have effects in pregnancy that they do not have in a nonpregnant person

DRUGS CAN AFFECT THE COURSE AND LENGTH OF LABOR

2

Local anesthesia

Lidocaine (numbing) - given before episiotomy or when repairing a tear(sutures)

NO EFFECT ON THE FETUS

3

Epidural block

Used for both vaginal and c-sections
Injecting local anesthetic into epidural space
Small test does may be given before full dose to ensure placement
Pts sometimes feel contractions and not pain is normal

4

Wrong placement of epidural

Dizziness
Draw back and have blood return
Tongue numb
Only one side of the body numb

5

Episiotomy

Cutting the vaginal opening

6

Adverse effects of epidural

Maternal low BP
Bladder distention (cannot feel the urge to pee)
Prolonged labor- slows down
Migration of the epidural catheter
Fever

7

Interventions for epidural block

Assisting during insertion (give support and help pt stay in position
Frequent vs
Urinary catheterizations
Help reposition
Make pt aware of contractions( may not feel them) and encourage pushing efforts
Observe for signs associated with catheter migration or adverse effects

8

Inhalants

Nitrous oxides is delivered by face mask in a 50% mixture with oxygen

9

What cocktail is in an epidural

Bupivacaine
Levobupivacaine
Lidocaine
Combined with
Morphine or fentanyl

10

Opioids- pts who dont want and epidural block

Meperidine
Fentanyl
Butorphanol
Nalbuphine
ADMINISTER AT THE START OF A CONTRACTION TO DECREASE THE AMOUNT TRANSFERRED TO THE FETUS

11

Sedatives- rarely used

Barbiturates
Small dose may be given to promote rest in exhausted woman from false labor or a prolonged latent phase

12

Poor candidates for epidural

Woman with scoliosis or spine surgery

13

General anesthesia used on...

C-section pts that cannot get an epidural block

14

General anesthesia involves

LOC
Woman breaths O2 for 3-5 min or 4 deep breaths to increase her oxygen stores for the short period of apnea during anesthesia induction
Position to promote placental blood flow (use wedge to put pt slightly on her right side)
Pt will be intubated and monitored
Meds are administered IV

15

Causes of ineffective contractions (power)

Fatigue
Maternal inactivity
Fluid and electrolyte imbalance
Low blood glucose
Excessive pain meds
Maternal response to stress or pain
Disproportion between the pelvis and the presenting part
Uterine distention

16

Hypotonic labor dysfunction

Weak contractions
Coordinated
Less frequent and shorter duration
Active phase after 4cm dilated

17

Management of hypotonic labor dysfunction

Amniotomy
Oxytocin administration
C-section might be needed if labor does not progress

18

Amniotomy

Artificially breaking of water

19

Hypertonic labor dysfunction

Contractions uncoordinated, unpredictable
Painful but ineffective
Usually occurs during latent phase
Uterus does not relax between contractions
Decreases fetal O2 supply
Woman has constant cramping pain

20

Management of hypertonic labor dysfunction

Pain management
Amniotomy if it occurs in active phase
Tocolytic drugs

21

Tocolytic drugs do what

Inhibit uterine contractions
Makes contractions weaker
Only used when contractions are strong but not affective

22

Macrosomia

Big baby
Between 4000-4500g
May cause uterine overdistention- reducing strength of contractions
Usually need an episiotomy
C-section worse case scenerio

23

Shoulder dystocia

Requires immediate intervention b/c umbilical cord and chest is compressed

Unpredictable-can happen at any wt

Shoulders stuck in pubis after head is delivered

24

Intervention for shoulder dystocia

McRoberts maneuver- thighs/knees to belly/chest

Superpubic pressure- pressure like CPR at the pubis

25

Classic sign for shoulder dystocia

Turtle sign- head comes out but comes back in a little

26

Abnormal fetal position



Can cause delay in fetal descent and other mechanisms of labor

Occiput posterior or occiput transverse is not preferred

Posterior position usually causes back pain in labor

Most OP position during early labor will rotate spontaneously to occiput anterior position

27

What maternal position changes can help fetus get into OA position

Rocking pelvis while on hands and knees

Side-lying (epidural)

Lunges

Squatting

28

When to use vacuum extractor or forceps

Baby position in OP position

29

C-section

Transverse or breech positions

30

Breech presentation

Cervical dilation and effacement are often slower
Head is delivered last causing cord compression
External version attempted to change baby’s presentation w/ manipulation (scheduled before labor occurs not during delivery
C-SECTION MOST COMMON

31

Hypotonic dysfunctions main cause

Uterine over distention from multifetal pregnancy

32

Multifetal vaginal delivery FHR

Each FHR is monitored separately

After the birth of the first baby, the FHR is still being monitored until its birth

33

Twin c-section birth

1st twin- nonvertex position w/ 2nd twin- vertex position

Both twins- non vertex position

34

Twin trail of labor

Both twins are in vertex position

1st twin is vertex position, 2nd twin is in nonvertex position

35

Precipitate labor

Labor begins then the baby is born within 3hrs.

Pain meds are not usually an option

36

Precipitate birth

Birth occurs so quickly the Dr. is NOT PRESENT

Pain meds are usually not an option

37

Never do what during precipitate labor/birth

Close mothers legs to the fetal head help back!!! NEVER EVER DO THIS!!!

38

Complications from a precipitate labor/birth

Fetal intracranial hemorrhage or nerve damage

Fetus may become hypoxia

39

Premature ROM

Rupture of amniotic sac before the onset of true labor

40

Risk factors for premature ROM

Infections
Amniotic sac w/ weak structure
Chorioamnionitis
Previous preterm birth
Fetal abnormalities
Incompetent cervix
Overdistention of the uterus
Recent vaginal intercourse

41

Complications of premature ROM

Preterm birth

Maternal and/or fetal infection

42

Therapeutic management of premature ROM

Depends on gestation and presence of infection
Determine if true rupture of membrane
Determination of lung maturity may be needed
Labor induction or C-section

43

What to do if premature ROM in preterm and ruled out induction or c-section

36 weeks & below
May stay inpatient until birth or receive 48 hrs of antibiotics then continue 5 days oral antibiotics at home
Avoid intercourse, orgasm, or breast stimulation
Check temp at least 4 times a day and report if greater than 100
Activity restriction
Report contractions or vaginal drainage with a foul odor

44

Preterm labor

Labor between 20 - 36 weeks gestation

45

Preterm risk factors

Maternal UTI, diabetes, drug use, domestic violence episodes, smoking, obesity
IVF
MULTIFETAL- BIGGEST RISK FACTOR
Preterm ROM
Oligoamnios
Birth defects
Inadequate prenatal care

46

Oligoamnios

Low amniotic fluid

47

Chorioamnionitis

Bacteria infection inside the amniotic sac

48

Preterm labor S/S

Uterine contractions
Cramps
Backache
Pelvic pressure
Pain, discomfort, or pressure in the vulva or thighs
Change or increase in vaginal discharge

49

Interventions to delay/stop preterm labor

Activity restriction
Prevent dehydration
TOCOLYTIC medication
Corticosteroids

50

Why do they give corticosteroids during preterm labor?

If gestation is before 34 weeks is given to the mother to mature fetal lung maturity.

Betamethasone
Dexamethasone
Serfacton

51

Tocolytic medications

Inhibit uterine contractions(weakens them)
Magnesium sulfate: can make mom feel sick
Calcium antagonists:Nifedipine, Nicardipine
Prostanglandin synthesis inhibitors: Indomethacin
Beta- adrenergics: TERBUTALINE (usually 1st choice)

52

Prolapsed cord

Feel pulse w/cervical exam or you can see the umbilical cord
Cord comes out before the baby
Usually occurs when the fit is poor between the fetal presenting part and the maternal pelvis when ROM occurs

53

Risk factors for prolapsed cord

Fetus that remains at a high station
A very small fetus
BREECH presentation
Transverse LIE
Hydra NIPS

54

S/S Of a PROLAPSED CORD

Umbilical cord presenting before head, visible at vaginal opening
Umbilical palpable
Changes in FHR: bradycardia or variable decelerations

55

Prolapsed cord intervention

Move baby’s head not the cord!!!
Position moms hips higher than her head
Give oxygen 8-10 L by face mask
USUALLY HAVE A C-SECTION

56

Uterine rupture

Rare-emergency
Tear in the uterine wall

57

Uterine rupture s/s

Labor stops (contractions stop)
Vaginal & internal bleeding
Abdominal pain/tenderness
Chest pain, pain in shoulder area
Hypovolemic shock
Absent fetal heart sound
Changes in FHR
Palpating of the fetus outside the uterus

58

Uterine rupture interventions

Stabilize woman and fetus
Perform c-section delivery
Repair uterus or perform hysterectomy
Blood transfusion, if needed

59

Uterine inversion



Very uncommon

Uterus completely or partly turns inside out
Placenta still attached to the uterine wall

60

Uterine inversion s/s

Uterus doesn’t feel like its in the right place

The interior of the uterus is protruding from the vagina

Massive blood loss, shock, pelvic pain

61

Signs a Dr should watch for before pulling the cord

1. Umbilical cord leugthus
2. Gush of blood
3. Uterus feels firm/ globular
4. Uterus rises to abdominal wall

62

Uterine inversion intervention

Dr. Attempts to replace the uterus thru the vagina
Give tocolytic drugs
If that doesn’t work laparotomy w/replacement is performed
Hysterectomy last resort
After uterus is replaced, oxytocin is administered to contract the uterus and control blood loss
Several units of blood are usually needed for transfusion