Alterations In Intrapartal Flashcards
Uterus doesn’t contract keeps becoming boggy
Uterine atomy
Who gets RhoGAM ? When do they get it?
Rh - mom, 28 week and within 72 hours of delivery
What is dystocia
Things that could cause difficult labor
What are operative obstetrics techniques
Help facilitate fetus to be brought to the outside
What part of uterus is where there is very little contacting done
Lower uterus
Where is placenta normally?
Upper front part if uterus
Placenta previa is improperly implanted placenta in the _________ with ____________
In lower uterine segment with painless bright red bleeding
Risk factors for placenta previa
Maternal age and number of C/S
Scaring in upper uterine segment
Smoking, cocaine
HTN, diabetes
Concerns with placenta previa
Bleeding, hemorrhage.. “Afterbirth comes first”
What is a medication to stop contractions and calm uterus? When would you use it?
Tocolytics, placenta previa
Why should there be no nipple stimulation or vaginal exam with placenta previa?
Release oxytocin which stimulate contractions. We do nothing to stimulate contractions. But if vaginal exam had to be done you have to have a double set up.
Premature separation or NORMALLY implanted placenta from uterine wall
Abruptio placenta
What kind of bleeding would you see with a marginal Abruptio placenta
Bright red bleeding
What’s important about central Abruptio placenta
May not know she has it until she delivers the baby. There will be fast bleeding which will cause the uterus to swell up and there will be a big clot behind placenta which can be painful for mom
What is important about fundal height with the complete Abruptio placenta
Fundal height will be much bigger than expected
What is a concern with severe central Abruptio placentae?
May observe Couvelaire uterus (blue uterus, abnormal fundal height, mother c/o of lots of pain) and risk of DIC ( disseminated intravascular clotting)
What is DIC
disseminated intravascular clotting- excessive activation of clotting factors and then they run out and bleeding occurs. insult that occurs in relation to something else it is not a disease by itself.
If there is vaginal bleeding should you do a vaginal or rectal exam?
Not without a double set up!!
What color bleeding with Abruptio placenta? Why?
Dark red bleeding because it is behind placenta
Symptoms of Abruptio placenta
Dark red bleeding, shock, severe abdominal pain
What is somebody with Abruptio placemat at a increased risk for
Hemorrhage, fetal distress, preterm labor/delivery depending on placenta problem
What is Cryoprecipitate
Anti-hemorrhage medication
Used with Abruptio placenta
Is the clot usually visible on the ultrasound with Abruptio placenta?
Less than 50% of cases
Where should cord normally attach
More towards the center
What are the three different ways of placental adherence?
- Accreta - (most common) superficially into myometrium
- Increta- myometrium invaded
- Percreta- myometrium penetrated
What is the most common type of placental adherence where the chronic villi attach directly to myometrium of uterus
Accreta
Type of placental adherence where myometrium is invaded, attached deep into myometrium
Increta
Type of placental adherence where myometrium is penetrated, attached through the myometrium
Percreta
Concerns with placental problems & umbilical cord variations
Hemorrhage failure of placenta to separate; abnormal separation of placenta
What is a person at increased risk for if they have placental problems and umbilical cord variations
Hemorrhage, fetal distress, preterm labor/delivery depending on problem
Most common types of twins
Fraternal (dizygotic) —67%
Two separate ovums? Single ovum?
Two separate- dizygotic
Single- monozygotic
With twins, triplets, or more the risk is increasing with ____________
Infertility treatment
What things are multifetal pregnancy at risk for
Pulmonary embolism, PROM, preterm labor, increased risk of maternal physical discomfort, increase risk fetal problems, increased risk or postpartum bleeding
Why could a multifetal pregnant mother be at risk for postpartum bleeding
Because of stretching
Do you just use one fetal monitor on a mom with multi fetus pregnancy
No- If the mom is expecting twins you do a dual external fetal monitor using 2 sets of belts
Most common procedure in OB
Amniotomy
What is amniotomy
Artificial rupture of membranes “strip membranes”
What do you use for amniotomy
Amnihook; sterile vaginal exam
When is amniotomy done
After engagement occurs–which is when head is in brim and not popping back out
What are some reasons for amniotomy
Induction or to facilitate labor contractions, gain access to fetus, at least 2 cm dilated cervix required
When should births occur after an amniotomy?
Must occur within 24 hours because of risk of infection
What risks increase if amniotomy is used
Cord prolapse, Abruptio placenta, fluid embolism
What is fluid embolism
Bolus of amniotic fluid enters maternal circulation & then the lungs. It is a rare occurrence but it is a obstetric emergency ( hypotension, hypoxia, coagulopathy, respiratory distress, circulatory collapse
What color does amniotic fluid turn?
Blue because it is alkaline
Is vagninal fluid acidic/basic
Acidic
For amniotomy…check temperature every ____ hours, _______ if no engagement, keep _____ and ________
Temperature every 2 hours, bed rest if no engagement, keep clean and dry
Forceps are a stainless steel instrument with two steel parts, _____&______, used to apply traction to fetal head
Cross and lock
If trial of labor is followed by failed forceps what is likely
C/S
What is outlet when talking about forceps
Most often used. Head on perineum, crowning
Are the forcep blades put on at the same time
No. Each blade put on separately brought together and locked
