Alterations In Intrapartal

Question 0

Uterus doesn’t contract keeps becoming boggy

Answer 0

Uterine atomy

Question 1

Who gets RhoGAM ? When do they get it?

Answer 1

Rh - mom, 28 week and within 72 hours of delivery

Question 2

What is dystocia

Answer 2

Things that could cause difficult labor

Question 3

What are operative obstetrics techniques

Answer 3

Help facilitate fetus to be brought to the outside

Question 4

What part of uterus is where there is very little contacting done

Answer 4

Lower uterus

Question 5

Where is placenta normally?

Answer 5

Upper front part if uterus

Question 6

Placenta previa is improperly implanted placenta in the _________ with ____________

Answer 6

In lower uterine segment with painless bright red bleeding

Question 7

Risk factors for placenta previa

Answer 7

Maternal age and number of C/S
Scaring in upper uterine segment
Smoking, cocaine
HTN, diabetes

Question 8

Concerns with placenta previa

Answer 8

Bleeding, hemorrhage.. “Afterbirth comes first”

Question 9

What is a medication to stop contractions and calm uterus? When would you use it?

Answer 9

Tocolytics, placenta previa

Question 10

Why should there be no nipple stimulation or vaginal exam with placenta previa?

Answer 10

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.

Question 11

Premature separation or NORMALLY implanted placenta from uterine wall

Answer 11

Abruptio placenta

Question 12

What kind of bleeding would you see with a marginal Abruptio placenta

Answer 12

Bright red bleeding

Question 13

What’s important about central Abruptio placenta

Answer 13

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

Question 14

What is important about fundal height with the complete Abruptio placenta

Answer 14

Fundal height will be much bigger than expected

Question 15

What is a concern with severe central Abruptio placentae?

Answer 15

May observe Couvelaire uterus (blue uterus, abnormal fundal height, mother c/o of lots of pain) and risk of DIC ( disseminated intravascular clotting)

Question 16

What is DIC

Answer 16

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.

Question 17

If there is vaginal bleeding should you do a vaginal or rectal exam?

Answer 17

Not without a double set up!!

Question 18

What color bleeding with Abruptio placenta? Why?

Answer 18

Dark red bleeding because it is behind placenta

Question 19

Symptoms of Abruptio placenta

Answer 19

Dark red bleeding, shock, severe abdominal pain

Question 20

What is somebody with Abruptio placemat at a increased risk for

Answer 20

Hemorrhage, fetal distress, preterm labor/delivery depending on placenta problem

Question 21

What is Cryoprecipitate

Answer 21

Anti-hemorrhage medication

Used with Abruptio placenta

Question 22

Is the clot usually visible on the ultrasound with Abruptio placenta?

Answer 22

Less than 50% of cases

Question 23

Where should cord normally attach

Answer 23

More towards the center

Question 24

What are the three different ways of placental adherence?

Answer 24

* Accreta - (most common) superficially into myometrium * Increta- myometrium invaded * Percreta- myometrium penetrated

Question 25

What is the most common type of placental adherence where the chronic villi attach directly to myometrium of uterus

Answer 25

Accreta

Question 26

Type of placental adherence where myometrium is invaded, attached deep into myometrium

Answer 26

Increta

Question 27

Type of placental adherence where myometrium is penetrated, attached through the myometrium

Answer 27

Percreta

Question 28

Concerns with placental problems & umbilical cord variations

Answer 28

Hemorrhage failure of placenta to separate; abnormal separation of placenta

Question 29

What is a person at increased risk for if they have placental problems and umbilical cord variations

Answer 29

Hemorrhage, fetal distress, preterm labor/delivery depending on problem

Question 30

Most common types of twins

Answer 30

Fraternal (dizygotic) ---67%

Question 31

Two separate ovums? Single ovum?

Answer 31

Two separate- dizygotic | Single- monozygotic

Question 32

With twins, triplets, or more the risk is increasing with ____________

Answer 32

Infertility treatment

Question 33

What things are multifetal pregnancy at risk for

Answer 33

Pulmonary embolism, PROM, preterm labor, increased risk of maternal physical discomfort, increase risk fetal problems, increased risk or postpartum bleeding

Question 34

Why could a multifetal pregnant mother be at risk for postpartum bleeding

Answer 34

Because of stretching

Question 35

Do you just use one fetal monitor on a mom with multi fetus pregnancy

Answer 35

No- If the mom is expecting twins you do a dual external fetal monitor using 2 sets of belts

Question 36

Most common procedure in OB

Answer 36

Amniotomy

Question 37

What is amniotomy

Answer 37

Artificial rupture of membranes "strip membranes"

Question 38

What do you use for amniotomy

Answer 38

Amnihook; sterile vaginal exam

Question 39

When is amniotomy done

Answer 39

After engagement occurs--which is when head is in brim and not popping back out

Question 40

What are some reasons for amniotomy

Answer 40

Induction or to facilitate labor contractions, gain access to fetus, at least 2 cm dilated cervix required

Question 41

When should births occur after an amniotomy?

Answer 41

Must occur within 24 hours because of risk of infection

Question 42

What risks increase if amniotomy is used

Answer 42

Cord prolapse, Abruptio placenta, fluid embolism

Question 43

What is fluid embolism

Answer 43

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

Question 44

What color does amniotic fluid turn?

Answer 44

Blue because it is alkaline

Question 45

Is vagninal fluid acidic/basic

Answer 45

Acidic

Question 46

For amniotomy...check temperature every ____ hours, _______ if no engagement, keep _____ and ________

Answer 46

Temperature every 2 hours, bed rest if no engagement, keep clean and dry

Question 47

Forceps are a stainless steel instrument with two steel parts, _____&______, used to apply traction to fetal head

Answer 47

Cross and lock

Question 48

If trial of labor is followed by failed forceps what is likely

Answer 48

C/S

Question 49

What is outlet when talking about forceps

Answer 49

Most often used. Head on perineum, crowning

Question 50

Are the forcep blades put on at the same time

Answer 50

No. Each blade put on separately brought together and locked