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NURS 2156 OB 2 > Assessing The Fetus & Intrapartum Complications > Flashcards

Assessing The Fetus & Intrapartum Complications Flashcards

1
Q

PDD

A

Post due date

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2
Q

Optional Prenatal Screening

1st trimester

Cell free DNA

Maternal blood drawn.

Gender determined

Test for…

A

Trisomy 21, 18, 13

Fetal Rh

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3
Q

Optional Prenatal Screening

1st trimester

Integrated Screen (2 blood test & US)

TEST FOR…

A

Trisomy 21 & 28

Neural tube defects

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4
Q

Nuchal translucency

Is looking for….

A

Thickness of neck for Chromosomal abnormalities

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5
Q

US by trimester

Confirm pregnancy
Genetic disorder
Id multiple
Check fht
Estimate GA
RO Ectopic
Assist with invasive procedures

A

1st

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6
Q

US by trimester

Structure growth
Fetal growth
Id placenta abnormalities
Confirm fetal presentation
Id fht
BPP
assist invasive procedure
Measure amniotic fluid

A

2 & 3rd

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7
Q

US by trimester

RO retained placental parts (POC)

A

POSTPARTUM

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8
Q

Transvaginal US is used when

A

Early gestation

Late gestation to evaluate cervix (Effacement)

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9
Q

US in early gestation have patient empty bladder first

A

False

Early GA full bladder moves early uterus up from pelvis and visible

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10
Q

Always this type of ultrasound to confirm cephalic posistion at admission

This type of US is used to determine if Cleft plaete

4D?

A

2D (width & height)

3D + depth

W, D, H and time

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11
Q

Chorionic Villus Sampling CVS

Tissue is aspirated from placenta to detect genetic defects in fetus.

Fetal ______

A

Fetal karyotype

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12
Q

Rho-gam is used for CVS

This abnormal diagnostic test is preformed when…

A

1st trimester

10 - 13 weeks

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13
Q

US guides needle through ab and aspirates fluid from amniotic sac.

Amniocentesis

When?

Determines (4)

A

15 - 20 wks 2nd trimester

Fetal karyotype
Chromosomal abnormalities
Lung maturity / bilirubin level (3rd tri)

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14
Q

Nonstress test NST

Requirements for Reactive & Nonreactive

A

Reactive = Good 2 Accelerations within 20 - 40 minutes

Nonreactive = bad lack of the 2 Accelerations in 20 - 40 minutes

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15
Q

Accelerations give us an idea of what is happening with this body system of the baby

A

Neurological

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16
Q

Tips to promote Accelerations

A

Eating
Drink
Posistion NO SUPINE
Sounds baby can hear
Touching belly
Fetal Scalp stimulation- Only in Labor - Contradicted in FHR decelerations

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17
Q

Contraction Stress Test - AKA Oxytocin Stress Test

Determines well being of baby in response to….

Used to determine…

Contraindicated in…

A

3 contractions in 10 minute period

How well baby will handle labor

CS patient

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18
Q

Contraction Stress Test CST

Define

Negative
Positive
Equivocal

A

Negative = Good things
No late decelerations

Positive = Bad thing
Late decelerations present with 50% UC

Equivocal (3) types

Suspicious: Intermittent late decelerations or sig variable Decelerations

Late Decelerations in with contractions more frequent than every 2 minutes or last longer than 90 seconds

Insufficient Fewer than 3 UC in 10 minutes or FHR that cannot be interpreted

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19
Q

5 components of Biophysical profile

A

Fetal breathing movements US
Gross body movements US
Fetal Tone US
NST results EFM
Amniotic fluid volume US

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20
Q

Scoring Biophysical profile

NST result

Fetal breathing

Gross Body Movements

Fetal tone

Amniotic fluid volume

A

NST result: 2 reactive / 0 Nonreactive

Fetal breathing: (2) >1 episode >30 sec within 30 min / 0 Absent

Gross Body Movements: (2) >3 body/limb movements in 30 min / (0) <2 movements in 30 minutes

Fetal tone: (2) >1 extension and flexion / (0) Slow extension and partial flexion, no movement

Amniotic fluid volume: (2) >1 cm pocket, in 2 different areas / (0) Doesn’t meet other criteria

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21
Q

Normal score for Biophysical profile

A

8 or 10

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22
Q

Reasons to get a Biophysical profile

A

High Risk

Nonreactive Nonstress Test results

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23
Q

Shoulder dystocia

When the head delivers but shoulders are trapped by pubic bone.

Interventions

SHOULDER

A

SHOULDER

S = Surgery for risk factors & turtle sign

Risk factors: LGA, DM, Obesity, AMA, Operative Delivery.

MOST COMMON = NO RISK FACTORS

TURTLE SIGN = head delivers all the way but gets sucked back in.

H = Help called

Minimum in Delivery Room:
Labor nurse, Dr / Midwife, Baby Nurse at warmer

O = Over to Hands & Knees.
(Gaskin Maneuver)
Flipping movements/ gravity Will dislodge impacted shoulder. Difficulty for epidural)

U = Use McRoberts & Suprapubic Pressure.
Flex moms legs to abdomen/ Lower HOB / Apply Suprapubic pressure NOT FUNDAL (Downward Lateral “CPR-like”)

L = Leave extra space for delivery
(Empty bladder / Episiotomy- Allows more room for invasive Maneuver)

D = delivery provider procedures
(Delivery of posterior arm / rotational Maneuver (Woods & Rubin) Pressure is put on anterior or posterior side of babies shoulder to rotate and release shoulder.

Maneuver of Last Resort

Deliberate Clavicle Fracture
Zavanellis Maneuver: Head pushed back into uterus and C/S.

E = Ensure good communication
SBAR, CHECK BACK (closed communication), CUS, 2 Challenge rule (Assert your concern atleast 2x then move up chain of command)

R = Rigorous Documentation
Delivery time Head, shoulder, Interventions, Personelle

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24
Q

Shoulder dystocia is when Head delivers but shoulder get stuck on pelvis.

Risk factors…

Turtle sign…

A

Risk factors: LGA, DM, Obesity, AMA, Operative Delivery ( forceps )

MOST COMMON = NO RISK FACTORS

TURTLE SIGN = head delivers all the way but gets sucked back in.

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25
Shoulder dystocia When the head delivers but shoulders are trapped by pubic bone What does the "H " stand for...
= Help called Minimum in Delivery Room: Labor nurse, Dr / Midwife, Baby Nurse at warmer
26
Shoulder dystocia When the head delivers but shoulders are trapped by pubic bone Describe gaskins Maneuver... Possible contraindicated with.....
On all 4s, running Maneuver Epidural
27
Flex moms legs to abdomen Lower HOB Apply Suprapubic pressure NOT FUNDAL (Downward Lateral "CPR-like" small quick pumps) Name of Maneuver...
Use McRoberts & Suprapubic Pressure.
28
Shoulder dystocia When the head delivers but shoulders are trapped by pubic bone Do this with the bladder... Episiotomy?
Catheter/ empty bladder Episiotomy YES
29
You will get Vacation & Sick days in nursing
😀
30
Name good communication Teachniques (4) How many times do you Assert your concern before moving up the chain of command
SBAR, CHECK BACK (closed communication), CUS, 2 Challenge rule (Assert your concern atleast 2x then move up chain of command)
31
What is documented in shoulder dystocia
Delivery time Head, shoulder, Interventions, Personelle
32
Assessment after Shoulder dystocia
Brachial Plexus nerve Broken Clavicle/ Humerus Bruising Skin inspection/ TCB Assess Moro Palpate for crepitus & asymmetry Hypoxia brain damage Assess cord blood gas
33
Low pulse ox fetus how long do we give them outside the uterus to increase pulse ox
10 minutes
34
Airway posistion
Sniffing posistion Nose slightly upwards
35
Suction mouth or nose firsr
Mouth
36
Low pulse ox infant after Drying, warming, stimulation Neutral Sniffing breathing posistion Suction What is the next intervention
Positive pressure ventilation Ambu bag / NeoPuff & SPO² monitoring
37
4 Ps of dysfunctional labor
Problems with POWER PASSENGER PASSAGE PSYCHE
38
Birth occurs within 3 hrs...
Preciptious birth
39
Complications with Preciptious birth
Transient newborn tachypnea Hypoxia Bruising Hematoma Laceration
40
Prolonged labor Look at - Reasons why Epidural? Previous SVD How big is baby? Things to do Min invasive procedure Monitor temp & EFM Promote rest in early labor and labor down Break Fear, tension, pain cycle Advocate more time for labor/ avoid CS Complications......
Both infection Maternal exhaustion Anxiety & fear Arrest Dilation & Decent
41
Prevent CS how
Early labor: Walking move birthing ball Promote change in posistion Pitocin when ripe Avoid AROM Delay epidural to promote movement Time
42
Bishop score measures...
Cervical ripeness 8 or higher
43
Most common reasons for CS sections
1. Labor arrest 2. Bad FHT 3. Malposistions
44
Normal labor progression 4-5 cm... 5-6 cm...
4 - 5cm = 6 hrs 5 - 6 cm = 3 hrs
45
PROM <37 wks is called Goal intervention....
Preterm Premature Rupture Membranes Keep mom pregnant in the hospital until baby is deliverable
46
PPROM <37 WKS Risks
Infection Cord compression Oligohydramnios Respiratory Distress Syndrome in preterm
47
PROM TX TERM... PRETERM... (meds)
Term: Induced after SROM, Monitor Temps, avoid invasive procedure (INFECTION RISK) Preterm: Temp, avoid invasive procedure, antibiotics, tocolytics, steroids
48
RO ROM (3) Procedures
Pooling (+ is pool of fluid noted near cervix) Nitrazine - blue is ROM Ferning = positive
49
Amniotic fluid Starts slow and increases and decreases around 32 weeks. Give value and associated problems Oligohydramnios / Polyhydramnios
Oligohydramnios <5 ROM, fetal hypoxia, fetal kidney dysfunction Polyhydramnios >25 DM, Esophageal atresia, fetal anomalies, kidney issues
50
Preterm dates (3) Subcategories Term (3) Subcategories Postterm
Preterm 20 - 36.6 Extreme Viability- 27.6 Very 28 -31.6 Late 32 - 36.6 Term 37 - 41.6 Early 37 - 38.6 Full 39 - 40.6 Late 41 - 41.6 Posterm 42
51
Preterm labor: Cervical changes at 20 - 36.3 weeks Risk for preterm baby.... Risk for mom....
Baby: Cerebral Palsy, Development delay, vision &, hearing problems Mom: same as term
52
ID preterm labor Cervical length... Incomptent cervix.. Fetal fibronectin Test.... Infection... watch for...
<25 mm Cerclage procedure - Stitch Cervix closed early GA Test amniotic membrane protein associated. More accurate for negative results: FALSE POSITIVE FROM SVE, Intercourse, VB Uti
53
Preterm treatment Promote this posistion...
Side laying relaxation NOT COMPLETE BEDREST
54
Drugs used for preterm labor Betamethasone Dose/Route/Frequency Function:..... Used in which patients (Time Frame) Greatest benefit SE
12 mg IM ×2 Doses 24 hours apart Promotes surfactant production & fetal lung maturity Used 23- 36 GA w/ risk of delivery in 7 days Greatest benefits when birthing within 24 hrs of 1st dose SE elevated BS for 7 - 10 days
55
Magnesium Sulfate (Preterm use) Dose / Route / time Function....
4 - 6 mg loading dose over 30 minutes follow by 2 gm / hr Function: Neurological protection Reduces Cerebral Palsy Smooth muscle relaxants
56
Preterm Drugs Nifedipine (Procardia) Indomethacin (Indocin) Terbutaline (Brethine) Prostaglandin synthesis inhibitor, NSAID (48 hr max due to closure of ductus Arteriosus) Treats PDA after birth Beta-adrenergic bronchodilator. USE: SLOWS DOWN CONTRACTIONS SE Tachycardia, palpation, Dysrhthmias, chest pain, Dyspnea. / Propranolol a BETABLOCKER Will reverse severe side effects CCB (Calcium Antagonist) Treats PTL & HTN What do they all have in common?
Nifedipine (Procardia) CCB (Calcium Antagonist) Treats PTL & HTN Indomethacin (Indocin) Prostaglandin synthesis inhibitor, NSAID (48 hr max due to closure of ductus Arteriosus) Treats PDA after birth Terbutaline (Brethine) Beta-adrenergic bronchodilator. SE Tachycardia, palpation, Dysrhthmias, chest pain, Dyspnea. / Propranolol a BETABLOCKER Will reverse severe side effects
57
BISHOP SCORE Value that vag birth is most likely Para 0: Value associated with successful IOL Para 1: Value associated with successful IOL Score that needs cervical ripening agents
8+ 7+ 5+ 4 or less
58
Misoprostol Dose route.... Hold...
25 - 50 mcg PO or Intravaginal Q4hrs Hold if >3 UC in 10 minutes
59
Prostaglandin E1 used to treat gastric ulcers Off lable use...(2) Contradictions... Risk....
Cervical ripener / PPH Contradicted previous uterine surgery (rupture risk) Risk: Tachysystole, Cat 2 or 3 tones, uterine rupture
60
Dinoprostone (Cervidill) Describe Risk
Cervical ripener Time released prostaglandin gel on a string left next to cervix for 12 hrs. Risk: Tachycardia, Cat 2 or 3 FHT, Uterine rupture
61
Can oxytocin be used to ripen cervix...
Yes
62
Mechanical forms of induction
AROM Membrane Sweep Uterine Foley bulb Lamonaria sticks
63
Marginal cord insertion is when the umbilical cord implants with in 3 cm of edge of placenta. Risk....
SGA Baby Detachment from the placenta
64
Velamentous Cord insertion... Risk for...(this condition)
When cord embeds into amniotic sac Risk for: Vasa Previa
65
Prolapse cord after ROM Risk Factors... Baby is most likely in this station... Interventions...
Small fetus, breech position, transverse lie, Polyhydramnios +2, +1 Lift baby's head off cord. Treatment: maternal posistion (Knee to chest / Trendelenberg, elevated hips) CS unless vag birth is faster Avoid touching cord!
66
Uterine Rupture What happens to contractions? What happens to the station? Worst case scenario
Contractions STOP Station REDUCES Baby Dies
67
Uterine Inversion Uterus complete or part way turned inside out. Cause...
Pulling on cord after birth Fundal pressure during or after birth Weak uterus
68
Interventions for uterine Inversion
Push it back in place. Give Pitocin after back in place May require hysterectomy
69
Anaphylactoid Syndrome aka Amniotic fluid embolism Mom blood stream is exposed to babies components Cascade of things going wrong. List maternal problems... Treatments....(FLUIDS)
DIC, Left Ventricle failure, organ failure, hemostatic instability. F FOLLOW CPR guidelines L liters of oxygen U Utilize mech vent I IV fluids D Donated blood S Survival of Fetus/ CS for cardiac arrest for mom
70
When is the fetus more vurnable to trauma forces 1st or 3rd
3rd more vulnerable 1st it's protected by pelvis
71
Any type of Trauma Requires hospital observation to RO abruption. With continuous monitoring T or F
T
72
Trauma Fetal effects
Hypoxia, acidosis, neurological defects, fractures, hemorrhage
73
Trauma management does follow the ABC but this.. Avoid Supine / Use wedge Abruption risk. Monitor baby Give this medication....
CAB Rho-gam
74
Gaskins Maneuver Describe/ Use
4 on the floor / Running Start posistion Used to allow room for baby stuck in shoulder dystocia
75
Rubins Maneuver
Pressure to the back of the baby’s front shoulder to rotate it inward, narrowing the shoulder width to help it pass through the birth canal.
76
Woods screw
Pressure to the front of the baby's back shoulder, rotating it in a corkscrew motion to help release the shoulder.
77
McRoberts Maneuver
Flexing the mother’s thighs sharply up toward her abdomen, which flattens the spine and tilts the pelvis, helping to widen the birth canal
78
Zavanellis Maneuver....
Head pushed back into uterus and C/S. Absolute last resort
79
Name and describe 3 tocolytics
Nifedipine, a calcium channel blocker, is used as a tocolytic by relaxing the smooth muscles of the uterus to reduce contractions in cases of preterm labor. Indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), also acts as a tocolytic by inhibiting prostaglandin synthesis, which helps decrease uterine activity and delay labor. Terbutaline, a beta-adrenergic agonist, is used to temporarily halt uterine contractions by relaxing uterine muscle, often administered in acute settings to manage preterm labor.
80
Incomplete abortion Interventions (5)
Interventions for... TS IV Fluids DC IV Oxytocin Hemorrhage medication (3) Misoprostol (Cytotec), Methylergonovine (Methergine) Carboprost (Hemabate)
81
Symptoms include: Membranes ruptured Cervix dilated Contractions Bleeding Describes....
Inevitable Abortion
82
When should you US labor and induction patients to confirm cephalic posistion at admission
Always
83
Tissue is aspirated to detect presence of genetic defects in fetus (Fetal Karyotype)...
Chorionic Villus Sampling
84
Results time frame for CVS
Preliminary 2 - 3hrs Full 5 - 7 days
85
Most accurate diagnostic test
Amniocentesis
86
Definition of Accelerations >32 wks <32wks
15 × 15 >32 weeks 10 × 10 <32 weeks
87
What type of result is a healthy result in NST
Reactive = 2 Accelerations within 20 - 40 mins Good Oxygenation
88
Shoulder dystocia Risk Factors
High birth weight GDM Operative vag delivery Previous shoulder dystocia Maternal obesity AMA
89
Do you debrief with patient and their family after SHOULDER Dystocia
Yes. But seperate
90
Preciptious labor = Preciptious birth =
Preciptious labor = <3 hrs Preciptious birth = Fast delivery (could be any length of time)
91
What date does the placenta become No Good.
>42 weeks
92
When is the latest we would induce labor
41 wks To avoid reaching 42 wks when the Placenta is No Good
93
Oxytocin has the same Contradictions as...
SVD Previa, breech, HSV lesions, uterine incision, prolapsed cord. Fetal distress: Cat 2 & 3
94
Prolonged use of Pitocin may oversaturate the receptor sites and cause...
Increase risk of PPH
95
What is the Goal with Oxytocin UC q ____ min, ____ sec, intensity ____ mmHg, resting tone < _____
UC q 2-3 min, 40 - 90 sex, 50- 80 mmHg, resting tone <20
96
Induction/ Aug Dose Oxytocin Start ____ & increase Doseage by ____ every 30 minutes Dose is increased by uterine response & absence of adverse effects
Start 0.5 - 1 mU/min & increase Doseage by 1- 2 mU/min every 30 minutes
97
Oxytocin PPH Prevention Dose
10 - 40U titrate
98
Which is associated with Vada previa Velamentous Cord insertion or Marginal Cord Insertion
Velamentous Cord insertion
99
SS Hypovolemic shock Pain ab chest scapula inspiratory Contractions STOP Station RECEDES Palpation of fetus outside the uterus Abnormal fetal HR Fetal Deoxygenation / Death From this problem....
Uterine Rupture
100
Uterine Rupture Tx if unstable
Immediate CS
101
Down syndrome Turner syndrome Klinefelter syndrome Trisomy 18 Trisomy 13 Cri du Chat syndrome Fragile X syndrome All this type of problem
Down syndrome (trisomy 21) Turner syndrome (missing X chromosome) Klinefelter syndrome (extra X chromosome in males) Trisomy 18 (Edwards syndrome), Trisomy 13 (Patau syndrome), Cri du Chat syndrome (deletion on chromosome 5) Fragile X syndrome Chromosomal

NURS 2156 OB 2 (12 decks)

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