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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
Q

Shoulder dystocia When the head delivers but shoulders are trapped by pubic bone

What does the “H “ stand for…

A

= Help called

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

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26
Q

Shoulder dystocia When the head delivers but shoulders are trapped by pubic bone

Describe gaskins Maneuver…

Possible contraindicated with…..

A

On all 4s, running Maneuver

Epidural

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27
Q

Flex moms legs to abdomen

Lower HOB

Apply Suprapubic pressure NOT FUNDAL (Downward Lateral “CPR-like” small quick pumps)

Name of Maneuver…

A

Use McRoberts & Suprapubic Pressure.

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28
Q

Shoulder dystocia When the head delivers but shoulders are trapped by pubic bone

Do this with the bladder…

Episiotomy?

A

Catheter/ empty bladder

Episiotomy YES

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29
Q

You will get Vacation & Sick days in nursing

A

😀

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30
Q

Name good communication Teachniques (4)

How many times do you Assert your concern before moving up the chain of command

A

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

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31
Q

What is documented in shoulder dystocia

A

Delivery time Head, shoulder, Interventions, Personelle

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32
Q

Assessment after Shoulder dystocia

A

Brachial Plexus nerve
Broken Clavicle/ Humerus
Bruising
Skin inspection/ TCB
Assess Moro
Palpate for crepitus & asymmetry
Hypoxia brain damage
Assess cord blood gas

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33
Q

Low pulse ox fetus how long do we give them outside the uterus to increase pulse ox

A

10 minutes

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34
Q

Airway posistion

A

Sniffing posistion

Nose slightly upwards

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35
Q

Suction mouth or nose firsr

A

Mouth

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36
Q

Low pulse ox infant after

Drying, warming, stimulation
Neutral Sniffing breathing posistion
Suction

What is the next intervention

A

Positive pressure ventilation

Ambu bag / NeoPuff

&

SPO² monitoring

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37
Q

4 Ps of dysfunctional labor

A

Problems with

POWER
PASSENGER
PASSAGE
PSYCHE

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38
Q

Birth occurs within 3 hrs…

A

Preciptious birth

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39
Q

Complications with Preciptious birth

A

Transient newborn tachypnea
Hypoxia
Bruising
Hematoma
Laceration

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40
Q

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……

A

Both infection
Maternal exhaustion
Anxiety & fear
Arrest Dilation & Decent

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41
Q

Prevent CS how

A

Early labor: Walking move birthing ball
Promote change in posistion
Pitocin when ripe
Avoid AROM
Delay epidural to promote movement
Time

42
Q

Bishop score measures…

A

Cervical ripeness 8 or higher

43
Q

Most common reasons for CS sections

A
  1. Labor arrest
  2. Bad FHT
  3. Malposistions
44
Q

Normal labor progression

4-5 cm…
5-6 cm…

A

4 - 5cm = 6 hrs
5 - 6 cm = 3 hrs

45
Q

PROM <37 wks is called

Goal intervention….

A

Preterm Premature Rupture Membranes

Keep mom pregnant in the hospital until baby is deliverable

46
Q

PPROM <37 WKS

Risks

A

Infection
Cord compression Oligohydramnios
Respiratory Distress Syndrome in preterm

47
Q

PROM TX

TERM…

PRETERM… (meds)

A

Term: Induced after SROM, Monitor Temps, avoid invasive procedure (INFECTION RISK)

Preterm: Temp, avoid invasive procedure, antibiotics, tocolytics, steroids

48
Q

RO ROM

(3) Procedures

A

Pooling (+ is pool of fluid noted near cervix)

Nitrazine - blue is ROM

Ferning = positive

49
Q

Amniotic fluid Starts slow and increases and decreases around 32 weeks.

Give value and associated problems

Oligohydramnios / Polyhydramnios

A

Oligohydramnios <5
ROM, fetal hypoxia, fetal kidney dysfunction

Polyhydramnios >25
DM, Esophageal atresia, fetal anomalies, kidney issues

50
Q

Preterm dates (3) Subcategories
Term (3) Subcategories
Postterm

A

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
Q

Preterm labor: Cervical changes at 20 - 36.3 weeks

Risk for preterm baby….
Risk for mom….

A

Baby: Cerebral Palsy, Development delay, vision &, hearing problems

Mom: same as term

52
Q

ID preterm labor

Cervical length…
Incomptent cervix..
Fetal fibronectin Test….
Infection… watch for…

A

<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
Q

Preterm treatment

Promote this posistion…

A

Side laying relaxation
NOT COMPLETE BEDREST

54
Q

Drugs used for preterm labor

Betamethasone

Dose/Route/Frequency

Function:…..

Used in which patients (Time Frame)

Greatest benefit

SE

A

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
Q

Magnesium Sulfate (Preterm use)

Dose / Route / time

Function….

A

4 - 6 mg loading dose over 30 minutes follow by 2 gm / hr

Function: Neurological protection
Reduces Cerebral Palsy
Smooth muscle relaxants

56
Q

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?

A

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
Q

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

A

8+

7+

5+

4 or less

58
Q

Misoprostol

Dose route….

Hold…

A

25 - 50 mcg PO or Intravaginal Q4hrs

Hold if >3 UC in 10 minutes

59
Q

Prostaglandin E1 used to treat gastric ulcers

Off lable use…(2)
Contradictions…
Risk….

A

Cervical ripener / PPH
Contradicted previous uterine surgery (rupture risk)
Risk: Tachysystole, Cat 2 or 3 tones, uterine rupture

60
Q

Dinoprostone (Cervidill)

Describe

Risk

A

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
Q

Can oxytocin be used to ripen cervix…

A

Yes

62
Q

Mechanical forms of induction

A

AROM
Membrane Sweep
Uterine Foley bulb
Lamonaria sticks

63
Q

Marginal cord insertion is when the umbilical cord implants with in 3 cm of edge of placenta.

Risk….

A

SGA Baby

Detachment from the placenta

64
Q

Velamentous Cord insertion…

Risk for…(this condition)

A

When cord embeds into amniotic sac

Risk for: Vasa Previa

65
Q

Prolapse cord after ROM

Risk Factors…
Baby is most likely in this station…

Interventions…

A

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
Q

Uterine Rupture

What happens to contractions?

What happens to the station?

Worst case scenario

A

Contractions STOP

Station REDUCES

Baby Dies

67
Q

Uterine Inversion

Uterus complete or part way turned inside out.

Cause…

A

Pulling on cord after birth

Fundal pressure during or after birth

Weak uterus

68
Q

Interventions for uterine Inversion

A

Push it back in place.

Give Pitocin after back in place

May require hysterectomy

69
Q

Anaphylactoid Syndrome aka Amniotic fluid embolism

Mom blood stream is exposed to babies components

Cascade of things going wrong.

List maternal problems…

Treatments….(FLUIDS)

A

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
Q

When is the fetus more vurnable to trauma forces

1st or 3rd

A

3rd more vulnerable

1st it’s protected by pelvis

71
Q

Any type of Trauma Requires hospital observation to RO abruption. With continuous monitoring

T or F

A

T

72
Q

Trauma

Fetal effects

A

Hypoxia, acidosis, neurological defects, fractures, hemorrhage

73
Q

Trauma management does follow the ABC but this..

Avoid Supine / Use wedge

Abruption risk. Monitor baby

Give this medication….

A

CAB

Rho-gam

74
Q

Gaskins Maneuver

Describe/ Use

A

4 on the floor / Running Start posistion

Used to allow room for baby stuck in shoulder dystocia

75
Q

Rubins Maneuver

A

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
Q

Woods screw

A

Pressure to the front of the baby’s back shoulder, rotating it in a corkscrew motion to help release the shoulder.

77
Q

McRoberts Maneuver

A

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
Q

Zavanellis Maneuver….

A

Head pushed back into uterus and C/S.

Absolute last resort

79
Q

Name and describe 3 tocolytics

A

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
Q

Incomplete abortion

Interventions (5)

A

Interventions for…

TS
IV Fluids
DC
IV Oxytocin
Hemorrhage medication (3)
Misoprostol (Cytotec), Methylergonovine (Methergine)
Carboprost (Hemabate)

81
Q

Symptoms include:
Membranes ruptured
Cervix dilated
Contractions
Bleeding

Describes….

A

Inevitable Abortion

82
Q

When should you US labor and induction patients to confirm cephalic posistion at admission

A

Always

83
Q

Tissue is aspirated to detect presence of genetic defects in fetus (Fetal Karyotype)…

A

Chorionic Villus Sampling

84
Q

Results time frame for CVS

A

Preliminary 2 - 3hrs

Full 5 - 7 days

85
Q

Most accurate diagnostic test

A

Amniocentesis

86
Q

Definition of Accelerations

> 32 wks

<32wks

A

15 × 15 >32 weeks

10 × 10 <32 weeks

87
Q

What type of result is a healthy result in NST

A

Reactive = 2 Accelerations within 20 - 40 mins Good Oxygenation

88
Q

Shoulder dystocia Risk Factors

A

High birth weight

GDM

Operative vag delivery

Previous shoulder dystocia

Maternal obesity

AMA

89
Q

Do you debrief with patient and their family after SHOULDER Dystocia

A

Yes. But seperate

90
Q

Preciptious labor =

Preciptious birth =

A

Preciptious labor = <3 hrs

Preciptious birth = Fast delivery (could be any length of time)

91
Q

What date does the placenta become No Good.

A

> 42 weeks

92
Q

When is the latest we would induce labor

A

41 wks

To avoid reaching 42 wks when the Placenta is No Good

93
Q

Oxytocin has the same Contradictions as…

A

SVD

Previa, breech, HSV lesions, uterine incision, prolapsed cord.

Fetal distress: Cat 2 & 3

94
Q

Prolonged use of Pitocin may oversaturate the receptor sites and cause…

A

Increase risk of PPH

95
Q

What is the Goal with Oxytocin

UC q ____ min, ____ sec, intensity ____ mmHg, resting tone < _____

A

UC q 2-3 min, 40 - 90 sex, 50- 80 mmHg, resting tone <20

96
Q

Induction/ Aug Dose Oxytocin

Start ____ & increase Doseage by ____ every 30 minutes

Dose is increased by uterine response & absence of adverse effects

A

Start 0.5 - 1 mU/min & increase Doseage by 1- 2 mU/min every 30 minutes

97
Q

Oxytocin

PPH Prevention Dose

A

10 - 40U titrate

98
Q

Which is associated with Vada previa

Velamentous Cord insertion or Marginal Cord Insertion

A

Velamentous Cord insertion

99
Q

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….

A

Uterine Rupture

100
Q

Uterine Rupture

Tx if unstable

A

Immediate CS

101
Q

Down syndrome
Turner syndrome
Klinefelter syndrome
Trisomy 18
Trisomy 13
Cri du Chat syndrome
Fragile X syndrome

All this type of problem

A

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 (8 decks)

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