Ch 41 Obstetrics Flashcards
The process of forming specialized body systems is known as….
Organogenesis
Describe the process of conception and fetal development from ovulation to the fetal stage. (pp 2327–2329)
From fertilization & implantation, the blastocyte (egg) migrates & implants into the endometrial wall approx 1 wk after conception.
Wk 1: the enzymatic activity and development begins.
Wk 2: blastocyte evolves into embryonic disc. Amniotic sac & placenta begin to differentiate their specialized duties.
Wk 3: egg has developed into an embryo, organogenesis begins, CNS & CV system, spine, & portions of skeletal system begin to develop. The heart begins to beat.
Wk 4: Placenta develops & acts as an endocrine gland & liver for the fetus, synthesizes glycogen, cholesterol, fatty acids, & produces antibodies.
Terminology commonly used to refer to A woman who is pregnant for the 1st time.
Primigravida
Terminology commonly used to refer to a woman who has only had 1 delivery
Primipara
Be aware of special considerations involving pregnancy in different cultures and with teenage patients. (pp 2332–2333)
Different cultures may have different views on pregnancy. It is important to respect these differences. Various differing views could be:
A.) some may not allow males to assess a pregnant pt.
B.) some may view pregnancy as a family status symbol
C.) some could cause shame, being unwed, raped, etc.
D.) Teenage pregnancies are sensitive, be sure to maintain their privacy, chaperone’s recommended for examinations
How would you document a pt that has had 4 pregnancies, but only carried 1 to term?
G4P1
Or
G4A3P1 (to show the 3 spontaneous abortions)
Normal changes that happen to a woman’s body during pregnancy.
Increased overall blood volume
Increased HR
Changes in blood clotting
At what stage of pregnancy should a pregnant pt be transported left lateral recumbent, and why?
2nd & 3rd trimester, 3+ months.
To displace the weight of the uterus from the INFERIOR VENA CAVA.
Describe the indications of an imminent delivery. (pp 2336–2337)
Regularly spaced contractions (less than 2 mins)
Gradually shorten interval between contractions
Intensity of contractions gradually increases
Pain meds do not eliminate the pain
Progressive effacement & dilation of cervix
Discuss complications related to pregnancy disorders (pp 2338–2343)
Substance abuse (including caffeine, tobacco, alcohol)
Peripartum Cardiomyopathy (1 Mon prior to delivery, up to 5 Mon after delivery)
Preeclampsia/Eclampsia
Seizures
Gestational Diabetes
Asthma/SOB
Renal disorders
Rh factor
Infections (HIV, STD’s, UTI, Cytomeglovirus (CMV))
Cholestasis (liver disorder where hormones affect the gallbladder, profuse, painful itching of hands and feet)
S/S of false labor.
Irregularly spaced contractions
Interval between contractions remains long
Intensity of contractions remains the same
Analgesics usually eliminate the pain
No cervical changes
When a pregnant uterus compresses the inferior vena cava, blood return to the heart is diminished, causing hypotension. What is this syndrome called?
Supine hypotensive syndrome
The leading cause of life-threatening infections in newborns during their first week of life is……
Strep B, that lives in the GU/GI tract of healthy individuals, and can be passed on to the newborn from the mother. Usually shows no S/S in healthy individuals. Mom is tested for this bacteria during at 35-37 wk gestation. Usually manifests within 1st 7 days of baby’s life, can cause pneumonia, sepsis, & meningitis.
What stage of labor does this describe?
Labor pains begin
Effacement begins, thinning and shortening of cervix
Progressive cervical dilation
Contractions become more intense, closer together, lasting longer
Cervix becomes fully dilated at 10cm
Woman feels the urge to push or have a BM
Amniotic Sac often ruptures
First Stage of Pregnancy
Explain the steps involved in normal delivery management. (pp 2349–2354)
Transport decision, rapid transport or deliver in place
Position pt, usually semi-fowlers, but could be standing, kneeling, or side-lying
Prepare OB kit
Encourage pt to rest between contractions, if she finds it difficult to not bear down, have her pant between contractions, panting makes it near impossible to push while doing so, bearing down requires a closed glottis.
Explain the necessary care of the baby as the head appears. (p 2352)
Control the delivery.
Place gentle pressure on newborns head, so it doesn’t delivery too quickly, or tear mom.
Support baby’s head as it starts to turn.
Slip your finger alongside newborns head to check for nuchal cord, if you find one, try to slip it over baby’s head. If this fails, place umbilical clamps 2in apart and cut the cord between the clamps.
If newborns airway appears obstructed, suction with bulb syringe.
Gently support the baby for duration of delivery.
Once delivered, maintain its body position at the same level as the vagina to prevent blood drainage from the umbilical cord.
Wipe blood or mucus from baby’s nose and mouth, suction as needed, dry baby with sterile towels, wrap in dry blanket. Record time of birth.
Describe the procedure followed to cut and tie the umbilical cord. (p 2354)
Handle with care, it tears easily.
Once the cord has stopped pulsating, clamp the cord about 4ins from baby’s navel, and clamp again approx 2 ins from other clamp.
Cut the cord between the 2 clamps.
Do not remove the 1st clamp.
Wrap newborn in dry blanket.
Describe delivery of the placenta. (p 2354)
If mom is stable, give newborn to her. Mom can begin breastfeeding, will stimulate uterus contractions, can speed up delivery of placenta.
Should happen within 30 mins after delivery of baby.
Place placenta in plastic bag and transport to the hospital.
Potential labor complications. (pp 2356–2357)
Preterm Labor
Fetal Distress
Uterine Rupture
high-risk pregnancy considerations birth staining fetal macrosomia disproportion. (pp 2357–2359)
Precipitous Labor - entire labor & birth took less than 3hrs.
Post-term delivery - delivery after 42wks gestation, possible malnutrition of baby, d/t placenta no longer functioning, increased chance of meconium aspiration, baby could be larger, making delivery more complicated, should get cesarean section.
Meconium staining - babies 1st BM in utero. Could cause respiratory depression in newborn. If needed assist with O2 & ventilations.
Fetal Macrosomia - Fetus weighing 9lbs or greater.
Multiple Gestations
Intrauterine Fetal Death
You may note a foul odor
Delivered fetus could have skin blisters, sloughing, and discoloration.
Head will be soft and deformed
DO NOT attempt to resuscitate an obviously dead fetus.
DO NOT confuse this situation with a newborn that has experienced a cardiopulmonary arrest from complications of delivery. You DO attempt to resuscitate these babies.
What is it called when the placenta fails to detach properly & adheres to the uterine wall, as a result, the uterus literally turns inside out.
Uterine Inversion
Potential causes for postpartum hemorrhage.
A.) lacerations, tears from delivery
B.) Prolonged labor, uterus gets “tired”.
C.) Retained products of conception
D.) Uterine atony, uterus loses ability to contract after childbirth
E.) Grand multiparity- w/many pregnancies, uterine tissue is replaced w/fibrous tissue, and it doesn’t contract as well.
F.) Multiple babies - overstretched uterine do not contract as well.
G.) Placenta Previa
H.) A full bladder may prevent proper placental separation and uterine contraction.
Rapid Identification of causes and treatment of maternal cardiac arrest, using the ABCDEFGH mnemonic.
Anesthetic complications
Bleeding
Cardiovascular complications
Drugs
Embolism
Fever
General H’s&T’s
Hypertension
What breech position is when the baby presents butt first?
Franks Breech
What breech position is when baby presents feet first, 1 or both?
Incomplete Breech
What type of presentation presents when the fetus lies crosswise in the uterus, one hand presenting?
Transverse presentation
Discuss management of maternal cardiac arrest. (pp 2367–2368)
Functions of the placenta.
A.) Respiratory gas exchange
B.) Transport of nutrients from mother to fetal circulation
C.) Excretion of waste
D.) Transfer heat from mom to fetus
E.) Hormone production
Terminology commonly used to refer to A woman who has had 2 or more pregnancies, irrespective of the outcome.
Multigravida
Terminology commonly used to refer to A woman who has had 2 or more deliveries
Multi-area
Terminology commonly used to refer to A woman who has never delivered.
Nullipara
Minimum PPE precautions need for imminent delivery.
Gloves, mask, eye protection, & gown
How do you transport a pregnant pt that requires spinal immobilization?
On an LSB, padded underneath on the RIGHT side.
Expulsion of the fetus, from any cause, before the 20th week of gestation
Abortion
Spontaneous abortion (miscarriage) or
Elected abortion
3 or more consecutive pregnancies that ends in abortion
Recurrent pregnancy loss
Fetus dies during 1st 20 weeks of gestation, but remains in utero.
Missed abortion.
Definitive treatment is D&C at hospital.
A spontaneous abortion that can not be prevented.
Imminent abortion
When part of the fetus has been expelled from the body, but portions remain in utero.
Incomplete abortion
An abortion that is threatening to take place, vaginal bleeding, abd pain/cramps.
Threatened abortion
A premature partial or incomplete separation of a normally implanted placenta from the wall of the uterus. Pt will present with sudden, severe abd pain, decreased fetal movement, possible vaginal bleeding, may present with signs of shock, uterus will be rigid and tender.
Abruptio Placentae
When the placenta is implanted low in the uterus, and as it grows, it blocks the cervical canal.
Placenta Previa
What stage of labor does this describe?
This stage begins with the cervix is fully dilated
Head of fetus presents (crowning)
Baby rotates to align head with shoulders
Contractions are more intense, 2-3 mins apart
This stage of delivery is concluded once the baby is fully delivered
Usually takes 1-2hrs in nullipara, 30 mins in multipara
Second Stage of labor does
What stage of labor does this describe?
When the placenta separates from the uterus and is expelled from the uterus
Usually happens within 30 mins of delivery of newborn
Second Stage of labor
A plug of mucus, sometimes mixed with blood, that is expelled from the dilating cervix.
Bloody show
What’s it called when the head has been delivered, but the shoulders can’t pass through?
Shoulder Dystocia
