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NU 330 > Chapter 10 > Flashcards

Chapter 10 Flashcards

1
Q

what is dystocia?

A
  • dysfunctional or difficult labor
  • sometimes called “failure to progress”
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2
Q

what is the most common reason for a c-section?

A

dystocia

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3
Q

what factors are associated with dystocia?

A
  • powers: uterine contractions are ineffective
  • passenger: fetal presentation, position or development
  • passage: bony pelvis is not adequate
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4
Q

uterine dystocia indicates __

A

weak or uncoordinated contractions
- hypotonic contractions
- hypertonic contractions

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5
Q

hypotonic contractions

A
  • low tone
  • do not promote cervical dilation
  • shape is kind of stretched out
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6
Q

hypotonic contractions: what are women at risk for?

A
  • exhaustion
  • infection
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7
Q

hypotonic contractions: what is the fetus at risk for?

A
  • intolerance of labor
  • asphyxia
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8
Q

hypotonic contractions: risk factor

A

multiparous women

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9
Q

hypotonic contractions: management

A
  • determine cause
  • consider augmenting with oxytocin
  • amniotomy
  • c section
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10
Q

hypertonic contractions

A
  • uncoordinated contractions
  • frequent
  • very painful
  • shape is very up and down/ ridged
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11
Q

hypertonic contractions: what are women at risk for?

A
  • exhaustion
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12
Q

hypertonic contractions: what is the fetus at risk for?

A
  • intolerance to labor
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13
Q

hypertonic contractions: risk factor

A

nulliparous women

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14
Q

hypertonic contractions: management

A
  • hydration to improve perfusion
  • pain medication
  • continuous monitoring
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15
Q

normal contractions are ___ shaped

A

bell

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16
Q

hypotonic contractions: nursing interventions

A
  • assess maternal fetal status
  • admin oxytocin per protocol
  • continuous external fetal monitor/ toco
  • explain interventions
  • minimize infection risk- minimal vaginal exams
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17
Q

hypertonic contractions: nursing interventions

A
  • admin pain meds: morphine, to allow uterus to rest
    -offer epidural
  • promote relaxation
  • hydrate - 250 ml/hr isotonic solution
  • explain interventions
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18
Q

when do stage 2 of labor disorders take place?

A
  • during the pushing phase
  • 10 cm to birth
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19
Q

what do stage 2 of labor disorders result from?

A
  • delayed pushing for extended period of time
  • epidurals
  • elevated BMI: >35
  • LGA babies: >4200g
  • occiput posterior positioning
  • fetal station
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20
Q

stage 2 of labor disorders: risks

A
  • risk of morbidity and mortality
  • decreases chance of SVD
  • fetus: asphyxia
  • woman: operative vaginal birth; extensive perineal trauma
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21
Q

stage 2 of labor disorders: management

A
  • monitor for labor
  • augment with pitocin
  • assist with vacuum OR forceps
  • consider c section
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22
Q

stage 2 of labor disorders: nursing actions

A
  • help woman by coaching pushing
  • try open glottis pushing
  • give adequate pain relief
  • change positions to allow gravity
  • support the patient
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23
Q

precipitous labor

A
  • lasts less than 3 hours from onset to delivery
  • increased pain and anxiety
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24
Q

precipitous labor: women are at risk for?

A

postpartum hemorrhage (PPH)

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25
Q

precipitous labor: fetus is at risk for?

A
  • hypoxia
  • CNS depression if mom had narcotics for pain
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26
Q

precipitous labor: risk factors

A
  • grand multiparas
  • hx of precipitous delivery
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27
Q

precipitous labor: nursing actions

A
  • remain with patient
  • monitor FHR continuously or at least q15 minutes
  • assess cervical change
  • listen to the patient
  • support the patient
  • anticipate complications such as hypoxia
  • prep for delivery
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28
Q

fetal dystocia

A

something about the fetus is delaying delivery
- LGA
- malpresentation
- multifetal pregnancy
- fetal anomaly

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29
Q

fetal dystocia: risks

A
  • asphyxia
  • fetal injuries
  • maternal lacerations
  • cephalopelvic disproportion = c section
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30
Q

what are the various malpresentations?

A
  • shoulder
  • face
  • brow
  • occiput posterior
  • frank breech
  • complete breech
  • footling breech: single or double
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31
Q

what do we do when labor does not happen on its own?

A
  • intervene when medically indicated
  • push to move away from elective inductions
    -use Bishop score for elective induction
  • labor induction
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32
Q

induction of labor is _

A

the chemical or mechanical initiation of uterine contractions before their spontaneous onset for the purpose of bringing about birth

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33
Q

how do you (medically) induce labor

A
  • induction of oxytocin
  • cervical ripening prior to oxytocin with cervidil or cytotec
  • stripping membranes
  • amniotomy
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34
Q

induction of labor: cervical ripening methods

A

purpose: to ripen or soften the cervix
- chemical agents: PGE 1 (cytotec) or PGE 2 (cervidil)

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35
Q

induction of labor: mechanical and physical methods

A
  • balloon catheters
  • hydroscopic dilators
  • amniotic membrane stripping
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36
Q

what is not recommended as a method to induce labor?

A
  • sexual intercourse
  • nipple stimulation
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37
Q

what are some alternative methods to induce labor?

A
  • blue cohosh
  • castor oil
  • acupuncture
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38
Q

amniotomy

A

artificial rupture of membranes (AROM)
- often used in combination with pitocin
- presenting part MUST be engaged (-2 or below) to prevent cord prolapse

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39
Q

labor interventions: induction

A
  • oxytocin induction
    -most common agent when cervix is favorable
    -bishop score 8 or greater
  • nursing care
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40
Q

induction of labor: risks

A
  • tachysystole
  • category II or III FHR tracings
  • failed induction
  • water intoxication
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41
Q

what is a bishop score?

A
  • a scoring system
  • an assessment of the cervix before labor to determine if an induction is likely to be successful
  • it can also determine if spontaneous labor may occur soon
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42
Q

bishop score of 6 or less

A
  • unfavorable for induction
    **if induction is indicated, cervical ripening agents will most likely be used
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43
Q

bishop score of 8 or more

A
  • favorable for induction
    OR
  • a vaginal delivery with induction will be similar to spontaneous labor
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44
Q

how does the bishop scoring system work?

A
  • scores of 0,1,2,3
  • assesses 5 categories
    -dilation
    -position of cervix
    -effacement
    -station
    -cervical consistency
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45
Q

an operative vaginal delivery could be ___ or ___

A
  • vacuum assisted
  • forceps
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46
Q

TOLAC stands for __

A

trial of labor after cesarean

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47
Q

VBAC stands for __

A

vaginal birth after cesarean

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48
Q

TOLAC / VBAC: risks

A
  • risk of repeat c/s in 20% - 40%
  • risk of uterine rupture
  • risk of fetal death
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49
Q

TOLAC / VBAC: benefits

A
  • shorter hospital stay
  • fewer complications
  • fewer neonatal breathing problems
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50
Q

possible brain damages due to forceps use

A
  • crushed, sheared and torn neurons
  • scalp hematoma
  • fracture through occipital bone
  • parietal bone overrides occipital bone
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51
Q

augmentation is

A

stimulation of contractions when labor fails to progress

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52
Q

augmentation: risks

A
  • stop oxytocin if there is no contraction or abnormal HR
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53
Q

augmentation: indications

A
  • add more with contractions that are hypotonic
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54
Q

augmentation: nursing care

A
  • ensure informed consent
  • intermittent auscultation (when HR remains in normal limits: Cat 1 tracing)
  • in presence of risk factors, continuous EFM, evaluate and document FHR q15 mins in active labor and q5 mins in the second stage of labor
  • monitor DIF of UCs q30 mins an indicator of oxytocin efficiency
  • evaluate uterine resting tone by palpation or IUPC pressure below 20 mmHg to ensure uterine relaxation between contractions
  • decrease or d/c oxytocin in event of uterine tachysystole or indeterminate or abnormal fetal status; *lower dose by 1/2 when decreasing
  • monitor labor progress with SVE for cervical dilation and fetal descent
  • assess the character and amount of AF and amount of bloody show
  • assess VS per policy- usually q2 hours
  • assess I&O q8 hours, for fluid overload- output should = input
  • ensure adequate hydration
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55
Q

external cephalic version (ECV): indications

A

to change fetal position to vertex

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56
Q

external cephalic version (ECV): contraindications

A

placental abnormalities

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57
Q

external cephalic version (ECV): risks

A

severe variable decelerations

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58
Q

what are patients often given prior to ECV procedure?

A
  • epidural/spinal
  • Terbutaline to relax the uterus
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59
Q

bishop score: dilation 0

A

closed

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60
Q

bishop score: dilation 1

A

1-2

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61
Q

bishop score: dilation 2

A

3-4

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62
Q

bishop score: dilation 3

A

5-6

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63
Q

bishop score: position of cervix 0

A

posterior

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64
Q

bishop score: position of cervix 1

A

mid position

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65
Q

bishop score: position of cervix 2

A

anterior

66
Q

bishop score: position of cervix 3

A
  • (N/A)
67
Q

bishop score: effacement 0

A

0-30%

68
Q

bishop score: effacement 1

A

40-50%

69
Q

bishop score: effacement 2

A

60-70%

70
Q

bishop score: effacement 3

A

80%

71
Q

bishop score: station 0

A

-3

72
Q

bishop score: station 1

A

-2

73
Q

bishop score: station 2

A

-1, 0

74
Q

bishop score: station 3

A

+1, +2

75
Q

bishop score: cervical consistency 0

A

firm

76
Q

bishop score: cervical consistency 1

A

medium

77
Q

bishop score: cervical consistency 2

A

soft

78
Q

bishop score: cervical consistency 3

A
  • (N/A)
79
Q

obstetric complications: risks to mom

A
  • difficult labor
  • increased injury to perineum
  • increased rate of cesarean section
  • infections
  • PPH
  • increased maternal anxiety
80
Q

obstetric complications: risks to fetus

A
  • stillbirth or neonatal death
  • macrosomia
  • fetal dysmaturity
  • oligohydramnios
  • meconium aspiration
  • placental insufficiency
81
Q

meconium-stained fluid is the result of __

A
  • GI maturation and neural stimulation
  • hypoxic stress
82
Q

meconium-stained fluid occurs in what % of births?

A

10-20%

83
Q

meconium-stained fluid can be ___ by fetus

A

aspirated by fetus
- can cause respiratory issues

84
Q

assessing for meconium-stained fluid

A

assess for green-tinge to amniotic fluid
- alert neonatal team
prepare for potential need for neonatal resuscitation

85
Q

obstetric complications: multiple gestation- risks

A
  • PTL
  • labor dystocia
  • antepartum hemorrhage
  • stillbirth
86
Q

obstetric complications: multiple gestation- medical management

A
  • method of delivery is determined based on fetal presentation, subsequent fetal position, and other medical considerations
    -ultrasound to determine presentation/placental locations
  • hospital birth w/ a level 2 or 3 nursery
  • two experienced obstetricians or one OB and one certified nurse-midwife
  • delivery is done in a surgical suite
87
Q

obstetric complications: multiple gestation- nursing care

A
  • anticipatory guidance
  • ensure placement of large bore IV for fluid replacement
  • continuous FHR monitoring- internal monitoring for twin A
  • have hemorrhage cart/meds available
  • anesthesia provider, circulating nurse, and scrub nurse available
  • ensure ultrasound access to confirm position of B after birth of A
  • neonatal team should be present for each twin
  • have type and cross-matched blood available
88
Q

obstetric complications: intrauterine fetal demise- risk factors

A
  • 1st time mom
  • advanced maternal age
  • obesity
  • DM
  • chronic HTN
  • african decent
  • smoking/alc use
  • pregnancy produced by artificial reproductive techniques
  • Male > risk
89
Q

obstetric complications: intrauterine fetal demise- management

A
  • induce labor within 24-48 hours of confirmed dx
  • stillborn delivery
  • vaginal misoprostol is less than 28 weeks
  • cervical ripening and induction of labor
90
Q

obstetric complications: intrauterine fetal demise- nursing care

A
  • priest or minister
  • support groups
  • memory box
  • anticipatory guidance in slow, small increments
  • allow patient to make decisions about plan of care
  • continuity of care
  • privacy and comfort
  • offer time with fetus to mom and family
91
Q

obstetric complications: intraamniotic infection- risks/ s/x

A
  • biochemical or microbiologic amniotic fluid results consistent with microbial invasion of amniotic cavity
  • fetal tachycardia
  • elevated white count in mom (>15000)
  • pus like vaginal d/c
92
Q

obstetric complications: intraamniotic infection- management

A
  • culture amniotic fluid
  • NICU- draw cultures to determine if anything grows in baby’s blood
  • control maternal temperature with antipyretics & judicious hydration may be required
  • intrapartum antibiotics
  • antimicrobial agents in case of suspected Triple I
93
Q

obstetric complications: intraamniotic infection- nursing care

A
  • antipyretics
  • antibiotics
  • communicate findings (fetal tachycardia, maternal WBC, etc.)
94
Q

pre-gestational complications: maternal obesity -risks

A
  • shoulder dystocia
  • macrosomia
  • increased risk of hemorrhage
  • delayed wound healing
  • increased risk DVT and infection rates
95
Q

obstetrical emergencies

A
  • shoulder dystocia
  • prolapse of umbilical cord
  • vasa previa
  • ruptured uterus
  • anaphylactic syndrome
  • disseminated intravascular coagulation (DIC)
96
Q

shoulder dystocia: risks to mother

A
  • severe perineal lacerations- 4th degree
  • maternal symphyseal separation/peripheral neuropathy
  • bladder injury
  • postpartum hemorrhage
  • emotional trauma
97
Q

shoulder dystocia: risks to fetus

A
  • asphyxia
  • neurological injury
  • increased intracranial pressure
  • encephalopathy
  • brachial plexus injuries
  • fractures- clavicle and humerus
  • death
98
Q

shoulder dystocia: management

A
  • mcRoberts manuever: two assistants sharply flexing each maternal thigh against the abdomen
  • suprapubic pressure: apply pressure above the pubic bone with palm/fist; pressure is directed on the anterior shoulder downward and laterally
  • if both mcRoberts and suprapubic pressure fail, deliver the posterior arm; Woods corkscrew manuever rotates posterior shoulder 180 degrees to disimpact the anterior shoulder
    *avoid fundal pressure
99
Q

shoulder dystocia: nursing actions

A
  • explain situation and interventions to woman and family
  • request mom not to push
  • request assistance, additional nurses needed to implement maneuvers to resolve shoulder dystocia
  • insert straight catheter
  • no fundal pressure
  • McRoberts maneuver
  • variety of techniques can be used to free impacted shoulder: pressure applied above pubic bone or laterally to pubic bone
  • notify neonatal team
  • prep for neonatal resuscitation
  • document interventions and clinical events with time intervals
100
Q

umbilical cord prolapse: risks

A
  • total or partial occlusion of the cord causing rapid deterioration in fetal perfusion and oxygenation
  • fetal hypoxia
    if not treated quickly:
    -long-term sequela
    -disability
    -death
101
Q

umbilical cord prolapse: management

A
  • vaginal or operative vaginal delivery may be attempted if birth is imminent
  • perform emergency c/s
102
Q

umbilical cord prolapse: nursing actions

A
  • elevate presenting part
  • request assistance, notify HCP, request immediate bedside evaluation
  • explain interventions to woman and family: necessary to expedite delivery and need for her assistance
  • recommend position changes to relieve pressure on cord (knee to chest/ trandelenburg)
  • admin O2 mask at 10 L/min
  • IV fluid hydration bolus
  • d/c oxytocin, consider tocolytic to decrease uterine activity
  • move toward emergency delivery: vaginal or c/s depending on if birth is imminent or not
103
Q

vasa previa: fetal risks

A
  • fetal asphyxia from cord compression
  • fetal death from exsanguination
104
Q

vasa previa: management

A
  • if dx prenatally with ultrasound, plan c/s @ 35 weeks
    -improves neonatal survival by 95%
  • if dx during labor, urgent c/s in cases of vaginal bleeding with suspected vasa previa
105
Q

vasa previa: nursing actions

A
  • if dx prenatally with ultrasound- patient will be prescribed corticosteroids and scheduled for a planned c/s @ 35 weeks
  • if bleeding occurs with SVE by the nurse, an immediate bedside evaluation by the provider is indicated because urgent c/s delivery should be accompanied in cases of vaginal bleeding with suspected vasa previa
106
Q

uterine rupture- risks

A
  • hypovolemic shock
  • infection
  • hypoxemia
  • acidosis
  • neurologic damage
  • possible death
  • maternal complications are primarily due to hypovolemia as a result of hemorrhage
  • fetal complications may be due to uteroplacental insufficiency, placental abruption, cord compression, asphyxia, and/or hypovolemia
107
Q

uterine rupture- management

A
  • emergency c/s
  • control maternal hemorrhage
  • hysterectomy may be necessary
  • transfusion may be necessary
108
Q

uterine rupture- nursing actions

A
  • explain interventions will expedite delivery and importance of their assistance
  • request assistance and notify provider; request bedside evaluation
  • gain/maintain large bore IV access; stabilize woman w/ O2, IV fluids, and blood products
  • maintain woman in lateral position to maximize urine blood flow
  • prep for emergency c/s: insert foley catheter
109
Q

anaphylactic syndrome/amniotic fluid embolism - risks

A

-acute pulmonary edema
- resp distress/arrest
- acute heart failure
- DIC

110
Q

anaphylactic syndrome/amniotic fluid embolism- risk factors/causes of

A
  • advanced maternal age (35 +)
  • oxytocin use for labor induction
  • multiple pregnancies
  • placental abnormalities: previa, abruption
  • c/s
  • operative vaginal delivery
  • eclampsia/preclampsia
  • cervical laceration
  • polyhydramnios
  • uterine rupture
111
Q

anaphylactic syndrome/amniotic fluid embolus- nursing actions

A
  • careful assessment, maternal pulse ox, maintain patent IV access, L uterine displacement, notify OB team, implement ACLS protocol, document
  • recognize life-threatening dx, ask for help and immediate bedside evaluation
  • prep for emergent interventions (ie rapid sequence intubation)
  • stabilize woman with O2 and IV fluids
  • continuous FHR monitoring
  • prep for emergency delivery
  • ABCs
  • s/ of shock- emergency c/section
112
Q

adverse obstetric events that could trigger DIC

A
  • placental abruption
  • severe preeclampsia
  • HELLP
  • massive obstetric hemorrhage
  • amniotic fluid embolism
  • acute fatty liver of pregnancy
  • sepsis
113
Q

DIC- management

A
  • prompt recognition and understanding is essential to the management of DIC and positive outcome
  • transfer to critical care unit
  • perinatologist manages the care
114
Q

what is shoulder dystocia?

A
  • difficulty encountered during delivery of the shoulder after the birth of the head
  • often occurs when the passage of the anterior shoulder is obstructed by the symphysis pubis
  • may also result from the impaction of the posterior shoulder on the maternal sacral promontory
  • unpredictable
  • unpreventable
115
Q

what is an umbilical cord prolapse?

A

when the cord lies between the presenting part of the fetus
- may prolapse in front of the presenting part, into the vagina, or through the introitis

116
Q

what is vasa previa?

A

abnormal fetal blood vessels that run through the fetal membranes, over or near the endocervical os, and are unprotected by the placenta or umbilical cord
- uncommon (1/2500-5000 pregnancies)

117
Q

what is a ruptured uterus?

A

spontaneous tearing of the uterus that may result in the fetus being expelled from the peritoneal cavity
- rare
- occurs in late pregnancy or active labor

118
Q

what is anaphylactic syndrome?

A
  • during rupture of membranes, amniotic fluid enters moms circulation, causes huge pro-inflammatory response
119
Q

what is DIC?

A

disseminated intravascular coagulation
- when the body is breaking down blood clots faster than it can form a clot
- leads to hemorrhage and maternal death
- associated with 25% of maternal deaths (1/4)

120
Q

DIC: what are the maternal trigger parameters?

A
  • temperature
  • BP
  • HR
  • RR
  • oxygen saturation
121
Q

critical care in maternity nursing includes

A
  • preexisting conditions/complications
  • assess high-risk situations continuously
  • A C L S algorithm
  • cared for in special obstetrics/gynecology units or in ICU
122
Q

what is the A C L S algorithm?

A

“advanced cardiac life support” protocol
- displacement of uterus during cardiopulmonary resuscitation facilitates blood return to the heart and is critical to return of spontaneous circulation
- fetal monitor components should be removed prior to defibrillation or cardioversion to decrease potential risks of arcing and damage to monitor components
- hand placement for chest compressions should be slightly higher on maternal chest due to cardiac displacement during pregnancy
- early advanced airway should be considered and performed by an experienced professional, as intubation of pregnant patients can be difficult

123
Q

how many stages of PPH are there?

A

4

124
Q

PPH: stage 1

A
  • > 500 ml (vaginal) and >1000 ml (c/s)
  • normal VS and lab values
125
Q

PPH: stage 2

A
  • continues to bleed
  • > 1500 ml
  • > 2 uterotonics
  • normal VS and labs
126
Q

PPH: stage 3

A
  • continues to bleed
  • > 1550 ml
  • 2 units of packed RBCs
  • abnormal VS and labs
127
Q

PPH: stage 4

A
  • cardiovascular collapse
  • profound hypovolemic shock
  • amniotic embolism
128
Q

PPH: 4 Ts

A

tone- uterine atony
tissue- retained placenta
trauma- lacerations
thrombin- coagulation

129
Q

ideal occiput positioning of fetus in passage?

A

LOA or ROA
**anterior!

130
Q

open glottis pushing

A
  • spontaneous, involuntary bearing-down accompanying the forces of the uterine contraction
  • usually characterized by expiratory grunting or vocalizations
  • involves 3-4 pushes of 6-8 seconds with each contraction
131
Q

closed glottis pushing

A
  • involuntary: refers to spontaneous pushing against a closed glottis (valsalva) in response to the descent of the fetal presenting part on the perineum
  • voluntary: valsalva technique, involves a voluntary directed strenuous bearing-down effort against a closed glottis for at least 10 seconds.
    -woman is instructed to take a deep breath and hold it for as long as she can (during each count of 10) using the entire contraction.
    -this method usually involves 2-3 pushes of 10 seconds each with each contraction
132
Q

cervidil: dose

A
  • thin, flat, rectangular-shaped, cross-linked, polymer hydrogel that releases dinoprostone from a 10 mg reservoir
133
Q

cervidil: nurse actions

A
  • nurse may perform if within scope of practice
  • woman should remain supine or lateral for 2 hours after insertion
  • continuous FHR and UC monitoring, and for 15 min post removal
  • delay oxytocin for 30-60 min after removal
134
Q

cytotec: dose

A
  • 25 mcg inserted in the posterior vaginal formix q3-6 hours (initial dose for cervical ripening/labor induction)
  • not to exceed 50 mcg
135
Q

cytotec: nurse actions

A

-continuous FHR and UC monitoring
- delay oxytocin for at least 4 hours after last dose

136
Q

how long should oxytocin be delayed after removal of cervidil?

A

delay oxytocin for 30-60 min after removal

137
Q

what is one major advantage to cervidil?

A

can be easily and quickly removed in the event of uterine tachysystole or other complications

138
Q

what has been associated with cytotec? (hint: negative outcomes)

A
  • tachysystole
  • indeterminate/abdnormal FHR changes
  • uterine rupture (rare)
139
Q

how long should oxytocin be delayed after administration of cytotec

A

at least 4 hours after the last dose

140
Q

cervical change of __ cm/hr indicates sufficient progress

A

1 cm/hr

141
Q

s/sx of fluid overload

A
  • decreased uterine output
  • edema
  • increased BP
  • pulmonary edema
142
Q

if vacuum pops off, indicates ____

A

indicates too much pressure was used

143
Q

vacuum: fetal risks

A
  • cephalohematoma
  • increased rates of jaundice
  • intracranial hemorrhage and retinal hemorrhage
  • scalp lacerations or bruising
144
Q

forceps: maternal risks

A
  • extension of episiotomy
  • hemorrhage
  • bruising of perineal: perineal hematoma
  • bladder trauma
  • vaginal and cervical lacerations
  • perineal wound infection
145
Q

forceps: fetal risks

A
  • facial nerve lac
  • corneal abrasion
  • facial palsy
  • trauma to face
  • skull fracture
  • intacranial hemorrhage
  • skin laceration or bruising
  • nerve injuries: craniofacial and brachial plexus injuries
  • cephalohematoma
146
Q

when would we use forceps?

A

-last resort, need to get kid out

147
Q

vacuum: maternal risks

A
  • vaginal or cervical lacerations
  • extensions of episiotomy
  • hemorrhage related to uterine atony, uterine rupture
  • bladder trauma
  • perineal wound infection
148
Q

forceps

A
  • outlet: when head is visible on the perineum and the skull has reached the pelvic floor, and rotation is < 45 degrees
  • low: when skull is at +2 station or lower in maternal pelvis and not on the pelvic floor, and rotation is > 45 degrees
149
Q

advantages to vacuum over forceps

A
  • easier application
  • less anesthesia required
  • less maternal soft tissue damage
  • fewer fetal injuries
150
Q

guidelines for vacuum application

A
  • fetal head needs to be engaged and cervix completely dilated
  • maximum of 3 attempts “3 pull rule”
  • want mom to empty bladder first
  • during a contraction- use uterine strength
  • if not successful, c/s
151
Q

indications for vac-use

A
  • suspicion of immediate or potential fetal compromise
  • need to shorten the second stage for maternal benefit
  • prolonged second stage
    -nullip: lack of continuous progress 3hr w/ anesthesia, or 2hr w/out
    -multip: lack of continuous progress 2hr w/ anesthesia or 1hr w/out
152
Q

indications for forceps-use

A
  • fetal head is engaged and cervix is completely dilated
  • suspicion of immediate or potential fetal compromise
  • to shorten stage 2 of labor for maternal benefit
  • prolonged 2nd stage
    -nullip: lack of continuous progress 3hr w/ anesthesia, or 2hr w/out
    -multip: lack of continuous progress 2hr w/ anesthesia or 1hr w/out
  • high level of regional anesthesia that inhibits pushing
  • maternal cardiac or pulmonary disease that contraindicates pushing efforts
153
Q

IUFD

A
  • 1/160 pregnancies
  • intraunterine death after 20 weeks
154
Q

intraamniotic infection is also known as

A

chorioamnionitis
- an infection with a resultant inflammation of any combination of the amniotic fluid, placenta, fetus, fetal membranes, or decidua

155
Q

anaphylactic syndrome/amniotic fluid embolus- management

A
  • manage cardiopulmonary arrest, hypotension and coagulopathy
    *management goals:
  • improve oxygenation
  • optimize cardiac output
  • correct coagulopathy
  • deliver fetus
156
Q

what other kind of rupture is associated with uterine rupture?

A

bladder rupture

157
Q

vasa previa: risk factors/causes

A
  • low-lying placenta or placenta previa
  • pregnancies in which placenta has accessory lobes
  • multiple gestation
  • IVF pregnancies
158
Q

umbilical cord prolapse: risk factors/causes

A
  • r/t fetus:
    -malpresentation (breech)
    -fetal anomalies
    -IUGR/SGA
    -unengaged presenting part
  • r/t pregnancy:
    -primary iatrogenic cause is AROM
    -polyhydramnios
    -multiple gestation
    -spontaneous ROM
    -preterm ROM
    -grand multiparity
159
Q

McRoberts maneuver

A

sharply flexing the thigh onto the maternal abdomen to straighten the sacrum
- used with shoulder dystocia fetuses

160
Q

shoulder dystocia: risk factors/causes

A
  • fetal macrosomia (> 4500 g)
  • maternal diabetes
  • hx of shoulder dystocia
  • prolonged 2nd stage of labor
  • excessive weight gain

NU 330 (18 decks)

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