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Maternity > Chapter 14 > Flashcards

Chapter 14 Flashcards

1
Q

Vaginal examination (8)

A
  1. cervical dialtion
  2. % effacemetn
  3. fetal membrane status
  4. presentation
  5. position
  6. station
  7. degree of head flexion
  8. skull swelling or molding
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2
Q

priority when rupture of membranes occurs

A

Assess FHR - identify deceleration which could mean cord prolapse or compression

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3
Q

When do fetal membranes typically ruptures

A

Stage 1 of labor (dilation)

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4
Q

How to confirm rupture

A

nitrazine yellow dye swab

  • vaginal fluid - stays yellow/ olive green
  • amniotic -blue
  • bloody show - blue (false positive)
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5
Q

fundus firmness = strength test

A

tip of nose = mild
chin = moderate
forhead = strong

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6
Q

technique to determine presentations, position and lie

A

Leopold maneuvers

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7
Q

Reasons fetus may pass meconium

A 
transient hypoxia
prolonged pregnancy
cord compression
intrauterine growth restriction
maternal hypotension, diabtes, or chorioamnionitis
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8
Q

When is meconium normal

A

breech position

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9
Q

purpose of evaluating FHR

A

determine fetal oxygen status

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10
Q

disadvantage of intermittent FHR

A

cant detect variability

cant detect types of decelrations

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11
Q

Where on mother is FHR normally found

A

lower abdominal quadrants

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12
Q

guidlines for FHR assessment during active labor

A

low risk- every 30 min

high risk - every 15 min

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13
Q

guidelines for FHR assessment during second stage of labor

A

low risk: every 15

high risk: every 5

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14
Q

reasons for continuous internal monitoring

A 
multiple gestation
decreased fetal movement
abnormal FHR
IUGR
maternal fever
preeclampsai
dysfuncitonal labor
preterm birth
maternal diabetes or hypertension
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15
Q

4 criteria required for use of internal monitor

A
  • dilation of 2 cm
  • ruptured membranes
  • presenting fetal part low enough for scalp electrode
  • skill practitioner
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16
Q

FHR assessment parameters

A
  1. baseline rate
  2. baseline variability
  3. presence of accelerations
  4. periodic or episodic decelerations
  5. changes or trends over time
17
Q

Normal baseline FHR

A

110-160

18
Q

Fetal bradycardia critiera

A

<110 bpm

>10 minute

19
Q

causes of fetal brady

A 
fetal hypoxia
prolonged maternal hypoglycemai
fetal acidosis
alangesic drugs to mother
hypothermia
anesthetic agents (epidural)
maternal hypotentsion
prolonged cord compression
fetal congenital heart block
20
Q

When is bradycardia ominous

A

accompanied by decrease in baseline variability and late decelerations

21
Q

Category I: normal

A

Good - no action necessary

  • moderate baseline variability
  • no late or variable decelerations
22
Q

Category II: intermediate

A

requires evaluation and surveillance

  • fetal tachy
  • fetal brady but baseline variability is fine
  • minimal or marked variability
  • recurrent late decelerations
  • recurrent variable decelerations
  • prolonged decelerations (2-10 min)
23
Q

Category III: abnormal

A

intervention required!

  • fetal bradycardia
  • recurrent late decel
  • sinusoidal pattern
24
Q

fetal tachy criteria

A

160bmp

>10 min

25
Q

Baseline variability categories

A

undetectable
fewer than 5bpm
6-25bpm
greater than 25bpm

26
Q

Causes of absent or minimal variability

A 
uteroplacental insufficiency
cord compression
preterm fetus
maternal hypotension
abruptio placenta
27
Q

Interventions for min var

A 
left lateral position
increase IV flow
oxygen 8-10 L/min
internal fetal monitoring
report to provider
28
Q

Causes of marked variability

A

cord prolapse or compression
maternal hypotension
abruptio placenta

29
Q

Interventions for marked var

A 
lateral position
increase IV  rate
oxygen
dc oxytocin*
consider internal monitoring
report to provider
30
Q

typical height of early deceleration

A

30-40 below baseline

31
Q

variable deceleration characteristics

A

abrupt decrease
unpredictable shape
possibly no consistent relationship with contractions

32
Q

what do variable decelerations mean?

A

cord compression

33
Q

prolonged decelreations characteristics

A

at least 15 bpm
2 - 10 minutes
rate usually drops to below 90

34
Q

what prolonged decels mean?

A 
abruptio placenta
cord prolapse
supine maternal position
vaginal exam
fetal blood sampling
maternal seizure
regional anesthesia
uterine rupture
35
Q

Sinusoidal pattern

A

3 to 5 bpm

>20 min

36
Q

Highest priorities on admission

A
  1. assess FHR
  2. assess cervical dilation and effacement
  3. have membranes ruptured
37
Q

what screen is important at 35-37 weeks

A

GBS

38
Q

frequency of vaginal exams

A

active phase of labor: every

Maternity (8 decks)

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