Chapter 33 - 2

Question 1

amniotomy

Answer 1

Artificial rupture of the amniotic sac

AROM (artificial rupture of membranes)
If membranes rupture on own their own then SROM (spontaneous rupture of membranes)

CONTRAINDICATIONS
Presenting part high or not a cephalic presentation

Question 2

RISKS OF AMNIOTOMY

Answer 2

Prolapsed Cord
Infection
Abruptio Placenta - vaginal bleeding, sharp stabbing pain, change in VS

Question 3

Augmentation:

Answer 3

artificial stimulation of uterine contractions that have become ineffective

Question 4

Induction:

Answer 4

artificial initiation of labor

Question 5

INDUCTION AND AUGMENTATION

Answer 5

Both done to stimulate uterine contractions
medical reasons - PIH pt getting worse, if baby died in utero, developing chroriniotisis, conditions worsening during preg, fetal compromised, if overdue

Question 6

WHEN INDUCTION CAN BE USED

Answer 6

When the cervix is “ripe”
BISHOPS SCORING- if score 3 cant induce
* five areas, up to 2 points each
*dilation, effacement, station, cervical consistency, cervical position
* 7 or higher for primagravida, 5 or higher for multipara

Question 7

CERVICAL RIPENING

Answer 7

TO SOFTEN (RIPEN) THE CERVIX FOR INDUCTION * PREPARATIONS CONTAINING PROSTAGLANDIN E2 (PGE2)-gels,cervidil,cytotec
   * MECHANICAL METHODS that are inserted in cervix, absorb fluid and expand the os-sponges, seaweed(Laminaria tent)

Question 8

PITOCIN ADMINISTRATION

Answer 8

Give to induce or augment labor
Used in the majority of births in the U.S.

GOAL: to produce uterine contractions of normal intensity, duration and frequency while using the lowest dose possible.

Begin with a starting dose of 1 milliunit/min. and increase by 1-2 q 20-30 mins. Till good labor pattern is established.

Question 9

ADVERSE REACTIONS TO PITOCIN

Answer 9

Uterine Tachysystole

Signs of Hypertonic Uterine Activity

1. Contractions longer than 90-120 seconds OR
2. Contractions occurring less than 1-2 minutes apart OR
3. More than 5 contractions in 10 minutes

Question 10

Nursing Actions for Non Reassuring Induction

Answer 10

• Reduce or stop oxytocin infusion
• Increase rate of primary (nonadditive) infusion-Ringers Lactate
• Keep laboring woman in a lateral position
• Give oxygen by snug face mask, 8 to 10 ml/min- Rebreather mask
• Notify physician or nurse-midwife
• Start internal monitoring if not already in place
• Order tocolytic drug with hyperactivity
• Identify the cause of the problem if possible

Question 11

version

Answer 11

Method used to change fetal position

External vs internal

Question 12

external version -

Answer 12

sometimes will stimulate labor so wait till 36 weeks to do

Question 13

internal version -

Answer 13

during delivery, grab baby by feet and pull down and have breech

Question 14

Vacuum Extraction/ Forceps Operative Birth

Answer 14

The physician applies traction to the fetal head during a vaginal birth
Either forceps or vacuum extractor (Kiwi)
- never use high forceps

Question 15

CESAREAN BIRTH

Answer 15

Working toward decreasing the number of c-sections has not been successful
25% in the 1980’s
Encouraging the VBAC (vaginal delivery after a cesarean
1996 c-sections begin to rise again
2008 c-sections are 32.3% of all deliveries
INDICATIONS FOR CESAREANS

Question 16

CESAREAN BIRTH RISKS

Answer 16

Infection
Hemorrhage
DVT
Paralytic illeus
Anesthesia complications
Preterm delivery

Question 17

TYPES OF CESAREANS **

Answer 17

Incisions on the abdomen

• Vertical
• Transverse (Pfannenstiel)

Incisions on the Uterus

• Low transverse (best bc muscles heel easily)
• Low vertical
• Classical