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OB Test 3 > chapter 33 > Flashcards

chapter 33 Flashcards

1
Q

dysfunctional labor

A

does not result in normal progress of cervical dilation, effacement or descent
(so no progress but could have normal contractions)

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2
Q

dystocia

A

any difficult labor or birth

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3
Q

powers =

A

uterine contractions

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4
Q

ineffective uterine contractions

A

A) Hypotonic dysfunction- Secondary Inertia

B) Hypertonic dysfunction- Primary Inertia

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5
Q

Hypotonic dysfunction- Secondary Inertia

A

more common, mom starts labor and does good until gets to 4cm and stays there (active phase)
“falls out of labor”
decrease frequency - intensity of contractions, decrease to 2-3 contractions/10 min
causes: cephalapdric dysportion (baby cant get through), positions of body, over distention of uterus, exhaustion, infection risk
if baby not born in 24 hrs then c-section

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6
Q

Hypertonic dysfunction- Primary Inertia

A

occurs during early phase of 1st stage so 0-3 cm
contractions are uncoordinated
in a lot of pain, never really goes away
want to stop labor and give analgesic to knock her out of labor
within 2-3 hours labor starts normally
get pt to rest while contractions stop

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7
Q

SECONDARY POWERS–INEFFECTIVE MATERNAL PUSHING; may result from

A 
Incorrect pushing (if pushing correctly will see bulging of peritoneum)
Fear 
Decreased/absent urge to push
Exhaustion
Analgesics/anesthesia
Psychologically unready
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8
Q

with secondary powers want to

A

promote effect pushing, make sure pt hydrated, don’t wast energy between contractions,relax, may need forceps or vacuum

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9
Q

using what graph for abnormal labor patterns

A

friedman graph

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10
Q

causes of abnormal labor patterns

A

contractibility, prob with fetus (too big), fetal presentation, med to knock out of labor

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11
Q

prolonged labor

A

Active phase- dilation should proceed at a minimum rate of 1.2cms./hr. (prima) or 1.5 cms./hr. in the multipara
Descent at a minimum of 1 cm/hr. in prima or 2cm/hr in the multipara
(don’t mem numbers)

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12
Q

precipate labor

A

birth occurs within 3 hours of onset
hard/fast labor - babies can have damage from it
mom more likely to have birth traumas, in a lot of pain but can’t give meds

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13
Q

passenger problems

A

I. FETAL SIZE
II. ABNORMAL FETAL PRESENTATION OR POSITION
III. MULTIFETAL PREGNANCY
IV. FETAL ANOMALIES

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14
Q

fetal size -

A

Macrosomia can cause Shoulder Dystocia

more likely if mom diabetic

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15
Q

abnormal fetal position/presentation

A

Rotation Abnormalities
Face Presentation
Breech (more difficult to deliver, more likely to have meconium/prolapsed cord)

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16
Q

multifetal preg

A

more likely preterm or mal presentations

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17
Q

fetal anomalies

A

big head baby, breech

18
Q

PROBLEMS WITH THE PASSAGE

A

I. PELVIS
II. MATERNAL SOFT TISSUE OBSTRUCTION
(full bladder can be a problem)

19
Q

gynecoid pelvis

A

50% of all women have

20
Q

anthropoid pelvis

A

25% of all white, 50% of nonwhite

21
Q

android pelvis

A

30%, heart shaped, narrow diameter, difficult to deliver

22
Q

PROBLEMS WITH THE PSYCHE

A

STRESS - tense, decrease blood flow to muscles = increase pain, decrease contractility (increase hypoxia)
ANXIETY
FEAR
can affect ability to tolerate pain

23
Q

intrauterine infection

A

Signs/symptoms: fetal HR >160, maternal
temp. > 100.4 F, elevated pulse (above 90)/respirations (above 20), foul smelling amniotic fluid
REDUCED THE RISK BY:
Limiting vaginal exams, maintaining aseptic technique, keeping bed pads dry, cleaning perineum

24
Q

other interpatum complications

A

I. intrauterine infection
II. obesity
III. premature rupture of membranes
IV. preterm labor

25
Q

obesity -

A

ultrasound may not work

26
Q

Premature Rupture of membranes (PROM)-

A

rupture before the onset of labor
may increase infection
24 hr period to have baby

27
Q

Preterm Premature Rupture of Membranes (PPROM)-

A

rupture of membranes before the 37th week of gestation

28
Q

Premature Rupture of membranes (PROM) causes -

A

a lot of times dont know, infections, chorioamnionitis - can cause rupture

29
Q

Premature Rupture of membranes (PROM) complications -

A

preterm labor - broad spectrum antibiotic, compressed umbilical cord

30
Q

Premature Rupture of membranes (PROM) management -

A

Gestation Near Term

Preterm Gestation - watch for s/s and sac

31
Q

Premature Rupture of membranes (PROM) nursing considerations -

A

if sent home then no sex
if contractions/ elevated temp - notify physician
take temp 4 times a day
modified bed rest

32
Q

preterm labor

A

33% of infant mortality associated with preterm birth
12.3% of all births in 2008
Labor that begins after the 20th week but before the 37th week of gestation
causes - preclampsia, small babies, placenta problems, cognitive malformation

33
Q

MANIFESTATIONS OF PRETERM LABOR

A 
Uterine contractions
Baby  “balling up”
Low back pain
Pelvic pressure (baby "dropping")
Pain, discomfort, pressure vulva/thighs
Change in vaginal discharge - increase amount, more watery, bloody/brown
“feeling bad”
34
Q

EDUCATING ABOUT PRETERM LABOR

A

TEACH HOW TO RESPOND IF S/S OCCUR:
Drink 3 glasses of water - dehydration can cause contractions
Empty the bladder- full bladder cause contractions
Lie down - on left side for at least 1 hour
Palpate contractions for one hour
Notify medical personnel if more than 4 contractions in an hour
CALL IMMEDIATELY IF—fluid leaking from vagina, vaginal bleeding, foul odor of vaginal discharge

35
Q

STOPPING PRETERM LABOR

A

THERAPEUTIC MANAGEMENT INCLUDES:

  1. Identifying preterm labor early
  2. Delaying birth
  3. Accelerating fetal lung maturity if preterm birth is likely
36
Q

IDENTIFYING PRETERM LABOR

A 
Frequent prenatal visits
Check for S/S
Ultrasound/cervical exams
Identify infections and treat
Biochemical marker- fetal fibronectin (FFN) - protein found in amniotic fluid, found in vagina can swab to see if preterm

Home Uterine Activity Monitoring

37
Q

Stopping Preterm Labor Initial measures

A

Identifying and treating infections
Identifying other causes for preterm contractions
Limiting activity
Hydrating woman - to make sure she doesn’t release oxytocin on ovum

38
Q

Stopping Preterm Labor Tocolytics

A

Beta-adrenergic drugs - uterine relaxant, stop contractions
Magnesium sulfate
Prostaglandin synthesis inhibitors
Calcium antagonists

39
Q

Bethine

A

beta antagonist
injection every 4 hours subq
once contractions stop and decrease eventually put them on bethine PO and go home
antidote - inderal

40
Q

mg sulfate -

A

tropolic, CNS depressant
relaxes smooth muscle
calcium glutamate
flushing/hot

41
Q

ACCLERATING FETAL LUNG MATURITY

A

Betamethasone 12 mg IM for 2 doses 24 hrs apart

OB Test 3 (8 decks)

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