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OB Exam Two > Chapter 8 > Flashcards

Chapter 8 Flashcards

1
Q

what kind of problems can you have because of powers of labor

A

pushing - uterine dysfunction

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2
Q

what kind of things can cause problems during pregnancy

A

multibaby, placental obstruction, inadequate bony pelvis, medical emergencies, complications from maternal disease

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3
Q

what is dystocia

A

long, difficult or abnormal labor

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4
Q

when does dystocia normally occur

A

1st stage with cervical dilation and effacement

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5
Q

who is dystocia more normal in

A

nullipara

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6
Q

what factors increase the risk for dystocia

A

uterine abnormality, uterine overdistention, fetus in occipito-posterior position in 2nd stage, fetal malpresentation, cephalopelvic disporportion, maternal body build, maternal anxiety/fear

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7
Q

what cause dystocia

A

powers, passenger, and/or passageway related to maternal positioning, fetal malpresentation, anomalies, macrosomia, multiple gestation, anxiety/fear

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8
Q

what is hypertonic dysfunction

A

strong painful contractions that dont effectivley produce cervical changes , increase in catecholamine release and results in poor uterine contractility

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9
Q

what can you do to manage hypertonic dysfunction

A

establishing effective labor pattern, rest, hydration, sedation of fetus in OP position (will need to rotate it)

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10
Q

what are some causes of hypertonic dysfunction

A

maternal anxiety, increase levels of catecholamines, fearful of loaa of control, previous truma, fear of pain

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11
Q

what meds are given to someone with hypertonic dysfunction

A

acetaminophen with benadryl, meperidine, hydromorphone, morphine

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12
Q

what is hypotonic labor

A

uterine contractions decrease in frequency and intensity = less then 2-3 contractions over 10 mins -

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13
Q

when is hypotonic labor more common

A

active phase of labor

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14
Q

what can you do to help for hypotonic labor

A

walking/position changes (allows for fetal decent), relaxation techniques, massage, hydrotherapy, amniotomy, stripping of membranes, nipple stimulation, oxytocin infusion

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15
Q

what are some causes of hypotonic labor

A

fetal macrosomia, anomalies, malpresentation, multiple gestation, hydramions, grand multiparity (more then 5 births), some meds (epidural anesthesia)

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16
Q

what is percipitous labor and birth

A

very rapid, intense contractions where labor lasts less then 3 hours from beginning of contractions to birth

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17
Q

what are some complications caused by percipitous labor

A

hemorrhage from uterine rupture, vaginal lacerations, fetal hypoxia ( decrease relaxation of uterus), fetal intracranial hemorrhage

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18
Q

what are some causes of percipitous labor

A

hypertonic contractions that are tetanic in intensity (very intense and sustaining)

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19
Q

what are some things that should be done before labor for percipitous birth

A

if history of percipitous birth plan induction 1 week before pervious precipitous birth

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20
Q

what should you tell the mom to do during percipitous labor

A

breath through the contractions rather then pushing

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21
Q

what interventions are needed after a perciptious labor

A

maternal soft tissue and placenta need to be carefully examined, lacerations need suturing, monitor for hemorrhage

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22
Q

what is pelvic dystocia

A

pelvis has limited capacity, fetus is too large or enters in malpresentation (like shoulder position)

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23
Q

what is pelvic dystocia causes

A

malnutrition, tumors, neoplasms, congential abnormalities, traumatic spinal injury, spinal disorders, imaturity of pelvis (like an adolescent patient)

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24
Q

what is soft tissue dystocia

A

birth passage obstructed by anatomical abnormality rather then pelvis

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25
Q

what is a bandal ring

A

pathological reaction between upper and lower uterine segements

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26
Q

what are some causes of soft tissue dystocia

A

placenta previa, uterine fibroids, ovarian tumors, full bladder or rectum

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27
Q

what is the purpose trial of labor

A

to assess for safety of having a vaginal birth to see how mom. baby tolerate, takes 4-5 hours with monitoring tolerance

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28
Q

what is a TOLAS

A

trial of labor after cesarian, do because mom wants vaginal birth after c section but need to assess risk of hemorrhage, need to see if uterine can handle it - if mom has tranderal incision

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29
Q

when does a trial of labor occur

A

when mom has questionable maternal pelvic (first rule out CPD), fetal abnormal presentation, when mom desires vaginal birth after c section

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30
Q

why is an amniotomy done

A

to augment labor (help it along, making regular strong contraction) or induce labor

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31
Q

what needs to be done after an amniotomy

A

assess FHT immediately to detect cord prolapse/ cord compression (varible decels and bradycardia)

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32
Q

how is an aminotomy done

A

aminohook, or other sharp instrument into lower segment of amniotic membranes

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33
Q

what should be done before amniotomy

A

check FHR, palpate for umbilical cord, determine fetal station and presentation, no prescence of active infection, or HIV infection

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34
Q

how long should it take for an aminotomy to work

A

after ROM labor should happen within 12 hours, if not there is an increase risk for infection, cord prolapse and fetal injury

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35
Q

what is cervix ripening

A

to make the cervix favorable for induction, makes the cervix softer for induction and effacement to occur

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36
Q

what is a bishop score

A

helps determine cervical ineducability which the increase score the more likley the success for induction

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37
Q

how is cytotec administered and when is it used

A

intravaginally, orally, sublingually, most effective is bishop scroe over 6 (can be used at 4 or lower just doesnt work as good)

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38
Q

what are dilators used for

A

placed in cervix to stimulate release of endogenous and prostaglandins

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39
Q

what are 2 different types of balloon catheters how long do they stay

A

hydroscopic (laminara), and synthetic (lamnicame), stay in place for 6-12 hours, must document number of dilators used and removed

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40
Q

what are the contraindications for balloon catheters

A

urinary retention, ROM, uterine tenderness, vaginal bleeding, fever, fetal distress

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41
Q

what are some complications of labor inducing

A

usually require more interventions like IV, amniotomy, epidural, longer stay

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42
Q

what are some indications for labor induce

A

post - term dates, maternal conditions, DM, gestational HTN, fetal demise, PROM, infection of choreon and amniotic membranes, abruption, IUGR, oligohydramnios, pre eclampsia/elcampsia

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43
Q

what are some cervical ripening agents

A

prostaglandins E1 and E2, dinoprostone (perpidil, cervadil), or misoprostol (cytotek)

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44
Q

what are some contrindications for cervical ripening agents

A

non reassuring FHT pattern, maternal infection/fever, vaginal bleeding, hypersensitivty, regular/progressive contractions, history of c-section or uterine scaring

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45
Q

what should be done before cervical ripening agents

A

consent, good FHR

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46
Q

what should be done after cervical ripening agents

A

maintain side laying of lateral tilt for 30-60min up to 2 hrs, monitor for unfavorable reactions - if there is then get clean sterile gauze and wipe med out

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47
Q

how is membrane sweeping/stipping done

A

gloved finger inserted into internal cervix and rotated 360 degree to seperate amniotic membrane in lower uterine segment which will release prostaglandins to start facilitating labor

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48
Q

what is tachysystole

A

contractions lasting over 90 seconds and occur over every 2 min, resting tone over 20-25 with peak pressure over 80

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49
Q

what is a non-assureing FHT

A

baseline below 110 or over 160 absence variability, repeated or prolonged decels

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50
Q

what does ocytocin hormone do

A

normal hormone produced by pituitary gland that stimulates uterine contraction, increase strength, duration and frequency of contractions

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51
Q

what does the med oxytocin do

A

can be used to induce or augment labor, requires 1:1 nurse patient, doesnt exceed 20mu/min unless specified and doc by HCP, if non reassuring FHT stop med

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52
Q

what are some herbs that can be used to induce labor

A

black haw, primerose oil, black and blu conosh, shamomile, red rasberry leabed, - concern is lack of research

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53
Q

why would assisted delivery be needed

A

because of maternal exhaustion, epidural anesthesia, fetal distress, need to rotate head

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54
Q

what are the diffrent types of forceps

A

outlet- when fetal scalp is visable on perineum
low - when fetal head is at 2+ station
mid- when fetal head is enlarged by less then 2+ station

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55
Q

what are some complications of forceps

A

perineal trauma, hemorrhage, fetal marks on presenting part, temporary facial paralysis (does go away)

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56
Q

when would vaccum assisted delivery be used

A

labor has stalled/labor arrest, cant push effectivley, needs expedited labor bc of fetal distress but must have vertex presnting, no CPD, and ROM must occur

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57
Q

what are the contraindications of vaccum assisted delivery

A

preterm infant (bc increase risk of intracranial hemorrhage), or if an infant has already had fetal scalp blood sampling already

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58
Q

when would forceps be used

A

dystocia, inability to push with contractions, prevent worsening of serioud medical conditions, abnormal fetal presentation/ immaturity/ arrest/ distress/ rotation,

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59
Q

what must happen for forceps to be used

A

fetus must be engaged, anesthesia admin for pelvic reaction, episotomy, consent, no CPD, ROM has to occur, FHR recorrded before and one applied to make sure cord wasnt clamped

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60
Q

what are the pros of using vaccum

A

fewer lacerations then forceps, less meds so baby comes out less depressed

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61
Q

what are maternal HTN goals

A

prevent further detoriation of affected organs and foster positive maternal-baby outcome

62
Q

what are some interventions that are done for moms with DM

A

sometimes TOL, may induce at 38-40 weeks releated to large baby, must closely monitor glucose levles, and fetal monitoring

63
Q

what are some interventions for preterm labor

A

bed rest, hydration, tocolytic therapy, c section to prevent complications and brain bleed

64
Q

what is the leading indirect maternal death and whats it related to

A

cardiac disease, releated to improvement in care of young girls with cardiac issues, advanced maternal age, associated health risks

65
Q

what are some complications of moms with DM

A

shoulder dystocia, fetal macrosomia, if c section schedule in AM for best glycemic control, after check FSBG ever 2 hours (want 80-100), increase risk for pre eclmapsis/eclampsia, infection, hemorrhage, breastfeeding moms at increase risk for hypoglyemia

66
Q

what are the interventions for DM in the 1st 24 hours

A

dramatic decrease in insulin requirments (so may no need for 24-72hours)

67
Q

what is external cephalic version

A

attempt before delivery to turn the baby

68
Q

how do you diagnosis fetal malpresentation

A

leopold manuvers and vaginal exam confirmed with ultrasound

69
Q

what are the complications of fetal malpresentation

A

slow lobor, increase risk for prolapsed cord with SROM

70
Q

what is asynclitsm presentation

A

brow and face presentation to another generally from breech to vertex

71
Q

what is version

A

turning fetus from one porition to another done at 37 weeks so the baby doesnt engage, but fetal lungs have more time to mature

72
Q

what are the risks for version

A

abruption, hemorrhage, cord prolapse, ROM, still birth, fetomaternal hemorrhage

73
Q

what are the contraindications for version

A

previous c section, uterine anomlies, CPD, previa/abruption, multifetal, oligohydramnios, nonreasuring fetal monitoring

74
Q

what should be done before version

A

consent, US to confirm fetal position, locate umbilical cord, rule out previa/abruption, assess maternal pelvic dimensions, amniotic fluid amount, fetal size, gestation age, presence of anomalies

75
Q

what are the meds used for version

A

trambutalin or magnesium sulfate for uterine relaxation

76
Q

what is shoulder dystocia

A

when head is delivered and anterior shoulder is stuck behind pubic arch - slow labor, turtle sign (when the head contractions into vaginal cannal with contractions)

77
Q

what is an internal version

A

hand inserted into uterus, mostly used for muligestations to deliver the 2nd fetus

78
Q

what could be some causes for shoulder dystocia

A

maternal pelvic deformaties, CPD, hisotry of shoulder dystocia, obestiy, excessive weight gain, DM, arrest of dilation, percipitous labor, instrument delivery, postdate pregnancy, fetal macrosomia

79
Q

what are some fetal injuries caused by shoulder dystocia

A

brachial plexus, fractures:humes or clavical caneirb paralysis (paralysis of the arm)

80
Q

what are some maternal injuries for shoulder dystocia

A

excessive blood loss, from uterine atony/rupture, lacerations, episiotomy extension

81
Q

what do you not want to do for shoulder dystocia

A

fundal pressure - bc if baby is stuck on pelvic bone it wont help

82
Q

what is the microberts manuever for shoulder dystocia

A

maternal thighs up on abdomen in lithotomy position to open pelvis

83
Q

what is the suprapubic pressure for shoulder dystocia

A

above symphysis pubis on anterior shoulder to get it under the pubis

84
Q

what is the zavanelli manuver used for shoulder dystocia

A

attempt to place head back into uterus to perform c section

85
Q

what is the woods/corkscrew manuver for shoulder dystocia

A

attempt to change anterior shoulder to posterior shoulder or vise versa

86
Q

what is cephalopelvic disporporation

A

fetus cant fit through maternal pelvis to allow vaginal birth

87
Q

what are the risks for multiple gestation

A

more at risk for hemorrhage (related to uterine atony), abruption, placental retention

88
Q

what are the causes of cephalopelvic disproportion

A

fetal size, maternal pelvic size, history CPD, slow progression of labor, lack of fetal decent, excessive pain during labor

89
Q

what is the management for cephalopelvic dystocia

A

maternal postion changes, relaxation, hydrotherapy, analgesics

90
Q

what is nuchal cord

A

cord is wrapped around fetal neck, occurs mostly with increased maternal age

91
Q

what happens because of nuchal cord

A

festal asphyxia, facial petechia, subconjunctival hemorrhage, facial duskiness, anemia, markings on neck

92
Q

what is oligohydraminos and what could it cause

A

less then 300ml, could cause fetal distress, cord entaglement, cord compression

93
Q

what is the treatment for oligohydramino

A

aminoinfusion by IV intrauterine of warm fluids

94
Q

what is meconium

A

fetus poops in uterus

95
Q

what causes oligohyamino

A

fetal renal abnormalities, poor placental perfusion, PROM

96
Q

what are the causes of meconium

A

fetal hypoxia related peristalsis and spincter relaxation, breech presentation, cord compression

97
Q

what is polyhydraminos and where do you see it

A

over 2L of fluid occurs in multiple gestation, fetal GI anomalies (issues with swallowing), maternal DM, abnormal brain development

98
Q

what are the maternal risks for polyhydramino

A

abruption, hemorrhage, PIL, PROM, can cause fetal malpresentation

99
Q

what is chorioamnionitis

A

maternal infection of amniotic membrane

100
Q

what are the ss of chorioamnionitis

A

maternal temp over 100.4, fetal tachycardia, uterine tenderness, foul smelling amniotic fluid

101
Q

what is the treatment for chorioaminoitis

A

delivery of infant and IV antibiotic

102
Q

what are the risk factors of ahorioamionitis

A

ROM, multiple vaginal exams, pre-existing infection, untreated GBS, internal monitoring, PPROM

103
Q

what is placenta previa

A

placenta has fallen closer to cervical opening

104
Q

how does delivery happen when placenta previa is a factor

A

if bleeding stopped, maternal VS stable and FHT good and less then 36 weeks just monitor, if newar term and bleeding then emergency C/S

105
Q

what is placental abruption

A

placenta separates uterus

106
Q

what are the causes for placental abruption

A

predisposing factors, maternal HTN, cocaine, direct trauma, history of abruption

107
Q

what are some interventions for placental abruption

A

no vaginal exams, maintain lateral position, blood/fluid replacement

108
Q

what are some complications from unresolved bleeding

A

DIC, couvelaire (blood between seperated placenta and uterine wall)

109
Q

what are the ss of DIC

A

easy bruising, multiple petechia, bleeding from IV sites

110
Q

what will you notice on the labs for DIC

A

decrease hgb/hct/fibrogen, increase fibrin split/degradation products

111
Q

what is thromboplastin

A

released in maeternal circulation bc of placental bleeding and clot formation which decrease clotting factors and increase circulating anticoagulant, leaving cirulatory blood unable to clot

112
Q

what are the interventions for DIC

A

side laying for placental perfusion, O2 (8-10L/min), monitor UOP, asses vaginal bleeding every 2-4hr

113
Q

what are the ss of complete uterine rupture

A

sudden severe abdominal pain during strong contraction followed by no pain (bc pressure released by rupture)

114
Q

what are the interventions for complete uterine rupture

A

hysterectomy and blood replacement

115
Q

what are the ss of incomplete uterine rupture

A

loaclized tenderness and aching pain over lower uterine segment, sudden changes in FHT, faintness, vomiting, hypotonic contractions, lack of labor progression, ss of hypovolemic shock (decrease BP increase HR, pallor)

116
Q

what are the causes of incomplete rupture

A

incision coming apart

117
Q

what are the interventions for small rupture

A

laporotomy and birth on infant, reapir of tear, volume replacement with fluids

118
Q

what is uterine inversion

A

uterus turns inside out,

119
Q

what is a complete/incomplete uterine inversion

A

complete = large red globular mass protrudes from vagina
incomplete= not seen but no fundal palpation and can feel mass in dilated cervix

120
Q

what are the causes of uterine inversion

A

usually from pulling the placenta out to speed it up which shouldnt be done, could also be fundal implantation, vigourous fundal pressure, uterine atony, macrosomic infants, magnesium sulfate, precipitous labor, short umbilical cord

121
Q

what are the ss of uterine inversion

A

maternal pain, large hemorrhage, with hypovolemic shock

122
Q

what is umbilical cord prolapse

A

loop of umbilical cord slips below presenting part of fetus

123
Q

what are the different types of umbilical cord prolapse

A

occult= cord no seen or felt during vaginal exam
complete= cord decends into vagina and felt as pulsating masswith vaginal exam
frank= visable prolapse usually right after ROM

124
Q

what are the risks for umbilical cord prolapse

A

malpresentation, transverse lie, polyhydraminos, preterm or low birth weight, multiple gestation, unengage presenting part

125
Q

how do you manage umbilical cord prolapse

A

relieve pressure on the cord by liftning the presenting part off of the cord, position changes, O2 (10l.min), if cord visable wrap with warm sailene and quick delivery

126
Q

what is velamentous cord insertion

A

fetal vessels separate at distal end of cord so they are no protected by jelly, creates risk for compression, rupture, and thrombosis

127
Q

what are the ss of velamentous cord insertion

A

sudden painless bleeding

128
Q

what is circumvallate

A

ring formed of double folded amnion and chorion near fetal surface

129
Q

what are the causes of circumvallate

A

antepartum hemorrhage, preterm delivery, fetal malformation

130
Q

what is succenturiate

A

contains 1 or 2 seperated lobes each with own circulation one lobe stays after birth which can cause maternal hemorrhage so needs to be manually removed

131
Q

what is placenta accrete

A

slight penetration of myometrium

132
Q

what is battledore

A

umbilical cord is implanted near margin of placenta, assosicated with fetal hemorrhage

133
Q

what is placental percreta

A

placental perforation of uterus

134
Q

what is placental increata

A

deep placental penetration of myometrium

135
Q

what is anaphylactoid syndrome

A

aka amniotic fluid embolism, not sure wheat happens but the amniotic fluid contains small particles of fetal debris that escapes in maternal circulation- triggering anaphylactic reaction and release of endogenous mediator which obstructs pulmonoary vessels making is hard to breath and circulatory collpase

136
Q

what are the ss of anaphylactic syndrome

A

during labor, delivery, or within 30 min of delivery sudden on set of cough, respiratory distress, decrease O2 sats, altered mental status, anxiety, restlessness, acute hypotension

137
Q

what are the risks for anaphylactic syndrome

A

advanced maternal age, multiparity, abruption, macrosomnia, meconium, fetal demise

138
Q

what is the management for anaphylactic syndrome

A

deliver the baby

139
Q

what are the indications for c section

A

maternal hypertension, active herpes, HIV, DM (bc big baby), fetal CPD, malpresentation, placental abnormalities, dysfunctional labor patterns, fetal distress, fetal distress, multiple gestation, cord prolapse

140
Q

what are the 2 types of c section

A

classical= vertical used in rare cases bc increase risk for complications
low transverse lie= vertical or transverse incision

141
Q

what should be done before a c section

A

type and cross, NPO, consent, external fetal monitoring, VS

142
Q

what are the complications of c section

A

hemorrhage, infection, thromboemobolism, urinary tract trauma, adhesions/dehiscene, placental issues with future pregnancies

143
Q

what is the prep for c section

A

prep abdome (clip peri hair shaving = infection), IV, foley cath, epidural, or general anesthesia

144
Q

what is the position on table for c section

A

on table supine with hip wedge (so no supine hypotension)

145
Q

what needs to be done post op after a c section

A

VS, fundal check, lochia checks, UOP every 15 mins for 2 hours, incentive spirometer,

146
Q

how does delivery work for a c section

A

delivery of head, suction face, delivery of shoulders then body

147
Q

what is a uterine rupture

A

with previous c section usally happens at side of previoud incision on uterus

148
Q

what are some complications of postdate pregnancy

A

fetal macromasia, still birth, oligohydraminos, meconium aspiration, fetal distress, maternal= hemorrhage, infection

149
Q

what is placental insufficiency

A

caused by increase aging of placenta past 40 weeks

150
Q

what assessment is done on the fetus for post date pregnancy

A

done for babies over 40 weeks, NST, daily kick count, contraction stress test, doppler flow measurement

151
Q

what is intrauterine fetal demise

A

death of fetus after 20 weeks or if age unknown fetus less then 500mg or less

152
Q

what is intrauterine fetal demise caused by

A

maternal infection, post-term pregnancy, advanced maternal age, trauma, abruption, previous still birth, pre-elcampsia, DM, placenta abnormalities, neonatal prematurity

OB Exam Two (8 decks)

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