Chapter 8 Flashcards
1
Q
what kind of problems can you have because of powers of labor
A
pushing - uterine dysfunction
2
Q
what kind of things can cause problems during pregnancy
A
multibaby, placental obstruction, inadequate bony pelvis, medical emergencies, complications from maternal disease
3
Q
what is dystocia
A
long, difficult or abnormal labor
4
Q
when does dystocia normally occur
A
1st stage with cervical dilation and effacement
5
Q
who is dystocia more normal in
A
nullipara
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
7
Q
what cause dystocia
A
powers, passenger, and/or passageway related to maternal positioning, fetal malpresentation, anomalies, macrosomia, multiple gestation, anxiety/fear
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
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)
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
11
Q
what meds are given to someone with hypertonic dysfunction
A
acetaminophen with benadryl, meperidine, hydromorphone, morphine
12
Q
what is hypotonic labor
A
uterine contractions decrease in frequency and intensity = less then 2-3 contractions over 10 mins -
13
Q
when is hypotonic labor more common
A
active phase of labor
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
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)
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
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
18
Q
what are some causes of percipitous labor
A
hypertonic contractions that are tetanic in intensity (very intense and sustaining)
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
20
Q
what should you tell the mom to do during percipitous labor
A
breath through the contractions rather then pushing
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
22
Q
what is pelvic dystocia
A
pelvis has limited capacity, fetus is too large or enters in malpresentation (like shoulder position)
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)
24
Q
what is soft tissue dystocia
A
birth passage obstructed by anatomical abnormality rather then pelvis
25
what is a bandal ring
pathological reaction between upper and lower uterine segements
26
what are some causes of soft tissue dystocia
placenta previa, uterine fibroids, ovarian tumors, full bladder or rectum
27
what is the purpose trial of labor
to assess for safety of having a vaginal birth to see how mom. baby tolerate, takes 4-5 hours with monitoring tolerance
28
what is a TOLAS
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
29
when does a trial of labor occur
when mom has questionable maternal pelvic (first rule out CPD), fetal abnormal presentation, when mom desires vaginal birth after c section
30
why is an amniotomy done
to augment labor (help it along, making regular strong contraction) or induce labor
31
what needs to be done after an amniotomy
assess FHT immediately to detect cord prolapse/ cord compression (varible decels and bradycardia)
32
how is an aminotomy done
aminohook, or other sharp instrument into lower segment of amniotic membranes
33
what should be done before amniotomy
check FHR, palpate for umbilical cord, determine fetal station and presentation, no prescence of active infection, or HIV infection
34
how long should it take for an aminotomy to work
after ROM labor should happen within 12 hours, if not there is an increase risk for infection, cord prolapse and fetal injury
35
what is cervix ripening
to make the cervix favorable for induction, makes the cervix softer for induction and effacement to occur
36
what is a bishop score
helps determine cervical ineducability which the increase score the more likley the success for induction
37
how is cytotec administered and when is it used
intravaginally, orally, sublingually, most effective is bishop scroe over 6 (can be used at 4 or lower just doesnt work as good)
38
what are dilators used for
placed in cervix to stimulate release of endogenous and prostaglandins
39
what are 2 different types of balloon catheters how long do they stay
hydroscopic (laminara), and synthetic (lamnicame), stay in place for 6-12 hours, must document number of dilators used and removed
40
what are the contraindications for balloon catheters
urinary retention, ROM, uterine tenderness, vaginal bleeding, fever, fetal distress
41
what are some complications of labor inducing
usually require more interventions like IV, amniotomy, epidural, longer stay
42
what are some indications for labor induce
post - term dates, maternal conditions, DM, gestational HTN, fetal demise, PROM, infection of choreon and amniotic membranes, abruption, IUGR, oligohydramnios, pre eclampsia/elcampsia
43
what are some cervical ripening agents
prostaglandins E1 and E2, dinoprostone (perpidil, cervadil), or misoprostol (cytotek)
44
what are some contrindications for cervical ripening agents
non reassuring FHT pattern, maternal infection/fever, vaginal bleeding, hypersensitivty, regular/progressive contractions, history of c-section or uterine scaring
45
what should be done before cervical ripening agents
consent, good FHR
46
what should be done after cervical ripening agents
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
47
how is membrane sweeping/stipping done
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
48
what is tachysystole
contractions lasting over 90 seconds and occur over every 2 min, resting tone over 20-25 with peak pressure over 80
49
what is a non-assureing FHT
baseline below 110 or over 160 absence variability, repeated or prolonged decels
50
what does ocytocin hormone do
normal hormone produced by pituitary gland that stimulates uterine contraction, increase strength, duration and frequency of contractions
51
what does the med oxytocin do
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
52
what are some herbs that can be used to induce labor
black haw, primerose oil, black and blu conosh, shamomile, red rasberry leabed, - concern is lack of research
53
why would assisted delivery be needed
because of maternal exhaustion, epidural anesthesia, fetal distress, need to rotate head
54
what are the diffrent types of forceps
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
55
what are some complications of forceps
perineal trauma, hemorrhage, fetal marks on presenting part, temporary facial paralysis (does go away)
56
when would vaccum assisted delivery be used
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
57
what are the contraindications of vaccum assisted delivery
preterm infant (bc increase risk of intracranial hemorrhage), or if an infant has already had fetal scalp blood sampling already
58
when would forceps be used
dystocia, inability to push with contractions, prevent worsening of serioud medical conditions, abnormal fetal presentation/ immaturity/ arrest/ distress/ rotation,
59
what must happen for forceps to be used
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
60
what are the pros of using vaccum
fewer lacerations then forceps, less meds so baby comes out less depressed
61
what are maternal HTN goals
prevent further detoriation of affected organs and foster positive maternal-baby outcome
62
what are some interventions that are done for moms with DM
sometimes TOL, may induce at 38-40 weeks releated to large baby, must closely monitor glucose levles, and fetal monitoring
63
what are some interventions for preterm labor
bed rest, hydration, tocolytic therapy, c section to prevent complications and brain bleed
64
what is the leading indirect maternal death and whats it related to
cardiac disease, releated to improvement in care of young girls with cardiac issues, advanced maternal age, associated health risks
65
what are some complications of moms with DM
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
what are the interventions for DM in the 1st 24 hours
dramatic decrease in insulin requirments (so may no need for 24-72hours)
67
what is external cephalic version
attempt before delivery to turn the baby
68
how do you diagnosis fetal malpresentation
leopold manuvers and vaginal exam confirmed with ultrasound
69
what are the complications of fetal malpresentation
slow lobor, increase risk for prolapsed cord with SROM
70
what is asynclitsm presentation
brow and face presentation to another generally from breech to vertex
71
what is version
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
what are the risks for version
abruption, hemorrhage, cord prolapse, ROM, still birth, fetomaternal hemorrhage
73
what are the contraindications for version
previous c section, uterine anomlies, CPD, previa/abruption, multifetal, oligohydramnios, nonreasuring fetal monitoring
74
what should be done before version
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
what are the meds used for version
trambutalin or magnesium sulfate for uterine relaxation
76
what is shoulder dystocia
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
what is an internal version
hand inserted into uterus, mostly used for muligestations to deliver the 2nd fetus
78
what could be some causes for shoulder dystocia
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
what are some fetal injuries caused by shoulder dystocia
brachial plexus, fractures:humes or clavical caneirb paralysis (paralysis of the arm)
80
what are some maternal injuries for shoulder dystocia
excessive blood loss, from uterine atony/rupture, lacerations, episiotomy extension
81
what do you not want to do for shoulder dystocia
fundal pressure - bc if baby is stuck on pelvic bone it wont help
82
what is the microberts manuever for shoulder dystocia
maternal thighs up on abdomen in lithotomy position to open pelvis
83
what is the suprapubic pressure for shoulder dystocia
above symphysis pubis on anterior shoulder to get it under the pubis
84
what is the zavanelli manuver used for shoulder dystocia
attempt to place head back into uterus to perform c section
85
what is the woods/corkscrew manuver for shoulder dystocia
attempt to change anterior shoulder to posterior shoulder or vise versa
86
what is cephalopelvic disporporation
fetus cant fit through maternal pelvis to allow vaginal birth
87
what are the risks for multiple gestation
more at risk for hemorrhage (related to uterine atony), abruption, placental retention
88
what are the causes of cephalopelvic disproportion
fetal size, maternal pelvic size, history CPD, slow progression of labor, lack of fetal decent, excessive pain during labor
89
what is the management for cephalopelvic dystocia
maternal postion changes, relaxation, hydrotherapy, analgesics
90
what is nuchal cord
cord is wrapped around fetal neck, occurs mostly with increased maternal age
91
what happens because of nuchal cord
festal asphyxia, facial petechia, subconjunctival hemorrhage, facial duskiness, anemia, markings on neck
92
what is oligohydraminos and what could it cause
less then 300ml, could cause fetal distress, cord entaglement, cord compression
93
what is the treatment for oligohydramino
aminoinfusion by IV intrauterine of warm fluids
94
what is meconium
fetus poops in uterus
95
what causes oligohyamino
fetal renal abnormalities, poor placental perfusion, PROM
96
what are the causes of meconium
fetal hypoxia related peristalsis and spincter relaxation, breech presentation, cord compression
97
what is polyhydraminos and where do you see it
over 2L of fluid occurs in multiple gestation, fetal GI anomalies (issues with swallowing), maternal DM, abnormal brain development
98
what are the maternal risks for polyhydramino
abruption, hemorrhage, PIL, PROM, can cause fetal malpresentation
99
what is chorioamnionitis
maternal infection of amniotic membrane
100
what are the ss of chorioamnionitis
maternal temp over 100.4, fetal tachycardia, uterine tenderness, foul smelling amniotic fluid
101
what is the treatment for chorioaminoitis
delivery of infant and IV antibiotic
102
what are the risk factors of ahorioamionitis
ROM, multiple vaginal exams, pre-existing infection, untreated GBS, internal monitoring, PPROM
103
what is placenta previa
placenta has fallen closer to cervical opening
104
how does delivery happen when placenta previa is a factor
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
what is placental abruption
placenta separates uterus
106
what are the causes for placental abruption
predisposing factors, maternal HTN, cocaine, direct trauma, history of abruption
107
what are some interventions for placental abruption
no vaginal exams, maintain lateral position, blood/fluid replacement
108
what are some complications from unresolved bleeding
DIC, couvelaire (blood between seperated placenta and uterine wall)
109
what are the ss of DIC
easy bruising, multiple petechia, bleeding from IV sites
110
what will you notice on the labs for DIC
decrease hgb/hct/fibrogen, increase fibrin split/degradation products
111
what is thromboplastin
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
what are the interventions for DIC
side laying for placental perfusion, O2 (8-10L/min), monitor UOP, asses vaginal bleeding every 2-4hr
113
what are the ss of complete uterine rupture
sudden severe abdominal pain during strong contraction followed by no pain (bc pressure released by rupture)
114
what are the interventions for complete uterine rupture
hysterectomy and blood replacement
115
what are the ss of incomplete uterine rupture
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
what are the causes of incomplete rupture
incision coming apart
117
what are the interventions for small rupture
laporotomy and birth on infant, reapir of tear, volume replacement with fluids
118
what is uterine inversion
uterus turns inside out,
119
what is a complete/incomplete uterine inversion
complete = large red globular mass protrudes from vagina
incomplete= not seen but no fundal palpation and can feel mass in dilated cervix
120
what are the causes of uterine inversion
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
what are the ss of uterine inversion
maternal pain, large hemorrhage, with hypovolemic shock
122
what is umbilical cord prolapse
loop of umbilical cord slips below presenting part of fetus
123
what are the different types of umbilical cord prolapse
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
what are the risks for umbilical cord prolapse
malpresentation, transverse lie, polyhydraminos, preterm or low birth weight, multiple gestation, unengage presenting part
125
how do you manage umbilical cord prolapse
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
what is velamentous cord insertion
fetal vessels separate at distal end of cord so they are no protected by jelly, creates risk for compression, rupture, and thrombosis
127
what are the ss of velamentous cord insertion
sudden painless bleeding
128
what is circumvallate
ring formed of double folded amnion and chorion near fetal surface
129
what are the causes of circumvallate
antepartum hemorrhage, preterm delivery, fetal malformation
130
what is succenturiate
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
what is placenta accrete
slight penetration of myometrium
132
what is battledore
umbilical cord is implanted near margin of placenta, assosicated with fetal hemorrhage
133
what is placental percreta
placental perforation of uterus
134
what is placental increata
deep placental penetration of myometrium
135
what is anaphylactoid syndrome
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
what are the ss of anaphylactic syndrome
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
what are the risks for anaphylactic syndrome
advanced maternal age, multiparity, abruption, macrosomnia, meconium, fetal demise
138
what is the management for anaphylactic syndrome
deliver the baby
139
what are the indications for c section
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
what are the 2 types of c section
classical= vertical used in rare cases bc increase risk for complications
low transverse lie= vertical or transverse incision
141
what should be done before a c section
type and cross, NPO, consent, external fetal monitoring, VS
142
what are the complications of c section
hemorrhage, infection, thromboemobolism, urinary tract trauma, adhesions/dehiscene, placental issues with future pregnancies
143
what is the prep for c section
prep abdome (clip peri hair shaving = infection), IV, foley cath, epidural, or general anesthesia
144
what is the position on table for c section
on table supine with hip wedge (so no supine hypotension)
145
what needs to be done post op after a c section
VS, fundal check, lochia checks, UOP every 15 mins for 2 hours, incentive spirometer,
146
how does delivery work for a c section
delivery of head, suction face, delivery of shoulders then body
147
what is a uterine rupture
with previous c section usally happens at side of previoud incision on uterus
148
what are some complications of postdate pregnancy
fetal macromasia, still birth, oligohydraminos, meconium aspiration, fetal distress, maternal= hemorrhage, infection
149
what is placental insufficiency
caused by increase aging of placenta past 40 weeks
150
what assessment is done on the fetus for post date pregnancy
done for babies over 40 weeks, NST, daily kick count, contraction stress test, doppler flow measurement
151
what is intrauterine fetal demise
death of fetus after 20 weeks or if age unknown fetus less then 500mg or less
152
what is intrauterine fetal demise caused by
maternal infection, post-term pregnancy, advanced maternal age, trauma, abruption, previous still birth, pre-elcampsia, DM, placenta abnormalities, neonatal prematurity
