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Labor and Delivery > exam 2 > Flashcards

exam 2 Flashcards

1
Q
  1. The goal of intrapartum FHR monitoring is to …….
  2. What is meant by asphyxia?
  3. Name a few monitoring techniques:
  4. Electronic fetal monitoring can be done ……….. or ……….. .
A
  1. identify and differentiate between normal and abnormal patterns.
  2. when fetal hypoxia results in metabolic acidosis
  3. Leopold’s maneuvers, and both intermittent and continuous fetal monitoring.
  4. externally or internally
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2
Q
  1. Name the 2 external fetal monitoring methods:
  2. What is the name of the internal fetal monitoring method?
  3. How can we monitor uterine contractions externally and internally?
  4. How is the tracing displayed on the paper or computer screen for the aforementioned monitoring methods?
A
  1. ultrasound transducer and toco transducer
  2. Fetal Scalp Electrode (FSE)
  3. Externally: palpating fundus, and external uterine contraction sensor TOCO(doesn’t strength). Internally: with an Intrauterine pressure catheter (IUPC)
  4. the FHR in the upper section and UA in the lower section
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3
Q
  1. where do contractions begin and where do they progress towards?
  2. In palpating the fundus, we can compare the feeling to palpating which three body parts?
  3. what are the disadvantages of the IUPC?
A
  1. uterine fundus, progresses downward to lower uterus.
  2. nose - mild contraction, chin - moderate contraction, forehead: strong contraction.
  3. membranes must be ruptured, risk of infection, uterine perforation, and hemorrhage.
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4
Q
  1. what is the baseline fetal heart rate?
  2. What is variability?
  3. Name and briefly describe the 4 types of FHR variability:
  4. What is the goal in variability?
A
  1. is the average rate during a 10-minute segment The normal range at term is 110 to 160 beats/minute.
  2. the fluctuations in the baseline FHR of two cycles per minute or greater and can be categorized into 4 different types.
  3. absent: no fluctuations
    minimal: < 5 bpm with fluctuations
    moderate: 6-25 bpm of fluctuation
    marked: >25
  4. to keep a moderate level
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5
Q
  1. how do we define fetal tachycardia?
  2. what are the reasons for fetal tachycardia?
  3. Fetal tachycardia is not a good sign, especially when combined with which two things?
A
  1. sustained
    baseline HR >160 bpm for 10 min. or more.
  2. Maternal side: infection/fever,
    chorioamnionitis, cocaine/meth,
    dehydration
    hyperthyroidism

Fetal side: anemia/hypoxia, infection, and cardiac dysrhythmias

  1. decelerations or absent variability
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6
Q
  1. How is fetal bradycardia defined?
  2. What are the reasons for fetal bradycardia?
  3. When
    bradycardia is accompanied by decreased variability or late decelerations, it’s a sign of …..
A
  1. <110 beats/min  10 minutes or more
2. placental insufficiency, 
Umbilical cord prolapse, 
Maternal hypotension,
Prolong umbilical cord compression,
Fetal congenital heart block,
Anesthetic medications,
Viral infection,
Maternal hypoglycemia,
Fetal heart failure,
Maternal hypothermia
  1. advanced fetal compromise.
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7
Q
  1. What is the difference between episodic and periodic changes in FHR?
  2. ……………. are considered an indication of fetal well-being.
  3. how is an acceleration timed?
  4. if an acceleration lasts longer than 2 min but less than 10min it is called a …… acceleration.
  5. Accelerations that lasts longer
    than 10 minutes is ………………….
A
  1. episodic changes are not associated with uterine contractions, whereas periodic changes are.
  2. accelerations
  3. increase of 15bpm for a min of 15 secs
  4. broad
  5. a change of the baseline.
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8
Q
  1. early decelerations are considered ………. . They have a gradual onset and their lowest point is …… sec. These coincide with…………….. They are the result of the stimulation of which nerve during a contraction?
  2. Late decelerations are due to …………? They do not return to the baseline until ………………
  3. Variable decelerations are variable in terms of
    their ……….. (4 things). They’re caused by …… . They have ….. shapr or a …… shape. If they occur occasionally, they are …… . But are concerning if they become repetitive.
  4. What do we do if there are variable decelerations?
  5. What is amniofusion?
A
  1. benign, greater than or equal to 30sec., contractions, vagus nerve.
  2. placental insufficiency. after the contraction is over
  3. onset, frequency, duration, and intensity. Compression of the umbilical cord. D or U. Benign.
  4. change position to take pressure off cord. Amniofusion
  5. done through intrauterine
    pressure catheter. Infusion of normal saline to relieve
    compression on the cord
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9
Q
  1. What is a prolonged deceleration?

2. What is VEAL CHOP?

A
  1. decrease of 15 bpm below the baseline lasting from 2-10min.
  2. acronym to match FHR to reasons it occurs. Variable Cord
    Early Head
    Accel Ok
    Late Placental
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10
Q

Describe the 3 tiers of fetal HR interpretation:

  1. Category 1
  2. Category 2
  3. Category 3
  4. what is the sinusoidal pattern?
A
  1. Category 1: all normal. FHR btw 110-160, moderate variability, no late or variable decelerations.
  2. Category 2: indeterminate. Includes everything that isn’t in categories 1 and 3.
  3. Category 3: Abnormal. Absence of baseline variability and any of the following: recurrent late decelerations, recurrent variable decelerations, bradycardia, or
    Sinusoidal
    pattern.
  4. smooth, wave-like. Can indicate severe anemia, chorioamniotitis, fetal sepsis. Severe problems.
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11
Q
  1. How do we manage abnormal patterns?

2. What are The five essential components of FHR tracing?

A
  1. monitor baseline rate, assist woman to side-lying, O2 admin (10L/min for 15-30min). Increase maternal fluid volume w/ IV bolus
  2. baseline rate, baseline variability, accelerations, decelerations, and changes or trends over time.
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12
Q
  1. what are the sources of pain during labor?
  2. What types of pain are experienced in the stages of labor?
  3. T or F anxiety and fear can cause muscle tension and slow labor?
A
  1. uteral ischemia, cervical dilation/effacement, and stretching of vagina and perineum.
  2. stage 1: visceral (felt all over lower abdomen & back)
    stage 2: visceral and somatic (same as 1st, but add stretching of genitalia)
    stage 3: visceral
  3. T
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13
Q
  1. Name some nonpharmacologic measures:
  2. What is the theory associated with nonpharmacologic measure?
  3. When is sedation used?
A 
1. heat/cold, massage
birthing balls
hydrotherapy
acupressure and acupuncture
position change
aromatherapy
music
hypnosis
  1. gate control theory
  2. for women in prolonged
    latent phase of labor when there is a need to decrease anxiety and promote sleep.
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14
Q
  1. What are the 2 major types of sedatives used in latent labor (note* not normally used in active labor)?
  2. What are their biggest side effects?
  3. What is the difference between analgesia and anesthesia?
A
  1. barbiturates and benzodiazepines
  2. drowsiness
    and hypotension
  3. analgesia: pain relief
    anesthesia: pain relief and loss of sensation
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15
Q
  1. How are narcotics administered in labor? Do they cross placenta? Are they given within 1 hour of delivery? Why?
  2. What is important to do before opioids?
A
  1. slow IV push. Yes. No because they depress the fetus CNS
  2. perform Stadol vaginal exam to
    assess cervical dilation and progress of labor
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16
Q
  1. which 2 drugs stimulate opioid receptors, mu and kappa?
  2. T or F, Morphine has an affinity for mu receptors?
  3. Which drug has lesser risk for neonatal sedation, Morphine or Demerol?
  4. Name 2 drugs which have an affinity for kappa and sigma receptors?
  5. What is the benefit of these drugs?
A
  1. Demerol and Fentanyl
  2. T
  3. Morphine
  4. Stadol, Nubain
  5. lesser Respiratory Depression
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17
Q
  1. Name a few benefits of Nitrous Oxide for analgesia:
  2. When is general anesthesia used?
  3. why does the baby need to be delivered right away n cases of general anesthesia?
A
  1. good for 1st and 2nd stages of labor, self-administered, very fast acting (30-60sec), brings analgesia, less anxiety, euphoria
  2. emergency c-sections
  3. risk of neonatal narcosis
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18
Q
  1. What is regional anesthesia?
  2. Which drugs are commonly used?
  3. What is a Pudendal block?
  4. When is it used?
A
  1. epidural or spinal anesthesia
  2. a combo of bupivacaine or proparacaine, and
    opioids such as fentanyl
  3. injection of a local anesthetic such as lidocaine into the pudendal
    nerve near the ischial spines.
  4. second stage or afterwards to repair tearing
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19
Q
  1. what are the contraindications to anesthesia?
  2. how long before epidural must we stop anticoagulation therapy?
  3. nursing actions before calling provider for anesthesia:
  4. what is crucial to do before epidural or spinal?
A
  1. allergy, history of spinal surgeries, active or anticipated hemorrhage, hypotension, or coagulopathy
  2. 24 hours before
  3. assess patient knowledge, labs, vitals, sterile vaginal exam, fetal assessment, and last meal of mother
  4. admin fluid bolus to prevent hypotension (hypotension is biggest side effect of epidural)
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20
Q
  1. Side effects of regional anesthesia:
  2. what must we do after administration of epidural?
  3. T or F foley is mandatory for epidural patients?
  4. What do we do if BP drops in epidural patient?
A 
1. Hypotension,
Changes in FHR,
Nausea/Vomiting,
Pruritis,
Urinary retention, Maternal temp
Headache 
High spinal (emergency)
Intravascular injection 
Epidural hematoma
  1. assess BP continuously (remember hypotension)
  2. T
  3. reposition mom, administer fluid bolus, admin O2, call provider, don’t leave patient alone.
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21
Q
  1. Name a couple obstetric emergencies:
  2. Why is shoulder dystocia an emergency?
  3. What are the risk factors to shoulder dystocia?
  4. What interventions are performed in dystocia?
A
  1. Shoulder dystocia, uterine rupture
  2. because the
    cord can be compressed between the fetal body and mom’s
    pelvis, and when the fetal head is out and chest is in, this prevents
    respirations.
  3. macrosomia (big baby), excessive weight gain (mom), abnormal pelvic anatomy, obesity, late term, short stature, history of dystocia.
  4. McRoberts manuever (flexing and abducting knees), suprapubic pressure, Zanvanelli manuver (push head in and c-section)
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22
Q
  1. What is uterine rupture?
  2. What are the risk factors to uterine rupture?
  3. signs of uterine rupture:
A
  1. tearing of the uterus at the
    site of a previous scar into the abdominal cavity.
  2. uterine scars, prior cesarean birth, prior rupture trauma, congenital
    uterine anomalies, drug cocaine use, and more.
  3. sudden fetal distress, acute and continuous abdominal pain, bleeding, hematuria, hypovolemic shock
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23
Q
  1. One of the most common obstetric complications is ……….. ………… .
  2. How do we define preterm labor?
  3. what are the risk factors to preterm birth?
  4. What are the often overlooked sign of preterm labor?
  5. name a few diagnostic tests for preterm labor:
A
  1. preterm birth.
  2. regular
    contractions with cervical effacement and dilation
    after the 20th week and before 37 weeks
  3. infections of urinary tract, vagina, or amniotic sac, previous preterm births, and multifetal pregnancies.
  4. uterine activity, cramping or low-back pain, feeling of baby pushing down, urinary frequency, and vaginal discharge changes.
  5. Fetal fibronectin,
    Cervical cultures, CBC, Urinalysis, Fetal Assessment and monitoring
24
Q
  1. What are the nursing tasks to manage preterm labor?
  2. What drugs are given for preterm labor?
  3. If contractions stop, what are patient instructions for home?
A
  1. vitals, I&O, bed rest in lateral position, admin of tocolytics (anti contraction drugs), admin of glucocorticoids (promotes fetal lung development), antibiotics, and hydration
  2. tocolytics, corticosteroids, magnesium sulfate, calcium channel blockers,
  3. no strenuous activity, bed rest, no sex, etc.
25
Q
  1. What is PROM?
  2. What is PPPROM?
  3. Although there are many risk factors to PPPROM, what is the most common?
  4. Name a test to determine premature rupture:
A
  1. (premature) Rupture of the amniotic sac before the onset of true labor.
  2. preterm premature rupture of the membranes. Refers to
    rupture of membranes before 37 weeks.
  3. Infection
  4. Nitrazine or FERN test. Tests acidity of fluids. Amniotic fluid turns strip blue.
26
Q
  1. What is labor dystocia?

2. T or F, labor dystocia is the main indicator for c-sections?

A
  1. Dysfunctional, difficult, or abnormal labor caused by various conditions related to the 5 P’s.
  2. T
27
Q
  1. what is induction or labor?
  2. What is augmentation of labor?
  3. name a few methods of cervical ripening and contraction induction:
  4. What is the main reason for induction?
  5. What are contraindications of induction?
A
  1. stimulation of contractions before spontaneous onset
  2. stimulation of hypotonic contractions once labor has spontaneously begun, but progress is inadequate
  3. mechanical (balloon/foley, seaweed/laminaria tents), pharmacological (cytotec, cervidil, oxytocin etc), surgical (membrane stripping, amniotomy), and nonpharmacological (nipple stimulation)
  4. prolonged gestation
  5. placenta previa,
    placental abruption, transverse fetal lie prolapse, umbilical cord, etc.
28
Q
  1. What is the Bishops score?
  2. A Bishops score of over 8 would indicate? Less than 6?
  3. Medical induction of labor has two components:
A
  1. a tool to score cervical readiness which helps to identify those most likely to achieve successful induction.
  2. indicates a possibility of a
    successful vaginal delivery. Less than 6 shows that cervical ripening method is needed prior to induction
  3. cervical ripening and induction of contractions
29
Q
  1. oxytocin has an ……….. effect,
    resulting in decreased urine flow and may lead to ………… ………….. .
  2. Symptoms of water intoxication include:
  3. what are 2 interventions to help fetus out during delivery?
A
  1. anti-diuretic, water intoxication.
  2. headache and vomiting
  3. forceps and vacuum-assisted births
30
Q
  1. What are a few factors explaining the increase of c-sections?
  2. What is a big concern and something nurses need to monitor with VBAC?
  3. what is the first indication of cord prolapse?
  4. What do we do with cord prolapse?
A
  1. electronic fetal monitoring which identifies fetal distress earlier, older mothers, reduced parity, increased maternal weight, and convenience.
  2. uterine rupture
  3. sudden fetal bradycardia or recurrent variable decelerations.
  4. do not leave woman, call for help, hold cord with wet sterile guaze, do not attempt to push it back in. Modify position, to trendelenberg or Nietzche’s.
31
Q
  1. What is an amniotic fluid embolism?

2. How does this affect the mother?

A
  1. life-threatening condition in which amniotic fluid enters mother’s blood stream causing a reaction like anaphylaxis or DIC
  2. sudden onset of hypertension, cardiac pulmonary collapse, hypoxia,
    and coagulopathy.
32
Q
      1. What are the categories of gestational hypertension?
A
  1. chronic hypertension
  2. gestational hypertension
  3. preeclampsia
  4. eclampsia
  5. HELLP syndrome
  6. chronic hypertension w/ superimposed pre-eclampsia
33
Q
  1. How do we define chronic hypertension?
  2. What is the danger in excessively lowering maternal BP with antihypertensives?
  3. How do we diagnose chronic hypertension w/superimposed preeclampsia?
A
  1. BP > 140/90 before pregnancy or before 20th week. Severe would be 160/110 (antihypertensive meds needed).
  2. decreased placental perfusion
  3. someone w/ chronic hypertension develops Sudden increase in BP and Proteinuria.
34
Q
  1. How do we define gestational hypertension?
  2. What % of women with gestation hypertension will develop preeclampsia?
  3. How do we differentiate gestational hypertension from preeclampsia?
A
  1. BP > 140/90 after 20th week in someone who didn’t have hypertension previously. It resolves after pregnancy.
  2. 50%
  3. preeclampsia has proteinuria whereas gestational hypertension doesn’t.
35
Q
  1. How do we define preeclampsia?
  2. How do we diagnose preeclampsia?
  3. Is edema still part of the preeclampsia diagnosis?
  4. What are the criteria of severe preeclampsia?
  5. What are the symptoms of severe preeclampsia?
  6. What are the risk factors to developing preeclampsia?
A
  1. multi-system disorder starting after week 20 that targets cardiovascular, renal, hepatic, and CNS. Can be mild or severe.
  2. BP >140/90 on 2 occassions. Proteinuria min of 300mg in a 24 hr urine collection (1+)
  3. no
  4. sudden development of BP 160/110 w/ proteinuria 3+ or 4+.
  5. Severe headache, visual changes, epigastric pain, pulmonary edema, rise in BUN and creatinine, oliguria, raised ALT/AST and thrombocytopenia
  6. mom >40yrs, previous preeclampsia, family history, diabetes, high BMI, hypertension, nulliparity, and multi gestation
36
Q
  1. briefly describe the pathophysiology of preeclampsia:
  2. What are some possible bad outcomes from preeclampsia?
  3. How do we assess for preeclampsia?
A
  1. condition leads to placental ischemia which leads to vasospasm which causes loss of intravascular volume and decreased cardiac output.
  2. IUGR (intrauterine growth restriction), preterm birth, oligohydramnios, placental abruption, altered FHR, death to fetus, maternal DIC, cerebral hemorrhage, renal and hepatic failure
  3. signs/symptoms, vitals, auscultate lungs, I&O’s, generalized edema, hyperactive reflexes, labs (CBC, AST, ALT, creatinine, uric acid, LDH), FHR, and uterine activity.
37
Q
  1. What are the patient goals for preeclampsia?
  2. how do we manage mild preeclampsia?
  3. How do we manage severe preeclampsia?
  4. Medications to treat hypertension (4):
A
  1. control HTN, prevent seizures, minimize risks for mom and baby
  2. vigilance, high protein diet, more frequent OB visits, rest w/ feet elevated, side-lying position to enhance renal and placental perfusion, home urine dipstick 2x’s/daily, delivery at 37 weeks
  3. admit to hospital, bedrest, treatment to prevent seizure, vaginal delivery preferred, C-section for emergency only due to high risk of hemorrhage.
  4. methyldopa (aldomet) PO in antepartum, nifedipine (adalat, procardia) PO antepartum, hydralazine (apresoline) IV push during labor, and labetalol (normodyne) IV push during labor.
38
Q
  1. What effects does Magnesium Sulfate have in the treatment of preeclampsia?
  2. What do we need to teach the patient about when we administer it by bolus?
  3. What are the signs of magnesium toxicity?
  4. What can happen from magnesium toxicity?
  5. What do we do in a case of toxicity?
  6. magnesium levels above 12mg/dL can cause what to happen?
A
  1. it blocks neuromuscular transmission and causes vasodilation
  2. It can cause hot flushing, confusion, weakness, diaphosesis, and breathing difficulty
  3. absence of deep patellar reflex, urine output < 30ml/hr, respiations < 12 breaths per min, decreased conciousness, magnesium levels >8mg/dL (therapeutic level is 4-7mg/dL)
  4. resp paralysis, CNS depression, cardiac arrest.
  5. stop infusion, admin of calcium gluconate 1g IV
  6. muscle paralysis and coma
39
Q
  1. Although there are no known preventions of preeclampsia, what are a couple possible things that could help?
  2. Preeclampsia can develop into clampsia. How is clampsia charcterized?
A
  1. aspirin, calcium, fish oil, vitamins D, C, E and low sodium diet
  2. loss of control of cerebral blood flow resulting in grand mal eclamptic seizure or coma
  3. restrain patient, call for help, try to get patient into L side-lying position
40
Q
  1. What is HELLP syndrome?
  2. What does HELLP stand for?
  3. What are signs and symptoms of HELLP?
  4. Is BP always elevated in HELLP?
  5. How to manage HELLP:
A
  1. HELLP is a lab diagnosed variant of severe preeclampsia that involves hepatic dysfunction
  2. H: hemolysis E: elevated L: Liver enzymes (2x higher) L: low P: platelets (<100,000)
  3. malaise, nausea, vomiting, epigastric pain, significant weight gain, edema
  4. no
  5. stabilize mom,evaluate fetus, manage BP and fluid status, magnesium, blood transfusion
41
Q
  1. What does bleeding indicate in each of the trimesters?
  2. ………… is a loss of pregnancy before the 20th
    week. But it’s ………….. after the 20th week of gestation.
A
  1. 1st: ectopic preg and miscarriage
    2nd: gestational trophoblastic disease or a molar pregnancy
    3rd: placenta previa and abruption
  2. miscarriage, stillbirth
42
Q
  1. name the types of spontaneous abortions:
  2. what is the most common reason for miscarriage?
  3. list some of the possible medications given to the patient after miscarriage:
A
  1. threatened (pregnancy continues),
    inevitable (cervix dilates membranes rupture), incomplete (not all contents are expelled), complete (all contents expelled), and missed (fetus dies, but not expelled).
  2. genetic abnormalities
  3. analgesics, sedatives, O2, prostaglandin, cytotec, oxytocin, antibiotics, RhoGam
43
Q
  1. What is an ectopic pregnancy?
  2. Why are these dangerous?
  3. What are the risk factors to an ectopic pregnancy?
A
  1. pregnancy outside of the uterus
  2. can lead to massive hemorrhage, infertility, and death
  3. history of, tubal surgery, prior tubal infection, IUD
44
Q
  1. What are the s/s of ectopic pregnancy?
  2. How to diagnose ectopic pregnancy?
  3. How to treat ectopic pregnancy:
  4. main teaching points to avoid ectopic pregnancy:
A
  1. unilateral stabbing pain, scant dark red/brown spotting btw 6-8 weeks, red blood from tubal rupture, referred shoulder pain (from phrenic nerve), faitness, dizziness, signs of hemorrhage and shock.
  2. low hCG, clinical s/s, transvaginal ultrasound, laparoscopy
  3. surgical repair of tube (salpingostomy), Methotrexate inhibits cell division thus ending pregnancy
  4. avoid risky sex because it increases chances for infections, know signs of PID, be aware if using an IUD since they can lead to PID, avoid smoking.
45
Q
  1. What is a molar pregnancy?
  2. What is the major risk of a molar pregnancy?
  3. what is the difference between partial and complete molar pregnancy?
A
  1. aka Gestational trophoblastic disease (GTD). Basically, there are the wrong amounts of chromosomes, so pregnancy fails, but a placenta forms.
  2. after a molar pregnancy, a cancer can occur that can be diagnosed only by measuring hCG hormone levels
  3. Complete hydatidiform mole (only dad’s chromosomes) has
    Placental proliferation, absent fetus
    Placental villi swollen, grape-like.

Partial (triploid 69 chromosomes) molar placenta and nonviable fetus.

Both are associated with choriocarcinoma. Complete has bigger chance to turn malignant

46
Q
  1. how do we diagnose a molar pregnancy?
  2. what does patient need to be aware of following a molar pregnancy?
  3. How do we treat a molar pregnancy?
A
  1. brown bleeding, uterine size is larger than it’s date, no FHtones, hyperemesis, High hCG, enlarged ovaries, expulsion of grape-like vesicles.
  2. must be monitored for development of cancer afterwards.
  3. promt D&C, monitor hGC, 1 year of contraception, monitor for development of cancer
47
Q
  1. What is placenta previa?
  2. which women have higher chance of this?
  3. What are the 3 degrees, or types of placenta previa?
A
  1. Placenta implanted in lower uterine segment near or over internal cervix
  2. multiparous
  3. Complete (always needs cesarean)
    Marginal, and
    Low-lying placenta
48
Q
  1. What are the risk factors to placenta previa?
  2. How does placenta previa present
  3. how do we confirm diagnosis and what do we avoid with these patients?
  4. how far from cervix must the placena be in order to deliver vaginally?
A 
1. Chronic hypertension/diabetes
Prior placenta previa
Multiparty
Multiple gestation
Increasing maternal age (>35)
Previous cesarean delivery
Previous uterine curettage
Smoking/cocaine use
  1. painless bright red vaginal bleeding during 2nd or 3rd trimester, often after sex
  2. confirm with ultra sound, avoid vaginal exams
  3. 2cm
49
Q
  1. What is placenta accreta?
  2. What is placenta inceta?
  3. placenta perceta?
  4. What can happen as a result of these?
A
  1. placenta attaches itself too deeply and firmly into the uterus
  2. placenta attaches even deeper into the wall of the uterus
  3. placenta attaches to the peritoneum
  4. hysterectomy after birth because hemorrhage cannot be stopped.
50
Q
  1. what is placental abruption?
  2. how is it graded and what are it’s symptoms?
  3. what is the big problem with placenta abruptio?
  4. risk factors to placenta abruptio:
A
  1. is premature separation of placenta from the uterine wall
    after 20th week of gestation
  2. mild, moderate, and severe. intense abdominal pain,
    board-like abdomen, also dark red vaginal bleeding, and intense pain at the site of separation. Bleeding may be concealed
  3. concealed hemorrhage
4. HTN,
Trauma(Blunt abdominal trauma)
Tobacco, cocaine, stimulants
Thrombophilias
Chorioamnionitis
Oligohydramnios, PROM
History of Abruption
51
Q
  1. assessment for abruption:

2. When is severe abruption, what do we do?

A
  1. vitals will reveal circulatory instability, monitor FHR and contractions, ultra sound to estimate fetal weight, lie, and evaluate placenta
  2. expedite delivery, maintain maternal circulation, prep for neonatal resuscitation, if fetus dies, vaginal deliveru is prefferred
52
Q
  1. How do we define gestational diabetes?
  2. What causes it?
  3. How to manage it?
  4. Risk factors:
  5. When do we screen patients for GD?
A
  1. Glucose intolerance that develops in pregnancy after 24th week
  2. the hormones produced during pregnancy(progesterone, cortisol, Human Chorionic somatomammotropin (HCS) can act as insulin antagonists and cause the woman’s body to become resistant to insulin.
  3. managed by diet and exercise.
  4. obesity, age, history of,ethnicity, and polycystic ovarian syndrome
  5. High risk patients are screened at the first perinatal visit, others screened at 24-28 weeks
53
Q
  1. How is the one-step oral glucose tolerance test OGTT done?
  2. what are some maternal complications to GD?
  3. what are some fetal and neonate complications to GD?
  4. congenital anomaly are more common if patient had …… …… ……., and ……… is more common with
    gestational diabetes.
A
  1. fast overnight, no smoking, no caffeine, blood sugar is tested first thing in the morning (should be less than 95). Give 75g of oral glucose and obtain serum levels at 1hr and again at 2hr.
  2. miscarriage, c-section, Hypertensive disorders, Preterm labor, Polyhydramnio, Hypoglycemia, Ketoacidosis
  3. Hypoglycemia, High bilirubin, Respiratory distress, Macrosomia, and Congenital anomalies
  4. unmanaged pregestational diabetes, macrosomia
54
Q
  1. why is it important to manage diabetes prior to conception? What test can you use to know blood sugar? What is a good level?
  2. In measuring a patient’s blood sugar, how many grams of carbs shouls a patient have if their blood glucose is 60? 50?
  3. Why should a patient with low blood sugar avoid foods with high fat/protein content?
A
  1. To avoid congenital anomalies, Hemoglobin A1C <7
  2. 10-15g, 20-30g
  3. fat and protein delay the peak of glucose response
55
Q
  1. What are signs of hyperglycemia in the mom?
  2. ………. …………… happens when the body begins metabolizing fats for energy.
  3. What triggers this?
  4. Diabetic ketoacidosis is caused by not enough ………..
  5. What do we give to someone in diabetic ketoacidosis?
A
  1. polydipsia, polyuria, polyphagia, blurred vision,
    headache, drowsiness, hyperpnea, nausea, and vomiting
  2. diabetic ketoacidosis
  3. stress, infection, inappropriate dose of
    insulin, also, steroids administration such as betamethasone and
    terbutaline.
  4. insulin
  5. fluids, and oxygen, insulin, and electrolyte
    replacement.
56
Q
  1. What causes hyperemesis gravidarum, and what are some of the criteria of this condition?
  2. What is is associated with?
  3. T or F, if a patient is admitted to hospital with hyperemesis gravidarum, can they receive TPN?
A
  1. elevated human chorionic gonadotropin levels. Weight loss of > 5% of prepregnancy body weight
    Dehydration, metabolic acidosis, alkalosis, and hypokalemia
  2. altered thyroid
    function.
  3. T

Labor and Delivery (3 decks)

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