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WOMENS > EXAM 2 > Flashcards

EXAM 2 Flashcards

1
Q

Cervical exams are usually performed every __ to __ hours

A

2-3

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2
Q

Amniotomy is considered when…

A

need to monitor fetal scalp HR or labor augmentation if labor has slowed

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3
Q

The first stage of labor begins when…

A

labor starts and ends with full cervical dilation to 10 centimeters.

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4
Q

labor is generally defined as….

A

beginning when contractions become strong and regularly spaced at approximately 3 to 5 minutes apart.

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5
Q

describe the latent phase of the first stage of labor

A

a preparatory stage marked by slow cervical dilation, with large biochemical and structural changes

0 to 6 cm

A normal latent phase can last up to 20 hours and 14 hours in nulliparous and multiparous women, respectively, without being considered prolonged.

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6
Q

describe the active phase of the first stage of labor

A

a much shorter and rapid dilational phase

6-10cm

During the active phase, the cervix typically dilates at a rate of 1.2 to 1.5 centimeters per hour.

Multiparas, or women with a history of prior vaginal delivery, tend to demonstrate more rapid cervical dilation.

The absence of cervical change for greater than 4 hours in the presence of adequate contractions or six hours with inadequate contractions is considered the arrest of labor and may warrant clinical intervention

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7
Q

The station of the fetus is defined relative to its proximity to mom’s ____ _____.

A

ischial spines

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8
Q

When the bony fetal presenting part is aligned with the maternal ischial spine, the fetus is___station.

A

0

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9
Q

describe how to indicate a baby’s station during labor

A

0 - -5 is further up in mom

0 - +5 is closer to being down birth canal

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10
Q

T/F: Sedation can increase the duration of the latent phase of labor.

A

True

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11
Q

Describe the parameters of the arrest of labor and may warrant clinical intervention

A

The absence of cervical change for greater than 4 hours in the presence of adequate contractions or six hours with inadequate contractions

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12
Q

During the active phase, the cervix typically dilates at a rate of ___ to ___ centimeters per hour

A

1.2 to 1.5

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13
Q

Describe the Second Stage of Labor

A

commences with complete cervical dilation to 10 centimeters and ends with the delivery of the neonate.

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14
Q

T/F: After cervical dilation is complete, the fetus descends into the vaginal canal with or without maternal pushing efforts.

A

true

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15
Q

The fetus passes through the birth canal via 7 movements known as the _____ _______.

A

cardinal movements.

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16
Q

What are the 7 cardinal movements

A

engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.

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17
Q

What elements may influence the duration of the second stage of labor

A

fetal factors such as fetal size and position, or maternal factors such as pelvis shape, the magnitude of expulsive efforts, comorbidities such as hypertension or diabetes, age, and history of previous deliveries

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18
Q

In parturients without neuraxial anesthesia, the second stage of labor typically lasts less than ____ hours in nulliparous women and less than ___ hours in multiparous women.

A

less than three hours in nulliparous

less than two hours in multiparous

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19
Q

In women who receive neuraxial anesthesia, the second stage of labor typically lasts less than ___ hours in nulliparous women and less than ___ hours in multiparous women.

A

less than four hours in nulliparous

less than three hours in multiparous

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20
Q

describe the third stage of labor

A

commences when the fetus is delivered and concludes with the delivery of the placenta

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21
Q

what are the three cardinal signs of the placenta detaching following birth

A

a gush of blood at the vagina, lengthening of the umbilical cord, and a globular shaped uterine fundus on palpation

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22
Q

A delivery time of greater than ___ _____________ is associated with a higher risk of postpartum hemorrhage and may be an indication for manual removal or other intervention.

A

30 minutes

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23
Q

why would a pre-term infant benefit from delayed cord clamping?

A

improved transitional circulation

better establishment of red blood cell volume, decreased need for blood transfusion

and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage

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24
Q

Friedman observed that labor typically has a ____________ shape

A

sigmoidal

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25
Q

Explain the five major factors that affect the labor process.
(AKA: The 5 P’s of labor)

A

Passageway
Passenger
Powers
Position of the mother
Psychological response

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26
Q

pelvic shapes indic what _____ looks like

A

midplane pelvis

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27
Q

Android-resembles a _____ pelvis

A

heart (male)

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28
Q

Gynecoid-resembles a _____ pelvis

A

female (circle)

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29
Q

difference between a Anthropoid and a Platypelloid pelvis shape

A

anthro oval shape pointed up and down

platy oval shape pointed side to side

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30
Q

describe the inlet of the pelvis

A

anterior/posterior-from symphysis pubis to spine

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31
Q

describe the midplane of the pelvis

A

symphysis to coccyx-normally the largest plane

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32
Q

describe the outlet of the pelvis

A

transverse diameter-distance between ischial spines

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33
Q

what are some considerations for the “passenger” (baby)

A

Fetal head
Fetal attitude
Fetal lie
Fetal presentation
Fetal position
placenta

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34
Q

what are the 2 types of fetal ie

A

longitudinal lie – fetal cephalocaudal axis is parallel to the mother’s cephalocaudal axis

transverse lie – fetal cephalocaudal axis is at right angle (90 degrees) to mother’s cephalocaudal axis

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35
Q

define Fetal lie

A

relationship of cephalocaudal axis of fetus to cephalocaudal axis of the mother

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36
Q

what is a normal fetal lie

A

longitudinal

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37
Q

what is a normal Fetal attitude

A

flexion

flexion of head/chin-to-chest, arms folded across the chest, and legs flexed up onto the abdomen

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38
Q

why would you be concerned if fetus attitude is anything other than flexion?

A

deviations especially related to the head will present larger diameters of the head for the pelvis

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39
Q

name four abnormal fetal presentations

A

full breech (flexion normal, head is just in fundus)

frank breech (legs straight against chest, flexible af)

single footing breech (fetus was in full breech but wanted to stick it’s foot through the cervix)

shoulder presentation (otherwise known as transverse lie, shoulder is sticking out of cervix)

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40
Q

describe Fetal position

A

the relationship of fetal presenting part to 1 of the 4 quadrants of the maternal pelvis i.e. front (anterior), back (posterior), or sides (right or left)

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41
Q

most common fetal position is…

A

occipitoanterior

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42
Q

what is a normal fetal presentation

A

vertex

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43
Q

3 notations used to describe fetal position

A

right (R) or left (L) side of maternal pelvis

landmark of fetal presenting part (occipit)

anterior (A), posterior (P), or transverse (T), depending on whether the landmark is in the front, back, or side of the maternal pelvis

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44
Q

what fetal position notation would be most favorable

A

ROA
LOA

left/right occipitanterior (baby is looking at left or right buttcheek)

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45
Q

describe the increment, acme, and decrement of a contraction

A

A typical contraction rises in intensity (increment), reaches a peak (acme), and then lessens (decrement).

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46
Q

how do you measure the frequency of a contraction

A

minutes and fractions of a minute

starts at the beginning of the hill, ends at the beginning of the NEXT hill

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47
Q

how do you measure the duration of a contraction

A

in seconds

starts at the beginning of the hill, ends at the end of the hill

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48
Q

how do you measure the intensity of a contraction

A

mild, moderate, strong

the intensity of a contraction is between 40-60 mmHg in the beginning of the active phase

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49
Q

What are the Primary Powers of Labor

A

Involuntary uterine contractions which causes:

effacement, dilation and change in station

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50
Q

define Effacement

A

the taking up, drawing up, and disappearance of internal os and cervical canal into the uterine side walls

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51
Q

define Dilation

A

widening of cervical os and cervical canal from less than a cm to approximately 10 cm

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52
Q

What are the Secondary Powers of Labor

A

Pushing! Contraction of maternal abdominal musculature for fetal and placenta expulsion

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53
Q

what is the Valsalva maneuver

A

used for managing the second stage of labor. The mother is asked to take a deep breath, hold the breath (closed glottis), and push downward when uterine contraction starts

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54
Q

why use an Upright position during the first stage of labor

A

Gravity assists with fetal descent
Facilitates dilation & effacement
Reduces pressure on major maternal structures

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55
Q

why use an Lateral (side-lying) during the first stage of labor

A

Increases cardiac output
Improves perfusion to organs
Removes pressure on major maternal structures
Helps with back pain & facilitates counterpressure

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56
Q

why use a Semi-recumbent (HOB elevated at least 30˚) position

A

Convenient for fetal monitoring & exams (not all that great otherwise)

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57
Q

why use a Hands and knees position during the first stage of labor

A

Helps back labor
Facilitates internal rotation of fetus
Good for OP presentation

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58
Q

what are some Preliminary Signs of Labor

A

Lightening – “dropping,” movement, or engagement of fetus into pelvic inlet

Sudden burst of energy - “nesting syndrome” – occurs approximately 24 to 48 hours prior to labor onset

Braxton Hicks Contractions: irregular, intermittent contractions that occurs throughout pregnancy

Cervical ripening – softening of cervix

Bloody show - small amount of blood loss occurs from exposed cervical capillaries. Can herald onset of true labor within 24 to 48 hours

Rupture of membranes (ROM) - 12 % females experience rupture prior to labor onset. 80 % females who experience ROM will experience true labor within 24 hours

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59
Q

difference between contractions and Braxton hicks

A

BH: cervical dilation does not occur, contractions tend to disappear or stop with change in activity

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60
Q

Main sign of TRUE labor is ….

A

progressive dilation & effacement of cervix

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61
Q

describe stage 1 of labor

A

latent (0-6cm)

active (6-10cm)

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62
Q

describe stage 2 of labor

A

10cm-birth

cardinal movements

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63
Q

describe stage 3 of labor

A

Birth to delivery of placenta

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64
Q

describe stage 4 of labor

A

Delivery of Placenta to 8 hours later

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65
Q

latent phase lasts about ___ hours for Nulliparas

A

20

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66
Q

latent phase lasts about ___ hours for Multiparas

A

14

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67
Q

signs of placental separation

A

globular-shaped uterus
increased fundal (top of the uterus) height in abdomen
sudden gush or trickle of blood
lengthening of umbilical cord out of vagina

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68
Q

what are the 7 cardinal movements

A

Engagement & descent
Flexion
Internal rotation to OA position
Extension (for expulsion)
External rotation – restitution
External rotation
Expulsion

69
Q

what to expect during stage four of labor

A

moderate drop in blood pressure
increased pulse pressure
moderate tachycardia

results from
blood loss (avg. 250-500 cc)
reduced weight of uterus
redistribution of blood into venous beds

70
Q

Usually give ______ IV or IM either before or after placenta delivery

A

Pitocin

71
Q

what is the average blood loss during labor

A

250-500 cc

72
Q

describe a 1st degree vaginal laceration

A

superficially disrupts mucosa

73
Q

describe a 2nd degree vaginal laceration

A

divides the perineal body (episiotomies)

74
Q

describe a 3rd degree vaginal laceration

A

tear involves anal sphincter

75
Q

describe a 4th degree vaginal laceration

A

tear involves rectal mucosa

76
Q

Uterus should be ____ and _______ during stage 4 of labor

A

contracted and midline

77
Q

what are normal side effects of stage 4 labor

A

Shaking
Urinary retention
Increased thirst & hunger

78
Q

blood volume increases by __% in pregnancy.

A

45

79
Q

T/F: BP goes up significantly due to pregnancy and more in labor

A

False

BP should stay stable d/t vasodilation & reduced vascular resistance. Slight cardiac hypertrophy d/t increased blood volume

80
Q

RBC increase by __-__% depending on iron stores

A

20-30

81
Q

why do pregnant people become easily anemic

A

Increased plasma volume causes physiologic anemia of pregnancy

82
Q

Blood glucose increases or decreases in labor?

A

Blood glucose decreases in labor

83
Q

Maternal O2 consumption increases __-__% above pre-pregnancy

A

20-40

84
Q

T/F: Proteinuria is a normal in pregnancy

A

no if not in labor. yes if in labor d/t work of labor

85
Q

why might a woman in labor feel super nauseous

A

Gastric motility slows in labor

86
Q

Fetal O2 supply is affected by:

A

Maternal blood flow
Maternal O2
Fetal circulation
Uterine tone
Placental vasculature

87
Q

what is the Leopold’s Maneuver

A

4 palpations to determine where the baby is in the uterus

  1. palpate the fundus to see of you feel a head or feet
  2. feel both sides of uterus. smooth=back, bumpy=arms
  3. pinch up with entire hand to see if you can move it to tell if engaged (can’t move it means its engaged)
  4. feel sides again where you think head is to see if baby is flexed or not
88
Q

where would you place an electronic fetal monitor (FSE) in-utero?

A

At the top of a shoulder blade

89
Q

how does an IUPC monitor the strength of contractions

A

measures in Montevideo units

Measure actual value of height of each contraction for 10 minutes & total it

Adequate labor ~200

90
Q

Tachysystole contractions are ___ contractions or more in a ___ minute period

A

Five contractions or more in a 10 minute period

91
Q

normal FHR range

A

110-160 bpm

92
Q

define Baseline variability

A

irregular fluctuations in baseline FHR

93
Q

what are the parameters for FHR Tachycardia

A

a rate of 160 bpm or more for 10 minutes

94
Q

what are the parameters for FHR Bradycardia

A

FHR less than 110 bpm for more than 10 minutes

95
Q

what are the 3 types of baseline variability

A

Minimal-less than 5 bpm
Moderate-6-25 bpm
Marked-greater than 25 bpm

96
Q

what is a Sinusoidal pattern when looking at baseline variability

A

A sinusoidal fetal heart rate pattern is a well-documented sign of massive maternal-fetal hemorrhage

seen as a smooth, sine-like undulating pattern with a cycle frequency of three to five cycles per minute that persists for >20 minutes.

It is most commonly associated with fetal anemia or hypoxia.

97
Q

What does FHR Tachy indicate?

A

Can be an early sign of fetal hypoxemia
Maternal or fetal infection
Fetal anemia
Maternal hyperthyroidism
Response to drugs

98
Q

What does FHR Brady indicate?

A

Late sign of fetal hypoxia
Drugs
Cord compression
Maternal hypothermia
Maternal hypotension
Tachysystole

99
Q

what do Early decels look like

A

Symmetrical & associated with contraction
Return by end of contraction

100
Q

what do Variable decels look like

A

Abrupt, random

101
Q

what do Late decels look like

A

Begins after contraction

102
Q

Accelerations are __ bpm above baseline lasting __ seconds or more

A

15,15

BUT

103
Q

if fetus is younger than ___ weeks, accelerations are 10 bpm above baseline lasting 10 seconds or more

A

32

104
Q

Prolonged accelerations are longer than __ min, less than __ min

A

longer than 2 min, less than 10 min

105
Q

Describe a Category 1 FHR tracing

A

(normal): strong predictor of normal fetal acid-base status, routine care, no action needed.

baseline: 110-160
Variability: moderate
Late/Variable Decels: Absent
Early decels: present or absent
Accelerations: present of absent

106
Q

Describe a Category 2 FHR tracing

A

(indeterminant): something is off but isn’t a 3. Requires continuous surveillance and re-evaluation.

baseline: brady with moderate variability
Variability: moderate or minimal w/ random decels OR ABSENT variability but CANNOT have decels
Late/Variable Decels: prolonged
Early decels: present or absent
Accelerations: present of absent

107
Q

Describe a Category 3 FHR tracing

A

(abnormal): abnormal fetal acid-base status. Needs prompt evaluation & action.

Variability: absent
WITH
baseline: bradycardia
OR
Late/Variable Decels: recurrent
Early decels: present or absent
Accelerations: present of absent
SINUSOIDAL PATTERN

108
Q

Variable decels can mean…

A

Cord compression

109
Q

Early decelerations can mean…

A

Head compression

110
Q

Accelerations can mean…

A

baby is doing good! they’re compensating

111
Q

Late decelerations can mean…

A

Placental insufficiency

112
Q

what does Visceral pain indicate?

A

Uterine ischemia
Cervical changes
Uterine distention

113
Q

what does somatic (cramping/knawing) pain indicate?

A

Distention & pressure
Traction
Laceration

114
Q

where is pain mostly felt during labor

A

area between the umbilicus and suprapubic bone, lower back, and vaginal/perineal area

115
Q

when would you give a sedative during labor

A

during the prolonged latent phase

116
Q

what are 3 Opioid agonists used during labor for pain management

A

morphine, Fentanyl, remifentanil (Ultiva)

117
Q

what are 3 Opioid agonists-antagonist used during labor for pain management

A

Stadol, Nubain

118
Q

what is a Pudendal

A

A medication close to your pudendal nerve in your pelvic region to provide temporary pain relief. Your pudendal nerve runs from the back of your pelvis to all the muscles and skin in your genital area, including the anus, vagina and vulva

119
Q

difference between an epidural and spinal

A

Spinal anesthesia involves the injection of numbing medicine directly into the fluid sac. Epidurals involve the injection into the space outside the sac (epidural space).

120
Q

describe Gate-control theory

A

Only limited number of sensory messages can travel nerve pathways at the same time

Distraction techniques block some of these, closing a “gate”

121
Q

Describe Non-pharmacologic pain management methods used in labor

A

Relaxation, focus, breathing
Effleurage & counterpressure
Music
Water therapy
Massage, heat
Others: TENS, Accupressure/puncture, hypnosis, biofeedback, aromatherapy, intradermal water block

122
Q

Describe Non-pharmacologic pain management PREPARATION used in labor

A

Lamaze, Bradley, Dick-Read

123
Q

What is Bishop Scoring

A

Scoring a mom to see if they’ll need an induction or not

124
Q

whare the 5 criteria in bishop scoring

A

dilation, effacement (%), station, consistency, and position

125
Q

how do you induce labor

A

Cervical ripening
AROM
Cytotec (Misoprostol)
Oxytocin/Pitocin

126
Q

what are examples of labor augmentation

A

AROM (amniotomy), oxytocin

Forceps: shorten 2nd stage, unable to push effectively, breech, malpresentation, arrest of rotation

Vacuum: preferred over forceps

127
Q

what is Prepidil

A

Prostaglandin (dinoprostone) gel

It can help dilate the opening of the uterus (cervix) in pregnant women.

Using sterile technique, introduce the gel with the catheter provided into the cervical canal just below the level of the internal os. Administer the contents of the syringe by gentle expulsion and then remove the catheter.

128
Q

what is Cervidil

A

Prostaglandin (contains dinoprostone,
similar to a natural prostaglandin
found in your body)

CERVIDIL is also the only FDA-approved vaginal. insert for cervical ripening.

looks like a string with a pad full of medication at end. the pad goes around the cervix

129
Q

what is Cytotec

A

Cytotec, also known as Misoprostol, is a drug administered in pill form that is used to treat gastric ulcers. Doctors currently rely upon it (despite the lack of FDA approval for this use) to ripen the cervix and promote the induction of labor.

130
Q

Mechanical Induction Methods for labor

A

cervical ripening balloon and laminaria tent and lamicel

131
Q

oxytocin is produced by the ____ gland

A

pituitary

132
Q

pitocin is Supplied in ____ (not mg!)

A

Units

133
Q

pitocin is __ or __ units per ___ or ____ ml in NS

A

20 or 30 units per 500 or 1000 ml NS

134
Q

Postpartum use of pitocin is ___ ml/hour or faster

A

125

135
Q

why wouldn’t you give miso

A

mom had a previous C/S

136
Q

Dysfunctional or prolonged labor refers to…

A

prolongation in the duration of labor, typically in the first stage of labor

137
Q

Describe Uterine hyperstimulation or hypertonic uterine dysfunction

A

Uterine tachysystole- the contraction frequency numbering more than five in a 10-minute time frame or as contractions exceeding more than two minutes in duration.

can be caused by oxytocin overdose

138
Q

Describe Hypotonic labor

A

notable especially during the active phase of labor, characterized by poor and inadequate uterine contractions that are ineffective to cause cervical dilation, effacement, and fetal descent, leading to a prolonged or protracted delivery.

139
Q

what are the six dysfunctional labor patterns

A

(1) prolonged latent phase,

(2) protracted active phase dilation

(3) secondary arrest of dilation

(4) prolonged deceleration phase

(5) protracted descent (When cervical dilation and descent of the fetal head are slower than normal)

(6) arrest of descent

140
Q

describe Cephalopelvic disproportion

A

baby’s head is too big to fit through your pelvis

141
Q

Low birth weight is defined as a birth weight of an infant less than _____ grams at full term

A

2500

142
Q

IUGR is also known as

A

intrauterine growth restriction

Intrauterine growth restriction is when a baby in the womb doesn’t grow at the expected rate during the pregnancy.

143
Q

what are side effects of using a vacuum during birth

A

Caput/cephalohematoma
Cerebral irritation-poor feeding, listless
Jaundice from bruising

144
Q

Caput vs. Cephalohematoma

A

caput is clear fluid bum caused by the pressure of the fetal ehad against the cervix during labor

cephalohematoma is caused by a subperiosteal hemorrhage

145
Q

T/F: forceps are less likely to cause damage to your baby’s head than a vacuum

A

true

146
Q

how do you fix shoulder dystocia during birth

A

McRoberts (hyperflex the legs up against abdomen) & suprapubic pressure

147
Q

the Brachial Plexus Injury is caused by

A

shoulder dystocia during birth

148
Q

how do you fix a Prolapsed umbilical cord

A

Trendelenburg or knee-chest
Monitor FHR
Emergency C/S

149
Q

how do you fix a Uterine rupture

A

Prevention is best treatment
Small-may be repaired; Large-may need hysterectomy

150
Q

how do you fix a Amniotic fluid embolism

A

Administer oxygen to maintain normal saturation. Intubate if necessary.

Initiate cardiopulmonary resuscitation (CPR) if the patient arrests. If she does not respond to resuscitation, perform a perimortem cesarean delivery.

Treat hypotension with crystalloid and blood products. Use pressors as necessary.

Avoid excessive fluid administration. During the initial phase, right ventricular function is suboptimal. Excess fluid may overdistend the Right ventricle which could increase the risk of a right sided myocardial infarction.

Consider pulmonary artery catheterization in patients who are hemodynamically unstable.

Continuously monitor the fetus. Deliver immediately following cardiac arrest if gestational age is ≥ 23 weeks. [26]

Early evaluation of clotting status and early initiation of massive transfusion protocols is recommended. [26]

Treat coagulopathy with FFP for a prolonged aPTT, cryoprecipitate for a fibrinogen level less than 100 mg/dL, and transfuse platelets for platelet counts less than 20,000/µL.

Lim and colleagues [32] reported a case of AFE in which the coagulopathy was treated with activated recombinant factor VIIa (rVIIa). The range of doses to treat serious bleeding is from 20-120 μg/kg. In a systematic review of case reports, 16 patients received rVIIa and 28 patients did not. The patients who received rVIIa had statistically worse outcomes, including death and multiple organ failure. The authors suggest that rVIIa only be used when hemorrhage cannot be stopped by other means. [33]

Hemodialysis with plasmapheresis [34] and extracorporeal membrane oxygenation (ECMO) with intra-aortic balloon counterpulsation [35] have been described in case reports with successful outcomes in treating AFE patients with cardiovascular collapse. The use of anticoagulation during ECMO may worsen bleeding in patients with AFE. Use of ECMO is not routinely recommended. [26]

151
Q

describe a Disseminated Intravascular Coagulation (DIC)

A

Consumes all clotting factors
Diffuse internal & external bleeding

causes:
Abruption
Retained fetal demise, gram negative sepsis
Amniotic fluid embolus
Preeclampsia, HELLP

Management:
Correct underlying cause
Fluid & blood replacement, O2 & perfusion maintenance
Antithrombin III factor, fibrinogen, or cryoprecipitate

152
Q

Placenta Previa is PAINFUL or PAINLESS?

A

PAINLESS

153
Q

Abruptio Placentae is PAINFUL or PAINLESS?

A

PAINFUL

154
Q

Difference between placenta accreta, increta, and percreta

A

placenta accreta, in which placental villi invade the surface of the myometrium;

placenta increta, in which placental villi extend into the myometrium;

placenta percreta, where the villi penetrate through the myometrium to the uterine serosa and may affect other organs

155
Q

describe Monozygotic (identical twins)

A

An ovum (egg) is fertilized by a single sperm
Within two weeks after conception, the fertilized embryo splits in two
Genetically identical embryos which develop into fetuses

156
Q

describe Dizygotic (fraternal or non-identical twins)

A

Two ova (eggs) are released during a single ovulation episode
Each ovum is fertilized by a different sperm
The fertilized embryos implant in separate locations within the uterus

157
Q

Describe Chorion Regarding Twins and Anatomical Developments

A

outer membrane surrounding the amniotic sac and embryo(s)

158
Q

Describe Amnion Regarding Twins and Anatomical Developments

A

innermost membrane containing amniotic fluid, embryo(s), placenta(s), umbilical cord(s)

159
Q

what is a dichorionic diaminitoic placenta

A

separate placentas, separate sacks

160
Q

what is a monochorionic diaminitoic placenta

A

single placenta, separate sacks

161
Q

what is a monochorionic monoaminitoic placenta

A

single placenta, single sack

162
Q

what are some antepartum complications for multi gestational pregnancies

A

Pre-eclampsia
Gestational Hypertension
Maternal Anemia
Intrauterine Growth Restriction
Oligohydramnios/Polyhydramnios
Low birth weight
Gestational Diabetes
Miscarriage (< 20 weeks) or Fetal Demise (> or = to 20 weeks)
Twin to Twin Transfusion (more common in monochorionic)

163
Q

what are some intrapartum complications for multi gestational pregnancies

A

Preterm labor and/or preterm birth
Placental abruption (can also happen during antepartum)
Increased risk cesarean section delivery (always deliver in the operating room)
Reasons may need cesarean section delivery include:
Twin A (twin closest to cervix) in transverse or breech position
Twin B does not present in vertex position
Non-reassuring fetal heart tracing(s), failure of labor progression, cephalopelvic disproportion, etc.

164
Q

why would you schedule a c/s

A

Previous C/S
Classical incision
Multiples
Breech or transverse
Placenta previa
Active maternal disease
CPD (cephalopelvic disproportion)
Cervical cerclage
Macrosomia
Fetal anomolies
Elective

165
Q

when would you have a Urgent or Emergent C/S

A

Failed labor or failed induction of labor
Dystocia
Shoulder dystocia
Malposition
Malpresentation
CPD
Abrutio placenta
Fetal distress
Cord prolapse

166
Q

what are the two types of c/s incisions

A

Horizontal/Low Segment/Pfannenstiel/Low transverse

Classical/Vertical

167
Q

what are your general anes postpartum Q 15 min checks

A

Fundus
VS/cardiac monitor
Bleeding: vaginal & incision
Dermatomes

168
Q
A

WOMENS (5 decks)

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