🀰🏾- Exam 2 Flashcards

0
Q

Placenta previa

A

Abnormal implantation of the placenta in the lower uterus at or very near the cervical os

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1
Q

First trimester ultrasound

A

Done at 5-6 weeks

Transvaginal

Done to confirm pregnancy and measure gestation with CRL (crown-rump length)

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2
Q

Indications for limited ultrasound scan

A

(Done quickly for a specific reason)

  • determine placental location
  • detect presence or absence of fetal ❀️ rate
  • assess volume of amniotic fluid
  • guide delivery of 2nd twin in a vag birth
  • assist with amniocentesis
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3
Q

Doppler ultrasound blood flow assessment

A

Performed on pregnancies complicated by hypertension or fetal growth restrictions

To identify abnormalities in the diastolic flow

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4
Q

Low vs high levels of MSAFP are associated with what

A

Low levels associated with chromosomal abnormalities
Ex: Down syndrome, trisomy 21

High levels are associated with open NTD and body wall defects
Ex: anencephaly, spina bifida, hydronephrosis

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5
Q

Alpha-Fetoprotein screening

A

Done between 16 and 18 weeks

** maternal weight can misconstrue results **

Screening test , not diagnostic

Done to detect possible open body defects and congenital anomalies

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6
Q

Chorionic villus sampling

A

The villi are fetal tissues

Done between 10 and 12 weeks to diagnose fetal chromosomal, metabolic or DNA abnormalities

Can cause limb reduction defects (LRD)

Give RhoGAM to 🀰🏾that is Rh-negative

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7
Q

Amniocentesis

A

Done at 15 to 20weeks

Can cause foot deformations

May resume normal activities 24hrs after procedure

Aspirate 20mL of amniotic fluid for testing

Give RhoGAM

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8
Q

Amniocentesis in 2nd vs 3rd trimester

A

2nd - done to identify chromosome abnormalities

3rd - done to determine fetal lung maturity and test for fetal hemolytic disease (anemic , jaundice and hydrops fetalis)

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9
Q

Percutaneous umbilical blood sampling

A

Aka cordocentesis

Aspiration of fetal blood from the umbilical cord for prenatal diagnosis and management rH disease, abnormal blood clotting and determination of the acid-base stays of the fetus

can deliver therapeutic drugs/blood trans that can’t be delivered to the fetus in another way

Umbilical VEIN is used because it’s larger

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10
Q

3 goals and types of antepartum fetal surveillance

A

Goals

  1. Determine fetal health or compromise as accurately as possible
  2. Reduce perinatal morbidity and mortality
  3. Guide intervention by the obstetric team

Types: nonstress test, contraction stress and biophysical profile

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11
Q

Non-Stress Test

A

Used to determine reactive/reassuring fetal movement = At least 2 fetal heart accelerations with or without movement occur within a 20min period .

before the NST, the woman should void

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12
Q

Fetal acceleration is classified as

A

An increase of heart rate at least 15 beats lasting at least 15 secs

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13
Q

Preterm acceleration in a NST

A

In a fetus younger than 32wks two accelerations that peak 10 beats and lasts for 10 secs - within a 20min window

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14
Q

What is the concern with FHR accelerations without fetal movement

A

Fetal hypoxemia and acidosis

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15
Q

Uteroplacental insufficiency

A

Inability of placenta to exchange oxygen, carbon dioxide, nutrients and waste products properly between maternal and fetal circulations

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16
Q

CST interpretation: negative, positive, equivocal or unsatisfactory

A

Negative- (reassuring) no late deceleration present

Positive- (abnormal) late decelerations are present

Equivocal- test must be redone

Unsatisfactory- fewer than 3 contractions in 10mins occurred; unable to test

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17
Q

What is used to induced contractions in a contraction stress test (CST)

A

Diluted oxytocin

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18
Q

Oligohydramnios

A

Decreased amniotic fluid

Which suggests prolonged fetal hypoxia

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19
Q

Biophysical profile (BPP)

A

Assess FHR, fetal breathing movements, gross fetal movements, fetal muscle tone and amniotic fluid volume

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20
Q

Gradual hypoxia concept

A

Fetal activity is effected in stages with how long hypoxemia lasts

  • loss of FHR reactivity (occurs first)
  • reduced, then absent, fetal breathing movements
  • reduced, then absent, gross (large) fetal movements
  • reduced fetal tone
  • prolonged hypoxemia: reduced amniotic fluid volume (occurs last)
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21
Q

Absence of fetal tone indicates what

A

Advanced asphyxia and acidosis

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22
Q

BPP score interpretation

A

Less than 4= deliver baby now

6= equivocal

8-10= normal

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23
Q

Maternal assessment of fetal movement

A

Assess the kick counts within a time period

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24
Fetal circulation umbilical vein vs arteries
Vein- carries oxygenated blood TOWARD the fetus Arteries- dexoxygenated blood AWAY from the fetus to the placenta
25
Adequate fetal oxygenation needs what 5 related factors
1 normal maternal blood flow and volume to the placenta 2 normal oxygen saturation in maternal blood 3 adequate exchange of oxygen and carbon dioxide in the placenta 4 an open circulatory path between the placenta and the fetus through vessels in the umbilical cord 5 normal fetal circulatory and oxygen-carrying functions
26
5 factors of fetal ❀️ rate regulation
1 autonomic nervous system 2 baroreceptors 3 chemoreceptors 4 CNS 5 adrenal glands
27
FHR and parasympathetic vs sympathetic nervous system
Sympathetic- increases ❀️ rate through release of epinephrine and norepinephrine Parasympathetic- reduces ❀️ rate and maintains variability through stimulation of the vagus nerve / exerts greater influence as the fetus matures between 28 and 32wks gestation *fhr in the term fetus is lower than in the preterm fetus*
28
Compromise of fetal oxygenation may occur because of what 5 factors
1 maternal cardiopulmonary alterations 2 hypertonic uterine contractions 3 placental disruptions 4 umbilical blood flow interruptions 5 fetal alterations
29
Doppler transducer
Produces a two-part muffled sound that resembles the sound of a galloping 🐴. Represent closure of the heart valves during systole (mitral / tricuspid) and diastole (aortic / pulmonic)
30
Tocotransducer
Detects changes in abdominal contour to measure uterine activity "assess contractions"
31
Classification of variability
Absent - undetectable Minimal - undetectable to 5 bpm Moderate - 6 to 25 bpm Marked - greater than 25 bpm
32
Early decelerations
Fetal head compression increases ICP causing the vagus nerve to slow the ❀️ rate - not associated with fetal compromise and require no intervention Mirror contractions
33
Late decelerations
Deficient exchange of oxygen and waste products in the placenta (uteroplacental insufficiency) Intervention: reposition to Left side, give oxygen, increase fluids, decrease pitocin
34
Variable decelerations
Conditions that reduce flow through the umbilical cord Interventions: reposition, decrease pitocin, give amnioinfusion
35
Aminoinfusion
Infusion of a sterile isotonic solution into the uterine cavity during labor to reduce umbilical cord compression May also be done to dilute meconium in amniotic fluid and reduce the risk that the infant will aspirate thick meconium at birth
36
Contraction frequency
Beginning of one contraction to beginning of the next
37
Contraction duration
Beginning to end of each contraction How long contraction lasts
38
Cord blood gases and pH
Umbilical cord blood analysis is used to asses the infants oxygenation and acid-base balance immediately after birth
39
What is the physiologic retraction ring
The division between the upper and lower segments of the uterus Upper- contracts actively and during labor becomes thicker Lower- and cervix contracts passively , during labor both become thinner and are pulled upward
40
Effacement vs dilation
Effacement is thinning and shortening of uterus Dilation is opening of uterus
41
During labor which cervix remains thickest a multipara or nullipara
Multipara'a cervix remains thicker that the nullipara's cervix
42
Increment, acme, decrement
3 phases of a contraction: Increment- period of increasing strength Acme- aka peak period during which the contraction is most intense Decrement- period of decreasing intensity
43
Physiological effects of the birth process: | Maternal response 5 systems
Cardiovascular - increase in maternal blood volume, increasing BP decrease ❀️ rate Respiratory - increased respirations , can lead to respiratory alkalosis GI - decreased motility can cause nausea and vomiting Urinary - decreased sensation of a full bladder Hematopoietic -
44
Respiratory alkalosis
Result of hyperventilation when she exhales too much carbon dioxide Presentation: Tingling of hands and feet, numbness and dizziness Intervention: Help mom slow her breathing and breathe into a paper bag to restore normal carbon dioxide levels
45
Physiological effects of the birth process: | Fetal response 3 systems
Placental circulation- Cardiovascular- alterations in ❀️ rate Pulmonary-
46
What are the 4 components of the birth process
Powers- uterine contractions (1st stage) and pushing efforts (2nd stage) Passage- maternal pelvis and soft tissues Passenger- fetus, membranes and placenta Psyche- psychological response to labor is influenced by anxiety, culture, expectations, life experiences and support
47
Fetal lie
The orientation of the long axis of the fetus to the long axis of the woman Longitudinal- in 99% of pregnancies parallel to the long axis of woman. Head or feet enter pelvis first Transverse- long axis of fetus is at right angle to long axis of mom
48
Fetal attitude
The relation of fetal body parts to one another Flexion- (normal) head flexed toward chest and arms and legs flexed over thorax Extension- (abnormal) head and right arm are extended
49
Fetal presentation or presenting part
The fetal part that first enters the pelvis: 1 cephalic 2 breech 3 shoulder *cephalic presentation with fetal head flexed most common*
50
4 variations of Cephalic presentation
Vertex- or occiput presentation. Most common. Fetal head is fully flexed Military- head in neutral position. Neither flexed or extended. Occipitofrontal presenting Brow- fetal head partly extended. Supraoccipitomental presenting Face- head is extended. Occiput near fetal spine. Submentobregmatic presenting
51
Which fontanel can be felt in the vertex presentation vs military presentation
Vertex- posterior Military- anterior
52
Breech presentation is more common in term or preterm fetus
More common in preterm births and when a fetal abnormality like hydrocephalus prevents the head from entering the pelvis Abnormalities of maternal uterus and pelvis or with placenta previa
53
3 variations of Breech presentation
Frank- most common. Fetal legs are extended across the abdomen towards the shoulders Full (complete)- reversal of cephalic presentation. Head, knees and hips are flexed but butt is presenting Footling- occurs when one or both feet are presenting
54
Lightening
Descent of the fetus toward the pelvic inlet before labor
55
What are the 7 cardinal movements
Descent Engagement Flexion Internal rotation Extension External rotation Expulsion
56
Descent
Descent of the fetal presenting part through the true pelvis
57
Engagement
The Fetal presenting part as its widest diameter reaches the level of the ischial spines of the mothers pelvis (0 station)
58
Flexion
Of the fetal head allows the smallest head diameters to align with the smaller diameters of the midpelvis as the fetus descends
59
Internal rotation
Allows the largest fetal head diameters to align with the largest maternal pelvic diameters
60
Extension
Of the fetal head as the neck pivots on the inner margin of the symphysis pubis, allows the head to align with the curves of the pelvic outlet *the head is born*
61
External rotation
Of the fetal head aligns the head with the shoulders during expulsion
62
Expulsion
Of the fetal shoulders and fetal body
63
What are the 4 stages of labor
Stage 1- cervical effacement and dilation occur **longest stage** Stage 2- (expulsion) begins with complete dilation and full effacement and ends with birth of the πŸ‘ΆπŸΎ Stage 3- (placental) begins with the birth of the baby and ends with the expulsion of the placenta **shortest stage, average length 6 mins** Stage 4- physical recovery and bonding **may experience chills**
64
Schultze mechanism vs Duncan mechanism
Schultze- placenta expelled with the SHINNY fetal side presenting first *more common* Duncan- ROUGH maternal side presents first
65
Latent phase of the first stage of labor
Lasts through the first 3cm of dilation Lasts 7.3-8.6hrs in nulliparas and 4.1-5.3hrs in multiparas Contractions every 5mins lasting 30-40secs
66
Active phase of the first stage of labor
Cervix dilates from 4 to 7cm , effacement is completed Fetus descends in the pelvis and internal rotation begins Contractions are 2-5 mins apart lasting 40-60secs
67
Transition phase of the first stage of labor
Cervix dilates from 8 to 10cm *bloody show increases with completion of dilation* Contractions 1.5-2mins apart lasting 60-90secs Leg tremors, nausea and vomiting are common
68
When should 🀰🏾go to the hospital
-contractions: nullipara 5mins apart for 1 hour multipara 10mins apart for 1 hour - ROM - Bleeding/increased bloody show - Decreased fetal movement
69
How does a nurse establish a therapeutic relationship with mom and their significant other
Make the family feel welcome, determine family expectations about birth, convey confidence, assign a primary nurse, use touch for comfort, respect cultural values
70
Maternal vital signs are assessed to identify signs of
Hypertension and infection A temperature of 38'C (100.4'F) or higher suggests infection
71
What are the signs of impending birth
Grunting sounds, bearing down, sitting on one butt cheek and saying "the baby's coming"
72
Database assessment during admission
- obtain basic info (LMP, Due date, GTPAL, etc) - fetal assessment presentation and position assessed using vaginal exam and leopold - labor status - physical examination **no vag exam if active bleeding or preterm , do speculum exam instead**
73
What are the 4 Leopold's maneuvers
1- distinguishes between cephalic or breech presentation 2- determines which side the fetal back is facing 3- determines if presenting part is engaged 4- determines if head is flexed or extended *not done if in breech position*
74
What does yellow or green amniotic fluid color mean
Amniotic fluid should be clear and may contain bits of vernix Yellow- cloudy, yellow and foul-smelling suggests infection Green- indicates that the fetus passed meconium before birth
75
Intact / bulging / ruptured membranes
Intact- feel slippery , no leakage of amniotic fluid can be detected Bulging- feel like a slippery, fluid-filled balloon Ruptured- show drainage of fluid from the vagina
76
What is 0 station
When the presenting part is at the ischial spine Negative numbers- no fetal descent Positive numbers- head descent through pelvis
77
Conditions associated with fetal compromise
- FHR outside the normal range or loss of variability - meconium stained amniotic fluid - cloudy, yellowish or foul-smelling amniotic fluid - Hypertonic contractions (reduces placental blood flow) - maternal hypotension or hypertension - maternal fever (100.4'F)
78
What does laboring down mean
The technique of delaying pushing until the reflex urge to push occurs
79
What is valsalva maneuver
"Purple pushing" Sustained pushing while holding a breath
80
Nursing interventions to elevate discomfort during birth
Comfort measures Teaching Encouragement Giving of self (spend time with patient) Pharmacologic measures Caring for the birth partner Evaluation
81
List examples of comfort measures during child birth the nurse should do
``` Dim lights Mouth care (ice chips) Adjust temperature Damp washcloths Maintain dry chux Change position Assist bladder emptying Provide cleanliness ```
82
Maternal positions during first stage vs second stage
First- sitting leaning forward with support, semi sitting, side lying, kneeling leaning forward with support Second- hands and knees, semi sitting and side lying
83
Back labor
When the back of the fetal head puts pressure on the woman's sacral promontory (occiput posterior position) Hands-and-knees position enhance the internal rotation mechanism of labor
84
Pushing before stage 1 is complete causes
Cervical edema Block labor Lacerations
85
Nurse's responsibilities during birth
- preparation of delivery table - perineal cleansing preparation - support with final pushing efforts - administer medications (oxytocin to contract uterus and control blood loss)
86
Nursing care during the fourth stage of labor
Care of the infant- cardiopulmonary , thermoregulatory and identifying the infant the mother- assess VS q15mins, assess fundus firmness and position, a full bladder interferes with contraction of the uterus and assess lochia the family unit- first hour after birth ideal for parent and infant attachment
87
Early nipple stimulation from the baby attempting to latch helps what
Initiate milk production and contract the uterus
88
What are the three risks associated with amniotomy
Prolapse cord Infection Abruptio placentae
89
Chorioamnionitis
Inflammation of the amniotic sac, usually caused by bacterial and viral infections
90
Hydramnios vs oligohydramnios
Hydramnios- excessive volume of amniotic fluid associated with some fetal abnormalities Oligohydramnios- abnormally small quantity of amniotic fluid maybe associated with placental insufficiency or fetal urinary tract abnormalities
91
What are the criteria for an amniotomy
Active labor (4cm) Term (37wks) Engaged (0 station)
92
Induction vs augmentation
Induction- to cause/initiate labor Augmentation- stimulate effective contractions after labor has begun
93
Indications for induction of labor
- gestational and chronic hypertension - PROM - chorioamnionitis - postterm (over 42 weeks) - intrauterine growth restriction - positive contract test - isoimmunization (maternal fetal blood incompatibility) - fetal death
94
Contraindications of induction of labor
- disproportion between fetal head and maternal pelvis - unfavorable fetal presentation (transverse or breech) - placenta previa/abruptio placentae - multifetal gestation or multiparity (6 or more) - prior classical uterine incision - active genital herpes - prolapse cord
95
Dinoprostone
(Prepidil) prostaglandin gel 0.5mg applied to cervix, maximum recommended dose 1.5mg applied to cervix and 2.5mg vaginally Actions for HC: side lying, 8-10L oxygen, administer tocolytic (terbutaline of mag sulfate) When to start oxytocin: delay 6-12hrs recommended Comments: remain still for 15-30mins after application, *increases effects of ephedra* , use caution in women with asthma/hypertension/glaucoma/Renal, liver or heart disease
95
Dinoprostone
(Prepidil) prostaglandin gel 0.5mg applied to cervix, maximum recommended dose 1.5mg applied to cervix and 2.5mg vaginally Actions for HC: side lying, 8-10L oxygen, administer tocolytic (terbutaline of mag sulfate) When to start oxytocin: delay 6-12hrs recommended Comments: remain still for 15-30mins after application, *increases effects of ephedra* , use caution in women with asthma/hypertension/glaucoma/Renal, liver or heart disease
96
Vaginal insert dinoprostone
Cervidil 10mg in a time release vaginal insert left in place for up to 12hrs. Remove with onset of active labor, ROM, uterine hyperstimulation Actions for HC: side lying, 8-10L oxygen, administer tocolytic (terbutaline of mag sulfate), remove insert When to start oxytocin: 30-60mins after removal of insert
96
Vaginal insert dinoprostone
Cervidil 10mg in a time release vaginal insert left in place for up to 12hrs. Remove with onset of active labor, ROM, uterine hyperstimulation Actions for HC: side lying, 8-10L oxygen, administer tocolytic (terbutaline of mag sulfate), remove insert When to start oxytocin: 30-60mins after removal of insert
97
Misoprostol
Cytotec 25mcg of 100mcg tablet vaginally Actions for HC: side lying, 8-10L oxygen, administer tocolytic (terbutaline of mag sulfate) When to start oxytocin: atleast 4 hours after last dose Comments: only approved for peptic ulcers but used for cervical ripening **contraindicated in previous cesarean or other uterine surgery**
97
Misoprostol
Cytotec 25mcg of 100mcg tablet vaginally Actions for HC: side lying, 8-10L oxygen, administer tocolytic (terbutaline of mag sulfate) When to start oxytocin: atleast 4 hours after last dose Comments: only approved for peptic ulcers but used for cervical ripening **contraindicated in previous cesarean or other uterine surgery**
98
Bishop score
Estimates whether the cervix is favorable for induction Cervical dilation, effacement, fetal station, cervical consistency, position Vaginal birth more likely to result if score is higher than 8
98
Bishop score
Estimates whether the cervix is favorable for induction Cervical dilation, effacement, fetal station, cervical consistency, position Vaginal birth more likely to result if score is higher than 8
99
Serial induction of labor
May be performed when the cervix is not favorable and she has an indication for induction but same-day birth is not imperative Postdate pregnancy
99
Serial induction of labor
May be performed when the cervix is not favorable and she has an indication for induction but same-day birth is not imperative Postdate pregnancy
100
Version
Change fetal presentation Contraindications: abnormal uterus shape, baby over 4000g, engagement of fetal head, nuchal cord Risks: fetal hypoxia, abruptio placentae and immediate c-section if compromised *perform NST or BPP, after 37wks, administer tocolytic or RhoGAM if needed*
100
Version
Change fetal presentation Contraindications: abnormal uterus shape, baby over 4000g, engagement of fetal head, nuchal cord Risks: fetal hypoxia, abruptio placentae and immediate c-section if compromised *perform NST or BPP, after 37wks, administer tocolytic or RhoGAM if needed*
107
Operative vaginal birth
Forceps or vacuum extraction Indications: exhaustion, inability to push effectively, non reassuring FHR patterns, failure of presenting part to rotate and descend Contraindications: severe fetal compromise, maternal CHF and pulmonary edema, high fetal station and disproportionate fetus size to maternal pelvis
108
Chignon
Scalp edema that often forms under the suction cup of a vacuum extractor
109
3 Classifications for operative vaginal delivery
Outlet operative vaginal delivery- fetal head is at perineum, with the scalp visible at vaginal opening Low operative vaginal delivery- fetal head between +2 and +3 (passed ischial spine) Midpelvis operative vaginal delivery- fetal head between 0 and +2 station
110
Median or midline episiotomy
Advantages: minimal blood loss, neat healing with little scarring, less postpartum pain Disadvantages: an added laceration may extend the median episiotomy into the anal sphincter, limited enlargement of the vaginal opening due to anal sphincter
111
Mediolateral episiotomy
Advantages: more enlargement of the vaginal opening (more room for the baby to come out), little risk that the episiotomy will extend to the anus Disadvantages: more blood loss, increased postpartum pain, more scarring and irregularity in the healed scar, prolonged dyspareunia (painful intercourse)
112
Why is the rate of c-sections increasing
- women having their first baby more like to do c-section - first baby induced greater risk for c-section - repeat c-sections more common - more common in older pregnant woman - breech position - higher maternal requests
113
Placenta accreta
Abnormal adherence of the placenta to the uterine wall, often along the previous incision area
114
Indications and risks of cesarean section
Indications- dystocia, cephalopelvic disproportion, hypertension, active genital herpes, previous uterine surgical procedures, prolapsed cord, breech, abruptio placentae Risks- infection, hemorrhage, UTI, thromboembolism, paralytic ileus, atelectasis
115
Why is Bicitra administered before cesarean section
Given to reduce gastric acidity
116
Pfannenstiel skin incision
Transverse or "bikini" cut Advantages: less visibility when healed and the pubic hair grows back, less chance of dehiscence or formation of a hernia Disadvantages: less visualization of the uterus, can't be done as quickly (emergency cesarean), can't easily be extended to give greater operative exposure, re-entry at a subsequent cesarean may require more time
117
McRoberts maneuver
To relieve dystocia the woman flexes her thighs sharply against her abdomen , which straightens the pelvic curve somewhat
118
Gynecoid shaped pelvis
- most common - round, cylindric shape throughout. Wide pubic arch (90 degrees or greater) - prognosis for vaginal birth: good
119
Anthropoid shaped pelvis
- long, narrow oval. Anteroposterior diameter is longer than transverse diameter. Narrow pubic arch - prognosis for vaginal birth: more favorable than android or platypelloid pelvic shape. Fetus may be born in occiput posterior position
120
Android shaped pelvis
- heart or triangular-shaped inlet. Narrow diameters throughout. Narrow pubic arch - prognosis for vaginal birth: poor
121
Platypelloid shaped pelvis
- flattened wide, short oval. Transverse diameter wide, but anteroposterior diameter short. Wide pubic arch - prognosis for vaginal birth: poor * not ideal for vaginal delivery= cesarean
122
Precipitate labor vs precipitate birth
Labor- birth occurs within 3 hours of its onset Birth- when a trained attendant is not present to assist
123
Medication used to accelerate fetal lung maturity
Betamethasone (celestone) - 12mg IM. Corticosteroid used to stimulate surfactant production BEFORE delivery. Dexamethosone - 6mg IM q12h x 4 doses
124
Fetal fibronectin
A protein present in fetal tissue that correlates with presence of onset of labor *positive fFN mid pregnancy could mean maternal or fetal infection
125
Prolapsed cord
Occult prolapse- cord compressed between fetus and pelvis and can't be seen or felt during vaginal exam Cord prolapsed infront of fetal head Complete cord prolapse- cord can be seen protruding from the vagina Interventions: reposition, give oxygen, don't touch cord, keep presenting part elevated