Exam 2 - Ch. 22 Flashcards
GBS colonization is symptomatic/asymptomatic for women.
GBS colonization is often asymptomatic for women but can be devastating for infants.
Signs and symptoms of GBS infections in neonates include
sepsis, pneumonia, or meningitis.
Women should be screened for GBS at what GA?
35 to 37 weeks of gestation.
GBS-positive women are treated in labor with antibiotics that must be started when?
at least 4 hours before delivery.
Women with preterm labor are treated for GBS with screening or without screening.
Without screening
What is Dystocia of labor?
is any labor with abnormally fast or slow progression.
How long does precipitous labor last?
A precipitous labor lasts 3 hours or less.
Hypotonic uterine dysfunction is
a condition where uterine contractions are either too uncoordinated or too weak to effectively dilate the cervix.
What phase of labor does hypotonic labor occur in?
Hypotonic uterine dysfunction occurs in the active phase of labor
Hypotonic labor is related to what conditions?
Related to polyhydramnios, macrosomia, or multiple pregnancy.
Hypotonic contractions feel like what on palpation?
Soft
Hypotonic contractions occur at what rate?
Occur at a rate of less than three or four every 10 minutes lasting less than 50 seconds.
How are hypotonic contractions treated?
Treatment may include rest, an amniotomy, or oxytocin administration.
Passageway complications often occur in conjunction with what?
Passageway complications often occur in conjunction with passenger issues.
A maternal pelvis that is smaller than normal, or contracted can lead to
Dystocia
Pelvimetry is associated with higher cesarean risks but improved or not improved outcomes?
Not improved outcomes
Can dystocia be caused by a full bowel or bladder?
Yes
T/F: Scar tissue on the cervix does not lead to soft tissue dystocia.
False. It does.
Pushing before the cervix is fully dilated can lead to swelling and what.
soft tissue dystocia
What is Cephalopelvic disproportion (CPD)?
is a mismatch between the size of the fetal head and the size of the maternal pelvis.
What is the most common fetal malpresentation?
Occiput posterior (OP) position.
Why are breech deliveries are often delivered by cesarean?
Higher risk of asphyxia or birth trauma
How are breech deliveries are often diagnosed?
Leopold’s maneuvers and confirmed by ultrasound visualization.
What maneuver can be attempted to turn a breech baby?
An external cephalic version (ECV)
An external cephalic version may be attempted at what GA?
May be attempted after 36 weeks to turn the fetus to a head down position.
What is an impacted shoulder above or behind the symphysis pubis called?
Shoulder dystocia
In many cases, no risk factors apply, however what are two conditions that predispose to shoulder dystocia?
Macrosomia and maternal diabetes often associated with shoulder dystocia.
Do infants born with shoulder dystocia experience damage?
5% can have permanent or temporary damage
What is the sign associated with shoulder dystocia?
Turtle sign
What are the first interventions to consider with shoulder dystocia?
First interventions to resolve a shoulder dystocia include McRobert’s maneuver and the application of suprapubic pressure.
Anxiety can have a positive or negative impact on normal labor progress and fetal outcomes.
Negative affect
Which positions can shorten the first stage of labor by 90 minutes?
Upright positions such as sitting, kneeling, squatting, or standing can shorten the first stage of labor by 90 minutes.
What is an episiotomy?
An episiotomy is a surgical incision of the posterior aspect of the vulva made during the second stage of labor.
In what stage of labor is an episiotomy done?
Second stage
When is an episiotomy used?
An episiotomy is used if the patient is at high risk for a third- or fourth-degree perineal tear or if an expedited delivery is needed because of fetal compromise.
What are the risks of an episiotomy?
Risks include infection, bleeding, and pain.
Prolonged second stage of labor, fetal compromise, or a disorder that limits the mother’s ability to push are indications of what procedure?
Operative vaginal delivery, including Forceps-assisted birth, Cesarean deliveries, Vacuum-assisted birth.
Forceps-assisted birth, Cesarean deliveries, Vacuum-assisted birth and examples of what?
Operative vaginal delivery
T/F: After an unsuccessful delivery using forceps, the provider will likely attempt a vacuum-assisted delivery.
False.
If one method of operative vaginal delivery is not successful, a second method is contraindicated because it is likely vaginal delivery has not occurred. Attempting a second method of operative vaginal delivery increases risks without improving outcomes.
Indications for cesarean delivery include:
Failure to progress
Nonreassuring fetal heart rate
Fetal malpresentation
Umbilical cord prolapse
Fetal macrosomia
Complications of cesarean delivery for mothers include
Bowel and bladder injury during surgery, hemorrhage, amniotic fluid embolism, and infection.
A major neonatal complication is
respiratory distress
Types of cesarian incisions
Classical (vertical), low vertical, or low transverse.
With what cesarian incision is it best to attempt a vaginal delivery?
It is safest to attempt a vaginal delivery after cesarean if a low transverse incision.
Cesarian section pre-op care considerations
Hemoglobin within last month, type and screen
Antibiotics
Thromboembolic prophylaxis
Fetal heart rate monitoring
Continuous uterine monitoring
Cesarian section post-op considerations
Routine vitals
Start breastfeeding in delivery room
Remove catheter as soon as possible
Ambulation within 6 hours after anesthesia wears off
Regular diet
Remove dressing in 24 or 48 hours
Increase activity as tolerated
Avoid heavy lifting for 1-2 weeks
After reviewing a patient’s prenatal record, the nurse determines which of the following is a contraindication for vaginal birth after cesarean?
A. Nonreassuring fetal heart rate
B. Previous cesarean birth due to a breech presentation
C. Previous cesarean birth with a vertical uterine incision
D. Occiput anterior fetal presentation
C. Previous cesarean birth with a vertical uterine incision
A vaginal delivery is contraindicated in women with a vertical uterine incision done in a prior cesarean delivery. Cesarean delivery may be indicated for a nonreasurring fetal heart rate tracing or a breech presentation. An occiput anterior fetal presentation is desirable for a vaginal delivery.
What can occur in women attempting a trial of labor after cesarean (TOLAC)?
Uterine rupture
Symptoms that include the sudden development of a category II or category III fetal heart rate pattern, weakening contraction, and abdominal pain are possible indication of what condition?
Uterine rupture
tear in the uterine lining secondary to increased pressureWhat are the treatment options for uterine rupture?
Treatment includes cesarean delivery and possible hysterectomy.
What is uterine rupture?
Tear in the uterine lining secondary to increased pressure
Complete
Incomplete
Dehiscence (window)
What is cord prolapse?
Condition where umbilical cord precedes fetal head in the birth canal.
What are causes of cord prolapse?
High station
Small or preterm fetus
Malposition of the fetus
Polyhydraminios
Treatment for cord prolapse
Relieve pressure of the cord to improve blood flow to the fetus and therefore increase oxygenation
First sign of a cord prolapse
The first sign of a cord prolapse is often a change in fetal heart rate tracing, typically severe fetal bradycardia and variable decelerations.
T/F: A cord prolapse is a non acute condition
False. A cord prolapse is an obstetric emergency typically requiring immediate cesarean delivery
WThe cord should be handled as little as possible to prevent spasm of what?
The cord should be handled as little as possible to prevent spasm of the umbilical artery
An amniotic fluid embolism, referred to as anaphylactoid syndrome of pregnancy may occur at what points in gestation or labor?
May occur in pregnancy, labor, delivery, and the immediate postpartum period.
An amniotic fluid embolism is caused when what?
Amniotic fluid enters maternal circulation and is associated with a maternal mortality rate of 32%.
The cesarian rate is the same as mortality rate from amniotic fluid embolism at what rate?
32%
What are the initial symptoms of amniotic fluid embolism?
Initial symptoms include respiratory failure and cardiac arrest.
If the patient survives an amniotic fluid embolism, she is at risk for what?
hemorrhagic shock with disseminated intravascular coagulation.
When a patient is experiencing an amniotic fluid embolism, what positio is best?
Side-Lying
A patient delivered 1 hour ago and suddenly experiences cardiac arrest. What should the nurse do next?
A. Call for help.
B. Open airway and assess breathing.
C. Initiate CPR.
D. All of the above.
D. All of the above.
An amniotic fluid embolism can occur up to 48 hours after delivery. First interventions include getting help, evaluating breathing, and initiating CPR without delay.
Risk for stillbirth is higher in what cases?
Risk is higher for adolescents, women over 35 years old, women of African descent, multifetal gestations, congenital anomalies, and maternal disease.
Stillbirth occurs at what point in gestation?
After 20 weeks
