Exam 3 Flashcards
1
Q
*Establish a trusting relationship
*Develop a plan of care for the pregnancy
*Counsel and educate to ensure healthy outcomes
*Nutrition
*Weight gain
*Physical discomforts
*Drug and alcohol use
*Sexuality
A
first prenatal visit
2
Q
Detect and prevent potential problems
*Perform comprehensive health history, physical exam, and lab tests
A
first prenatal visit
3
Q
*Reason for seeking care
*Possible pregnancy: missed period, positive home test
*LMP?
*Signs and symptoms
*Perform urine or blood test
A
comprehensive health history
4
Q
*Health history: past medical, surgical, personal, and family history
*Reproductive history: menstrual, obstetric, and gynecologic history
A
comprehensive health history
5
Q
nageles rule
A
1st day of last period + 7 days - 3 months
6
Q
*Vital signs, height, and weight
*Head-to-toe assessment
*Head and neck
*Chest
*Abdomen
*Extremities
*Pelvic Exam
A
Physical exam
7
Q
*Assess for protein, glucose, ketones, bacteria
A
urinalysis
8
Q
*Assess H&H, RBC, WBC, platelets
A
CBC
9
Q
urinalysis
CBC
*Blood typing and Rh factor
*Rubella titer
*Hepatitis B surface antigen
*HIV
*RPR/VDRL
*Gonorrhea and chlamydia screening
*Additional test depending on identified risk factors
A
laboratory test during pregnancy
10
Q
follow up visits every _____ weeks up to 28 weeks
A
4
11
Q
follow up visits every ____ weeks from 29-36 weeks
A
2
12
Q
follow up visits every ____ from 37 weeks to birth
A
week
13
Q
*Continued assessments
*Weight and BP
*U/A (protein, glucose, ketones, nitrites)
*Fundal height
*Fetal movement
*Fetal heart rate
*Teaching: danger signs vs common discomforts of pregnancy
*Reinforce: nutrition, prenatal vitamin, exercise
A
follow up visits
14
Q
screened for gestational diabetes
A
24-28 weeks
15
Q
RhoGAM for mother who are Rh negative
and done again how long after birth
A
28 weeks
72 hours
16
Q
GBS screening
A
35-37 weeks
17
Q
Spotting/bleeding
painful urination
severe persistent vomiting
fever > 100F
lower abdominal pain with dizziness and shoulder pain
A
danger signs of first trimester
18
Q
Regular uterine contractions
pain in calf
sudden gush or leaking of fluid from vagina
no fetal movement > 12hrs
A
danger signs of second trimester
19
Q
sudden weight gain
periorbital or facial edema
severe upper abdominal pain, headache with visual changes decrease in fetal movements >24hrs
A
danger signs of third trimester
20
Q
*Urinary frequency or incontinence
*Fatigue
*Nausea and vomiting
*Breast tenderness
*Constipation
*Nasal stuffiness, bleeding gums, epistaxis
*Cravings
*Leukorrhea
A
1st trimester discomforts
21
Q
*Backache
*Leg cramps
*Varicosities of vulva and legs
*Hemorrhoids
*Flatulence with bloating
A
second trimester discomforts
22
Q
*Return of many 1st trimester discomforts
*Shortness of breath
*Heartburn and indigestion
*Dependent edema
*Braxton Hick contractions
A
3rd trimester discomforts
23
Q
*Transducer emits high frequency sound waves
*Fetal heartbeat and malformations can be assessed and measurements can be accurately made.
*Accurate dating determined up to ___ weeks
A
ultrasound
12
24
Q
*Assessment of anatomical development _____ weeks
*Evaluate fetal size, growth, and placental position ___ weeks
Noninvasive, safe, cost effective
A
ultrasound
18-20
34
25
done early during pregnancy, used to confirm pregnancy
vaginal transducer
26
gets sound waves during pregnancy
can look at measurements and assess for mild formations
abdominal transducer
27
First ultrasound done during __ weeks confirming pregnancy and giving estimate of due date
12
28
*Measures the velocity of blood flow
*Detects movement of RBCs in vessels
*Detect fetal compromise in high-risk pregnancies
doppler flow studies
29
Pregnancies complicated by HTN or fetal growth restriction the diastolic blood flow may be absent or reversed
*Noninvasive and no contraindications
doppler flow studies
30
so use ultrasound -> measures blood flow of placenta from baby
Beneficial for high-risk pregnancy -> High blood pressure
doppler flow studies
31
when is an alpha-fetoprotein analysis performed
16-18 weeks
32
Measured by drawing maternal blood
False positives: incorrect dating, multiple fetuses, incorrect drawing time
alpha fetoprotein analysis
33
high AFP mean
open neural tube defects
gastrointestinal defects (intestine out of abdomen)
34
what does low AFP mean
trisomy 21 or 18 (edward syndrome)
35
Assess maternal blood to look at measurement of
alpha fetal protein
36
when are marker screening test performed
16-18 weeks
37
types of marker screening test
triple screen
quad screen
38
measured in a triple screen
alpha fetal proten
HcG
unconjugated estriol
39
measured in quad screen
alpha fetal protein
HcG
unconjugated estriol
inhibin A
40
*Enhance accuracy for down syndrome in women <35
quad screen
41
*Low inhibin A
low unconjugated estriol
low AFP
high hCG
concern for down syndrome
42
when is a nuchal translucency screening performed
11-14 weeks
43
*Measures the fold of the fetal neck
*Early detection of chromosomal and structural abnormalities
*Increase NT: trisomy 21, 18, 13
nuchal translucency screening
44
Performed by ultrasound -> noninvasive
If fold of neck is thicker and widened it would show signs of abnormalities
Also look at nasal bone for concerns of abnormalities
nuchal translucency screening
45
when can an amniocentesis be performed
15-20 weeks
46
*Collects amniotic fluid to examine fetal cells
*Confirms chromosomal abnormalities, neural tube defects, and several metabolic defects
amniocentesis
47
*Used at 35 weeks to determine fetal lung maturity
*RhoGAM if RH negative
amniocentesis
48
Collection of fetal cells by going through abdomen and collecting amniotic fluid
Can confirm abnormalities and neural tube defects
Can be done at 35 weeks -> done to confirm fetal lung maturity (looks at LS ratio to confirm surfactant production)
amniocentesis
49
If done earlier than 15 weeks can cause miscarriage
Invasive procedure so use sterile technique
amniocentesis
50
*Lower abdominal pain and cramping
*Spontaneous abortion
*Maternal or fetal infection
*Postamniocentesis chorioamnionitis
*Fetal-maternal hemorrhage
*Leakage of amniotic fluid
post amniocentesis risk
51
infection between placenta and fetus
amniocentesis chorioamnioitis
52
Collects a sample of chorionic villi from placenta
Diagnostic for chromosomal disorders
Cannot detect neural tube defects
RhoGAM if RH negative
chorionic villus sampling
53
Detects chromosomal abnormalities
Does not detect neural tube defects
Is invasive -> RHOGAM for RH negative, given transabdominally and trans vaginally
chronic villus sampling
54
Done 10-13 week of pregnancy
Transabdominal-> needle through abdomen
Trans vaginally -> Catheter through cervix
chronic villus sampling
55
Results available sooner: 48 hours
Earlier prenatal diagnosis to help make an informed decision about pregnancy
advantages of chronic venous sampling
56
*Vaginal bleeding and cramping
*Hematoma
*Spontaneous abortion
*Rupture of membranes
*Limb abnormalities
*Infection (chorioamnionitis)
Fetal-maternal hemorrhage
risks of chronic venous sampling
57
Doesn't take 3 weeks like amniocentesis does
Risk for limb abnormalities because limbs not fully developed and can be affected
Done earlier in pregnancy and can confirm chromosome abnormalities
chronic villus sampling
58
when can you perform chronic villus sampling
10-13 weeks
59
when can a non stress test be performed
after 28 weeks
60
*Indirect measure of uteroplacental function and fetal well-being by assessing FHR
*Healthy fetus= FHR acceleration with movement
nonstress test
61
*Recommended for: diabetes, IUGR, preeclampsia, post-term pregnancy, renal disease, multiple gestation
Looking at accelerations in response to movement to see if baby is happy
nonstress test
62
*Eat before to stimulate fetal activity
*Place on left lateral: avoid supine hypotension and increase blood flow to placenta
*Time: 20-30 minutes
nonstress test monitoring
63
in 20 min, 2 accelerations that are 15 bpm x 15sec
reactive to NST
64
in 40 min 1 acceleration or no accelerations that are 15bpm x 15 sec
nonreactive NST monitoring
65
Within 20-40 min need at least 2 fetal accelerations
Eat before the NST
Baby would be considered reactive if there were 2 fifteen beat per minute accelerations within a 20 min time frame
Nonreactive would be no or one accelerations within 40 min
NST monitoring
66
Uses ultrasound and NST to assess fetal well-being
*Reduce stillbirth by early detection of hypoxia
*Time: 10-30 minutes
biophysical profile
67
Good for pt with high-risk pregnancy like diabetes and pre-gestational diabetes
Physical to see how baby is doing
Can detect early concerns for hypoxemia and depending on results able to intervene sooner
gives more results that NST alone
biophysical profile
68
BATMAN scoring for BPP
Breathing
Amniotic fluid volume
Tone
Movements
And
NST
69
*5 components and each worth 2 points
*2 points if criteria is met or 0 points if not met
*8/10 normal; 6 or below need further investigation
BPP scoring
70
> or equal to one episode of rhythmic breathing lasting > 30 seconds within 30 min
breathing
71
a pocket of amniotic fluid that measures at least 2cm
amniotic fluid volume
72
> or equal to 1 episode of extremity extension and subsequent return to flexion
tone
73
> or equal to 3 discrete body or limb movements within 30 min (arm, leg, torso)
movement
74
> or equal to 2 accelerations of 15 beats/min for 15 sec within 20-40 min
reactive NST
75
BPP scoring has ____ to take place
30 min
76
¡Increased risk in pregnancy
¡Increased needs for mother and fetus
¡Expanded maternal blood volume
Poor nutrition: iron-deficient diet
iron deficiency anemia
77
Complications: preterm labor, low birth weight infant, perinatal mortality, maternal hemorrhage, postpartum depression
iron deficiency anemia
78
fatigue
difficulty concentrating
dizziness
pale skin
headache
S&S anemia
79
anemic signs:
hgb <
hct <
serum iron <
11 g/dL
35%
30 mcg/dL
80
¡Eliminate symptoms, correct deficiency, replenish iron stores
¡Daily prenatal vitamin and iron supplements
¡Take iron with vitamin C to promote absorption
¡Take iron with meals and increase intake of fiber and fluids if GI discomforts occur
anemia management
81
foods with iron
dried fruits
whole grains
leafy vegetables
peanut butter
iron fortified cereals
82
take with iron to promote absorption
vitamin C (orange juice)
83
Complications: preterm labor, low birth weight infant, poor maternal weight gain, preeclampsia, iron-deficiency anemia, postpartum depression
adolescent pregnancy
84
Concerns for prenatal care: financial resources
Negative impact: malnutrition, infectious diseases, healthcare deficiencies, social risks
Psychosocial concerns: loss of self-esteem, social discrimination
adolescent pregnancy
85
Support and educate
Identify options: abortion, self-parenting, adoption, temporary foster care
Future planning: goals, return to school, job counseling
Identify barriers to prenatal care
Evaluate physical and emotional well-being
adolescent pregnancy management
86
Impact: fetal vulnerability, addiction, lack of prenatal care
Complications: preterm labor, abortion, IUGR, placenta abruption, fetal demise, meconium
substance abuse in pregnancy
87
Fetal Risk: low birth weight, decreased APGARs, neurobehavioral abnormalities, fetal anomalies, developmental concerns
substance abuse in pregnancy
88
fetal alcohol syndrome
alcohol
89
low birth weight
nicotine
cocaine
meth
90
neonatal abstinence syndrome
sedatives
opiates
narcotics
91
newborn tremors
marijuana
92
Most common harmful effect of heroin and other narcotics
Symptoms: irritability, hypertonicity, seizures, jitteriness, fever, high-pitched cry, vomiting, diarrhea, feeding disturbances (poor sucking), disturbed sleep, respiratory distress, diaphoresis
neonatal abstinence syndrome
93
History and physical
Screening questions: reduces stigma
Used for all women of childbearing age
Urine toxicology screen
Assess recent use
Use for at risk patients
substance abuse assessment
94
Nonjudgmental approach
Support and counseling
Education: effects, interventions, outreach programs
Positive newborn screen needs investigation by state protection agency
substance abuse management
95
Age of 35 or older
Complications: infertility, pregnancy loss, chromosomal abnormalities, stillbirth, gestational diabetes, gestational hypertension, preeclampsia, SGA, cesarean deliveries, postpartum hemorrhage
May already have chronic health conditions
advanced maternal age
96
Preconception counseling: optimal state of health
Labs and diagnostic test
Establish baseline
Detect chromosomal abnormalities:
advanced maternal age
97
test for chromosomal abnormalities done for advanced maternal age
amniocentesis
quadruple screen
98
Education: risk factors, nutrition
Encourage early and regular prenatal care
Promotion of healthy pregnancy
advanced maternal age pregnancy management
99
Stress of pregnancy" can expose underlying undiagnosed cardiac problems and exacerbate known cardiac disease
Assess risk before pregnancy
More prenatal visits: every 2 weeks
cardiovascular disorders
100
Fetal risk: growth restriction, premature birth, low birth weight, respiratory distress syndrome
cardiovascular disorders
101
high cholesterol
HTN
diabetes
smoking
obesity
sedentary lifestyle
risk factors for cardiovascular disorders
102
common at 28-32 weeks and 1st 48 hours postpartum
cardiac decompensation
103
syncope with exertion
chest pain with effort
rapid respirations
SOB on exertion
palpitations
swelling of face, hands, and feet
cardiac decompensation
104
when is cardiac decompensation common
28-32 weeks
1st 48 hrs postpartum
105
Education, counseling, and support
Collaboration: cardiologist, OB, high-risk, nurses
Possible drug therapy
Fetal monitoring: NST & fetal movements
cardiovascular disorders management
106
"Failure to Progress"
Lack of progressive dilation and/or descent
Apparent during the active phase of labor
dystocia of labor
107
Need an adequate trial of labor to declare
#1 reason for cesarean delivery
Complications: postpartum hemorrhage, infection, perineal lacerations
dystocia of labor
108
*Epidural analgesia/excessive analgesia
*Maternal exhaustion: ineffective pushing
*Abnormal fetal position: occiput posterior
*Multiple gestation
*Nulliparity
risk factors for dystocia of labor
109
Short stature <5ft
Fetal birth weight over 8.8 lb
Maternal age >35yrs
Overweight
Ineffective contractions
risk factors for dystocia of labor
110
5 P's P dystocia of labor
passage
passenger
position
powers
psyche
111
pelvis/birth canal
passage
112
position that can cause dystocia of labor
occiput posterior
113
Presentation- face, brow, breech
Fetal development- multiples, macrosomia, structural abnormalities
passenger
114
Hypertonic- never fully relaxes
Hypotonic- too relaxed
powers
115
Psychological distress- fear, anxiety
psyche
116
Risk: primigravida
Prolonged latent phase; stay 2-3 cm
Assessments: minimal relaxation, compromised placental perfusion
Treatment: relaxation
hypertonic iterine dysfunction
117
Risk: overstretching of the uterus
Occurs during active phase
Assessments: mild and infrequent ctx
Treatment: stimulation- Oxytocin
hypotonic uterine contraction
118
having too many contractions
can have concerns for placental perfusion
late decelerations -> give terbutaline and then start oxytocin for better contraction pattern
hypertonic uterine contractions
119
not enough contraction
can be seen in active phase
oxytocin is main treatment
hypotonic uterine contractions
120
treatment for hypertonic uterine contactions
relaxation
terbutaline
121
treatment for hypotonic uterine contractions
oxytocin
122
Review risk factors
Assess signs of stress and support
Evaluate uterine contractions and FHR
Assess fetal position
Perform vaginal exams
assessments for dystocia of labor
123
Can position mother -> peanut ball decreases risk of primary c section for first time mother
Place foley for pt with epidural
If bladder is full then you can not have baby deliver -> why important to put in foley
nursing management for dystocia of labor
124
Provide physical and emotional support
Promote comfort for relaxation and normal labor progress
Prepare family for cesarean delivery if labor does not progress
nursing management for dystocia of labor
125
Labor is completed in < 3 hrs from start of contractions to birth
Common causes:
§Hypertonic labor
§Use of oxytocin
§Multiparity
§Drug use
precipitate labor
126
Maternal risks: uterine rupture, lacerations, amniotic fluid embolism, postpartum hemorrhage
Fetal risks: hypoxia, intracranial hemorrhage, nerve damage
precipitate labor
127
Can increase risk for lacerations and hemorrhage
More babies had -> faster delivery can happen
Hypertonic contractions can cause concern for hypoxemia
precipitate labor
128
therapeutic management for preterm labor
tocolytics
corticosterids
antibiotics
129
Regular uterine contractions with cervical effacement and dilation before the end of 37 weeks
preterm labor
130
Risk factors: African American, smoking, cocaine, multiples, infections, cervical insufficiency
preterm labor
131
Infant risk: respiratory distress syndrome, infections, thermoregulation, feeding difficulties, hypoglycemia
preterm labor
132
Any type of infection, STI, etc can increase risk for -> treat infections
If do not know GBS positive or negative bc of early delivery give penicillin G anyways
preterm labor management
133
may prolong pregnancy for 2 to 7 days while steroids can be given for fetal lung maturity
▪ Procardia (nifedipine)
▪ Magnesium sulfate
tocolytics
134
prophylaxis for women with group B streptococcus (GBS)
antibiotics
135
decrease neonatal respiratory distress syndrome, given between 24 and 34 weeks
corticosteroids
136
given to mature lungs
want 2 doses apart 24 hours apar
can be given during labor -> one dose 12mg IM
betamethasone
137
Preterm Labor Tocolytics (Its not my time!)
magnesium sulfate
indomethacin (Indocin)
nifedipine (procardia)
terbutaline (brethine)
138
reduces the muscle's ability to contract
given IV
magnesium sulfate
139
Inhibits prostaglandins and uterine contraction, given PO.
Contraindicated if >32 weeks, risk for neonatal side effects
indomethacin
140
Blocks calcium movement into the muscle cells, inhibits uterine contractions
given PO
Contraindicated with cardiovascular disease
nifedipine (procardia)
141
betamimetic, prevents and slows uterine contractions
given SubQ
do not give beyond 48-72 hours
terbutaline (brethine)
142
buy time for betamethasone to be given to buy time for lung development
tocolytics
143
given is to relax the uterus due to preterm labor
magnesium sulfate
144
no give if > 32 weeks
indomethacin
145
CCB that relaxes uterus, given PO, can lower BP -> dizziness
nifedipine
146
slows contractions, acts very quickly, normally used for hypotonic uterine contractions
terbutaline
147
Contraction pattern: 4 contractions q20min or 8 contractions in 1hr
Cervical exam: dilation and effacement
Lab and diagnostic testing: CBC, urinalysis, amniotic fluid analysis, fetal fibronectin, cervical length
preterm labor assessment
148
pelvic pressure
change in vaginal discharge
period like cramps
low, dull backache
abdominal cramps
signs of pre-term labor
149
found at the junction of fetal membranes and uterus
Acts as the glue attaching fetal membranes to the uterine lining
fetal fibronectin
150
Usually not detected between 24-34 weeks unless there has been a disruption
Nothing in the vagina 24hrs prior to test
shouldnt be present unless there are signs of labor
fetal fibronectin
151
Measurement of the closed portion of cervix by transvaginal ultrasound
Single most reliable parameter for preterm labor in high-risk women
cervical length
152
Best obtained 16-24 weeks
Unlikely to delivery in the next 2 weeks if cervical length is 3 cm or more
concern for preterm labor if measurement is lower than 3cm
cervical length
153
Pregnancy continuing past 42 weeks
Maternal risks: cesarean birth, dystocia, birth trauma, postpartum hemorrhage, infection
post-term labor
154
Fetal risks: macrosomia, shoulder dystocia, brachial plexus injuries, low Apgars, postmaturity syndrome, meconium staining
post-term labor
155
(loss of subcutaneous fat and muscle and meconium staining)
post-maturity syndrome
156
Has concern for baby not getting oxygen bc of all the meconium
Placenta is also worn down and wont supply oxygen
post-term labor
157
determine gestational age
daily fetal movement
BPP twice weekly
weekly cervical exams
post-term pregnancy assessment
158
*start contractions by medical or surgical means
induction
159
*enhancing ineffective contractions after the start of labor
augmentation
160
Indications: prolonged gestation, prolonged premature rupture of membranes, gestational hypertension, cardiac disease, chorioamnionitis, dystocia, intrauterine fetal demise, diabetes
reasons for induction
161
complete previa, placenta abruption, malpresentation, classical uterine incision, active genital herpes, abnormal FHR
contraindications for induction
162
cesarean birth, prolonged labor, instrumented delivery, epidural analgesia
risk for induction
163
Helps determine if cervical ripening agents need to be used or if you can use oxytocin
Give score based off assessments in vaginal exam
bishop scoring system
164
< 6 means they need more cervical ripening and you would need to give
cervidil (dinoprostone)
cytotec (misoprostol)
165
> ____ indicates successful induction
8
166
Review indications and contraindications
Gestational age determination
Fetal status
Cervical readiness; Bishop score
induction/augmentation assessments
167
Explanations; Informed consent
Medication administration with continued monitoring of maternal and fetal status
Pain relief and support
induction/augmentation management
168
Severe variable decelerations due to cord compression
Oligohydramnios
Rupture of membranes
Thick meconium fluid
reasons for amnioinfusion
169
teaching, maternal and fetal assessment, preparation for possible cesarean
nursing management for amnioinfusion
170
Application of traction to fetal head
Risk: tissue trauma
forceps/vacuum assisted birth
171
Maternal: lacerations, hematoma, hemorrhage, infection
Newborn: lacerations, facial nerve injury, cephalohematoma, caput succedaneum
risk of forceps/vacuum assisted birth
172
Criteria: membranes ruptured, complete dilation, vertex position and engaged, adequate pelvis size
forceps/vacuum assisted birth
173
*Prolonged 2ndsStage
*Nonreassuring FHR/ fetal distress
*Maternal heart disease
*Inability to push effectively
*Maternal fatigue
*Failure of head to fully rotate and descend
forceps/vacuum assisted birth
174
indication for forceps/vacuum assisted birth
maternal heart disease
175
Classic or low transverse incision
Indications:
Maternal: AMA, obesity, previous c-section (classical incision), active genital herpes, dystocia of labor
cesarean birth
176
Fetal: distress, presentation (breech), congenital anomalies, macrosomia
Placenta: previa, abruption
indications for c section
177
client teaching, blood type and crossmatch, CBC, surgical site prep, Foley catheter, IV antibiotics, epidural/spinal
pre-op management for c section
178
assess vitals, lochia, fundas, abdominal dressing, and pain; auscultate bowel sounds; early ambulation; encourage use of incentive spirometer
post-op c section management
179
Risk: uterine rupture and hemorrhage
Contraindications: classic incision, myomectomy, ripening agents
Special considerations: consent, documentation, surveillance, readiness for emergency
Nurses advocate for client; expertise in fetal monitoring to identify nonreassuring pattern and institute measures for emergency delivery
vaginal birth after c section
180
*Obstruction of fetal decent and birth after delivery of head due to fetal shoulders
shoulder dystocia
181
*Risks: macrosomia, excessive weight gain, hx of shoulder dystocia, gestational diabetes, large baby
shoulder dystocia
182
*Warning: turtle sign
shoulder dystocia
183
maternal outcomes of shoulder dystocia
PP hemorrhage
laceration
184
fetal outcomes of shoulder dystocia
brachial plexus injury
clavicle fracture
185
nursing interventions for shoulder dystocia
suprapubic pressure
McRoberts maneuver
186
Increase lacerations -> risk for hemorrhage
shoulder dystocia
187
*Cord precedes the fetus causing occlusion of blood flow
Rapid fetal deterioration
umbilical cord prolapse
188
*Risks: malpresentation, high station, preterm labor, low birth weight, multiple gestations, hydramnios
umbilical cord prolapse
189
*Need to relieve compression
*PROMPT RECOGNITION
umbilical cord prolapse
190
S&S is sudden fetal bradycardia or recurrent variable decelerations -> bc of cord compression
Can feel pulsating cord with vaginal exam
umbilical cord prolapse
191
FHT drops to 40 what do you suspect
umbilical cord prolapse
192
Prepare for emergency c section, monitor FHR, give O2
Outcomes -> birth asphyxia due to lack of O2 towards baby
give O2
Outcomes -> birth asphyxia due to lack of O2 towards baby
umbilical cord prolapse
193
See variable decelerations -> feel cord -> push up on presenting part with hand and do not let go of it until delivery (c-section) -> use 2 fingers, this relieves pressure
umbilical cord prolapse
194
*Tearing of the uterus into the abdominal cavity
*Sudden fetal bradycardia
uterine rupture
195
*Risks: uterine scar, prior rupture, trauma, hypertonic contractions
*Urgent cesarean delivery
uterine rupture
196
Seletct all that apply signs and symtoms of uterine rupture
Loss of station
Fetal bradycardia
Tachycardia
Irregular abdomen contour
all
197
Asses fetal heart rate, contraction patterns, and amount of blood (hemorrhage) -> watch for sudden fetal bradycardia
Moms BP drop, HR increase (looks like hypovolemic shock)
Assess mom for loss of fetal station (can't feel presentation)
uterine rupture
198
Interventions -> c section
Possible outcomes: hemorrhage, postpartum infection, hysterectomy, maternal/infant death
Only have minutes to save baby and mom
uterine rupture
199
Amniotic fluid containing hair, skin, vernix, or meconium enters maternal circulation and obstructs pulmonary vessels
amniotic fluid embolism
200
Amniotic fluid and particles get in maternal circulation and mothers blood -> results in embolism
Can have pulmonary collapse
amniotic fluid embolism
201
*Rapid maternal deterioration and poor prognosis
*Risks: placental abruption, uterine overdistention, fetal demise, uterine trauma, amnioinfusion, amniocentesis, ROM
amniotic fluid embolism
202
*Symptoms: difficulty breathing, sudden hypotension, hypoxia, and coagulation failure-disseminated intravascular coagulation (DIC)
amniotic fluid embolism
203
Intervention -> supportive care, c-section, concern for seizures (neurological injury), oxygen, increased vaginal bleeding aka DIC -> blood on the way
amniotic fluid embolism
204
Normally occurs right after delivery, can happen during if placental abruption
Number one assessment -> mother not responding
amniotic fluid embolism
205
4 cardinal signs of amniotic fluid embolism
respiratory failure
altered mental status
DIC
hypotension
206
Someone has amniotic fluid embolism and no pulse what do u do first
Call HCP and start CPR
Begin IV fluid bolus
Begin blood transfusion
all
207
Who is the best to have a VBAC
Previous pelvic fracture
Previous classical incision C section
Previous breech baby
Last was one of the pelvis shaped that don’t let babies through
all
208
German Measles: prevention by MMR vaccine
Spread by droplet or direct contact
Identify women who are non-immune
rubella
209
if someone is non immune to rubella
give vaccine before discharge
210
Newborn complications: congenital cataracts, glaucoma, cardiac defects, microcephaly, hearing and intellectual disabilities
rubella
211
Most common congenital and perinatal viral infection
Infection concerns: 1st trimester or early 2nd
Transmission: utero, birth, breastfeeding
cytomegalovirus
212
Newborn complications: hearing loss, intellectual disability, abortion, stillbirth, low birth weight, IUGR, seizures, jaundice, microcephaly, and blindness
cytomegalovirus
213
needed to reduce transmission of cytomegalovirus
good hygiene
214
main complications of cytomegalovirus
hearing loss
intellectual disability
215
stay way from _____ to prevent cytomegalovirus transmission
bodily fluids
216
Naturally occurring bacterial infection in about 50% of adults
NOT A STI!
Considered a carrier if GBS+
GBS
217
¡Present in the rectum or vagina and exposes newborn during birth
GBS
218
Newborn complications: sepsis, meningitis, pneumonia
Treatment: IV Penicillin G to mothers during labor
GBS
219
Genital herpes caused by HSV type 1 or 2
Great risk of transmission to newborns exposed to an active primary infection
Transmission: ascending infection after ROM or direct contact
HSV
220
Cesarean birth required if active lesion is present
Newborn complications: abortion, birth anomalies, IUGR, preterm labor, birth-acquired disseminated herpes simplex
HSV
221
Management: Prophylactic antiviral during pregnancy
HSV
222
Screen for HbsAg
Infection concerns for acute infection in pregnancy
hep B
223
Newborn complications: preterm birth, fetal distress in labor, meconium peritonitis, low birth weight, neonatal death
hep B
224
Treatment: HBV vaccine and HBIG within 12 hours of birth
hep B
