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Maternity > Exam 3 - week 10 > Flashcards

Exam 3 - week 10 Flashcards

1
Q

Potential indications for induction of labor

A
  • prolonged gestation (most common reason)
  • Also: chorioamnionitis (bacterial infection that occurs before or during labor), any type of fetal compromise, nonreassuring fetal heart rates, PPROM, gestational hypertension, cardiac disease, renal disease, dystocia, intrauterine fetal demise, isoimmunization, and diabetes, preeclampsia
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2
Q

Contraindications to labor induction

A

-complete placenta previa or abruptio placentae
-transverse fetal lie
-prolapsed umbilical cord
-prior classic uterine incision that entered the uterine
cavity
-pelvic structure abnormality
-previous myomectomy
-vaginal bleeding with unknown cause
-invasive cervical cancer
-active genital herpes infection
- abnormal FHR patterns

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3
Q

Before labor induction can be started, what 2 things need to happen?

A
  1. assessment of fetal maturity (dating, ultrasound, amniotic fluid studies, assess lung maturity)
  2. cervical readiness (vag exam and bishop score)
    Both of these need to be favorable for a successful induction!
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4
Q

What are the characteristics of a ripe cervix?

A

shortened, centered (anterior), softened, and partially dilated

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5
Q

What are the characteristics of an UNripe cervix?

A

LONG, CLOSED, POSTERIOR, AND FIRM

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6
Q

The HIGHER/LOWER the bishop score, the longer the expected duration of labor

A

lower

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7
Q

The HIGHER/LOWER the bishop score, the shorter the expected duration of labor

A

higher

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8
Q

If you want to induce labor but the bishop score is low, what can you do?

A

use a cervical ripening method prior to induction

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9
Q

What is a precipitous delivery?

A

delivery that occurs after 3 hours of labor from start to finish

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10
Q

possible complications of precipitous delivery?

A
  • lacerations and potential for uterine rupture

- fetal complications: head trauma (intracranial hemorrhage or nerve damage) and hypoxia d/t rapid labor progression

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11
Q

nursing care/interventions for precipitous deliveries?

A

o PROTECT PERINEUM and support fetal head as it emerges!!
o Check to make sure cord isn’t around neck
o Gently pull out head (turn head to side if needed), guide shoulders as they emerge
o Receive baby, have cloths/hat ready to wrap baby, place on skin-to-skin (blanket on top)
o Don’t cut cord until the placenta is delivered (need cord clamp and scissors, best to have the “kit” with you)
-stay CALM, promote safety
-never leave pt alone
-have “kit” ready: sterile towel, 2 kelly clamps, sterile gloves
-complete assessments

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12
Q

what is a vacuum extractor and how’s it used?

A
  • cup-shaped instrument attached to a suction pump used for extraction of the fetal head (cup placed against occiput of head)
  • Pump creates negative pressure (suction) of approximately 50-60 mm Hg.
  • Birth attendant then applies traction until head emerges from vagina.
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13
Q

indications for forceps- or vacuum-assisted birth?

A
  • prolonged 2nd stage of labor
  • distressed FHR pattern, failure of the presenting part to fully rotate and descend in the pelvis, limited sensation and inability to push effectively due to the effects of regional anesthesia
  • presumed fetal danger or fetal demise
  • maternal heart disease
  • acute pulmonary edema
  • intrapartum infection
  • maternal fatigue
  • infection
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14
Q

Risks of forceps or vacuum extractor deliveries?

A
  • Risks of tissue trauma to mother (perineal lacerations, hematoma, hemorrhage, infection) &
  • Risks to newborn (trauma, brachial plexus injury, ecchymoses, face/scalp lacerations, cephalhematoma, caput succedaneum, facial nerve injury)
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15
Q

What’s the recommended length of time and number of times that you can use a vacuum suction during delivery?

A

o Don’t let suction last more than 30-40 seconds and don’t use it more than 3 times
• Keep on the fetal HR monitor to make sure the baby is tolerating

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16
Q

what is cephalhematoma

A

subperiosteal collection of blood secondary to the rupture of blood vessels btwn skull and periosteum-aka, - collection of blood btwn the periosteum of a skull bone and the bone itself) occurs in 2.5% of all births & typically appears within hrs after birth

• Like a water-filled balloon
-usu not present at birth (takes 24-48 hrs to develop)

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17
Q

what is caput succedaneum

A

caused by edema of head against the dilating cervix during birth

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18
Q

what are the differences btwn caput succedaneum and cephalhematoma?

A
  • Caput disappears in 2-3 days (cephalohematoma takes longer bc it’s a collection of blood)
  • caput is mainly just fluid/eduema, it’s more generalized
  • caput crosses suture lines and goes deeper
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19
Q

What is brachial plexus injury

A

-usu occurs w/ larger babies, babies w/ shoulder dystocia, or breech delivery
• Results from stretching, hemorrhage within a nerve, or tearing of the nerve or roots assoc w/ cervical cord injury

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20
Q

What are the methods of induction?

A
  • Cervical Ripening Agents

* Oxytocin/Pitocin Intravenous Infusion

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21
Q

Role of Oxytocin/Pitocin Intravenous Infusion for labor induction?

A

o Initiating uterine contractions or augmentation of arrested labor

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22
Q

Examples of cervical ripening agents?

A

o Cytotec

o Prostaglandin

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23
Q

What are the risks associated with labor induction?

A

o Hypertonic contractions of the uterus (occurs when uterus never fully relaxes btwn contractions)
o Uterine rupture
o Water intoxication

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24
Q

What to know about administration of oxytocin infusion for labor induction?

A
  • Primary bottle of IV fluid prepared
  • Piggyback oxytocin solution into primary tubing
  • 10 to 20 units oxytocin + 1 L 5% dextrose in lactated Ringer’s solution
  • 10 or 20 milliunits of oxytocin/ml
25
Q

What are the contraindications for Induction or Augmentation

A
  • Partial placenta previa or complete placenta previa
  • Transverse fetal lie
  • Umbilical cord prolapse
  • Previous classical cesarean delivery
  • Active genital herpes infection
  • Previous myomectomy entering endometrial cavity
26
Q

What is a perineal laceration?

A

-Tear of perineal tissue
• Categorized in terms of degree:
o 1st-degree-involves only skin and superficial structures above muscle
o 2nd-degree-extends through perineal muscles
o 3rd-degree – extends through rectal sphincter muscle
o 4th-degree – extends through rectal sphincter AND rectal mucosa

27
Q

If a woman has bright red blood discharge but a FIRM UTERUS, what do we suspect?

A

an undiagnosed, unrepaired laceration or episiotomy

28
Q

what is macrosomia?

A

large fetus size - 4,000grams (8lb13ounces and up)

29
Q

What is a cesarean section?

A

Birth of infant through abdominal and uterine incision

30
Q

C-section Indications:

A
  • Abnormal presentation - Breech, shoulder, face
  • Previous uterine surgery (e.g. c-section)
  • Placental previa
  • Non-reassuring fetal status
  • Arrested dilatation or descent
  • Post dates
  • Active herpes infection/HIV
  • True CPD (cephalopelvic disproportion)
31
Q

What is CPD?

A

cephalopelvic disproportion – even the smallest fetal head diameter, WONT fit through the true pelvis
o This is something you can’t really tell until woman is in labor, or maybe by doing a vaginal exam towards the end of pregnancy

32
Q

what are the 2 primary types of techniques for c-sections?

A

skin incisions: transverse (Pfannenstiel) or verticel

uterine incisions: 1) lower uterine segment (transverse) or 2) upper uterine segment (vertical)

33
Q

What are the pros of doing a transverse (Pfannenstiiel) c-section?

A
  • more cosmetically appealing

- tends to cause less post-op pain

34
Q

What are the pros of doing a vertical (classic) incision for a c-section?

A
  • it’s very quick

- tends to cause less bleeding

35
Q

What is the postpartum care post C-section?

A
  • Assess dressing, stitches, staples
  • perineal pad checked every 15 minutes
  • Fundus palpated
  • Determine if remaining firm AND NOT BOGGY
  • IV oxytocin
  • Assist with cough, deep breathing
  • Newborn Safety
  • Promote Bonding
36
Q

Is there a difference in postpartum vaginal discharge post vag birth or c-section?

A

yes!
-o Women who’ve had c-sections should have much less vaginal bleeding postpartum bc their uteruses were cleaned out manually by hand

37
Q

typical blood loss in c-section

A
38
Q

typical blood loss in vaginal birth

A
39
Q

what are the 2 types of breech?

A

frank (fanny first) or footling breech or complete

40
Q

Risks of a breech presentation?

A

o Cord prolapse
o Neuromuscular disorders
o Head trauma during birth

41
Q

What is shoulder dystocia?

A

• Impingement of anterior shoulder on symphysis pubis (head comes out but shoulder gets stuck)
-obstruction of fetal descent and birth by the axis of the fetal shoulders after fetal head has been delivered.
• Head is delivered then retracts back on perineum

42
Q

possible risks for developing shoulder dystocia?

A

o Increased suspicion with prolonged second stage

o May be associated with fetal macrosomiaBirth weight over 4000 gms

43
Q

what are the maternal and fetal complications of shoulder dystocia?

A

Maternal: postpartum hemorrhage, secondary to uterine atony or vag lacerations
-fetal: transient erb’s or duchenne’s brachial plexus palsies and clavicular or humeral fractures. Also greater chance of body disproportions

44
Q

what is the McRobert’s maneuver and when is it used?

A

The woman flexes her thighs up onto her abdomen
• Uses the natural angle of the pelvis (some ppl will actually flex feet/legs back towards women’s head
-can be used to help with shoulder dystocia

45
Q

Clinical therapy for shoulder dystocia?

A
  • McRoberts maneuver
  • episiotomy
  • elective clavicular fractur of newborn
46
Q

What is always our #1 concern with obstetrical emergencies?

A

-uteroplacental insufficiency (d/t risk of hypoxia)

47
Q

What is a prolapsed umbilical cord?

A

Cord precedes fetal presenting part
o Trapped between presenting part, maternal pelvis
o Presenting part not firmly against cervix
o Potential obstruction of blood flow through cord (worry abt hypoxia)
o Variable or Prolonged Decelerations

48
Q

What are some potential conditions associated with prolapse umbilical cord? (6)

A
  • Breech and Transverse lie
  • Contracted pelvic inlet
  • Small fetus
  • Multiple pregnancy
  • Extra long cord
  • ROM with high presenting part (we loose the fluid cushion)
49
Q

Clinical therapy/interventions for prolapsed umbilical cord

A
  • **Prevention
  • Assessment with ROM
  • Elevate presenting part (usu the head) which prevents compression of cord (life-saving measure. Nurse CAN do this if HCP not present)
  • ***Knee-to-chest position (takes the pressure off the cord)- (life saving measure) (Always call hcp but can do this immediately)
  • Emergency Cesarean
50
Q

what is placenta previa?

A

-literally, “afterbirth first”
bleeding condition that occurs during the last 2 trimesters of pregnancy.
-placenta implants over cervical os. May cause serious morbidity and mortality to the fetus and mother
-need c-section

51
Q

what is abruptio placentae?

A

separation of a normally located placenta after the 20th week of gestation and prior to birth that leads to hemorrhage. It is a significant cause of third-trimester bleeding, with a high mortality rate.

52
Q

what is postpartum hemorrhage?

A

-obstetrical emergency!!
• Varying definitions
o Primary within 24 hours
o Secondary after 24 hours up to 12 weeks
• Excessive bleeding that results in clinical presentation and Sx of blood loss
o Hypotension, tachycardia, oliguria, low oxygen saturation
o 10% drop in H&H
• >500mL vaginal delivery or >1000mL cesarean

53
Q

what’s the number 1 cause of postpartum hemorrhage?

A

uterine atony

54
Q

What’s the clinical presentation of postpartum hemorrhage?

A

o Often LATE
o Hypotension, dizziness, tachycardia, oliguria, low O2 sat
o Change in H&H may be delayed (may not have had time to order the labs)
o Poor Uterine Tone -#1 risk factor
o Visible vaginal bleeding

55
Q

Possible pathophysiologies from postpartum hemorrhage?

A

o Uterine Atony (#1 cause. Primary cause (80% of PPH). Risks: overdistention, prolonged labor, labor stimulation, uterine relaxants, infection
o Retained placenta
o Placental abnormalities
o Coagulopathies (genetic or d/t drugs)
o Trauma, lacerations (this is why vaginal exams are critical)

56
Q

Nursing care for postpartum hemorrhage?

A 
o	Prompt identification of situation
o	1ST ACTION: massage uterus vigorously to stimulate uterus to contract
o	Prompt notification of PCP
o	Collaborative Management
o	Assessment
•	Vaginal bleeding
•	Uterine tone
•	Clinical signs: May not occur until later due to increased blood volume during pregnancy
57
Q

Nursing interventions for postpartum hemorrhage?

A

o Uterine massage (do ASAP)
o Administration of oxytotic meds (uterotonic agents, to help uterus contract)
o Maintain and restore circulatory volume
o Maintain adequate oxygenation
o May require return to OR– D&C, Hysterectomy
o Support and care for pt/partner/family
o Blood transfusion

58
Q

What are meds we can give to contract the uterus in the event of postpartum hemorrhage?

A 
o	Oxytocin/Pitocin
•	10-20 units IM or 10-40 units diluted in LR 1000 to run at 125-200 mU/min
o	Methylergonivine/Methergine
•	0.2mg IM Q 2-4 hrs
•	Can cause hypertension

Maternity (6 decks)

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