Exam 9 Flashcards
Sinciput
fetal brow
Vertex
area btwn anterior & posterior fontanelles
Occiput
area beneath posterior fontanelle occupied by occipital bone
Mentum
fetal chin
4 bones of pelvis
2 innominate
1 sacrum
1 Coccyx
Supports weight of growing & directs presenting part into true pelvis
False Pelvis
Bregma
anterior fontanelle
Intersection btwn posterior cranial sutures
Posterior Fontanelle
relationship of fetal spine to the maternal spine
Lie
Attitude (Fetal orientation)
relationship of fetal parts to one another (flexion/extension)
fetal body part entering the pelvis 1st or lying over the inlet
Presentation (Fetal orientation)
Cephalic Presentation
fetal head first
Breech Presentation
fetal buttocks, feet or knees first
3 classifications of Breech Presentation
Complete
Frank
Footling
Shoulder Presentation
transverse lie
1+ presenting part
Compound presentation
Ex: head, hand and arm.
Rapid, slow or irregular FHT
Fetal hypoxia
Greenish-Brown amniotic fluid in for a check presentation
Fetal distress
Port-wine colored amniotic fluid/bleeding
placenta previa
Separation of the placenta; torn maternal tissue; DIC
Unengaged presenting part
Disproportion or malpresentation
Failure to progress in dilation
Prolonged labor w/ increased danger of perinatal loss
Failure of presenting part to descend after complete cervical dilation
Disproportion or Error in estimate dilation
Rising B/P
Preeclampsia
Low BP (significance)
Shock; postural hypotension; reaction to drugs
Significance of fever
Amnioitis; extrauterine infection
Significance of maternal tachycardia
Impending shock
Foul or Purulent vaginal discharge
Amnioitis (Eventual fetal infection)
Significance-abnormal abdominal pain/tenderness
Separation of placenta;
Rupture of uterus;
Abnormal condition not r/t pregnancy
Uterine tetany (significance)
Interuterine bleeding D/T premature separation of placenta, possible uterine rupture
Excessive C/O pain (significance)
Hysteria;
Undetected abnormality;
Reaction to medication;
Prolapsed cord (significance)
W/o instant intervention-perinatal death
Unconsciousness (significance)
Eclampsia
Shock
Hysteria
Sedation
Pallor, cool damp skin, air hunger
Bleeding; shock
Cyanosis (significance)
Aspiration of vomitus
Cardiac failure
Pulmonary embolism
Stage–>onset of labor to complete cervical dilation
First stage
Three phases of the first stage of labor
Latent
Active
Transition
Labor on set to 3 cm dilation
Latent phase (first stage)
4– 7 cm dilation
Active phase (first stage)
8–10 cm dilation
Transition (first stage)
Complete dilation to birth of baby
Second stage of labor
Birth to placental expulsion
Third stage
1–4 h after placental expulsion; uterus contracts to control bleeding
Fourth stage of labor (recovery)
Single most important factor influencing fetal well being
euglycemic status of mother
S&S of impending labor
Premonitory Signs
aka as engagement; fetus descends into pelvic inlet
Lightening
Subjective sensation
Weeks before delivery Lightening occurs in Primigravida
2-4 weeks before delivery
Lightening in Multigravida occurs
with onset of labor
Support wait a growing uterus and directs presenting part into true promise
False pelvis
top of V
There any limits of birth canal
True pelvis
Point where baby interstate true pelvis
Inlet
Female pelvis
Inlet is rounded
favorable for delivery
50%
Gynecoid pelvis
Normal female pelvis
Usually OA
Gynecoid pelvis
Male pelvis
Android pelvis
Inlet heart-shaped
Head decent into pelvis slow
Arrest of labor frequent -> C/S
Android pelvis
Android pelvis (head engages)
Head usually engages transverse or OP
Favorable influence
labor inlet is oval
Abe like pelvis
Anthropoid pelvis
Anterior fontanelle
Bregma
Relationship of fetal parts to one another (flexion/extension of fetal head)
attitude
Cephalic presentation
Fetal head first
Shoulder presentation
Transverse lie
You don’t hips are flexed, knees are extended; buttocks present. (Legs by ears)
Breech (frank) presentation
HTN w/o Proteinuria after 20wks gest.
Gestational HTN
HTN + Proteinuria post 20wks gest.
Preeclampsia
0.3g+/24h protein excrete
proteinuria
Mild pre-eclampsia
140/90+ +proteinuria
Severe pre-eclampsia
160/110+
160/110+ >15 MIN =
MEDICAL EMERG
3+ proteinuria or 5+g/ 24h
Severe Preeclampsia
Oliguria <500cc/24h Cerebral visual disturbances Pulmonary edema/ cyanosis RUQ/ Epigastric Pain Impaired Liver Function Thrombocytopenia IUGR
s/s of severe preeclampsia
New-onset grand mal seizures in woman with pre-eclampsia
Eclampsia
New onset/ sudden increase of proteinuria in a woman with HTN PRIOR to 20 wks best, sudden increase in HTN or HELLP syndrome
Superimposed preeclampsia
Antihypertensive of choice in Pregnancy (Chronic HTN)
Aldomet
Methyldopa
AntiHTN Meds Necessary if BP>
150-160/100-110
HELLP
Hemolysis
Elevated Liver enzymes
Low Platelets
Danger Signs
Clonus
HA
Vision Changes
RUQ Pain
MgSulfate
Monitor BP
I&O
RR (CNS depressant)
Deep tendon reflexes
MgSulfate Antidote
Ca+ Gluconate
Must Keep at Bedside
Hour PP Risk for Seizures Continues
48h
Diuresis –>Decreased Risk
Nursing Considerations Pre-eclampsia
Close to RN Station Dark, quite, low stimuli Private L side lying Decrease Na+ Increase Protein
relative position of fetal presenting part above or below an imaginary line drawn between maternal ischial spines
Station
largest diameter of presenting part reaches or passes through pelvic inlet
Engagement
Irregular contractions
Pain in fundus, lower abd, or groin (all up front)
Easily Sedated
False Labor
Pain felt in back and radiates forward, Contractions become regular, Sedation is not effective
True Labor
Only Definitive Way to Dx Labor
Vag Exam
Reassess 1h after admit
During Stage 1 of Labor SBP
increases w/ contractions
During Stage 2 of Labor (BP)
SBP& DBP increase w/ contractions, may stay SLIGHTLY elevated btwn
During labor- GI motility, gastric emptying, blood glucose, and insulin requirements
decrease–> N/V (esp w/ transition)
Increase during labor
O2 demand/ consumption –> increased RR; Immune response –> Increased WBC
+GBS
PCN q4 x 2 doses
Pattern and intensity directly effect labor length (wavelike)
uterine contractions
Amniotic Fluid Characteristics
Clear
Alkaline
May have white flakes/ earthy odor
Natrazine Test
pH
want blue/ purple (alkaline)
MUST be before bag. lube
Green Natrazine Test
False Reading
Negative Natrazine Test
Yellow
Ferning
(ROM)Definitive
Sample placed on slide–> fern pattern
Always first intervention after ROM
Immediately assess FHR
ROM–> Temp
q1-2h before ROM (q2-4)
Hours of labor vs cervical dilation
based on prime vs multi
Labor Curve
Uterine Contractions MUST BE
validated by PALPATION
q15-30
note f,d,I, Tone
1 stage assess FHR
q15-30 min
Continuous monitoring best
2nd Stage Assess FHR
q5-15 mins
Continuous monitoring best
BP, Pulse, RR
q1h (dictated by status/ meds/ induction)
Low platelets
NO EPIDURAL
Contraindications for Activity
ROM w/o engagement Faulty presentation/ fetal position Complications of preg Vaginal Bleeding Active Labor Meds
Frequent voiding prevents
distended bladder–> slows fetal descent & increases discomfort w/ contractions
Effleurage
counterclockwise
straight back
tactile stimulation/distraction
Helps w/ back ache
Breathing to prevent pushing
Panting
Ritgen’s Maneuver
push on rect. area –> lift fetal head (extend)
Suction
mouth then nose before body delivered
bladder fails to close properly during embryonic development –> fistula between the bladder and umbilicus
patent urachus
Clinical Manifestations of patent urachus
Clear odorless fluid draining from base of the cord→ph test
Exstrophy of the Bladder:
bladder on the o/s
asc. w/ multiple deformities
No tub baths
IgG
Passive acquired immunity:
Transferred to fetus in utero
Fetus does NOT produce
Protection of IgG
Active against bacterial toxins
Acquisition IgM
Active immunity
Fetus is able to produce by 20wks gestation
Stimulated by infectious agents
IgA
Does NOT cross placenta
Not produced by fetus
Protects respiratory, GI, eyes
Passive immunity of the NB is gone by
3 mo of age
