High Risk Intrapartum Flashcards

1
Q

5 factors of Bishop scale

A
Cervical dilation
Cervical Effacement
Fetal Station
Cervical  Consistency
Cervical position
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2
Q

Most common cause of preterm labor

A

dehydration

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3
Q

PROM

A

Membranes rupture before labor begins. At any point during gestation (can be 40th week)

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4
Q

PPROM

A

Membranes rupture before the 37th week of gestation and labor hasn’t begun yet.
Direct correlation with smoking

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5
Q

Risk factors for preterm birth

A
Multiple gestations
Hx of previous preterm births
UTI during pregnancy
B.V
Poor weight gain
Hx of cervical surgery
Fetal abnormality
Drug use
Anything that elevates your BP (pre and eclampsia, drug use, smoking)
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6
Q

Predicting factors for preterm labor

A

Cervix of 1 inch or less
PPROM Hx
Positive Fetal Fiber Nectin test

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7
Q

Positive Fetal Fiber Nectin test

  1. False Positive
A

done 20-38th week
FiberNectn should be negative in those weeks. If positive: at term.
1. Sexual intercourse within 24 hrs of test, vaginal bleed/infection, cervical exam

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8
Q

Management of Preterm labor
goal
Point of no return

A
Stop labor
3 cm
1.Activity limitation (decreases uterine activity and increases uteroplacental flow) Increased risk for thrombophlebitis and clots.
2.Hydration: also with tocolytics: pulmonary edema
3. Tocolytics
4. Celestone
at 32-36: deliver
before 32: Meds
before 26: amnioinfusion
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9
Q
Tocolytic therapy
given
Mom S/E
Fetal S/E
NI
A

given if labor starts before the 34th week
Will not be given if past 34 (delivery)
Mom: anxiety, restlessness, nervous, tachycardia, muscle cramps, pulmonary edema, increased blood glucose.
Fetal: tachycardia, irritable, hypoglycemia
NI: Monitor lung sounds before each dose

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10
Q

Celestone (betamethasone)
Used with and for what
S/E
NI

A

steroid
in conjugation with tocolytics
Given to hasten fetal lung maturity. (PROM)
S/E: nervous, insomnia, increased WBC, pulmonary edema. Sodium retention: swelling due to fluid retention.
NI: Gonna need more insulin if diabetic
check lung sounds prior.

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11
Q

Umbilical cord Prolapse

A

Compression of the cord between maternal pelvis and fetal presenting part

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12
Q

Complete cord prolapse

A

can be palpated
may or may not be seen
may have 2 presenting parts

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13
Q

Hidden cord prolapse

A

cannot see or feel it

severe bradycardia

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14
Q

Risk factors for cord prolapse

A
multiparity
Low birth wt
Premature
Breech
2nd twin
unengaged presenting part
hydramnios
oblique or transverse lie
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15
Q

Cord Prolapse NI

A

Knee chest position
Trandelenbergs
Put hand up vagina putting pressure on presenting part and get woman to OR
Foley catheter into woman so bladder pushes baby up
Warm, moist Saline towel on cord

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16
Q

Abruptio placentae Risk factors

A

Vasoconstriction (smoking, cocaine, alcohol)
High BP
Abdominal trauma (fall, car accident, punch to belly)
Advanced maternal age
Fibroid underneath her placenta
Short umbilical cord (<18)

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17
Q

Complete abruptio placenta

A

Entire placenta pulls away

Baby will die

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18
Q

Partial abruptio placenta tx

seen by

A
sonogram
If > 50% pulled away: get baby out
If < 50% and baby is 24 weeks or less: baby stays in, admitted, watched and tested
if 38 weeks: get baby out
if baby is dead: vaginal delivery
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19
Q

S&S of of abruptio placenta

A
Abdominal pan
Rigid abdomen
Vaginal bleeding 
Concealed (blood builds up inside: increased fundal height)
S&S of hemorrhage
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20
Q

NI for abruptio placentae

A
Monitor VS 
maintain bedrest, give 02, IV fluids
Trendelenburgs or lateral 
Monitor bleeding carefully (fundal height and pads)
Monitor for DIC and hemorrhage
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21
Q

Complications of Tx of preterm labor

A
Thrombophlebitis (bed rest)
Pulmonary edema (hydrating and tocolytics)
22
Q
Brethine drug
action
class
indication
S/E
NI
A

decreased effect of calcium in smooth muscles
decreases uterine activity
tocolytic
used to stop preterm labor (not FDA approved)
can increase blood glucose level in mother (monitor neonate for hypoglycemia)
S/E: anxiety, restless, tachycardia
Assess FHR, Mom VS, Lung sounds, pulmonary edema

23
Q

PPROM etiology

A

hydramnios
stress
nutrition
multifetal

24
Q

PPROM Tx

A

36-37 weeks: induce and deliver
<25: very poor fetal outcome
administer tocolytics, IV lines, I&O

25
Q

well contracted funds with continuous bright red bleeding

A

Suspect laceration

26
Q

1st Degree laceration

A

Fourchette (vulvva, external)
perineum skin
vaginal mucus membranes

27
Q

2nd degree laceration

A

all first lacerations and muscles of perineum

28
Q

3rd degree laceration

A

all first and second lacerations and anal sphincter

29
Q

4th degree laceration

A

all first,second and third and rectum

30
Q

Indications for C-section

A
CPD
Dystocia
active herpes
Placental abruptio/previa
Twins
breech presentation
fetal distress
cord proplase
preeclampsia
31
Q

Vertical incission/classic C-section
indications
Contraindications

A

emergencies
more than one any
gross obesity
–VBAC

32
Q

Pfannenstiel C-section incision

A

bikini cut incision
VBAC possible
Longer
Doesn’t allow for extension

33
Q

Preop for C-section

A
Inc.spir./CDB/T&P
What time they ate last?
Antacids 30 min before
Abd prep
Foley cath (stays for 24 hrs)
IV hydration
Wedge under hip
Signed consent
34
Q

Postop for C-section

A

TCDP
football hold for breastfeed
Maternal VS q 5 min till stable, 15 first hour, 30 until discharge
Check abd. dressing and peripad q 15 min
monitor fundus form side and support incision
Can she move legs?
Check foley. blood? nicked bladder?
Pain assessment
BS!!!
Gas in abdomen
Homan’s sign/lochia/Ambulate ASAP/Benodyne boots

35
Q

Forceps delivery

Indications

A

Cardiac disease
Fetal distress
Maternal exhaustion
HEAD ROTATION IS DONE BETWEEN CONTRACTIONS

36
Q

Forceps delivery prereqs

A
Fully dilated
ROM
know position and station of baby
No CPD
monitor FHR before and after
Empty bladder
Epidural/pudenal block
37
Q

Post op care Forceps delivery

A

Check hematomas

baby facial bruising, facial nerve paralysis and cephalohematoma

38
Q

Vacuum extraction

Fetal risks

A

same as forceps
NO ANESTHESIA
baby can develop chignon (area of swelling)
hyperbilirubenimia risk!!!
intracranial bleeding risk!! fontanelles bulging

39
Q

Incompetent cervix

etiology

A

cervical trauma
LEEP procedure
exposed to DES
usually in 2nd trimester of pregnancy

40
Q

incompetent cervix dx

A

hx of 2nd trimester abortions

things go will up to 16th week

41
Q

Tx of incompetent cervix

A

week 14: Cerclage procedure (suture cervix)

McDonald’s procedure (temporary procedure, at 38 weeks take strings off, Normal vaginal delivery)

42
Q

Ripe cervix

A

short
anterior
Partially dilated

43
Q

Unripe

med to ripen it

A

long
posterior
firm
-Cervidil (a prostaglandin, need consent, given prior to pitocin) Give and antipyretic and antiemetic with it

44
Q

ABO incomp med tx

A

NONE

45
Q

Risk factors for hydatiform mole

A
Infertility hx
⬆️paternal age
Extremes of age
Asian women 
Low karotene and animal fats
46
Q

Dx of hydatiform mole

A

Sonograms and HCG levels (high)

47
Q

S&S of hydatiform mole

A

Hyperemesis gravidarum
HTN before 20 weeks
No FHR

48
Q

Management of hydatiform mole

A

Evaluate uterus (D&C)
Monitor for a year (invasive chorion carcinoma)
Monitor HCG levels to make sure dont rise
Chest x ray (mets)

49
Q

HIV diagnostics

A

NST at 32

Sonograms every week start at 32

50
Q

HIV management

A

No internal monitoring (risk)

Ritgen maneuver

51
Q

Early S&S of HIV in newborn

A

Thrush infection in mouth
Failure to thrive
Lymphadenopathy
Umbilical cord that constantly drains

52
Q

DIC risk factors

A
HTN
abruptio placenta
Fetal demise 
Amnionic fluid embolism
Hydatiform mole
Infection