High Risk Obstetrical Emergencies Flashcards
What is the mauriceau maneuver?
A method of delivering the head in an assisted vaginal breech delivery in which the infant body is supported by the right forearm while traction is made upon the shoulders by the left hand. Head is maintained in a flexed position by placing the index and middle finger of the maxillary prominence on either side of the nose.
Which type of breech presents with buttocks flexed at the hip and extended at the knees?
Frank Breech
65-70% of breechs
Which type of breech presents with hips and knees flexed so that the baby is sitting cross legged with feet beside the buttocks?
Complete Breech
Which type of breech presents with one or both feet come first with the buttocks at a higher position.
Footling Breech
Which type of breech presents with one or both legs extended at the hips and flexed at the knees?
Kneeling
What is a hypertonic Uterus?
Hyperstimulated.
An overdose of oxytocin may cuase this type of uterine activity
V C
E H
A O
L P
Variable Cord compression
Early Head compresion
Accelerated Okay
Late Placenta
What is the first stage of labor?
Onset of labor and ends when the cervix is 100% effaced and completeley dilated to 10cM 12-17 hrs
What is the second stage of labor?
When cervix is completely effaced and dilated and ends with birth. 1-2 hours
What is the third stage of labor?
Begins with birth and ends at delivery of placenta. 15-20 minutes
What is the fourth stage of labor?
Delivery of placenta and ends after 1-2 hours after delivery
Fetus of preelcamptic mother during labor will comonly experence
Late Decelerations
Normal Magnesuim level is
1.5-2.5
Theraputic serum magnesium to prevent seizures in OB
4-8mEq/L
What are the main assessment fingings in pregnacy induced hypertension (PIH)
Hypertension, Edema, proteinuria
Fesus’s variability is
expected to increase during active labor, normal 10-15 beats per minute and the best indicator of fetal viability
What is minimal variability
<5
What is moderate variability
6-25
What is Marked variability
> 25
Causes of Sinusoidal pattern on EFM
Fetal hypovolemia, accidental tap of the umbilical cord during amniocentesis, placetal abruption
What does HELLP stand for?
Hemolysis, Elevated Liver enzymes and Low Platlets
complication of severe preeclampsia, life threatening
Platelet count lower than 100,000 is characteristic of HELLP
High biliruben, lower platelet and red blood cell fragment and irregularly shaped red blood cells
When do you give methergine?
0.2mg administered IM or IV is recommended to prevent or control bleeding following birth.
What side effects can be seen after magnesium sulfate administrion
Flushing of skin, diaphoresis, nausea, vomiting and drowsiness. A decrease in FHR variability may be observed.
What is given to prevent hemolytic disease of newborn
Rho(D)
Frequency of contractions is defined as
begnning of one contraction to the begnning of another
The Duration of contractions is defined as
beginning of one contraction to the end
How do you measure fundal height
From top of bupic bone to top of the uterus
Fundal height just above the umbilicus is how many weeks
20-24 Weeks
Where do most ectopic pregnancies occur
Fallopian tubes
What medications can decrease or stop uterine activity
Terbutaline, mag, nsaid’s
What med can help decrease the chance an infant will have respiratory distress syndrome
Betamethasone (Celestone)
A small amount of fluid is spread on a sline and allowed to dry, a frond crystallization pattern of dried amnionitic flud will be seen under microscopic exam, what is this called
Postivie Ferning
Nitrazine paper will turn what color in presence of amniotic fluid
Blue
What are contraindications for Magnesium sulfate administration
Myasthenia gravis and renal failure
What is Macrosomia
Newborns with excessive birth weight
When can Uterine inversion occur
excessive cord traction, fundal pressure, uterine atony
rate mecial emergency where uterus turns inside out and protrudes into the vagina.
treatment is immediate manual reduction by pushing up on the fundus is returned to its normal position
What is the most common cause of preterm labor
Infection
Define Placental abruption
premature detachment of a normally implanted placenta from uterine wall
Diasotlic BP goal when managing pregnancy induced hypertension is
90-100
What method should be used to monitor an OB patient with suspected concealed bleeding
marking and determining fundal height frequently
EFM strip is V-shaped or W-shaped and what does it indicate
Variable deceleration
Cord compression
Normal FHR
110-160
Fetal Bradycardia
<100 bpm
Fetal tachycardia
> 160
What is the most common cause of postpartum hemorrhage
uterine atony
Loss of tone in the uterine musculature
75-80% of postpartum hemorrhage is due to uterine atony
Leopolds Maneuver is
Common and systematic way to determine the position of a fetus inside the uterus.
Physiologic changes to mother during pregnancy
Increase blood volume
increase CO
increased minute ventilation
ABG cahnges to compensated rep alkalosis
Preterm labor patient is identified as
24-36 weeks
What medication should the pre term labor mother recieve
Tocolytic agent, Terbutaline 0.25 mg or Mag 4G infuse
What presents with fetal parts palpated inthe abdomen
Uteine rupture, likley caused by trauma
Pregnancy HTN meds
Mag 4g in 100ml over 20 min
Labetolol 10 mg SIVP with stacked dosing (10,20,40)
Hydralazine (alpresoline)
Nifedipine (procardia) CCB that targets the arteries
Magnesium toxicity presents with what and what is given to reverse the effects
reduced DTR, CNS depression, Hypotension,
Give galcium as a reversal agent
A EFM where heart rate deceleration occurs completly after the contaction is complete
Late Decel
A EFM where heart rate deceleration occurs at the same time as contaction
Early Decel
A EFM where heart rate deceleration occurs in a V shape or sharp decline
Variable decel
A EFM where heart rate acceleration occurs with contraction
Normal
What do you do if the OB patient develops uterine tetany
discontinue infusion
