Interventions Flashcards
What are examples of intrauterine Resuscitation Techniques?
Maternal repositioning
Reduction of uterine activity
IV fluid bolus
Correction of maternal hypotension
Amnioinfusion during the first stage of labor
Modification of maternal pushing efforts during the second-stage of labor.
Lateral Positioning or Change of Position
-This alters the relationship between the umbilical cord, fetal parts, and the uterine wall, and decreases the frequency of uterine contractions
-In the lateral position, the uterus does not compress the vena cava or aorta; thus maternal cardiac return and cardiac output are maximized, and blood flow to the uterus is optimal
Reduction of Uterine Activity
Uterine contractions cause an intermittent decrease in blood flow to the intervillous space where oxygen exchange occurs.
-if this intermittent interruption of blood flow reaches an abnormal level as a result of too-frequent contractions, the fetus is at risk for hypoxemia
-As fetal deterioration progresses, the fetus will likely respond with late decelerations and the fetal heart rate will lose variability and reactivity.
-Oxytocin discontinuation, IV fluid bolus, and change to lateral position.
How long after the discontinuation of Oxytocin is it similar to a person who has not received in the first place?
30-40 minutes
IV Fluid Administration
Increasing IV fluids will positively affect uterine blood flow and thus fetal oxygenation
Amnioinfusion
This is the transcervical instillation of fluid into the amniotic activity.
-this is a therapeutic option to attempt to resolve recurrent variable fetal heart rate decelerations by correcting umbilical cord compression
Modification of Maternal Pushing Efforts
-Discourage prolonged breath-holding- instead instruct the woman to bear down and allow her to choose whether or not to hold her breath while pushing
-Discouraging more than three pushing efforts with each contraction and more than 6-8 seconds
What are the suggested interventions for STABLE tachysystole?
- Lateral position change
- 500 mL fluid bolus
- Wait 15 minutes
- Decrease the Pitocin by half
- Wait another 15 minutes
- Turn the Pitocin off
What are the suggested interventions for UNSTABLE tachysystole?
- Turn the Pitocin off
- Lateral position change
- 500 mL fluid bolus
What are the three positions for forceps?
- Outlet- scalp is visible at the vaginal opening
- Low- fetal head is at +2
- Mid- +2 and above head engaged
What is the name of the forceps used for breech deliveries?
Piper forceps
What is an important intervention prior to an operative delivery?
Empty the bladder
What are fetal/ Neonatal Complications from vacuum deliveries?
Retinal hemorrhage, Cephalohematoma (does not cross the suture lines), intracranial hemorrhage, abrasion/ lacerations, fractures, Erb’s Palsy, jaundice, infection
What are the limitations with a vacuum delivery?
up to 3 attempts/ pulls, maximum amount of pop-offs, no more than 600 mmHg, must make descent with pulls, time applied should not exceed 15-20 seconds, a maximum of 20 minutes
What is a genetic side effect of general anesthesia?
Malignant Hyperthermia Syndrome
What are major symptoms of Malignant Hyperthermia?
Muscle rigidity, extremely dark urine, fever (late sign), jaw clench (1st sign), hyperkalemia, arrhythmia, hypoxia
What is the medication to give in Malignant Hyperthamia?
Dantroline
What is a common side effect of epidurals?
Hypotension
What is a dural puncture?
This is where the dura has been punctured and there is a loss of spinal fluid where there is less fluid around the brain, therefore there is pressure of the brain from the skull
What is a hallmark sign of a dural puncture?
Severe headache. This gets worse when sitting up and immediately better when laying flat.
What are some conservative treatments for a dural puncture?
Fluids, caffeine, and pain medications
What is another treatment for a dural puncture?
An epidural blood patch
This is where the patient’s blood is injected into the epidural space and seals the hole.
What is the use for glucocorticoids in preterm labor?
This increases the surfactant production for the alveoli to stay open
What are three side effects of giving glucocorticoids?
Decrease in variability, decreased in the number of accelerations, and increase in the fetal heart rate.
What are side effects of giving Terbutaline?
Increase in blood pressure, chest pain, nervousness, hypokalemia, anxiety, tremors, hypotension, tachycardia
How does Procardia work to help with preterm labor?
Decreases contractility of smooth muscles
What are side effects of indomethacin administration?
Oligo
What is a side effect in the neonate that can happen if indomethacin is given after 32 weeks?
Premature closure of the ductus arteriosus- this is blood that goes to the baby’s brain
How does Magnesium Sulfate used for neuroprotection in preterm fetuses?
This causes the brain to vasodilate which increases blood flow (which has more O2), this decreases the risk for CP.
