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OB TEST 3 > Intrapartum > Flashcards

Intrapartum Flashcards

1
Q

Precipitous Delivery

A

Rapid intense contractions

Labor less than 3 hrs

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2
Q

Dystocia

A

Long, difficult, or abnormal labor

As a result of
Powers
Passenger
Passageway

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3
Q

Dysfunctional Labor Pattern

Hypertonic

A

Hypertonic

Strong, painful, ineffective contractions
Contributing factor: maternal anxiety
Occiput-posterior malposition of fetus

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4
Q

Dysfunctional Labor Pattern

Hypotonic

A

Hypotonic

Contractions decrease in frequency, intensity
Maternal and fetal factors that produce excessive uterine stretching

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5
Q

Structural Dystocia (4)

A

Shoulder Dystocia McRoberts Maneuver

Cephalo-Pelvic Disproportion (CPD)

Fetal Anomalies

IDM or LGA

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6
Q

Uterus Complications

A

Uterine inversion – uterus follows the placenta out
Surgical repair

Uterine rupture - complete separation vs. small tear
Obstetric emergency
Sharp referred pain -> between scapula

Increased risk during VBAC = vaginal birth after C-section

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7
Q

Umbilical Cord

A

Umbilical cord complications
Nuchal cord
“loose vs. tight” “knots”
“how many loops”

Umbilical cord prolapse
Obstetric emergency
-> c/s

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8
Q

Placenta Complications

5

A

Placenta irregularities:

Implantation
Circumvellate,Succenturiate

Adherence
Accreta, Increta, Percreta

Insertion of cord
Battledore, Velamentous

Infarcts
Substances – cocaine

Insufficiency
Smoking

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9
Q

Amniotic Fluid Complications (5)

A

Oligohydramnios -> less amniotic fluid, amniofusion, kidney problems of baby not urinating

Polyhydramnios –> too much amniotic fluid, tracheoesophageal atresia

Amniotic Fluid Emboli –> amniotic fluid and fetal tissue in moms blood supply, fast death

Meconium –> Meconium-stained; seizure, stress on baby
Pea soup – thick and under a lot of stress –> aspiration and pneumonia

Infection – Chorioamnionitis

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10
Q

Intrapartal Infections
Chorioamnionitis “chorio”
7 symptoms

A

Maternal fever (100.4 F)

Plus
WBC > 15,000
Maternal tachycardia (> 100 bpm)
Fetal tachycardia (> 160 bpm)
Foul or strong-smelling amniotic fluid
Cloudy or yellow amniotic fluid
Tender uterus

Tocolytics are contraindicated in the presence of symptomatic Amniotic Fluid Infection.

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11
Q

Perineal Trauma (8)

A

Lacerations
1st degree to 4th degree

Birth weight > 4 kg
Persistent occipitoposterior position
Nulliparity
Induction of labor
Epidural analgesia
Prolonged second stage > 1 hr
Midline episiotomy
Forceps delivery
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12
Q

Intrapartum Assessment

A

Maternal and fetal well-being

Analyze labor status
Monitor for symptoms of complications
Facilitate progression of labor
Ensure safety of patient and fetus/newborn

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13
Q

Fetal Assessment
Changes in Fetal HR

Tachycardia (9)

Bradycardia (8)

A

Changes in Fetal Heart Rate

Tachycardia   > 160 bpm
maternal fever or infection
maternal dehydration
maternal anemia
maternal anxiety
maternal medications or illicit drugs
prolonged fetal stimulation
compensatory response to transient fetal hypoxemia
chorioamnionitis
fetal anemia
Bradycardia 
maternal supine positioning
mom hypotension
mom meds/illicit drugs
mom hypothermia
mom hypoglycemia
umbilical cord prolapse
decompensating fetus
prolonged PSNS
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14
Q

Fetal Assessment

–> C-Section HR STATS

A

Fetal heart rate

Baseline FHR
Tachycardia
> 160 bpm x 10 mins
Bradycardia

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15
Q

Interpret FHR, EFM Tracing

What are you looking for

A

Contractions
Frequency and Intensity

FHR Pattern
Reassuring
Non-reassuring

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16
Q

EFM Assessment

A 
Baseline FHR
Presence of...
Variability
Accelerations
Decelerations
Early
Variable
Late
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17
Q

Acceleration

A

Abrupt increase in HR from baseline
Can occur at any time during labor
Reassuring sign of fetal well being

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18
Q

Variable deceleration

A

Abrupt decrease in HR from baseline
Onset varies with contractions
Extremely common, present in 83% of labors

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19
Q

Late Decelerations

A

Gradual, symmetrical, decrease in HR
HR returns to baseline after contraction ends
Onset occurs at peak of contraction

May indicate fetal distress if repetitive or severe

20
Q

Early vs. Late Decelerations

And Variable

A

Early decelerations caused by head compression

Late decelerations caused by uteroplacental Insufficiency

Variable decelerations caused by cord compression

21
Q

VEAL CHOP

A

variable - cord
early - head
acceleration - ok
late - placenta

22
Q

Nursing Interventions
FHR decelerations
Early vs. variable and late (6)

A

Early: no action

Variable and Late
Discontinue oxytocin
Lateral position change
Increase IVF rate
Oxygen per face mask
Palpate for hyperstimulation
Notify HCP
23
Q

Obstetric interventions (4) for labor

A

Induction of Labor
Labor is started artificially

Labor Augmentation
Assisting labor which has started spontaneously but is ineffective

Instrument Assisted Labor
Vacuum Extraction
Forceps

Cesarean Section

24
Q

Post term pregnancy
Time
Management

A

Post-term—extends beyond 42 wks
Risk for fetal/neonatal problems
Increased maternal risk
Management—labor induction

25
Q

Indications for induction (6)

A

Post term pregnancy
Premature Rupture of Membranes (PROM)
Chorioamnionitis
HTN: Chronic, Gestational, or Preeclampsia (mild)

Maternal co-morbidities
Diabetes
Cardiac or Respiratory
Psychosocial (including hx precipitous or rapid labor & distance to hospital )

Fetal compromise
Intrauterine growth restriction (IUGR)
Oligohydramnios
Isoimmunization
Fetal demise
26
Q

Induction and the Cervix

Mechanical vs. Medication

A

Mechanical
Amniotomy = AROM
Membrane Stripping

Medication
Cervical Ripening
dinoprostone insert or gel
misoprostol (off-label)
laminaria
Synthetic Oxytocin IV
27
Q

Augmentation of Labor
Mechanical
Medication

A

Prolonged labor
“failure to progress”

Mechanical
AROM
Membrane Stripping

Medication
Synthetic Oxytocin IV

28
Q

Indications for Vacuum extraction

A

Maternal fatigue, ineffective pushing, vacuum

29
Q

C-Section STAT Indications (5)

A 
Fetal distress (prolonged deceleration without recovery)
Umbilical cord prolapse
Placenta Abruptio
Uterine rupture
Hemorrhage
30
Q

C-Section Scheduled (6)

A 
Scheduled 
Repeat
Multiples
Infection: HIV, active herpes lesions
Previous 4th degree perineal laceration

Scheduled during last weeks
Placenta previa
Presentation: breech, transverse

31
Q 
C-Section
Not emergent (5)
A

Not emergent
Failure to progress – prolonged labor
Failed labor induction
Macrosomia / CPD

Complications:
Preeclampsia and HELLP
Preterm labor (if progressing and 22-28 wks)

32
Q

Surgical Procedure

Major Risks

A

Respiratory Depression
Anesthetic gases or medications (epi/spinal)
Maternal or Newborn respiratory depression

Infection -> Pre-operative prevention
Surgical Care Improvement Project Measure

33
Q

General Anesthesia for C/S

A

Though an increased risk for post-op complications
Respiratory

Preferred if
Platelet count is less than 100,000
Epidural/spinal is not effective
“STAT” emergency section for fetal or maternal distress

34
Q

Perinatal Fetal Loss

A 
Communication and care techniques
Actualize the loss
Provide time to grieve
Interpret normal feelings
Allow for individual differences
Cultural and spiritual needs of parents
Physical comfort
35
Q

High Risk Newborns

Birth weight

A

Birth Weight
Low birth weight (LBW) 2500
Very low 1500
Extremely low 1000

36
Q

High Risk newborns
IUGR
SGA

A

Intrauterine Growth Restriction
Lack of intrauterine fetal growth may also be SGA

Small for Gestational Age
Infants born at any gestational age, birth weight is below the 10th percentile on the growth charts

37
Q

High Risk Newborns
Risk Factors
Physiology

A

Risk Factors
Intrauterine development
Intrapartum processes
Extrauterine adaptation

Physiology
Lung immaturity
Circulatory immaturity
Neurological immaturity

38
Q

Lung Immaturity
Lower airway characteristics
(3)

A

At 24-28 wks gestation, surfactant begins to line the alveoli

Inhibits alveolar collapse at end of expiration

Increases area available for gas exchange

39
Q

Premature newborn

Severe vs. Moderate

A

Severe prematurity
22 to 26 weeks
Moderate prematurity
26 to 30 weeks

40
Q

Apnea of Prematurity

Treatment

A

Apnea – not breathing >15 to 20 secs accompanied by pallor, hypotonia, cyanosis, and bradycardia

Apnea
Periodic breathing
Central apnea
Reflux

Caffiene
Apnea Monitor
CPR training for parents and caregivers before D/C

41
Q

Respiratory Distress Syndrome

A

Premature newborn –>
Underdeveloped alveoli, lack of surfactant
Atelectasis, congestion, edema in lung spaces

GFR = grunting, flaring, retractions

42
Q

Preterm Newborn Challenges

A

Hypoglycemia
Hypothermia
Hyperbilirubinemia

43
Q

Transient tacypnea of the newborn

A

Fetal lung fluid not fully absorbed

44
Q

Meconium aspiration syndrome

A

Meconium-stained amniotic fluid
Light
Moderate
Pea Soup

-> Suctioning before first breath to prevent aspiration pneumonia

45
Q

Post term newborn

A

Newborns remain in utero after the optimal growth

Skin is parchment-like
Fingers are long and peeling
Muscle wasting is present

46
Q 
Infections of Newborn
Bacterial --4
Fungal -- 1
TORCH -- 3
\_\_\_\_\_\_\_
A 
Bacterial infections
Group B strep
Escherichia coli
Tuberculosis
Chlamydia

Fungal infections
Candida

TORCH
Cytomegalovirus
Toxoplasmosis
Herpes

HIV

47
Q

Symptoms of Sepsis

A 
Temperature Instability
Feeding 
Poor suck
Feeding intolerance 
Hypoglycemia
Respiratory - “GFR”
Hypotonia

GFR

OB TEST 3 (2 decks)

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