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nurs 335: women > intrapartum pt 3: induction & augmentation, high risk labor & birth, and C-section > Flashcards

intrapartum pt 3: induction & augmentation, high risk labor & birth, and C-section Flashcards

EXAM 2 content

1
Q

what is the difference between induction & augmentation labor?

A
  • induction = starting labor from scratch
  • augmentation = enhancing what is already happening
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2
Q

what are the different types of techniques you can do for induction?

A
  • cervical ripening: bishop score, chemical & mechanical
  • Misoprostol (Cytotec)
  • Oxytocin/Pitocin
  • stimulate nipples
  • sex & semen
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3
Q

what does cytotec (misoprostol) do?

A

helps with cervical ripening & labor induction

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4
Q

what does stimulating the nipples do?

A

releases oxytocin

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5
Q

how would sex & semen induce labor?

A
  • sex releases oxytocin
  • semen has prostaglandins –> induce contractions
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6
Q

what are the different types of techniques you can do for augmentation?

A
  • active management: AROM & oxytocin
  • forceps: shorten stage 2 of labor
  • vacuum: usually preferred over forceps
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7
Q

why would we use forceps for augmentation?

A
  • mom is unable to push effectively
  • baby is breech
  • malpresentation
  • arrest of rotation
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8
Q

what does the bishop score indicate?

A

measuring the cervix’s ripeness & readiness

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9
Q

what does a bishop score of 8 + mean?

A

the cervix is favorable for induction!

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10
Q

what is the criteria when measuring for the bishop score?

A
  • dilation
  • effacement
  • station
  • consistency
  • position
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11
Q

what does consistency mean in the bishop score criteria?

A

how soft is the cervix? does it feel like the tip of a nose or earlobe?

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12
Q

what does position mean in the bishop score criteria?

A

is the cervix anterior towards the mom’s front?
- cervix will move towards the front, this is what we want to see

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13
Q

what are the chemical methods we use for induction?

A
  • PREPIDIL
  • CERVIDIL
  • CYTOTEC
  • OXYTOCIN
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14
Q

what is PREPIDIL?

A

a prostaglandin gel –> starts contractions

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15
Q

what is CERVIDIL?

A
  • prostaglandin
  • inserted into cervix –> expands & softens it
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16
Q

what is CYTOTEC?

A
  • aka MISOPROSTOL
  • contracts uterus
  • cervical ripening
  • pill for PO or break into pieces and insert into cervix
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17
Q

what are the different types of mechanical induction methods?

A
  • cervical ripening balloon
  • laminaria tent + lamicel
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18
Q

what is a cervical ripening balloon? how do you use it? how does it work?

A
  • most common
  • just like a catheter
  • puts pressure on both sides of the cervix –> causes body to release prostaglandins
  • balloon is trying to mimic descent of the head by its pressure
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19
Q

what is a laminaria tent or lamicel? how do you use it? how does it work?

A

dry seaweed
- dries out cervix –> expands
- the more natural way

laminaria tent = actual seaweed
lamicel = synthetic version of seaweed

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20
Q

what is an amniotomy? where does this fall under, induction or augmentation? when should you do this?

A

under augmentation
- using an amnihook to artificially rupture amniotic membrane
- do this only a few hours before delivery !!

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21
Q

what is the synthetic form of oxytocin?

A

PITOCIN

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22
Q

what is oxytocin / pitocin measured by? and what is the usual units per 500 or 1000 mL of NS?

A

units
- 20 or 30 units PER 500 or 1000 mL NS

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23
Q

how should you convert a Pitocin drip to IV? how much do they usually start on the mom with?

A

converting milliunits/min –> mL/hr
- 2-4 milliunits to see how mom reacts

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24
Q

when giving mom pitocin, what else should we do to monitor the fetus? and why?

A

continuous electronic fetal HR because of hyperstimulation & fetal distress are a risk
- more contractions = less o2 for fetus

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25
Q

how should we set the IV during postpartum?

A

125mL/hr or faster

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26
Q

what is dystocia?

A

painful & dysfunctional labor

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27
Q

what can happen in dystocia, dysfunctional labor?

A
  • hypertonic uterine dysfunction: frequent contractions close together, cervix is not dilating –> taxing baby
  • hypotonic uterine dysfunction: no strong contractions
  • secondary powers are low: mom is exhausted pushing or epidural is too heavy
  • precipitous delivery: labor is < 3 hours
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28
Q

why is a precipitous delivery not favorable?

A
  • does not give time for baby’s head to mold
  • cervix dilated too fast and there was no time for stretching
  • more damaging to mom
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29
Q

what is pelvic dystocia, what are common causes?

A
  • pelvic dystocia: painful & difficult pelvis

soft tissue dystocia:
- fibroid, tumors, full bladder
- placenta previa

30
Q

what fetal factors cause dystocia?

A
  • fetal anomalies
  • fetal position & proportions: cephalopelvic disproportion
  • multifetal pregnancy
  • malposition
  • malpresention
31
Q

what is cephalopelvic disproportion?

A

mismatch of sizes of fetal head & maternal pelvis

32
Q

how do multifetal pregnancies (TWINS) increase risk of dystocia?

A
  • LBW & IUGR
  • anomalies
  • cord prolaspe
  • malpresentation: 1st bby out, 2nd breech, etc
  • placental separation: 1st bby out but not 2nd, but body wants to remove placenta
33
Q

what can providers do if fetus has malpresentation?

A
  • breech delivery: emergency c-section
  • version: turning bby into normal position from outside of belly –> risk for abruption
34
Q

lets say mom needs help pushing and uses a vacuum, what is that under & what are some of it’s complications? what do you do as a nurse?

A

AUGMENTATION
- record the # of attempts & time

risk for:
- caput or cephalohematoma
- cerebral irritation –> poor feeding & listeless
- jaundice from bruising

35
Q

how do babies get jaundice from bruising?

A

there is too much blood for the baby to break down, they can not handle it
- they still have an immature liver system and filtration

36
Q

what is the difference between caput & cephalohematoma?

A
  • caput = edema, some blood, & periosteum still attached to head
  • cephalohematoma = blood & periosteum is NOT attached to head
37
Q

lets say mom needs help pushing and uses forceps, what is that under & what are some of it’s complications? what do you do as a nurse?

A

AUGMENTATION
- FHR monitoring
- assess for trauma after delivery

risk for:
- bruising & brain injury
- tearing mom’s vagina
- meconium prior to birth due to stress –> aspiration post delivery –> infection to baby

38
Q

what is meconium? when should this appear?

A

the first poop of newborn baby, should happen AFTER birth

39
Q

what is shoulder dystocia? how do we fix this? what kind of fetus can this happen to?

A

where the anterior shoulder of baby can not pass under the pubic arch, but the head is already out
- macrosomic babies
- McRoberts & suprapubic pressure
- NO fundal pressure

40
Q

what can result from shoulder dystocia? what are the symptoms?

A

brachial plexus injury
- weak arm or hand
- their arm is held against body or their elbow is straight
- tightness & decrease feeling in shoulder, arm, or hand

41
Q

what situations are considered OB emergencies?

A
  • prolapsed umbilical cord
  • uterine rupture
  • amniotic fluid embolism
42
Q

is mom has a prolapsed cord, what should we do? what kind of dystocia is this?

A

soft tissue dystocia
- put her in trendelenburg / knees to chest –> removing pressure off from cord
- monitor FHR
- EMERGENCY C/S

43
Q

if mom has a uterine rupture what should we do based on its size? why can this happen if its so rare?

A

previous c-section increase risk
- try to prevent uterine rupture
- small rupture –> can be repaired
- large rupture –> may need hysterectomy

44
Q

what can an amniotic fluid embolism cause? what happens when it ruptures?

A

when the amniotic sac ruptures BUT the baby is NOT ready or is not in the pelvic area
- 10% of deaths
- fluid contains debris –> enters mom’s blood flow –> obstructs pulmonary vessels –> death

45
Q

what is disseminated intravascular coagulation? (DIC)

A

a pathological form of clotting – abnormal clotting throughout the body

46
Q

what are some causes of DIC?

A
  • placenta abruption
  • retained fetal demise – gram negative sepsis
  • amniotic fluid embolism
  • preeclampsia
  • HELLP
47
Q

how do we manage DIC?

A
  • correct underlying cause
  • fluid & blood replacement
  • O2 & perfusion maintenance
  • antithrombin III factor, fibrinogen, or cryoprecipitate
48
Q

what is the difference between placenta previa & abruptio placentae?

A

placenta previa = painless vag bleeding
- partial or complete covering cervix

abruptio placentae = painful vag bleeding
- partial or complete detachment of placenta

49
Q

what is the placenta accreta spectrum (PAS)?

A

the spectrum of the placenta attaching too deeply into uterine wall

50
Q

what are the PAS stages?

A
  1. placenta accreta: placenta attaches too deeply into uterine wall
  2. placenta increta: placenta attaches into uterine muscle
  3. placenta percreta: placenta goes completely through uterine wall, sometimes invading nearby organs like bladder
51
Q

what increases risk of PAS?

A

frequent c-sections due to scar tissue

52
Q

how does the placenta attach in a normal pregnancy?

A

placenta attaches to a temporary layer in the uterus that’s shed in delivery

53
Q

if the placenta is increta or percreta, what do we need to do?

A

a hysterectomy

54
Q

what is the difference between monozygotic & dizygotic?

A

monozygotic = identical
- one egg, one sperm –> divides

dizygotic = fraternal or non identical
- two eggs, fertilized by two diff sperm –> implant in separate locos in uterus

55
Q

what does chorion & amnion mean?

A
  • chorion: outer membrane surrounds the amniotic sac & embryo(s)
  • amnion: innermost membranes contains amniotic fluid, embryo(s), placenta(s), & umbilical cord(s)
56
Q

what are some potential complications for multiple gestations in antepartum?

A
  • preeclampsia
  • gestational htn
  • gestational diabetes
  • LBW
  • maternal anemia
  • placental abruption
  • intrauterine growth restriction
  • oligohydramnios or polyhydramnios
  • miscarriage of < 20 weeks
  • fetal demise of > or = to 20 weeks
  • twin to twin transfusion (more common in monochorionic)
57
Q

what are some potential complications for multiple gestations in intrapartum?

A
  • preterm labor &/or preterm birth
  • placental abruption
  • increased risk of c-section delivery –> always deliver in operating room
58
Q

why would we need to do a c section with multple gestation pregnancies?

A

twin A = closest to cervix
- twin A in transverse or breech position
- twin B isnt in vertex position

  • non reassuring fetal heart tracings
  • failure of labor progression
  • cephalopelvic disproportion
59
Q

what are some potential complications for multiple gestations in postpartum?

A

increase risk of maternal hemorrhage

60
Q

what are reasons people get scheduled c-section? what is the most common reason?

A
  • most common reason: previous c/s, classical incision
  • multiples
  • breech or transverse
  • placenta previa
  • active maternal disease
  • CPD (cephalopelvic disproportion)
  • cervical cerclage
  • fetal anomalies
  • elective
61
Q

what are some indications of an emergent c-section?

A

dystocia
- shoulder dystocia
- malposition
- malpresentation
- CPD

  • failed labor or failed induction of labor
  • placental abruption
  • fetal distress
  • cord prolapse
62
Q

before a c-section happens, how do we as nurses prep before going into the OR?

A

before going into the OR
- do labs, IV, have a large bore needle
- put on gown, cap, & remove jewelry
- take mom’s last PO intake –> might have to wait to go into OR based on last meal
- give antacid: FAMOTIDINE, OMEPRAZOLE, BICITRA
- ask if mom has any metal in her body

63
Q

before a c-section happens, how do we as nurses prep IN the OR? why is the OR cold?

A
  • OR is cold to prevent bacteria growth
  • spinal injection: get medication in quicker
  • catheter
  • SCD
  • bair hugger
  • cautery grounding
  • draping & abdominal prep
  • let mom be slightly tilted to prevent supine hypotension
64
Q

how do you do abdominal prep on mom in OR?

A

paint iodine around abdomen from mons pubis to under breast before incision

65
Q

what are the different incision techniques? is it always the same type of incision for the skin & uterus?

A
  • horizontal = low segment, low transverse
  • classical = vertical

sometimes its not always the type
- if mom has placenta previa –> horizontal on skin & classical on uterus

66
Q

what kinds of anesthesia do we use for c-sections?

A
  • spinal: common for c/s, done in OR & has a faster effect
  • epidural: takes around 15-20 mins
  • general: we try not to use this, emergency, NO partner in OR for this
67
Q

how do we give c-section postpartum care?

A
  • in PACU for 1-2 hours
  • q15 min checks on: fundus, v/s, cardiac monitoring, vaginal bleeding, incisional bleeding, dermatomes
  • baby in PACU when stable –> intiate breastfeeding
  • SCD’s & foley catheter for first 12 hours
  • PITOCIN IV: twice more than a vaginal delivery
  • TOLAC
68
Q

what do we need to do for vaginal & incision bleeding in c/s postpartum?

A

ice! especially on perineum of vagina

69
Q

what are dermatomes?

A

areas of the skin that is connected to a spinal nerve, helps provider where they are numb down
- usually when moms are out of OR they are numb from T4 down

70
Q

what is TOLAC? what do we have to do with it? when can you not do this?

A

TOLAC = trial of labor after cesarean
- can not do this if they have a classical incision on uterus
- do in hospital
- monitor
- be cautious for uterine rupture
- NO CYTOTEC: once in cervix you can not take it out or change the amount

nurs 335: women (5 decks)

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