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
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
3
Q
what does cytotec (misoprostol) do?
A
helps with cervical ripening & labor induction
4
Q
what does stimulating the nipples do?
A
releases oxytocin
5
Q
how would sex & semen induce labor?
A
- sex releases oxytocin
- semen has prostaglandins –> induce contractions
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
7
Q
why would we use forceps for augmentation?
A
- mom is unable to push effectively
- baby is breech
- malpresentation
- arrest of rotation
8
Q
what does the bishop score indicate?
A
measuring the cervix’s ripeness & readiness
9
Q
what does a bishop score of 8 + mean?
A
the cervix is favorable for induction!
10
Q
what is the criteria when measuring for the bishop score?
A
- dilation
- effacement
- station
- consistency
- position
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?
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
13
Q
what are the chemical methods we use for induction?
A
- PREPIDIL
- CERVIDIL
- CYTOTEC
- OXYTOCIN
14
Q
what is PREPIDIL?
A
a prostaglandin gel –> starts contractions
15
Q
what is CERVIDIL?
A
- prostaglandin
- inserted into cervix –> expands & softens it
16
Q
what is CYTOTEC?
A
- aka MISOPROSTOL
- contracts uterus
- cervical ripening
- pill for PO or break into pieces and insert into cervix
17
Q
what are the different types of mechanical induction methods?
A
- cervical ripening balloon
- laminaria tent + lamicel
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
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
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 !!
21
Q
what is the synthetic form of oxytocin?
A
PITOCIN
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
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
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
25
how should we set the IV during postpartum?
125mL/hr or faster
26
what is dystocia?
painful & dysfunctional labor
27
what can happen in dystocia, dysfunctional labor?
- 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
28
why is a precipitous delivery not favorable?
- 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
29
what is pelvic dystocia, what are common causes?
- pelvic dystocia: painful & difficult pelvis
soft tissue dystocia:
- fibroid, tumors, full bladder
- placenta previa
30
what fetal factors cause dystocia?
- fetal anomalies
- fetal position & proportions: cephalopelvic disproportion
- multifetal pregnancy
- malposition
- malpresention
31
what is cephalopelvic disproportion?
mismatch of sizes of fetal head & maternal pelvis
32
how do multifetal pregnancies (TWINS) increase risk of dystocia?
- 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
what can providers do if fetus has malpresentation?
- breech delivery: emergency c-section
- version: turning bby into normal position from outside of belly --> risk for abruption
34
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?
AUGMENTATION
- record the # of attempts & time
risk for:
- caput or cephalohematoma
- cerebral irritation --> poor feeding & listeless
- jaundice from bruising
35
how do babies get jaundice from bruising?
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
what is the difference between caput & cephalohematoma?
- caput = edema, some blood, & periosteum still attached to head
- cephalohematoma = blood & periosteum is NOT attached to head
37
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?
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
what is meconium? when should this appear?
the first poop of newborn baby, should happen AFTER birth
39
what is shoulder dystocia? how do we fix this? what kind of fetus can this happen to?
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
what can result from shoulder dystocia? what are the symptoms?
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
what situations are considered OB emergencies?
- prolapsed umbilical cord
- uterine rupture
- amniotic fluid embolism
42
is mom has a prolapsed cord, what should we do? what kind of dystocia is this?
soft tissue dystocia
- put her in trendelenburg / knees to chest --> removing pressure off from cord
- monitor FHR
- EMERGENCY C/S
43
if mom has a uterine rupture what should we do based on its size? why can this happen if its so rare?
previous c-section increase risk
- try to prevent uterine rupture
- small rupture --> can be repaired
- large rupture --> may need hysterectomy
44
what can an amniotic fluid embolism cause? what happens when it ruptures?
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
what is disseminated intravascular coagulation? (DIC)
a pathological form of clotting -- abnormal clotting throughout the body
46
what are some causes of DIC?
- placenta abruption
- retained fetal demise -- gram negative sepsis
- amniotic fluid embolism
- preeclampsia
- HELLP
47
how do we manage DIC?
- correct underlying cause
- fluid & blood replacement
- O2 & perfusion maintenance
- antithrombin III factor, fibrinogen, or cryoprecipitate
48
what is the difference between placenta previa & abruptio placentae?
placenta previa = painless vag bleeding
- partial or complete covering cervix
abruptio placentae = painful vag bleeding
- partial or complete detachment of placenta
49
what is the placenta accreta spectrum (PAS)?
the spectrum of the placenta attaching too deeply into uterine wall
50
what are the PAS stages?
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
what increases risk of PAS?
frequent c-sections due to scar tissue
52
how does the placenta attach in a normal pregnancy?
placenta attaches to a temporary layer in the uterus that's shed in delivery
53
if the placenta is increta or percreta, what do we need to do?
a hysterectomy
54
what is the difference between monozygotic & dizygotic?
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
what does chorion & amnion mean?
- chorion: outer membrane surrounds the amniotic sac & embryo(s)
- amnion: innermost membranes contains amniotic fluid, embryo(s), placenta(s), & umbilical cord(s)
56
what are some potential complications for multiple gestations in antepartum?
- 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
what are some potential complications for multiple gestations in intrapartum?
- preterm labor &/or preterm birth
- placental abruption
- increased risk of c-section delivery --> always deliver in operating room
58
why would we need to do a c section with multple gestation pregnancies?
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
what are some potential complications for multiple gestations in postpartum?
increase risk of maternal hemorrhage
60
what are reasons people get scheduled c-section? what is the most common reason?
- 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
what are some indications of an emergent c-section?
dystocia
- shoulder dystocia
- malposition
- malpresentation
- CPD
- failed labor or failed induction of labor
- placental abruption
- fetal distress
- cord prolapse
62
before a c-section happens, how do we as nurses prep before going into the OR?
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
before a c-section happens, how do we as nurses prep IN the OR? why is the OR cold?
- 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
how do you do abdominal prep on mom in OR?
paint iodine around abdomen from mons pubis to under breast before incision
65
what are the different incision techniques? is it always the same type of incision for the skin & uterus?
- 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
what kinds of anesthesia do we use for c-sections?
- 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
how do we give c-section postpartum care?
- 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
what do we need to do for vaginal & incision bleeding in c/s postpartum?
ice! especially on perineum of vagina
69
what are dermatomes?
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
what is TOLAC? what do we have to do with it? when can you not do this?
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
