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OB > Intrappartum Care > Flashcards

Intrappartum Care Flashcards

1
Q

goals of L&D

A 
safe birth
happy experience for all involved
comfortable
manage complications if arise
support family interaction & bonding
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2
Q

triage for labor

A

time of onset of contractions, frequency, bleeding, ROM (rupture of membrane)
med/OB hx, pregnancy complications, allergies, meds. last PO intake
GBS status
VS, UA

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3
Q

GBS

A

group B streptococcus
usually found in genitourinary tract
70% rate of vertical transmission to fetus once membranes rupture

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4
Q

MCC of neonatal sepsis?

A

GBS

babies have respiratory sx’s that resemble RDS

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5
Q

risk factors for neonatal transmission of GBS

A

premature delivery
prolonged ROM
maternal fever in labor
multiple gestation

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6
Q

most of the time, women with GBS are ____________

A

asymptomatic

although some may have GBS induced UTIs

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7
Q

when do you want to check women for GBS?

A

35-37 weeks w/ vaginal & rectal swab

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8
Q

prophylactic Abx in labor for GBS- use what?

A

PCN 5 mil units IV loading dose then 2.5 mil units q 4 hrs until delivery

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9
Q

monitoring L&D

A

contraction frequency
strength by palpation
fetal heart rate by EFM or intermittent doppler
confirm status of membranes, dilatation, effacement & station
EFW (est. fetal wt)

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10
Q

PPROM

A

antenatally/preterm (preterm premature rupture of membranes)

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11
Q

PROM

A

at term but before the onset of labor

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12
Q

SROM

A

spontaneously at onset of or during labor

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13
Q

AROM

A

amniotomy or artificial rupture of membranes via practitioner

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14
Q

check amniotic fluid for

A

color
odor
presence of blood

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15
Q

meconium staining

A

term/ postterm fetus are developmentalyy able to move their bowels & may do so spontaneously causing meconium stained fluid
stressed/hypoxic baby will also pass meconium
occurs about 20%

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16
Q

mgnt of meconium if light

A

epectant mgnt

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17
Q

mgnt of thick/dark meconium

A

notify peds
most likely suction nares & mouth immediately after delivery of the head before the delivery of the body
will prepare for possible intubation immediately after deliver to visualize below the vocal cords for meconium aspiration

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18
Q

meconium aspiration syndrome

A

mechanical obstruction & chemical pneumonitis leading to serious pulmonary HTN
frequently fatal
may suffer long term neuro defects

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19
Q

L&D fetal monitoring should occur when?

A

q 15-30 min in active labor

q 5-10 min during second stage (usually by RN per protocol)

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20
Q

UCs are usually noted as above

A

pts on pit (pitosun)

VBAC (vaginal birth after c-section) need continuous EFM (electronic fetal monitoring) & toco

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21
Q

EFM

A

monitors fetal well being
tolerance of labor
occurrence of uterine contractions

22
Q

what is a primary indicator of fetal well being per neurologic status & normal cardiac response?

A

EFM

23
Q

Accels in EFM

A

a reassuring indicator of fetal well-being

nml response to fetal mvnt

24
Q

Decels in EFM

A

periodic FHR changes associated w/ UCs

25
Q

periodic decels

A

can be in response to contraction

26
Q

variable decels

A

jagged looking
can be variable in what they mean
often caused by compression on umbilical cord d/t baby moving & getting tangled up
-over time if we keep seeing variable decels, it may become stressful to baby, b/c baby is holding its breath during these
another reason- oligohydramnios

27
Q

blunted (early) decels

A

mirror contraction
usually in response to compression on babies head, causing a vagal response
generally represents progress & doesn’t stress baby out

28
Q

late decels

A

most problematic
uterine placental perfusion deficiency?
-fluid boluses, lie on left side

29
Q

to relieve variable decels

A

move mom
increase perfusion to placenta via fluid bolus to mom
give mom extra O2

30
Q

things that can affect how labor progresses

A

mom’s health
mom’s energy
babies position, size

31
Q

internal fetal monitor

A

attached to head of baby

tiny wire that screws into babies scalp

32
Q

fetal surveillance during pregnancy

A 
PMH
FH
genetic hx 
psychosocial hx
fetal movement (FM) awareness
FHR
uterine growth
palpable movement
33
Q

measurement of term fetus

A

utilized in cases of preterm labor, PROM, severe maternal or fetal dz requiring delivery
GA presumed to be term at 37 wks
wt presume to be >2500g

34
Q

amniotic fluid analysis

A

thru amniocentesis or vaginal collection if ruptured
analyzed lecithin:sphingomyelin (L:S) ratio- should be 2:1 if mature
phosphatidyglycol (PTG) presence signifies mature

35
Q

fetal surveillance via sonograms

A

confirm GA
# of fetuses
placental location
r/o anomalies- nuchal translucency, anatomic scan
check growth & position
check amniotic fluid levels (amniotic fluid index-AFI)
doppler velocimetry

36
Q

vibroacoustic stimulation (VAS)

A

uses artificial larynx held at belly to startle baby into activity thru sound & vibration
should ellicit accels
can also be used intrapartum if fetus has little FHR variability to determine sleeping baby vs hypoxic

37
Q

NST (nonstress test)

A

most commonly used 3rd trimester to measure fetal well being
neurologically intact, oxygenated fetus will have >/= 2 15 bpm each lasting >/= 15 secs accelerations above baseline in 20 min of monitoring

38
Q

NST findings

A

reactive- meets/exceeds criteria
nonreactive- nonreassuring finding
nonreactive or inconlusive usually requires f/u w/ BPP or contraction stress test (CST)

39
Q

what is the most accurate predictors of uteroplacental insufficiency

A

contraction stress test (CST)

40
Q

CST

A

more expensive, takes more time, high false positives
can be used from 26 wks on
used to f/u nonreactive NST
can cause labor

41
Q

what do you use during a CST to create contractions?

A

oxytocin (pitocin) or nipple stimulation

42
Q

CST grading

A

criteria: 3 UCs/10min, felt or not felt
negative (good): FHR stable, no late decels
positive (bad): repetitive late decels w/ each UC
equivocal: unable to obtain satisfactory tracy
hyperstimulation (UCs q <2min)
nonrepetive late decels
few false negatives, many false positives

43
Q

BPP (biophysical profile)

A

combined w/ electronic fetal monitoring nonstress test (NST)

44
Q

fully oxygenated fetus that is neurologically intact will demonstrate what during BPP (monitored w/ sonogram)

A 
muscle tone
gross mvnt
respiratory activity
and will have: an adequate AFI
A reactive NST
45
Q

looking at placenta w/ BPP

A

placental grade 0-3

depends upon smoothness of chorionic plate, echogenic densities, and echospared fallout areas

46
Q

Rh isoimmunization

A

infrequently seen today w/ advent of Rh immune globulin (Rhogam) antenatally & postpartum
red cells of the fetus or newborn are destroyed by maternally-derived alloantibodies
when an Rh negative mother carries an Rh+ fetus

47
Q

complications of Rh isoimmunization

A

alloimmune hemolytic dz of the newborn (HDN)
aka erythroblastis fetalis (when it is of the fetus)
susequent anemia & risk for neuor defects, heart failure, edema & ascites

48
Q

antigens that cause IgM antibodies

A 
cannot cross placental barrier
generally innocuous:
A, P(1), Le(a), M, I, IH, Sd (a)
Lewis Ab & some I & IH are prevalent
some Lewis have IgG component but rarely cause clinical dz
49
Q

poorly expressed antigens

A

capable of causing significant hemolytic rxns but are poorly developed at birth & so rarely cause dz
Lu(b), Yt(a), VEL

50
Q

high risk antigens

A

responsible for the majority of HDN cases including anti-c, anti-D, anti-E, anti-Kell
-requires intrauterine or direct fetal transfusion during pregnancy or exchange transfusion postpartum

51
Q

management of Rh

A 
blood type & Rh
indirect Comb's
Ab titers if indicated
test FOB if mom tests + for Ab/genetic counseling
repeat indirect Coomb's at 28 wks
administer Rhogam @ 28 wks
check neonate w/ Direct Coomb's 
administer postpartum rhogam if indicated
52
Q

mgnt continued for Rh

A

serial amnicentesis to check fetal effects
possible deliver before term if fetus affected
in severe cases, fetal transfusion

OB (13 decks)

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