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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?

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
periodic decels
can be in response to contraction
26
variable decels
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
blunted (early) decels
mirror contraction usually in response to compression on babies head, causing a vagal response generally represents progress & doesn't stress baby out
28
late decels
most problematic uterine placental perfusion deficiency? -fluid boluses, lie on left side
29
to relieve variable decels
move mom increase perfusion to placenta via fluid bolus to mom give mom extra O2
30
things that can affect how labor progresses
mom's health mom's energy babies position, size
31
internal fetal monitor
attached to head of baby | tiny wire that screws into babies scalp
32
fetal surveillance during pregnancy
``` PMH FH genetic hx psychosocial hx fetal movement (FM) awareness FHR uterine growth palpable movement ```
33
measurement of term fetus
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
amniotic fluid analysis
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
fetal surveillance via sonograms
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
vibroacoustic stimulation (VAS)
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
NST (nonstress test)
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
NST findings
reactive- meets/exceeds criteria nonreactive- nonreassuring finding nonreactive or inconlusive usually requires f/u w/ BPP or contraction stress test (CST)
39
what is the most accurate predictors of uteroplacental insufficiency
contraction stress test (CST)
40
CST
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
what do you use during a CST to create contractions?
oxytocin (pitocin) or nipple stimulation
42
CST grading
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
BPP (biophysical profile)
combined w/ electronic fetal monitoring nonstress test (NST)
44
fully oxygenated fetus that is neurologically intact will demonstrate what during BPP (monitored w/ sonogram)
``` muscle tone gross mvnt respiratory activity and will have: an adequate AFI A reactive NST ```
45
looking at placenta w/ BPP
placental grade 0-3 | depends upon smoothness of chorionic plate, echogenic densities, and echospared fallout areas
46
Rh isoimmunization
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
complications of Rh isoimmunization
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
antigens that cause IgM antibodies
``` 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
poorly expressed antigens
capable of causing significant hemolytic rxns but are poorly developed at birth & so rarely cause dz Lu(b), Yt(a), VEL
50
high risk antigens
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
management of Rh
``` 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
mgnt continued for Rh
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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