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L&D > Lecture 3 > Flashcards

Lecture 3 Flashcards

1
Q

PROM

A

premature rupture of membranes prior to labor
- will only allow this state for 24 hours or there is risk for infection

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2
Q

why PROM is an issue

A
  • infection
  • if water isnt there and there are contractions then each one will start to try and push baby out
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3
Q

PPROM

A

preterm premature rupture of membranes
- want to keep pregnant for as long as possible in this situation

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4
Q

primary prevention for preterm birth

A

quit smoking, quit drugs, systemically address barriers to accessing prenatal care

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5
Q

secondary prevention for preterm birth

A

screening for bacterial vaginosis/UTI and STI’s

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6
Q

2 tocolytics acting as preterm labor management

A

stop or slow contractions
- nifedipine (calcium channel blocker), Indocid (NSAID)

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7
Q

magnesium sulfate used in management of preterm labor

A

neuroprotection
- improves neurodevelopment and used only for imminent preterm birth

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8
Q

dexamethasone and betamethasone in management of preterm labor

A

glucocorticoid steroids that cross placenta and help with fetal lung development

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9
Q

chorioamnionitis

A

ascending infection reaches the uterus and fetus
- can be a result of PROM

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10
Q

maternal complications of chorioamnionitis

A

prolonged labor, risk of PPH, wound infection

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11
Q

post term pregnancy

A

pregnancy reaching or exceeding 42 weeks gestation

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12
Q

risk of post term pregnancy on fetus

A
  • macrosomia (10x greater risk)
  • death because placenta does not function as well
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13
Q

normal placenta

A

stationed on top of baby

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14
Q

low-lying placenta

A

stationed beside baby’s head
- can lead to placenta previa
- can still attempt vaginal birth

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15
Q

placenta previa

A

placenta is stationed below baby

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16
Q

risk factors for placenta previa

A

previous c-section, AMA, multiple gestation, smoking/cocaine, in vitro fertilization

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17
Q

placenta previa management

A

no vag exam, c-section, if less than 34 weeks administer corticosteroid

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18
Q

recommended delivery for placenta previa

A

between 36-37 weeks to prevent risk of bleeding with prolonged pregnancy

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19
Q

placental abruption

A

premature separation of all or part of the placenta
- can occur after 20 weeks of gestation

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20
Q

S+S of placental abruption

A
  • hemorrhage
  • late decelerations
  • DIC due to excess thromboplastin released bc of damage to uterine wall
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21
Q

most concerning S+S of placental abruprion

A

no bleeding with rigid/board-like abdomen
- late decels due to hypoxia

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22
Q

fetal issues for placental abruption

A

nearly 100% mortality, preterm labor, hypoxia

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23
Q

GBS

A

fetus can acquire at birth from mom (common and harmless bacteria) and then get disease
- get swab at 35-36 weeks regardless of if having vaginal or c-section delivery

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24
Q

dystocia

A

“failure to progress”
- dysfunctional uterine contractions causing abnormally slow labor and hinder cervical dilation

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25
Q

hypertonic uterine dysfunction

A

occurs before 5cm and is linked to fear/tension
- overactive uterus not allowing rest leading to inadequate contractions
- contractions are ineffective and painful

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26
Q

hypotonic uterine dysfunction

A

develops in the active phase
- less intense contractions

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27
Q

cause of hypotonic uterine dysfunction

A

cephalopelvic disproportion or occiput posterior

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28
Q

hypertonic uterine dysfunction management

A

rest, analgesics, bath, oxytocin to regulate contractions

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29
Q

hypotonic uterine dysfunction management

A

nipple stimulation, repositioning, oxytocin, ROM

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30
Q

shoulder dystocia

A

inability of fetal shoulders to deliver spontaneously

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31
Q

turtle sign

A

diagnostic of fetal shoulder dystocia
- head out with chin stuck inside (pushing will not move baby)

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32
Q

McRoberts maneuver

A

used for shoulder dystocia
- bring knees back

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33
Q

precipitous labor

A

any labor lasting 3 hours or less from onset of regular contractions to birth

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34
Q

post c-section nursing care

A
  • don’t take ASA or aspirin bc it can interfere with clotting
  • use football hold for breastfeeding
  • make sure there is bowel movement at day 3/4 post op
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35
Q

uterine rupture definition

A

tear in the wall of the uterus that can expel the baby into the mother’s abdomen

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36
Q

mothers are at high risk of uterine rupture due to this..

A

trial of labor after cesarean (TOLAC)
- due to scarring

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37
Q

a uterine rupture can cause..

A

severe blood loss and hypoxic-ischemic encephalopathy (HIE)

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38
Q

cord prolapse

A

umbilical cord wants to come out before baby and is below baby’s head

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39
Q

cord prolapse management

A

getting on hands and knees and sticking bum in the air

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40
Q

S+S of cord prolapse

A

will feel heavy and like something needs to come out

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41
Q

amniotic fluid embolism

A

amniotic fluid in the bloodstream
- usually occurs 48 hours after birth and is very high mortality

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42
Q

2 causes of amniotic fluid embolism

A
  1. breach in placenta allows amniotic fluid to enter bloodstream and lodge in pulmonary arteries
  2. amniotic fluid in bloodstream activates immune response and causes an anaphylactic reaction
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43
Q

S+S of amniotic fluid embolism

A

pale, SOB, chest pain, low O2, heavy chest, hypotension, tachycardia, DIC, altered mental status

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44
Q

PPH

A

more than 500ml of blood loss after a vaginal birth or more than 1000 mlp of loss after a c-section

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45
Q

primary PPH

A

occurs within the first 24 hours

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46
Q

secondary PPH

A

occurs days later and is higher risk bc mom may not know what’s going on

47
Q
  • 4 T’s (causes) of PPH
A
  • thrombin
  • tone
  • tissue
  • trauma
48
Q
  • thrombin (4 T’s)
A

blood not clotting
- includes bleeding disorders, placental abruption, and preeclampsia

49
Q
  • tissue (4 T’s)
A

retained placenta or clot
- includes retained placenta, placenta accreta, and retained products of conception

50
Q
  • tone (4 T’s)
A

soft/boggy uterus
- includes placenta praevia, overdistention of the uterus, and previous PPH

51
Q
  • trauma (4 T’s)
A

laceration or uterine inversion
- includes c-section, episiotomy, macrosomic baby

52
Q

PPH management

A
  • fundal massage
  • IV fluid replacement
  • administer plasma
  • administer misoprostol
53
Q

hematoma

A

collection of blood in body outside of a vessel and commonly found in the vulva, or retroperitoneal space
- often associated with lacerations and episiotomies

54
Q

common S+S of hematoma d/t labor

A

issues with voiding
- may need catheter

55
Q

hypovolemic shock

A

caused by uncontrolled hemorrhage and is triggered when the volume of blood circulating decreases to point of O2 deprivation

56
Q

body response to hypovolemia

A

adrenal glands sense it and release catecholamines to cue arterioles and venules to constrict in other organs so blood can be rerouted

57
Q

hypovolemic shock treatment

A

restore blood volume with LR or NS and administer 10-12L of O2

58
Q

thromboembolic disease

A

2nd most common cause of pregnant female death
- blood clot inside a vein

59
Q

key sign of venous thromboembolism

A

swelling and inflammation below the blockage site

60
Q

taking in phase

A

1-2 days after delivery
- dependent on support people
- indecisive
- anxious/uncertainty

61
Q

taking hold phase

A

2-4 days after delivery
- initiates decision making
- starts to settle
- starts to focus more on newborn than self

62
Q

postpartum blues

A

day 3 PP to 2 weeks
- sadness, irritability, sleeping problems
- usually due to hormones

63
Q

postpartum depression

A

can occur anytime after 2 weeks PP to 1 year
- feelings of hopelessness, worthlessness, suicidality

64
Q

IUGR stands for and possible causes are …

A

intrauterine growth restriction
- can be due to placental issues, infection, or maternal nutrition

65
Q

SGA stands for…

A

small for gestational age

66
Q

LGA stands for..

A

large for gestational age
- known as macrosomia

67
Q
  • caput succedaneum
A

edema of the scalp of presenting part of neonates head due to pressure against mothers cervix during labor
* crosses the suture lines
- dissipates within days

68
Q

causes of caput succedaneum

A

mechanical trauma
- pushing, prolonged/difficult delivery, vacuum extraction

69
Q

caput succedaneum puts the fetus at risk for ..

A

jaundice; due to bruising

70
Q

cephalohematoma

A

accumulation of blood under the scalp
* does not cross suture lines

71
Q

cold stress

A

excessive heat loss that results in compensatory mechanisms that can contribute to RDS and hypoglycemia

72
Q

cold stress occurs through..

A

evaporation, convection, conduction, and radiation

73
Q

thermoregulation of the newborn is closely related to…

A

metabolism rate and oxygen consumption

74
Q

characteristics affecting thermal instability

A
  • decreased subcutaneous fat/thin epidermis
  • blood vessels closer to surface of skin
  • un-flexed posture
75
Q

neonatal sepsis

A

deadly systemic inflammatory response occurring in the first 4 weeks of life as a result of infection

76
Q

S+S of neonatal sepsis

A

respirations higher than O2 sats, fever, poor feeding, grunting, nasal flaring, chest retractions

77
Q

neonatal symptomatic hypoglycemia

A

blood levels less than 2.6

78
Q

symptomatic hypoglycemia can result in…

A

neuronal injury

79
Q

treatment of symptomatic hypoglycemia

A

IV 10% dextrose 80 ml/kg/day

80
Q

neonatal asymptomatic hypoglycemia

A

blood levels of 1.8-2.5

81
Q

treatment of asymptomatic hypoglycemia

A

dextrose gel (40%)
- absorbed into buccal membranes

82
Q

S+S of neonatal hypoglycemia

A

poor feeding, sleepy, shakes,

83
Q

hyperbilirubinemia

A

high load of bilirubin due to destruction of maternal RBC’s and shortened RBC lifespan of the newborn causing fat destruction leading to decreased ability to clear bilirubin
- peaks 4-5 days after birth
- greater than 95 percentile on scoring chart

84
Q

risk factors for hyperbilirubinemia

A
  • prematurity
  • significant bruising
  • blood type
  • ineffective breastfeeding
85
Q

physiologic jaundice

A

fetus does not have enterohepatic circulation in utero so it is normal to have some jaundice initially as there is an increase in bilirubin and moving it around is difficult
- first few days of life (2/3 until day 7)
- unconjugated

86
Q

enterohepatic circulation

A

breakdown of used RBC’S and bilirubin excess is filtered through bloodstream by the liver then released to intestinal tract for disposal but the breakdown of the cells is yellow causing the physiologic jaundice

87
Q

pathologic jaundice

A

present at birth or within first 24 hours of life
- usually related to blood incompatibility (hemolytic disease of the newborn)
- always conjugated

88
Q

2 common causes of pathologic jaundice

A
  1. increased production of bilirubin due to blood incompatibility
  2. decreased clearance of bilirubin due to endocrine disorders or metabolic dysfunctions
89
Q

breastfeeding jaundice

A

appears in first few days of life due to poor feeding and dehydration
- jaundice and sleepiness
- unconjugated
- common in mothers with little supply

90
Q

treatment for breastfeeding jaundice

A

rehydration

91
Q

breast milk jaundice

A

high level of free fatty acids in mothers breastmilk which competes with albumin sites inhibiting the conjugation process
- bilirubin levels increase after 5-7 days of life and last until 2-3 weeks of life
- unconjugated

92
Q

high risk infants expected bilirubin levels

A

want total serum bilirubin to be 15 by day 5 (aka 257)

93
Q

medium risk infants expected bilirubin levels

A

want total serum bilirubin to be 18 by day 5 (aka 320)

94
Q

low risk infants expected bilirubin levels

A

want total serum bilirubin to be 21 by day 5 (aka 363)

95
Q

key things for phototherapy

A
  • eye mask/eye drops
  • change fetal position every so often
  • do US every 2-4 hours
  • lights do not emit heat
96
Q

neonatal jaundice

A

jaundice that occurs in newborns up to 28 days of age

97
Q

bilirubin induced neurological dysfunction

A

happens when there is too much bilirubin buildup (which is a neurotoxin) and crosses the BBB

98
Q

1st phase of acute bilirubin encephalopathy

A
  • mild hypotonia
  • sleepiness
  • poor suck
99
Q

intermediate phase of acute bilirubin encephalopathy

A
  • high pitched cry
  • difficult to console
  • febrile
  • hypertonic
100
Q

advanced phase of acute bilirubin encephalopathy

A
  • apnea
  • inability to feed
  • seizures
101
Q

kernicterus

A

deposition of bilirubin in the brain causing necrosis
- chronic outcome of bilirubin induced neurological dysfunction

102
Q

chronic bilirubin encephalopathy

A

occurs when necrosis of the brain occurs due to deposition of bilirubin

103
Q

RDS

A

lack of surfactant to help keep alveoli from collapsing by reducing surface tension
- common in preterms

104
Q

RDS can lead to…

A

expiratory atelectasis

105
Q

S+S of RDS

A

grunting, tachypnea/apnea, nasal flaring, low O2, chest indrawing

106
Q

treatment of RDS

A

betamethasone (corticosteroid) in 2 doses 12-24 hours apart

107
Q

transient tachypnea of the newborn (TTN)

A

respiratory distress due to inability to clear lung fluid; most common cause of respiratory distress
- short term issue
- c-section babies are at greater risk

108
Q

S+S of TTN

A

normal appearing respiratory transition but shortly after birth presents with
- expiratory grunting
- nasal flaring
- mild cyanosis

109
Q

TTN can lead to …

A

persistent pulmonary hypertension and bradycardia

110
Q

TTN management

A

CPAP, tube feeding, ABG, chest x-ray

111
Q

meconium aspiration syndrome (MAS)

A

aspiration of meconium amniotic fluid in utero or first breaths of life causing mechanical airway obstruction
- more likely to occur in term babies

112
Q

causes of MAS

A

stress during pregnancy, post dates

113
Q

MAS can lead to…

A

pneumothorax, persistent pulmonary hypertension

114
Q

S+S of MAS

A

chest retractions, rapid breathing, cyanosis, LOW APGAR

L&D (7 decks)

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