Maternity Ch. 11

Question 1

The major maternal medical indications for a cesarean birth are:

Answer 1

● Previous cesarean birth. 
● Placental abnormalities. 
● Mechanical impediment of the progress of labor or arrest of active labor. 
● Cephalopelvic disproportion
● Preexisting or pregnancy-related maternal health factors such as: 
-Cardiac diseases. 
-Severe hypertension, preeclampsia. 
-Severe diabetes mellitus. 
-Obesity.

Question 2

Cephalopelvic disproportion

Answer 2

which occurs when ineffective uterine contractions lead to prolonged first stage of labor or when the size, shape, or position of the fetal head prevents it from passing through the maternal pelvis or when the maternal bony pelvis is not large enough or appropriately shaped to allow for fetal descent

Question 3

The major fetal medical indications for a cesarean birth are:

Answer 3

• Breech presentation
• Transverse lie
• Category 2 or 3 FHR pattern

Question 4

If c-section is done for nonmedical reasons

Answer 4

• Must be at least 39 weeks
• Cervix must be favorable (especially in nulliparous women)
• Allow normal first and second stage as long as possible
• Educate mom that is can lead to issues with other pregnancies

Question 5

Operative vaginal delivery

Answer 5

with forceps or vacuum extractor are acceptable when indicated and can safely prevent cesarean delivery in appropriate situations

Question 6

Scheduled c-section births occur?

Common reasons for doing them?

Answer 6

• Occur before the onset of labor

- Malpresentation dx before birth

Question 7

Emergent c-section

Answer 7

indicates an immediate need to deliver the fetus (e.g., prolapse of umbilical cord or rupture of uterus).

Question 8

Urgent c-section

Answer 8

indicates a need for rapid delivery of the fetus, such as with malpresentation diagnosed after onset of labor or placenta previa with mild bleeding and fetal heart rate with Category I FHR

Question 9

Nonurgent c-section

Answer 9

Indicates a need for cesarean birth related to complications such as failure to progress (cervix does not fully dilate) and failure to descend (fetus does not descend through the pelvis) with Category I FHR.

Question 10

Perioperative care for c-section

Answer 10

• Obtain baseline VS 20mins before and 20 after anesthesia
• Aspetic wash
• Given ABX 60 mins before
• NPO for 6-8 hours
• Insert foley
• Preload IV fluid before spinal or epidural

Question 11

Why do you preload fluid?

Answer 11

Increase fluid volume and decrease risk of hypotension

Question 12

How much fluid is preloaded?

Answer 12

500-1000mL

Question 13

Use of prewarmed IV fluid does what?

Answer 13

increased maternal core temperature, improved neonatal umbilical arterial pH, and improved Apgar scores

Question 14

In PACU what do you want to assess for?

Answer 14

PE

Question 15

S/S of PE

Answer 15

Signs and symptoms are dyspnea, tachypnea, chest tightness, shortness of breath, hypotension, and decreasing oxygen saturation levels.

Question 16

Recovery time for c-section?

Answer 16

6 Weeks

Question 17

C-sections increases what?

Answer 17

Maternal death and infection

Question 18

Maternal-newborn bonding

Answer 18

SKIN TO SKIN

Question 19

Discharge Prep

Answer 19

• Assess fundus and lochia
• Monitor and educate mom of s/s of secondary hemorrhage
• Vaccinate mom - b/c can pass stuff to baby
• Remove foley
• Remove staples

Question 20

When are staples removed?

Answer 20

Before discharge

Question 21

S/S of secondary hemorrhage

Answer 21

Bright red blood

Big blood clots with odor