Maternity Exam II Flashcards
Where are contractions felt during Braxton Hick’s contractions?
Not in the front
When should mom come in when she has contractions?
5 minutes apart
45-60 seconds
strong enough to not be able to converse
Dilation for early, active and transition phases:
E: 0-3
A: 4-7
T: 8-10
Effacement for early, active and transition phases:
E: 0-40
A: 40-80
T: 80-100
Duration for early, active and transition phases:
E: 5-6hrs
A: 4-6hrs
T: 30min-1hr
Contractions for early, active and transition phases:
E: 1-2 for 30-45seconds
A: 2-5 for 45-60seconds
T: 5-10 for 60-90seconds
What are the 3 phases of the contraction?
increment
acme
decrement
when do the fontanel’s close?
anterior: 18-24 months
posterior: 6-12 weeks
Signs of placental separation:
cord lengthens
uterus becomes globular
vagina is filled with blood
When is the Rubella vaccine recommended?
w/i 48 hours after birth before discharge
Do NOT take for 28 days before becoming pregnant
Can BF moms get the Rubella vaccine?
YES - does not pass through breast milk
What is the main side effect of an epidural?
HYPOtension
What must be done before an epidural?
administer during the ACTIVE phase
administer IV bolus to avoid the HYPOtension
What must be monitored after an epidural?
HYPOtension (don’t be supine)
urinary retention (pee w/i 12 hours)
fetal BRADYcardia
maybe give pit to contract a boggy uterus
Intervention for spinal headache after an epidural?
maternal blood patch
lateral recumbent
When is a pudendal block indicated? Side effects?
after mom tears, or has an episiotomy
SE: bruising, numbness, allergic rxn
Describe lochia postpartum
rubra - deep red for 3-4 days
serosa - pink/brown for 3-10 days
alba - white/light brown for 10-14 days (up to 6 weeks)
Describe vitals/WBC postpartum
temp is elevated for 24 hours
HR is BRADY for 2 weeks at 40-60 r/t HYPOvolemia
WBC elevated for 4-6 days
cardiac output postpartum
increased for 3 months
what is a common complication of pregnancy r/t hematology?
DVT - Pregnancy is a hypercoagulable state and mom will stay that way for 2 weeks
Involution of the uterus:
immediately after - midline b/w umbilicus and pubic symphysis
12 hours after - 20 cm (umbilicus)
each day after it drops 1cm until day 10 when it drops into the true pelvis and we can’t feel it
What is the danger of bladder distention?
it can cause uterine atony
straight cath mom if she hasn’t voided in 12 hours
Nursing actions for postpartum hemorrhage:
fundal massage (for boggy uterus) and void (to avoid bladder distention)
When should we administer Rhogam?
within 72 hours of birth
if we know, then give a dose b/w 26-28 weeks
Category I-III?
I: normal
II: indeterminate
III: abnormal
normal FHR:
110-160
Causes of fetal TACHYcardia?
chorioamnionitis (infection of membranes)
hypoxia
prematurity
maternal fever
treatment of fetal TACHY?
stop the Pit
look for infection
causes of fetal BRADY?
heart px
beta-blockers
maternal brady
second stage of labor
Nitrazine swab interpretation?
test pH to see if the fluid is amniotic or vaginal
blue stick = amniotic
Describe Leopold’s maneuvers:
1: presentation (feel fundus for butt or head)
2: position (where is baby’s back)
3: confirmation of presentation
4: fetal attitude (is head flexed/engaged in the pelvis)
What is the most important aspect of FHR?
variability
Describe variability:
absent: undetectable - VERY BAD
minimal: fluctuation <5 bpm
moderate (normal): fluctuation b/w 6-25bpm
marked: fluctuation >25 bpm
causes of decreased variability:
hypoxia
acidosis
drugs
fetal sleep
Criteria of accelerations?
baseline increase of at least 15bpm
lasts 15sec-2min
Cause of EARLY decels? Interventions?
head compression
NO intervention
Cause of VARIABLE decels? Intervenions?
cord compression
reposition
IV fluids
give OP2
Cause of LATE decels? Interventions?
UPI STOP the Pitocin get ready for the OR IV fluids reposition give O2
4 criteria to use an internal FHR monitor?
- membranes have ruptured
- 2 cm dilated
- presenting fetal part low enough
- skilled practitioner available
how long is a small box on an FHR monitor strip?
10 seconds (6 boxes = 1 minute)
Where do we put the FHR monitor?
over the baby’s back
How to increase O2 supply to the baby during labor?
give O2 to mom
reposition mom
Elevated Alph-Fetoprotein levels indicate:
neural tube defects, hydrocephaly, turner syndrome
Low Alph-Fetoprotein levels indicate:
down syndrome
What do triple and quadruple marker screenings assess for?
neural tube defects and down syndrome
VEAL CHOP
Variable = Cord compression Early = Head compression Acceleration = OK Late = Placental Insufficiency
L/S ratio tests for _______. How do you assess the results?
fetal lung maturity
L/S of 2 or higher = lung maturity
L/S of 1.5 or less = respiratory distress syndrome (ARDS)
2 risks of the stress test
bradycardia
hyperstimulation of the uterus
Which two tests are diagnostic?
Amniocentesis and CVS “Chronic Villus Sampling”
Amniocentesis is done when?
2nd trimester to check for chromosomal abnormalities, hereditary metabolic defects, and neural tube defects.
What needs to be done before an amniocentesis?
full bladder during 1st-trimester
empty bladder during 2nd and 3rd trimester
Rh monitoring to make sure blood can mix
When is CVS done?
10-13 weeks to test for chromosomal abnormalities (NOT neural tube defects)
When can I do the Harmony test?
10 weeks
analyzes DNA to test for the Trisomy’s
can also tell GENDER
What does a biophysical profile test for?
UPI
What is a normal biophysical profile score?
3 or more body movements
3 discrete fetal movements
2 FHR accelerations (reactive non-stress)
1 breathing movement
1 pocket of amniotic fluid volume 2cm or more
Biophysical profile score interpretation:
8-10 normal
4-8 suspicious
0-4 abnormal
What does a non-stress test look for?
accelerations in response to glucose
NOT contractions
What does a stress test look for?
contractions in response to oxytocin
we want to see 3 contractions in 10 minutes with NO decelerations
Define gestational HTN vs. HTN:
gestational: the onset of HTN with NO proteinuria after 20th-week
chronic: present before pregnancy, or dx before 20th-week gestation
What is eclampsia?
seizure activity or coma after preeclampsia
What is the priority intervention for eclampsia?
mag sulfate
what is preeclampsia?
the onset of HTN WITH proteinuria after 20th week - indicative of placental px
What is a hallmark sign of preeclampsia?
3rd-trimester headache, increased pain, high BP
Pathology behind preeclampsia?
poor perfusion resulting in VASOSPASM
What are the 4 complications of preeclampsia?
DIC
HELLP
Proteinuria
IUGR
What is the most common side effect of an epidural?
itching
What is HELLP?
Hemolysis (decreased RBC)
Elevated Liver enzymes
Low Platelets
When is mag sulfate indicated?
severe preeclampsia
eclampsia
HELLP
used to decrease risk of seizures
Therapeutic magnesium sulfate level
4-7 mEq/L
Mag sulfate antidote?
calcium gluconate
S&S of mag sulfate toxicity?
SLOW SLOW SLOW
decreased RR, HYPOtension etc.
S&S of abruptio placenta vs. placenta previa:
Abrupto: PAIN, dark vaginal bleeding
Previa: NO PAIN, light vaginal bleeding
Abruptio placenta management:
prevent DIC
left lateral
Placenta previa management:
monitor bleeding
DO NOT DO A VAGINAL EXAM
What are the 3 drugs to give during premature labor?
corticosteroids to increase fetal lung maturity
betamethasone (best 2-7 days after 1st dose)
Fibronectin (we want NEGATIVE result)
When am I assessing nuchal translucency?
11-14 weeks
When are tocolytics indicated?
to delay contractions
What is the MOST COMMON tocolytic?
mag sulfate
What are the 4 tocolytics?
INMT "it's not my time" Indomethacin Nephedapine Mag Sulfate Terbutaline
