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RNC-MNN Mometrix > Medications Used in Labor, Complications of Labor and Methods of Delivery > Flashcards

Medications Used in Labor, Complications of Labor and Methods of Delivery Flashcards

1
Q

fentanyl dosage, route, onset and duration

A

25-100mcg IV, onset 3-10mins, with 1 hr duration

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2
Q

does fentanyl effect the fetus/newborn?

A

fetal depression, neonatal respiratory depression

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3
Q

butorphanol dosage and route

A

1-2mg IV or IM q4 hours

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4
Q

nalbuphine dosage and route, side effects

A

10-20mg IV or IM q3 hrs, excessive sedation if given repeatedly

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5
Q

promethazine use, dosage, and route

A

used along with narcotics, relief of anxiety and decrease narcotic use; promethazine 25-50mg IM, promethazine hydrochloride 20-40 IV or IM

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6
Q

timing to use nitrous oxide properly

A

30-60 secs prior to contraction since it a delayed effect

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7
Q

side effects of nitrous oxide on mother?

A

n/v, excessive sleepiness, HA

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8
Q

lumbar epidural explained

A

labor should be well established; mother is placed in sitting position; catheter placed at L3-L5; mixtures of local anesthetic and opioids

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9
Q

spinal analgesia explained

A

injection into the subarachnoid space with opioids and local anesthetics; sometimes used in the first stages of labor; single doses or given intermittently per catheter;

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10
Q

spinal anesthesia (saddle block) explained

A

usually given just be delivery to provide rapid perineal anesthesia; not given during labor because it interferes with motor function; prior to patient must be given a bonus of 500-1000ml of fluid; placed while patient is in sitting position, very small needle is placed in the subarachnoid space; medications (locals and opioids) are given between contractions for about 30 secs; patient remains sitting for 3 mins and then is placed in the lithotomy position with a L uterine displacement to prepare for delivery

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11
Q

pudendal nerve block

A

used in the 2nd stage of labor to help with somatic (constant) pain; used for episiotomy and relaxation of the pelvic floor during a forceps delivery; patient is in lithotomy position; transvaginal or transperineal injection of local anesthetic meds

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12
Q

general anesthesia/c-section process and side effects

A

-used for emgenency procedures or when mother are not good candidates for epidural or subarachnoid blocks. oral antacid is given prior if mother is not NPO; mother at risk for aspiration/aspiration PNA; wedge is placed under R hip to displace the uterus to the left prior to anesthesia.
-woman experience resp depression which affects the oxygenation of fetus; relaxation of uterine muscles = increase risk of PPH; anesthesia usually affects the fetus within 2 mins of onset, general anesthesia is contraindicated in high risk or preterm fetus due to the risk of fetal depression

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13
Q

what is the purpose of tocolytics?

A

suppress preterm labor and premature birth

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14
Q

list 4 tocolytics

A

indomethacin, nifedipine, terbutaline, and magnesium sulfate

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15
Q

indomethacine

A

NSAID that inhibit is prostaglandin production; first line therapy 24-32 week gestational; used up to 32 weeks; crosses the placenta and case reduction in amniotic fluid after 32 weeks; cause premature closure of the ductus arteriosus

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16
Q

nifedipine

A

calcium channel blocker; reduces muscle contractility, most commonly used because of its effectiveness and safety; may increase FHR; first line for 32-34 weeks, 2nd line for 24-32 weeks

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17
Q

terbutaline

A

beta adrenergic asthma drugs that relaxes the uterine muscle; may increase FHR; 2nd line therapy to nifedipine

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18
Q

magnesium sulfate

A

relaxes the uterine muscles; close monitoring required due to adverse effect such as fetal/neonate resp and motor depression

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19
Q

premature rupture of membranes (PROM)

A

ROM where labor fails to begin within 1 hour, about 80% of woman will go into labor within 24 hours, close monitoring required, may require induction or augmentation to prevent infection of fetus/neonate

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20
Q

preterm premature rupture of membranes (PPROM)

A

occurs less then 37 weeks and rigor to the onset of labor, one of the leading causes of premature births

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21
Q

prolonged rupture of membranes

A

ROM persists 18-24 hour prior to the onset or labor, associated with increase risk of infection to the neonate

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22
Q

precipitous delivery

A

labor to birth onset is less then 3 hours

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23
Q

cause of precipitous delivery’s

A

strong uterine contractions and low muscle resistance

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24
Q

affects of precipitous deliveries on neonate

A

low APGAR scores, increased risk of meconium aspiration, subdural/dural tears, unexpected outside the hospital delivery; strong uterine contractions may interfere with blood supply to fetus

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25
Q

hypertonic

A

ineffectual contractions in the latent phase of labor that become more frequent but do no result in dilation or effacement; resting tone of myometrium increases; may interfere with fetal oxygenation; may cause cephalohematoma, caput succedaneum, or excessive molding; treatment includes oxytocin or AROM

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26
Q

hypotonic

A

fewer then 3 contractions in 10 mins with less then 1 cm per hour progression - treatment AROM or oxytocin

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27
Q

post term delivery definition and risk for fetus?

A

greater then 42 weeks; LGA, aspiration of mec, and post maturity syndrome (related to IUGR)

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28
Q

military malpresentation

A

head is erect and neck not flexed - poses little problem because flex will occur as the head decends

29
Q

brow malpresentation

A

the neck is extended so that the brow presents first; SGA, LGA, hydramnios, uterine/fetal anomalies; increased risk of brith trauma to fetus; c-section of episiotomy usually required

30
Q

face malpresentation

A

neck is so severely extended that the face presents first; prolongs labor, increased edema to fetus w possible fetal trauma and facial bruising; c-section is generally required

31
Q

frank breech

A

buttocks presentation with legs extended upwards

32
Q

complete breech

A

buttocks and both feet presentation

33
Q

incomplete breech

A

buttocks and x1 foot presentation

34
Q

footling or double footling breech

A

one or two foot presentation

35
Q

shoulder malpresentation

A

transverse lie - extreme risk of uterine rupture - must be delivered via c - section

36
Q

compound malpresentation

A

two presenting parts such as a head and a head; increase risk of laceration

37
Q

what does deep suction put neonate at risk of?

A

vagal response resulting in dangerous arrhythmias

38
Q

walk through current NRP guidelines for when mec is present

A

-neonate is crying and showing no signs of resp distress = suction not recommended; visible drainage wiped cloth
-neonate shows sign of resp distress = bulb suction first (mouth before nose), deep suction only if no change
-resp distress continues after all non invasive efforts, intubate
stomach may need to be suctioned as well, mec can be aspirated into lungs*

39
Q

vasa previa

A

one of the fetal vessels lies across the internal cervical os - high fetal mortality if vessel is damaged - planned c-section increased fetal survival rate to 97%

40
Q

detective decides basalis and list the 3 types

A

abnormal adhenese of the placenta to the uterine wall - more common where previous c section or placenta previa is present - dx done at time of surgery - high risk for maternal hemorrhage and hysterectomy
1. placenta accrete
2. placenta increta
3. placenta percreta

41
Q

placenta grows directly into the uterine wall is called?

A

placenta accreta

42
Q

placenta increta

A

trophoblastic cells invaded the myometrium of the uterine wall

43
Q

trophoblastic cells

A

thin layer of cells that help the developing embryo attach to the wall of the uterus, protect the embryo and forms a part of the placenta

44
Q

placenta percreta

A

trophoblastic cells penetrate through the uterine wall and invade other organs such as the bladder

45
Q

uterine dehiscence

A

uterine wall separates at the site of previous scar but fetal membranes and the fetus stay intake

46
Q

signs of uterine rupture in mother

A

sharp, tearing uterine pain, FHR decelerations, n/v, fainting, vaginal bleeding, tachycardia, hypotension and shock

47
Q

what is uterine inversion?

A

turning inside out of the uterus

48
Q

what are causes of uterine inversion

A

spontaneously without cause, fundal pressure, traction of umbilical cord, large fetuses, short umbilical cords , adherent of placental tissues, and the use of oxytocin

49
Q

prolapsed umbilical cord

A

the umbilical cord precedes the fetus and becomes entrapped by the descending fetus; management includes elevated the presenting part off the cord, having the mother elevate her knees to her head, preparing for a c-section

50
Q

velamentous cord insertion

A

abnormality in which the cord is inserts into the membranes rather than the middle of the placenta - leaving exposed vessels unprotected by wharton’s jelly; more common with placental previa and multiple gestation; 25% are associated with spontaneous abortions; treatment is careful monitoring and c-section

51
Q

what is a normal fluid index?

A

5-24cm depending on the weeks of gestation

52
Q

oligohydramnios

A

AFI less then 5cm; linked with fetal urinary tract abnormalities

53
Q

polyhydramnios

A

AFI over 24 cm; acute or chronic; associated with fetal anomalies of the CNS or GI; maternal diabetes or multiple gestation

54
Q

amniotic fluid embolism

A

amniotic fluid enters the mothers circulatory system (c-section/labor/delivery); mother has a anaphylactic response

55
Q

what is the normal time between placenta and delivery?

A

5-30 mins post delivery

56
Q

explain how the placenta separates from the uterus?

A

change in size of the uterus post delivery, hematoma forms between the placenta and uterine wall, and the placenta is separated from the uterine wall

57
Q

signs of placenta separation

A

sudden increase in vaginal bleeding, lengthening of the umbilical cord, and the rising of the uterus in the abdomen

58
Q

perineal lacerations

A

the perineal skin and mucous membranes of the vagina are torn

59
Q

second degree tear

A

perineal skin, vaginal mucous membranes as well as the fascia and muscle of the perineum

60
Q

3 degree tear

A

perineal skin, vaginal mucous membranes, fascia and muscle of perineum and the tear extended to the rectal sphincter

61
Q

fourth degree tear

A

perineal skin, vaginal mucous membranes, fascia and muscle of the perineum are torn, tear extends into the rectal sphincter and the inner lumen of the rectum is exposed

62
Q

maternal risk of forcep delivery

A

infection, cervical and birth canal lacerations, extension of episiotomy, anal sphincter injury, weakening of pelvic floor muscles

63
Q

neonate risks of forceps delivery

A

bruising/edema to face, caput succedaneum, cephalhematoma, low APGAR score, rental hemorrhage, ocular trauma, erb’s palsy, elevated bilirubin

64
Q

erb’s palsy

A

paralysis of the arm cause by injury to the upper arms main group of nerves

65
Q

pressured used in vaccum assisted deliveries

A

50-60 mmHg

66
Q

suction limits for vacuum assisted deliveries

A

suction limited to 20-30 mins, scalp trauma is more likely after 10 mins, suction can only be dislodged 3 times and then vacuum is discontinued

67
Q

success rates of VBAC

A

60-80%

68
Q

benefits of delayed cord clamping

A

increased hemoglobin, improved iron status, lower rates of intraventricular hemorrhage and necrotizing enterocolitis

69
Q

ml of blood related to mins in delayed cord clamping

A

80ml in the first min and 100ml in the first 3 mins

RNC-MNN Mometrix (15 decks)

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