Module 10 (Exam 3) Obstetric Procedures

Question 1

Indications of Cesarean Birth

Answer 1

1. Fetal malpresentation
2. Dystocia (failure to progress, cephalopelvic disproportion)
3. Maternal Morbidity/Complications: multiple gestation, diabetes, preeclampsia, cardiac disease

Urgent/Emergent Indications:

1. Umbilical Cord Prolapse
2. Persistent non-reassuring fetal heart patterns
3. Hemorrhagic disorders (unstable placenta previa or abruption)

Question 2

Risks of C-Section

Answer 2

1. Maternal: infection, hemorrhage, anesthesia-associated issues, decreased level of wellness postpartum
2. Fetal/Neonatal: birth related injury, inadvertent preterm birth, transient tachypnea of the newborn

Question 3

Regional Anesthesia

Answer 3

Epidural or Spinal Block

Advantages: medication does not cross placenta barrier, mother may witness birth of her child

Disadvantages: maternal hypotension (decreased fetal oxygenation), time from placement to efficacy (not indicated for urgent/emergent delivery)

Question 4

General Anesthesia

Answer 4

Combination of inhalation and intravenous

Advantages: rapid induction, anesthesia of choice for emergent events

Disadvantages: readily crosses placental barrier, potential for neonatal respiratory depression, lack of maternal partcipation in birth

Question 5

Skin Incision (C-section)

Answer 5

• Vertical/Midline
• Pfannestiel (Horizontal) - most common

Question 6

Uterine Incisions (c-section)

Answer 6

• Classical (Vertical): more likely to separate/rupture with subsequent labr
• Low Trnasverse (Horizontal): low risk of rupture with subseqent labor, preserves potential for vaginal birth after cesarean (VBAC)

Question 7

Indications for Induction of Labor (IOL)

Answer 7

• Conditions in which the intrauterine environment is determined to be less safe than the extrauterine environment
  
  • Post-dates pregnancy
  • SROM at term without spontaneous labor
  • Maternal morbidity: diabetes, chorioamnioitis, preeclampsia/eclampsia, pre-exisiting chorinc illness

Question 8

Risks of Induction of Labor

Answer 8

1. Hypertonic uterine contractions: impaired fetal oxygenation
2. Potential for uterine rupture: increased risk with uterine overdistention or VBAC
3. Maternal H2O intoxication: ADH-like side effect = transient rise in BP
4. Increased potential for c/s delivery, chorioamnionitis, post partum uterine atony (post partum hemorrhage)

Question 9

Uterine Tachysystole

Answer 9

Hypertonic uterine activity that impacts/impairs fetal oxygenation

Question 10

Defining Characteristics of Uterine Tachysystole

Answer 10

1. Contraction frequency less than 2 minutes apart or greater than 5 contractions in 10 minutes
2. Contraction duration greater than 90-120 seconds
3. Resting interval less than 30 seconds
4. Elevated resting tone
5. Indicators of fetal distress: FHR bradycardia or tachycardia, decreased FHR variablity, late FHR decelerations or variables

Question 11

Nursing management of Uterine tachysystole

Answer 11

1. Stop pitocin
2. Increase main IVF
3. O2 @ 8-10L/min VIA non-rebreather mask
4. Side lying position
5. Notify provider

Question 12

Indications for forceps-assisted vaginal birth or vacuum-assisted vaginal birth

Answer 12

1. Prolonged second stage labor (greater than 3 hours)
2. Maternal exhaustion
3. Arrest of descent
4. Non-reassuring FHR patterns

Question 13

Nursing management of FAVB/VAVB

Answer 13

• Anticipatroy guidance/appropriate teaching
• Assess for complications post-birth
  
  • Maternal: vaginal wall laceration, increased risk for PPH, vaginal, labial, or perineal hematoma, increased risk for impaired urinary elimation, perineal tissue integrity/healing of episiotomy
  • Neonatal: cephalohematoma (jaundice), facial nerve injury, facial brusing

Question 14

Episiotomy

Answer 14

Perineal incision to enlarge the vaginal introitus

Indications: shoulder dystocia, FAVB or VAVB, occiput posterior position

Risks: pain, infection, compromised tissue integrity

Question 15

Management of Cervical Ropening

Answer 15

• Chemical management: prostaglandins
  
  • Dinoprostone (intravaginal administration)
  • Misoprostol (intravaginal or PO administration): may be used for cervical ripening and/or for induction of labor
• Mechanical management: balloon catheter
  
  • 30 mL or 50mL foley catheter
  • Applies pressure to lower uterine segment and cervix

Question 16

Pitocin Induction

Answer 16

• Pitocin 30 units/500 mL LR
  
  • milliunits/minutes = mL/hour
• Administered VIA infusion pump
  
  • Beginning at 0.5-6milliunits/minutes
  • Increasing 1-2 milliunits/minute q15-40 minutes until effective contraction pattern is achieved/maintained
• Continous electronic fetal monitoring
• Close maternal monitoring

Question 17

Bishop’s Scoring

Answer 17

1. Cervical Dilaton:
   
   • 0cm = 0
   • 1-2cm = 1
   • 3-4cm = 2
   • 5-6cm = 3
2. Cervical Effacement:
   
   • 0-30% = 0
   • 40-50% = 1
   • 60-70% = 2
   • Greater than 80% = 3
3. Consistency:
   
   • Firm = 0
   • Medium = 1
   • Soft = 2
4. Position:
   
   • Posterior = 0
   • Middle = 1
   • Anterior = 2
5. Fetal Station:
   
   • -3 = 0
   • -2 = 1
   • -1 or 0 = 2
   • +1 or +2 = 3

Multipara: Greater than or equal to 5 will likely be successful induction

Primipara: Greater than or equal to 7 will likely be successful induction