OB Flashcards
OB Physiological Changes
Up to 50% increase in blood volume “Anemia of pregnancy”
Decreased Tidal Volumes
HR increased by 10-20 bpm
Report Info
Gravida - Number of pregnancies
Para - Number of live births
Number of abortions under 20 weeks
Gestational Age
Fetal Assessment
Fundal Height
20 wks: Fundus should be at umbilicus.
36 wks: Sternum
Station: Measured -3-+3 - “dropping”
FHR Variability
Healthy fetal heart rate variability reflects a healthy CNS and cardiac function.
Decreased FHR Variability
Fetal hypoxia
Prematurity
Congenital heart problems
Increased FHR Variability
Fetal Hypoxia
Mechanical compression of umbilical cord
Fetal Bradycardia
<120 bmp >5-10m
Cord compression
Cord prolapse
Anesth esia to spinal cord
Maternal seizures
Fetal Tachycardia
> 160bpm >5-10m
Fetal Hypoxia
Maternal Fever
Anemia
Hyperthyroidism
Accelerations
Increased roughly 15 bpm for roughly 10-15 seconds.
Reflective of fetal well-being.
Early decelerations
Mirrors contractions
Head is compressed.
Going to canal.
NOT HARMFUL
Late Decelerations
At peak of contraction
returns to baseline after contraction
Smooth/shallow dips
WORRISOME - Fetal Hypoxia
Sinusoidal
EMERGENCY
No changes in contractions
Sine wave appearance
Fetal anemia/hypoxia
Interventions for fetal distress
Oxygen
IV Bolus
Rule out cord prolapse
Lateral Positioning
DC infusion of oxytocin if having tetanic contractions
Pre-Term Labor
20-37 wks gestation
Increased Vaginal Discharge
Increased pelvic pressure
Lower backache
Tocolytics
CCB, Mg, NSAIDS, NTG, Terbutaline
Contraindications:
Fetal Demise
Lethal fetal anomalies
Severe Pre-eclampsia
Maternal Bleeding
Intraamniotic Infection
Nifedipine
> 32 Weeks Gestation CCB
Indomethacin
NSAID
Cyclooxygenase Inhibitor
<32 weeks gestation
Contraindications:
Platelet dysfunction
Hepatic/renal dysfunction
Hypersensativity to ASA
Terbutaline
Beta Andrenergic Receptor Agonist
-Off Label for preterm labor
FDA Warning against prolonged use
Contraindications:
Tachycardia Sensitive cardiac disease
Poorly controlled hyperthyroidism/Diabetes
It does cross placenta lines. Can cause tachycardia in fetus.
OB Magnesium Sulfate
Relatively weak tocolytic effects
Neuroprotection of fetus.
Monitor BP, Respiratory Status, and DTR
Contraindications: Myasthenia Gravis
Cardiac Compromise
Antidote: Calcium Gluconate
OB Nitroglycerin
Smooth muscle relation.
Monitor blood pressures
OB Corticosteroids
Betamethasone
Boost development of fetal lung, brain, and digestive systems.
Takes up to 48 hours for full effect
Decreases risk of intraventricular hemorrhage.
OB Antibiotics
Group B Strep.
Usually given >35 weeks gestation. If less than 35 wks gestation, consider giving antibiotics.
Premature Rupture of Membranes
Risk to fetus:
Infection
Pre-term delivery
Umbilical cord prolapse/compression
Signs of Imminent Delivery
1-2 minute contractions
Bloody Show
Urge to bear down
Crowing
ITS COMING
Pregnancy Induced Hypertension
> 140/90
Weight Gain
Headache
Visual Disturbances
Edema
Oliguria
NO PROTEINURIA
Treatment:
Hydralazine
Labetalol
Nifedipine
Preeclampsia
Typically diagnosed >20 weeks gestation or <4 weeks post-partum
Hypertension
Weight Gain/Edema
PROTEINURIA
Usually acute onset.
Treatment:
Hydralazine/Labetalol
Mag Sulfate
Valium/Ativan
Eclampsia
SEIZURES
Immediate delivery of fetus.
Hypertension
weight gain/edema
PROTEINURIA
Manage seizures, hypertension, and deliver baby.
HELLP Syndrome
Hemolysis, Elevated Liver Enzymes, Low Platelets
RUQ epigastric pain
Headache
N/V
Myalgia
Immediate delivery if >34 weeks.
Placenta Previa
Placental attachment over opening of cervix
Pain BRIGHT RED bleeding
C section
Supportive Treatment
DEFER VAGINAL EXAM
Placental Abruption
Premature separation of placenta from uterine wall
Risk of fetal hypoxia and death
Uterine tenderness, board-like abdomen, DARK RED VAGINAL BLEEDING
Uterine Rupture
Baby is typically outside of the uterus.
Signs of previous C-section?
Watch fundal height or palpable uterine defects.
LOSS OF FETAL STATION
Support Care:
Blood
Oxytocin
DELIVERY
Nuchal Cord
Variable Decelerations
Somersault Maneuver
Clamp and cut before shoulder delivery
Post-Partum Hemorrhage
> 500ml in vaginal
1000ml in Cesarean
Causes: 4 T’s
Tone - atony
Trauma - tears, rupture
Tissue - retained placenta?
Trombosis - coagulopathy
Fluid/Blood
External Uterine Massage
Oxytocin for uretal atony
Pitocin, Methergine, Cytotec
Blood
Bimanual Uterine Compression
Uterine Inversion
Supportive Care
DO NOT REMOVE THE PLACENTA
- Stop uterotonic medications
(johnson maneauver)
Anaphylactoid Syndrome
Antibody response to amniotic fluid and fetal components entering maternal circulation
Hypoxia, hemodynamic compromise/instability, coagulopathy (petichae, contusion)
Supportive Care:
Corticosteroids
Epinephrine
PRBC’s, FFP, Cryopreceipitate
