OB (6/10) Flashcards
fetal HR can be dopplered as early as _________ wks but difficult to continuously monitor until around _______ wks
10; 24
what are the 2 worst things you can see on a fetal heart rate monitoring strip
- no variability
- late deceleration
cause of variable deceleration
cord compression
intervention for variable deceleration
reposition - left uterine displacement
cause of early deceleration
head compression
intervention for early deceleration on Fetal heart strip
no intervention necessary
cause of late deceleration
placental insufficiency
intervention for late deceleration
assess why:
- stop pitocin
- give fluids
- give O2
- reposition
- possible C/S if persists
- elevate legs
- vaginal exam by RN/OB
- terbutaline if hyperstimulation is present
an acceleration on fetal heart strip is defined as __________________
abrupt increase in FHR of at least 15 bpm and lasting at least 15 seconds
early deceleration will have decrease in fetal HR by __________ bpm
10-24
deceleration of FHR that is a mirror tracing of the contraction = ____________
early deceleration
vaginal bleeding during labor could indicate
abruption
preterm labor is defined as
any labor before 38 weeks
fever in labor is indicative of
chorioamnionitis
tx for chorioamnionitis
- abx.
- tylenol
- amniotic infusion
- delivery
Tx for shoulder dystocia
McRoberts maneuver: push moms legs up super high and someone else places suprapubic pressure
tx for retained placenta
D & C
tx for postpartum hemorrhage
pitocin
what are the different intrapartum fetal assessments
- ultrasound (bedside or radiology)
- non-stress test (on L&D)
- biophysical profile “BPP”
ultrasound fetal assessment can assess what things?
- fetal viability
- presentation
- size
- weight
- placental location
- cervical length
- structural anomalies
fetal nonstress test
- external detection of FHR and fetal movement in relation to uterine contraction
- fetal heart tracing for 30 -40 minutes
what are the components of the fetal nonstress test
- baseline FHR
- baseline FHR variability
- presence of accelerations
- presence of periodic or episodic accelerations
- changes of FHR pattern over time
what are the three results you may get from a fetal nonstress test
- reactive
- non-reactive
- uncertain
when is the fetal nonstress usually performed
near term
what is the fetal vibroacoustic stimulation test
response of FHR to acoustic stimulation
what is a fetal contraction stress test
they give pitocin to see the FHR response to contraction
fetal biophysical profile is conducted using _________________ and evaluates what 5 fetal parameters
ultrasound;
1. fetal breathing
2. gross fetal body movement
3. fetal tone
4. heart rate acceleration
5. amniotic fluid volume over 30-40 minutes
each of the 5 parameters on a fetal biophysical profile receives a score between ________________
0-2
a fetal biophysical profile score of 8-10 = ________________
reassuring
a fetal biophysical profile score of 4-6 = _______________
suspicious
a fetal biophysical profile score of 0-2 = ___________________
nonreassuring
pain in stage 1 labor is due to changes in the _______________ & ___________
lower segment of uterus; cervical dilation
pain in the late 1st stage & 2nd stage of labor is due to __________________________
distension of the pelvic floor, vagina, and perineum
what is the cranial boundary of the epidural space
foramen magnum
what is the caudal boundary of the epidural space
sacrococcygeal ligament
what is the anterior boundary of the epidural space
posterior longitudinal ligament
what is the lateral boundary of the epidural space
vertebral peduncles
what is the posterior boundary of the epidural space
ligamentum flavum and vertebral laminae
T/F: the epidural space is not really a structure
true - it is a potential space
characteristics of epidural that makes in ideal labor analgesic
- technique is safe for mom and baby
- does not interfere with labor and delivery process
- provides flexibility in response to changing conditions
- provides consistent pain relief
- long DOA
- minimal s/e
- minimizes ongoing demands of anesthesia providers time
T/F: the epidural space is a series of discontinuous compartments that become continuous when potential space separating compartments is opened up by fluid or air
true
what level block is necessary for C/S anesthesia
T4
what level block is necessary for adequate labor analgesia
T10
what is sacral sparing block
block that does not cover the S2-S4 region, so pt experiences pain on delivery/can feel foley catheter after epidural is placed
layers you pass through when trying to place epidural
- skin
- SubQ
- supraspinous ligament
- interspinous ligament
- ligamentum flavum
what are the advantages of the loss of resistance technique for epidural placement
- simplicity
- reliability
- speed
loss of resistance technique for epidural, what can be used in the syringe?
- air
- NS
- both
hanging drop technique is usually reserved for ___________________
cervical injections
how far should the epidural catheter be threaded into the epidural space
4-6 cm
if I am placing an epidural catheter and I lose resistance at 5 cm, where will I leave my catheter at the skin?
10 cm
