ob emergencies Flashcards
grand multipara
> = 5 births
subinvolution
uterus does not return to normal size
prolapsed umbilical cord definition
protrusion of the umbilical cord past the presenting part through the cervical os
prolapsed umbilical cord presentation
- persistent variable decelerations- OR bradycardia (compression doesn’t let up)- felt on cervical exam (keep fetal pulse > 100!)
umbilical cord prolapse nursing interventions
- maternal positioning (trendelenberg, knee chest, lateral = depends on cord. RELIEVE PRESSURE)- oxygen- increase IV fluids to maximize baby perfusion- prep for delivery- educate and support
shoulder dystocia
impaction of fetal shoulders within maternal pelvisno breath + compressed cord = unhappy babbyno reliable risk identifiers, predictors, tools (ok a few)
fetal macrosomia non-diabetic vs diabetic moms
nondiabetic 5000 gdiabetic 4000 g
shoulder dystocia anticipatory management
- assess labor pattern (slow progress in second stage, caput)- squatting- empty bladder- anaesthesia, peds @ delivery- newborn assessment- prepare for pph- documentation ESSENTIAL
caput succedaneum
swelling of the scalp in a newborn- most often brought on by pressure from the uterus or vaginal wall during vertex delivery- more likely to form during a long or hard delivery
turtle sign
shoulder dystocia indication - head out then in
mcroberts maneuver
position maternal thighs up onto abdomen (straightens sacrum, decreases angle of incline of syphysis pubis)for shoulder dystocia
suprapubic pressure
NEVER FUNDAL PRESSUREpressure is hand over anterior fetal shoulder with downward and lateral motion
gaskin maneuver
roll the patient onto all fourssafe, rapid, effective,
amniotic fluid embolus
aka anaphylactoid syndrome of pregnancyrare (1/40000)immunologic response (anaphylaxis, septic shock-ish)- sudden maternal hypoxia- cardiovascular collapse- coagulopathmom’s circulation collapses - shunting happens to brain/heart NOT UTERUSonly 15% survive neurologically intact
anaphylactoid syndrome of pregnancy supportive therapy
CALL FOR HELP (rapid response team)- high O2 concentrations- CPR, intubate, ventilate, crystalloid solutions- blood product replacement- monitor fetus- perimortem c-section: ASAP 4 minutes after cardiac arrest
CPR in pregnant women: TRICK!
tilt to get pressure off aorta - use a wedge
single most significant cause of maternal mortality worldwide
obstetric hemmorhage
obstetric hemorrhage
serious morbidity: ARDS, DIC, AKI29-93% of deaths are PREVENTABLE
obstetric hemorrhage: class I
EBL 1000 mls/s: none, dizzy, palpitations, minimal BP changes
obstetric hemorrhage: class II
EBL 1500 mls/s: orthostatic hypotension, tachycardia, tachypnea, narrowing pulse pressure, weakness, delayed cap refill
obstetric hemorrhage: class III
EBL 2000 mls/s: hypotension, marked tachycardia (120 - 160), tachypnea (30-50), cold, clammy, palor, restless
obstetric hemorrhage: class IV
EBL > 2500 mls/s: cardiogenic shock (BP absent, peripheral pulses very week, air hunger, oliguria/anuria)
estimating blood loss nota bene
hypotension, dizziness, pallor, oliguria do not occur until blood loss is SUBSTANTIALpregnant women especially lose more before showing signs of compromise
physical adaptations to hemorrhage nota bene
pH lowered, hyperventilation to compensate for metabolic acidosis (not enough O2)
ob hemorrhage management goals
- maintain systolic >90- maintain adequate uop- maintain normal mental statusTREAT SOURCE OF HEMORRHAGE
ob hemorrhage nursing considerations
- rapid response team- foley ( I/O q 1’, > 30 ml/hr, NO LASIX)- cumulative blood loss totals- IV access (large bore + crystalloid solutions to support CO)- blood typing- maternal positioning to optimize CO (lateral, elevate LE)- monitor VS frequently (O2 > 95%)- monitor fetal status (emergent delivery)- monitor maternal pain
abruptio placentae is
premature separation of normally implanted placenta; IT HURTS (uterus contracts when placenta separates)revealed: external, darkconcealed: internal, clot forming inside1 to 3 levels (3 worst)
abruptio placentae risk factors
- previous abruption- cocaine, smoking- grand multip- chronic htn, preeclamp- sudden uterine decompression (trauma)- pprom - maternal thrombophilias (clotting disorder)- uterine malformation
abruptio placenta presentation
varies widely- uterine tenderness- backache, shoulder pain, abdominal pain- vaginal bleeding DARK, PORT WINE - increased uterine tone BOARDLIKE- uterine irritability, hypertonus- maternal tachycardia- fetal compromise –> fetal death
placenta previa is
implantation of placenta over cervical os; will bleed as cervix softens PAINLESS BRIGHT REDtotal: internal ospartial: implants near, partially covers internal osmarginal: implants near/doesn’t cover any oslow-lying: near region of osendometrial scarring: 50% riskimpeded vascularization: htn, dm, smoking
placenta accreta
chorionic villi adhere to myometrium; not an issue until delivery- 75% of placenta previa
placenta increta
invasion of chorionic villi into myometrium, but not across serosa- 15 to 20% of placenta previa- dramatic increase of risk with increased # c sections
placenta percreta
growth of chorionic villi through myometrium- 5 to 10% of placenta previa
abruption vs previa
abruption: painful and darkprevia: painless and bright
uterine rupture is
symptomatic disruption, separation of layers of uterus or previous scarrisk: VBAC because c-section scar tissue contracting, grand multiparity, polyhydramnios
uterine rupture s/s
abnormal FHR- uterine activity change- abdominal pain- loss of fetal station- palpable fetal parts- vaginal bleeding- suddenly anxiety, restlessness- maternal shock (hypotension, tachycardia)CAN BE ASYMPTOMATIC
uterine rupture management
- rapid response team, notify PCP, anaesthesia, neonatal- oxygen, positioning- monitor fetus- emergency c section- volume resuscitation, blood replacement
postpartum hemorrhage is
blood loss > 500 ml (vaginal birth)> 1000 (cesarean)be prepared: in late pregnancy, blood flow to placenta is ~750-1000ml/minuterine atony 80%
pph: early (when and why)
- within first 24 hoursdue to lacerations, trauma, placental fragments, inversion, rupture, invasive placentation, coagulation disorders
pph: late (when and why)
- 24 hours to 6 weeks postpartumdue to infection, placental fragments, placental site subinvolution, coagulation disorders
uterine involution
placenta does not detach from uterus and pulls uterus inside out as it exits omfg
pph management (manipulative)
bladder drainageuterine massageuterine exploration
pph management (pharm)
oxytocin, methergine, prostaglandin, misoprostol
