oB exam 3 Flashcards
> 3mm could indicate genetic disorder on what scan
nuchal translucency scan
when can an amniocentesis be performed
after 14wks
excessive amniotic fluid
polyhydramnios
cause: unknown, may be r/t DM or twin-to-twin infusion
polyhydramnios
decreased amniotic fluid that may be caused by fetal anomalies or PROM
- fetal anomolies associated w/ poor kidney function, PROM
oligohydramnios
tx oligohydramnios
amnioinfusion or LR into amniotic sac
T/F: obesity decreases ability for mother to sense fetal movements/kicks
T
includes NST, fetal breathing movement, fetal muscle tone, amniotic fluid volume
biophysical profil (BPP)
2 eggs fertilized, fraternal twins
dizygotic
one egg fertilized & then split into 2, identical twins
monozygotic
unusually acute nausea & vomiting
hyperemesis gravidum
what can hyperemesis gravidum lead to?
malnutrition, electrolyte imbalances, wt loss
- occurs before 20wks GA
- normally result of chromosomal abnormalities
- evaluate for bleeding, cramping, passage of tissue
spontaneous abortion
pregnancy occurring outside of uterus, most commonly the fallopian tube
ectopic pregnancy
what is a possible complication if an ectopic pregnancy isnt treated?
fallopian tube rupture
what to do with a suspected miscarriage
watchful waiting
this med stops cell division, tx for ectopic pregnancy
methotrexate
HTN &/or stable/pre-existing proteinuria prior to 20wks GA & persisting after 12wks PP
chronic HTN
development of preeclampsia or eclampsia in pt w/ chronic HTN
superimposed preeclampsia or eclampsia
systolic BP >140 &/or diastolic BP 90+ without proteinuria or s/s end-organ dysfunction after 20wks GA
gestational HTN
development of convulsions or coma in preeclamptic pt
eclampsia
this medication lowers seizure threshold, tx preeclampsia; reduces CNS irritability caused by cerebral edema
magnesium sulfate
140/90mmHg+ on 2 occassions at least 4h apart & proteinuria OR other organs effected
preeclampsia
during seizure:
tun on side (aspiration), O2 admin
- severe headache that won’t go away w/ meds
- swelling of face/hands
- wt gain 2lb+ in 1 wk
- difficulty breathing, gasping, panting
- nausea after mid-pregnancy
- changes in vision
- RUQ abdominal pain/shoulder pain
- increased DTR
preeclampsia s/s
want serum mg to be:
4-7
mag reversal agent
calcium gluconate
HELLP syndrome
hemolysis, elevated liver enzymes, low platelets
GDM
maternal body not able to keep up with demands
when do you screen for GDm?
24-28wks
if BG is over _____, further testing is indicated
130
DM diagnosed during pregnancy & diet controlled
A1
DM diagnosed during pregnancy requiring medication
A2
if a GDm pt is getting a c-section, can she take her AM insulin?
no
how does the baby react to DKA?
metabolic acidosis, death
what disease can be transferred to fetus?
herpes
tx of syphilis
penicillin G
may block birth canal, vaccine available
HPV
tx trichomonas
flagyl
painless, premature dilation of cervix in 2nd trimester pregnancy in absence of contractions
cervical insufficiency
tx cervical insufficiency
maternal progesterone, cervical cerclage
cervical canal narrowed after suture placement, must unstitch around 36wks; labor often soon after removal
cervical cerclage
use this to minimize maternal supine hypotension
wedge
where do you perform CPR on pregnant client
higher on chest
normal bacteria that can colonize in vagina, asymptomatic mom
GBS
when do your get swabbed for GBS
35-37wks
how would baby get exposed to GBS in labor?
while coming down vaginal canal
want to delivery baby within ___ hr PROM
24
promote lung maturity, prevent brain bleed, prevent necrotizing enterocolitis, prevent neonatal death
corticosteroids
these drugs kill contractions
tocolytics
tocolytics may be used for ____ hrs to allow for full course corticosteroids admin
48
tocolytics may be used for ____ hrs to allow for full course corticosteroids admin
48
give corticosteroids ___x 24h apart to prevent baby from having problems
2
this specific medication is given maternally for fetal lung development
- not used after 34wks
betamethasone
when treating preterm labor, what medication can be given to extend pregnancy?
progesterone
this medication can help protect fetus from cerebral palsy
magnesium sulfate
infection of amnion, chorion, or both
chorioamnionitis
s/s:
- EFM tachycardia
- fould smelling discharge
- elevated WBC
- FEVER
chorio
- admin vaginally or orally
- CI women previous c-section due to risk of uterine rupture
- monitor for uterine tachysystole
- cervical ripening agent
misoprostol
- causes release of own prostaglandins to mechanically ripen cervix
balloon catheter
dosing oxytocin
1mu/min = 1mL/h
placental tissues overlies the internal cervical os (cervical opening)
- placenta attached ot where opening is
placenta previa
what type of bleeding is placenta previa associated with?
bright red vaginal bleeding
T/F: vaginal delivery is indicated for placenta previa
F
premature detachment of placenta from uterine lining, mild or severe
placental abruption
- dark red bleeding
- knife-like pain
- uterine tenderness
- contractions
- hard/rigid uterine tone
- decreased fetal movement/activity
placental abruption
pathologic activation clotting cascade resulting simultaneously in blood clots, platelets & clotting factor depletion, therefore bleeding
DIC
contractions happen in middle of uterus, causing no downward pressure (non-laboring contractions)
hypertonic
weak contractions w/ not enough power
hypotonic
too many contractions
tachysystole
interventions for ineffective pushing
laboring down, allow rest before 2nd stage, educate & encourage
labor lastig <3h
precipitous labor
maternal pelvis smaller than body
cephalopelvic disproportion
baby head is stuck halfway out, unable to be oxygenated
turtle sign
hyperflexion of hip to bring knees back toward laboring woman
mcrobert’s maneuver
woman moved onto hands & knees
gaskin maneuver
downward pressure just above pubic bone in an attempt to rotate anterior shoulder
suprapubic pressure
aid fetal descent & delivery
forceps-assisted birth
used in someone w/ cardiac disease who cannot push, baby is in distress
forceps-assisted delivery
- lower maternal injury than forceps, risky to neonate
- only can have 2x popoffs
vacuum-assisted delivery
trial of labor after c-section
TOLAC
- sudden category II or III FHR
- fetal station change
- weakening CTXs
- abdominal pain
- vaginal bleeding
- hematuria
uterine rupture
tx prolapsed cord
presenting part held off cord until can get c-section
amniotic fluid enters maternal circulation
amniotic fluid embolism
- dyspnea
- cyanosis
- tachycardia
- shock
- seizures
- hypotension
- DIC
amniotic fluid embolism
