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Childbearing > OB Exam 3 - Obstetric Procedures > Flashcards

OB Exam 3 - Obstetric Procedures Flashcards

1
Q

External Version

A

Change the fetal position from a breech, shoulder (transverse lie), or oblique presentation to avoid c-sec

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2
Q

Internal Version

A

Used to change the presentation of the second twin in order to deliver vaginally.

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3
Q

Version Technique

A

Use ultrasound, fetal monitoring, VS’s Terbutaline, RhoGAM if indicated.

Before, during, after to confirm position change and cord location

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4
Q

Version Risks

A

ROM
Fetus tangled in cord
abruptio placenta
emergency c-sec

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5
Q

Contraindications to Version

A 
Uterine malformation
Previous C-sec (classic)
CPD (cephalopelvic disproportion) 
Placenta Previa
Multifetal gestation
Oligohydramnios
ROM 
Nuchal cord
Non reassuring FHR
Breech is engaged
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6
Q

Terbutaline

A

Tocolytic, Bronchodilator that is used to relax uterine muscle
Given SC to stop preterm contractions
Given SC for FHR Bradycardia

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7
Q

Tocolytic

A

Drug that relaxes the uterine muscle

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8
Q

Induction

A

Must be 39 weeks (unless health emergency)

Cervical Readiness favorable (Bishop score)

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9
Q

Cervical Readiness Variables

A

Bishop Score (grades the variables)

  1. Dilation (Closed= 0, 1-2= 1, 3-4= 2, 5= 3)
  2. Effacement (>4= 0, 3-4= 1, 1-2= 2, 0=3)
  3. Station (-3=0, -2=1, -1,0 =2, +1,+2 =3)
  4. Cervical consistency (Firm=0, Medium=1, soft=2, none=3)
  5. Position of Cervix (Posterior=0, Midline=1, Anterior=2, —=3)
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10
Q

Cervical Ripening Drugs

A

-Prostaglandin Gel (prepidil gel)
(0.5mg-1.5mg applied to cervix or 2.5mg vaginally)
-Cytotec (misoprostol)
25mcg tab vaginally q3-6hr

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11
Q

Cervical Ripening via Mechanical Means

A

Laminaria Tents (seaweed)
Lamicel (synthetic seaweed)
Balloon on catheter

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12
Q

Cytotec Induction

A
  • Given to ripen cervix
  • Prior to aministering Pitocin (Pit has to be at least 4hrs after last dose)
  • 25mcg inserted in posterior vagina
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13
Q

Prior to Cytotec

A
  • No uterine activity
  • Reactive NST
  • No concern CPD
  • IV in place & Terbutaline available
  • Not to be given to women who have had prior csec/uterine surgery due to risk of hyperstimulation
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14
Q

High dose Cytotec

A

600-800mcg
Used for post-partum hemorrhage
DIU fetus evacuation

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15
Q

Amniotomy

A

Used to augment or induce labor or for internal monitoring.
-AmniHook to perforate sac

RISK = PROLAPSED CORD

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16
Q

Nursing Consideration for Amniotomy

A
  • Obtain baseline: FHR, station, position & presentation
  • Should be ZERO station
  • Assist w/procedure, chux under pt
  • Post ROM care: PRIORITY is to check the FHR for one minute (b/c greatest risk is cord prolapse), then note color, amount, odor
  • Check temp q2hrs after ROM
17
Q

Aminotomy Risk

A

Cord prolapse (GREATEST RISK)
Infection
Abruptio Placenta

18
Q

Nurse Care Prolapsed cord

A

**

19
Q

Induction & Augmentation of Labor Indications

A

-Intrauterine environment hostile to fetus (IUGR, blood incompatibility)
-SROM at or near term without onset of labor (PROM)
-Postterm pregnancy
Chorioamnionitis (inflammation of the amniotic sac)
-HTN (reduced placental blood flow)
-Abrutio placentae
-Maternal medical conditions (GDM, HTN, renal disease
-DIU

20
Q

Induction & Augmentation of Labor Contraindications

A

Placenta previa
Vasa previa
Umbilical cord prolapse
Abnormal fetal presentation
Fetal presenting part above the pelvic inlet (above zero station)
Previous upper uterine surgery like classical c-sec

21
Q

Induction & Augmentation of Labor Risks

A

Hypertonic Uterine activity
Uterine rupture
Maternal water intoxication (from pitocin)
Greater risk for chorioamnionitis and c-sec

22
Q

Oxytocin (Pitocin) Administration

A

10 units or 10,000 milliunits diluted in 500 mL of isotonic solution = 20 milliunits/mL

  • Administered as SECONDARY line at the port CLOSEST to the venipuncture
  • Monitor UC pattern, FHR, and maternal VS
23
Q

Induction & Augmentation of Labor Considerations

A
  • Observe FETAL response
  • Complete FHR 20-30min baseline prior to induction
  • Observe MATERNAL response
  • Monitor for hyper stimulation
24
Q

Water Intoxication S/S

A 
HA
Blurred Vision
increased blood pressure
increased respiration
decreased pulse
rales 
coughing

**Monitor for postpartum hemorrhage (uterine atony due to muscle fatigue)

25
Q

Nursing Considerations Version

A

/

26
Q

Operative Birth procedures

A

Forceps & vacuum extraction

27
Q

Operative Vaginal Birth - Maternal indications

A

-Shorten second stage, exhaustion, inability to push effectively
Cardiac or pulmonary disorder (dont want mother to valsalva which happens with pushing)

28
Q

Operative Vaginal Birth Contraindications

A

C-sec birth preferable
high fetal station
CPD

Childbearing (4 decks)

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