OB Exam 3 - Obstetric Procedures

Question 1

External Version

Answer 1

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

Question 2

Internal Version

Answer 2

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

Question 3

Version Technique

Answer 3

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

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

Question 4

Version Risks

Answer 4

ROM
Fetus tangled in cord
abruptio placenta
emergency c-sec

Question 5

Contraindications to Version

Answer 5

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

Question 6

Terbutaline

Answer 6

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

Question 7

Tocolytic

Answer 7

Drug that relaxes the uterine muscle

Question 8

Induction

Answer 8

Must be 39 weeks (unless health emergency)

Cervical Readiness favorable (Bishop score)

Question 9

Cervical Readiness Variables

Answer 9

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)

Question 10

Cervical Ripening Drugs

Answer 10

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

Question 11

Cervical Ripening via Mechanical Means

Answer 11

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

Question 12

Cytotec Induction

Answer 12

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

Question 13

Prior to Cytotec

Answer 13

• 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

Question 14

High dose Cytotec

Answer 14

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

Question 15

Amniotomy

Answer 15

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

RISK = PROLAPSED CORD

Question 16

Nursing Consideration for Amniotomy

Answer 16

• 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

Question 17

Aminotomy Risk

Answer 17

Cord prolapse (GREATEST RISK)
Infection
Abruptio Placenta

Question 18

Nurse Care Prolapsed cord

Answer 18

**

Question 19

Induction & Augmentation of Labor Indications

Answer 19

-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

Question 20

Induction & Augmentation of Labor Contraindications

Answer 20

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

Question 21

Induction & Augmentation of Labor Risks

Answer 21

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

Question 22

Oxytocin (Pitocin) Administration

Answer 22

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

Question 23

Induction & Augmentation of Labor Considerations

Answer 23

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

Question 24

Water Intoxication S/S

Answer 24

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

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

Question 25

Nursing Considerations Version

Answer 25

/

Question 26

Operative Birth procedures

Answer 26

Forceps & vacuum extraction

Question 27

Operative Vaginal Birth - Maternal indications

Answer 27

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

Question 28

Operative Vaginal Birth Contraindications

Answer 28

C-sec birth preferable
high fetal station
CPD