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OB EXAM 3 > OB FINAL > Flashcards

OB FINAL Flashcards

1
Q

SMALL FOR GESTATIONAL AGE (SGA):

A

5.5lbs, <2500g, <10% on growth chart

 baby may be preterm, term or post-term – based on weight not dates

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2
Q

What is the main problem small for gestational age babies face?

A 
a decrease in placenta function in utero* and may be due to:
o	Asphyxia
o	Aspiration syndrome
o	Hypothermia
o	Hypoglycemia
o	Polycythemia
o	Meconium aspiration
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3
Q

Intrauterine Growth Retardation

A 
•	SGA PLUS additional complications of: 
o	1) Congenital malformations
o	2) Intrauterine infections – syphilis 
o	3) Continued growth difficulties – anemia
o	4) Cognitive difficulties
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4
Q

What is the main symptom for IUGR

A

small gestational age baby

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5
Q

LARGE FOR GESTATIONAL AGE (macrosomia)

A

baby that weighs >8.8lbs, >4000g, >90% on growth chart

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6
Q

What are some causes of IUGR

A

o Advanced diabetes
o High blood pressure or heart disease
o Infections such as rubella, cytomegalovirus, toxoplasmosis, and syphilis
o Kidney disease or lung disease
o Malnutrition or anemia
o Sickle cell anemia
o Smoking, drinking alcohol, or abusing drugs

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7
Q

What are some causes of large for gestational age baby

A
  • Infant of a diabetic mother
  • Multiparity
  • Diabetes
  • Erythroblastosis fetalis
  • Cardiac etiology: transposition of the great vessels
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8
Q

What are complications of LGA

A

o Cephalopelvic disproportion – birth trauma d/t head not fitting in pelvis
o incidence of cesarean birth and induction of labor
o Hypoglycemia, polycythemia and hyperviscosity
• Jaundice d/t hyperbilirubinemia

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9
Q

Risk factors for LGA

A

o Maternal diabetes mellitus or glucose intolerance
o Multiparity
o Prior history of a macrosomic infant – hx of big baby more likely to have another
o Postdates gestation
o Maternal obesity
o Male fetus
o Genetics

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10
Q

What is the most common defect associated w diabetic mothers

A

cardiac anomalies

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11
Q

Characteristics of infant of diabetic mother

A
  • LGA or SGA
  • Ruddy in color
  • Excessive adipose tissue
  • Large umbilical cord and placenta
  • Decreased total body water
  • Excessive fetal growth from exposure to high levels of maternal glucose
  • At risk infants – require close observation for first hours and days possibly.
  • 4kg =8.8 lbs
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12
Q

Newborns of women with diabetes but WITHOUT vascular complications

A

Large for gestational age

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13
Q

newborns of women with diabetes and vascular disease

A

small for gestational age

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14
Q

Anemia of prematurity

A

 Exaggerated response from hypoxic state in utero to hyperoxic state after birth
 Normochromic, normocytic and hyporegenerative anemia
 Low serum erythropoietin levels despite having low Hb levels
• Do not have ability to make new RBC
 Will spontaneously resolve in 3 months
 Anemia of prematurity where everything is premature

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15
Q

Intraventricular hemorrhage

A

• incidence at <30-weeks gestation
• Occurs because preemies cerebral vessels are so fragile
o Causes bleeding into the ventricles of the brain
o Must protect their head during transport b/c of jarring vessels

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16
Q

Complications of Meconium Aspiration syndrome

A
  • Pneumothorax
  • Pneumonia – d/t extra fluid that can then become infected
  • Persistent Pulmonary Hypertension
  • Bronchopulmonary Dysplasia
  • Neurologic complications
  • Possible Death
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17
Q

What is phase 1 of TTNB

A

grunting- to open the alveoli

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18
Q

What is phase 2 of TTNB

A

phase 2- tachypnea phase where RR is 100-120

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19
Q

Common Predictors of TTNB

A

C-section w/o labor –> baby isn’t getting squeezed

  • Precipitous delivery
  • Prolonged labor
  • Male > female
  • 2nd twin
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20
Q

Oxygen support

A

• Hood  mixed air
• Heated flow cannula: oxygen that is humidified and warmed
• CPAP (continuous positive airway pressure): slight pressure reminds them to breathe and open up airways
• Ventilator w/ ET tube attached
• Oscillator: specialized machine that is more sophisticated means of O2 support
o 200 revolutions over the chest every minute
• ECMO (extracorporeal membrane oxygenation)
o Heart lung bypass
o Oxygenate blood for the babies
Baby version of heart-lung bypass

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21
Q

Treatment for respiratory disorders

A

• Oxygen support
• Continuous oximetry
• Chest PT – to break up secretions
• Keep temp, CS, fluids and electrolytes stable
• Monitor ABGs, CBC, blood cultures
• Prophylactic antibiotics if questionable CBC or mom Group B strep (+)
o Just give it!
• Surfactant if respiratory distress syndrome
• Chest tube if pneumothorax

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22
Q

Signs and symptoms of respiratory disorders

A
  • Tachypnea (resp. rate > 60 bpm, up to 120 bpm with TTN)
  • Grunting
  • Retracting
  • Nasal flaring
  • Hypoxia  causes cyanosis
  • Transillumination of a pneumothorax will show light on the affected side
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23
Q

characteristics of neonatal abstinence syndrome

A
  • High pitched cry
  • Colic – early on and prolonged
  • Increased muscle tone, tremors
  • Poor sleep patterns
  • Seizures
  • Diarrhea
  • Temperature instability
  • Poor feeding
  • Sneezing
  • Often start after 24 or 48 hours – may be home
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24
Q

Ectopic pregnancy

A

gestation implanted outside uterus
–> pregnancy that develops outside of the uterus
• Sites: fallopian tube (98%), ovary (1%), cervix (1%), or abdomen (0.75-1%)
o Conception tends to occur in the outer third of the fallopian tube
o And then the fertilized and dividing egg will work its way through the tube to get to the uterus to implant
o Any issues to the fallopian tubes will remarkably  potential for ectopic pregnancy in the tube (ex. PID, hx of sx)

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25
Q

risk factors for ectopic pregnancy

A

o PID & endometriosis
o Use of IUDs
o Tubal surgery
o Tubal tumors/congenital tubal anomalies
 Accessory tubes, excessively long tubes
o History of:
-Previous ectopic pregnancy
-Abdominal or pelvic surgery
-Appendicitis/therapeutic abortion/infertility

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26
Q

signs and symptoms of ectopic pregnancy

A

1) abdominal pain-colicky, vague, cramping and can be localized to either the L or R
2) Amenorrhea
3) unilateral leg swelling
4) shoulder pain-referred pain
5) abnormal vaginal bleeding

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27
Q

Complete spontaneous abortion

A

when all products of conception are entirely expelled
 Baby + placenta + membranes
 Very few physical complications occur but emotional support is necessary

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28
Q

septic spontaneous abortion

A

products of pregnancy are retained in uterus and infection sets in
 Immediate termination of pregnancy by method appropriate to duration of pregnancy is needed
 Cervical C & S studies are done and broad-spectrum antibiotic therapy is started (for anaerobic & aerobic initially)
• Vaginal vault = aerobic
• Uterine cavity = anaerobic

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29
Q

missed spontaneous abortion

A

fetus dies but continues to be retained in the uterus for > 8 weeks

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30
Q

autolysis

A

after 4 weeks with an infant dead within the mother

 The dead cells start to release enzymes that cause the breakdown of clotting factors and can lead to DIC in the mother

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31
Q

habitual abortion

A

woman is repeatedly aborting
 Get into the second trimester and weight of pregnancy begins to be more than what the cervix can hold
 Individuals will get to ~15-20wks gestation and cervix will begin to dilate to allow pregnancy to pass

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32
Q

What procedure is done in habitual abortion to close the cervix temporarily or permanently

A

 A purse string suture called a Shirodkar (cerclage) or McDonald procedure may be done to close the cervix temporarily or permanently
• Can be done to help maintain the pregnancy through the vaginal vault
• May also be done through the abdominal cavity to the top of the cervix  requires C-section birth

33
Q

when do we deliver baby if placenta previa is diagnosed

A

by cesarean section @ 37 weeks if not before

34
Q

major symptom of placenta previa

A

sudden onset of painless vaginal bleeding

35
Q

predisposing factors for placenta abruptio

A

o Maternal hypertension
o Preeclampsia
o Folic acid deficiency – required for healthy placenta development
o Severe abdominal trauma
o Short umbilical cord- descending baby will create traction on the cord
o Malnutrition
o Sudden  in uterine size
o Maternal age >35
o Rough or difficult external version  manipulating uterus to rotate baby
o Cocaine use, especially crack
• Warrants very close observation or cesarean section

36
Q

signs and symptoms of placenta abruptio

A

o Board-like, rigid abdomen
o Severe, relentless abdominal pain out of proportion to labor
  level of discomfort is how to assess if pt having previa or abruptio
o Back pain
o Colicky, uncoordinated uterine contractions
o Or continuous tetanic contractions
o Bleeding
o Pain localized or generalized
o FHR shows periodic changes – late, variable, prolonged, sinusoidal
o Loss of variability
o Aggressive/exaggerated fetal movement
o Increasing fundal height – d/t uterus filling with blood
o Maternal shock
o May not show on ultrasound
 Can only confirm if it is complete or central but cannot r/o if marginal

37
Q

placenta abruptio

A

placenta detachment- it’s where it’s supposed to be but it starts to detach from the uterine wall

38
Q

what is the # 1 cause for uterine rupture?

A

previous uterine surgery (C-section)

39
Q

Risk factors for uterine rupture

A

o Previous uterine surgery (#1 cause) – C-section
o Trauma
o Uterine over distention
o Uterine abnormalities
o Placenta percreta: placenta has gone beyond its normal level of implantation
o Choriocarcinoma

40
Q

Cephalopelvic disproportion

A

baby is too big to make it through the maternal pelvic or is in a position that makes it difficult to come through
maternal bony pelvis is often a factor

41
Q

Signs and symptoms of cephalopelvic disproportion

A

o Arrest of dilation or descent
o Abnormal labor patterns
o Acute maternal discomfort – “bone on bone” pain
o Maternal exhaustion or fetal exhaustion
o Early fetal HR decelerations

42
Q

Nursing interventions for cephalopelvic disproportion

A 
o	Reposition
o	Assess labor pattern
o	Assess fetal status
o	Keep provider appraised of progress or lack there of
o	Keep hydrated
o	Consider analgesia or anesthesia
43
Q

Cord prolapse

A

umbilical cord escapes beyond the presenting part and becomes trapped between the presenting part and the bony pelvis
-occurs when the membranes rupture before the baby is engaged enough to cork off the pelvis

44
Q

cord prolapse nursing care

A

o One person must do a continuous vaginal exam and hold the head up off of the cervix
o Put patient in trendelenberg or knee chest position
o Prepare for an immediate C-section
o IV bolus
o O2 via mask
o Prepare for resuscitation of the infant

45
Q

How do we treat a cord prolapse

A

immediate cesarean section is warranted

46
Q

Shoulder dystocia

A

head has come out, but the shoulders are too large and have gotten caught in anterior-posterior dimension of pelvis

47
Q

Turtle sign

A

classic retreat of the head after it has delievered
o Head will recede back into vaginal vault
o Considered life threatening for the baby

48
Q

Risk factors for shoulder dystocia- Maternal

A 
	Abnormal pelvic anatomy 
	Gestational diabetes – baby big AND fat 
	Post-dates pregnancy 
	Previous shoulder dystocia 
	Short stature in patient
49
Q

Risk factors for shoulder dystocia- fetal

A

suspected macrosomia

50
Q

Labor related risk factors for shoulder dystocia

A

 Assisted vaginal delivery (forceps or vacuum)
 Protracted active phase of first-stage labor
 Protracted second-stage labor

51
Q

What is the most common risk factor associated with shoulder dystocia

A

the use of extractor or forceps during delivery

52
Q

shoulder dystocia maternal complications

A

 Postpartum hemorrhage
 Rectovaginal fistula – extensive lacerations that can be difficult to repair
 Symphyseal separation or diathesis, with or without transient femoral neuropathy
• Anterior portion of pelvis where there is connective tissue b/w two halves of pelvis that becomes separated
 Third- or fourth-degree episiotomy or laceration
 Uterine rupture

53
Q

fetal complications of shoulder dystocia

A

 Brachial plexus palsy  shearing of nerves that go over arms
 Clavicle fracture
 Fetal death
 Fetal hypoxia, with or without permanent neurological damage
 Fracture of the humerus

54
Q

incomplete abortion

A

embryo of the fetus has passed out of the fetus but the placenta remains

55
Q

threatened abortion

A

women experiences vaginal spotting or bleeding in early pregnancy
CERVIX NOT DILATED and placenta still attached to uterine wall

56
Q

inevitable abortion

A

placenta has separate from the uterine wall, CERVIX HAS DILATED, bleeding has increased
CANNOT BE PREVENTED

57
Q

preeclampsia triad

A

1) elevated BP >140/90
2) protenuria
3) generalized edema

58
Q

risk factors for preeclampsia

A 
maternal age >35
nulliparity
diabetes
chronic HTN
hydratiform mole
fetal hydrosis
59
Q

HELPP syndrome

A

due to the vascular bed inability to maintain that 30-40% blood volume increase during pregnancy-MAIN MECHANISM IS VASOSPASM

  • body begins to spasm and spasm which leads to microshearing
  • as the RBC try to get through vessels that are broken due to vasospasm hemolysis occurs as they break down
  • platelets try to adhere to all the microshearing which leads to a low platelet count
  • this syndrome affects vascular organs primarily the liver which leads to elevated liver enzymes
60
Q

management for preeclampsia

A
  • bedrest w close monitoring and status

- we want to try to deliever asap but also want to prolong it for baby’s lung’s to mature more so we give BETAMETHASONE

61
Q

what is the only true cure of preeclampsia

A

DELIVERY

62
Q

signs and symptoms of preeclampsia

A

Signs and symptoms: o Edema
o Proteinuria
o increased BP
o Headaches – usually frontal and not relievable by Tylenol
§ R/t cerebral edema o Nosebleeds
o Nausea/vomiting
o Epigastric pain – often associated when liver starts to become affected
§ High correlation for progression from preeclampsia to eclampsia o Visual disturbances – stars, flashes of light, diplopia
o Hyperreflexia – CNS gets irritable
o Oliguria

63
Q

what is the most critical assessment of the baby during preeclampsia

A

respiratory! lung maturity

64
Q

Magnesium sulfide

A

given to prevent seizures BUT given cautiously bc it causes CNS depression and respiratory arrest so we want to monitor every 1 hour and do neuro checks
- falls are also a risk and they have trouble with physical activity

65
Q

What is the therapeutic level of magnesium sulfide

A

5-8 mg

66
Q

what are some complications of magnesium sulfide

A

-visual distortion or disturbances
-eyes cannot accomodate
-difficulty walking
FALLS

67
Q

What other meds besides magnesium sulfide

A

Apresoline- if it’s a hypertensive crisis but it decreases placenta perfusion

68
Q

What is the first line of treatment for preeclampsia

A

Labetolol

69
Q

When do we give Methotrexate

A

for ectopic pregnancies where the fallopian tube is intact

70
Q

Which complication has painless vaginal bleeding as the main symptom

A

placenta previa

71
Q

What must we do for placenta previa

A

delievery by c-section @ or before 37 weeks NEVER VAGINAL DELIVERY

72
Q

Why do we wait before 37 weeks to deliver baby via c-section if placenta previa occurs

A

because if we wait, the cervix will thin and may cause the placenta to break away and severe hemorrhage may occur

73
Q

Vaginal exams w placenta previa

A

WE DON’T DO and we don’t do it especially if we don’t know where the placenta is

74
Q

What are some predisposing factors for placenta previa

A

multiple pregnancy- multiple placenta implants that leave behind scarring

  • previous placenta previa
  • previous therapeutic abortion
75
Q

placenta percepta

A

when the placenta goes beyond its normal level of implantation and implants on other organs

76
Q

what is the single most common risk factor associated with shoulder dystocia?

A

-the use of a vacuum extractor or forceps during delivery

77
Q

Shoulder dystocia prevention

A

weight gain within the normal range
induction of labor with larger infants
elective c-section
good control of diabetes in pregnancy

78
Q

McRobert’s position

A

hyperflexion of the maternal hips bilaterally

-increases anterior posterior dimensions of outlet of pelvis to maybe help the infant come through

79
Q

Absolute Contraindictations w Oral Contraceptives

A

1) Known or suspected pregnancies
2) Hx of thrombophlebitis or clotting disorders
3) If the patient is age 35 and is a smoker
4) Impaired liver function
5) breast or endometrial cancer
6) Factor 5 Leiden mutation
7) gallbladder disease
8) CV or CAD
9) Undiagnosed genital bleeding
10) Type II Hyperlipedemia
11) Cholestatic Jaundice
12) Hepatic adenomas, cancers or tumors

OB EXAM 3 (1 decks)

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