OB - Module 6

Question 1

Hypotonic contraction interventions

Answer 1

get her moving, position changes, upright, and amniotomy may be performed. Contractions could be augmented with pitocin until contractions are around 3 mins lasting 60-75 seconds.

Question 2

Hypertonic contraction interventions

Answer 2

Infrequent, Extremely painful, and does not cause cervical dilation. May administer analgesics/narcotics/epidural, tocolytics, or pitocin to coordinate contractions. If signs of fetal distress, turn on side.

Question 3

Ineffective maternal pushing inverventions.

Answer 3

Correct the problem. If no urge to push, have her labor down. If in the wrong position, reposition her. If no energy, take a break.

Question 4

Macrosomia

Answer 4

> 8lbs 8oz. Common in diabetic mothers.

Question 5

Shoulder dystocia

Answer 5

head passes but shoulders are caught inside.

Question 6

Turtle sign

Answer 6

Common during shoulder dystocia in which the head retracts back toward the perineum. Risk for cord compression and clavicle fracture and is an emergency.

Question 7

Fetal presentation interventions

Answer 7

Hands and knees leaning forward, squat/lunge, or side-lying position opposite side of the fetal occiput.

Question 8

Obstruction intervention

Answer 8

Check bladder for distention hourly

Question 9

Chorioamniotitis Symptoms

Answer 9

Maternal fever and uterine tenderness.

Question 10

Nitrazine tests

Answer 10

Checks if fluid is alkaline and fern which indicates true rupture.

Question 11

What determines whether labor will be induced in a premature rupture of membranes?

Answer 11

No infection and mature lungs indicates safety for induced labor. If there is no infection but IMMATURE lungs, then the mother may be given antibiotics and monitored.

Question 12

Signs of infection

Answer 12

FHR >160, Maternal temp > 100.4, and cloudy or yellow amniotic fluid.

Question 13

Signs of preterm labor

Answer 13

Baby curling, low back ache, menstrual cramping, increased pressure, and change in discharge. However, it must be diagnosed in person. If they feel bad, they should come in.

Question 14

Fetal fibronectin

Answer 14

Fibronectin attaches fetal sac to uterine lining and it SHOULD NOT BE SEEN until 1-3 weeks before delivery. if test is positive, then the mother is at risk for delivery within next 2 weeks.

Question 15

Transvaginal ultrasound

Answer 15

Determines cervix length (effacement)

Question 16

Preterm interventions

Answer 16

Tocolytics if cervix dilation not

Question 17

Prolonged pregnancy interventions

Answer 17

Non stress test, determine if gestational age is actually correct.

Question 18

Placenta accreta/increta/

Answer 18

Accreta: Abnormal appearance of placenta to the uterine wall
Increta: placenta infilitrates uterine wall
Percreta: placenta infiltrates all the way through the uterine muscle.
Treatment is a hysterectomy.

Question 19

Prolapsed umbilical chord interventions

Answer 19

Position hips higher than head, push with fetal presenting part facing upward, give oxygen 8-10L, tocolytics, and saline towel to moisten chord.

Question 20

Symptoms of uterine rupture

Answer 20

Severe pain, hypovolemic shock(loss of fluid), impaired fetal oxygenation, and cessation of contractions. Treatment includes repair for small ruptures, or hysterectomy and blood transfusion for large ruptures.

Question 21

Symptoms of uterine inversion

Answer 21

Massive hemorrhage, shock, and pain. Treatment includes manual return or hysterectomy as it is an emergency, tocolytics, pitocin to stop bleeding after it has been put back into position, and a foley insertion.

Question 22

Anaphylactoid syndrome

Answer 22

Fluid from fetus (emboli) goes into maternal lungs. Treated with cpr, mechanical ventilation oxygen, IV fluid, and blood replacement.

Question 23

Primary vs Secondary Apnea

Answer 23

Primary: Stops breathing, but starts to breathe when stimulated. starts after birth
Secondary: Requires support to begin breathing. starts before or after birth

Question 24

Resuscitation

Answer 24

Begin if HR

Question 25

Meds used for resuscitation

Answer 25

Epinephrine to stimulate heart
Sodium bicarbonate for acidosis
D10 for hypoglycemia
LR to expand volume
Narcan to counteract narcotics.

Question 26

Transient tachypnea

Answer 26

SELF RESOLVING. Rapid respiration (>60) from inadequate re absorption of lung fluid. Administer oxygen hood, IV/gavage(NG) feedings NO BREAST UNTIL STABLE, and possibly antiinfectives/labs.

Question 27

Kernicterus

Answer 27

Chronic permanent staining of brain tissue leading to cerebral palsy.

Question 28

When is Rhogam given?

Answer 28

Given to RH negative mom after birth and after 28 weeks.

Question 29

Jaundice management

Answer 29

Phototherapy, blood levels check, keep warm with no clothes, and eye protection for the lights.

Question 30

When are accuchecks given

Answer 30

With a diabetic mother accucheck is done at birth and before the 1st 3 feedings. 60, IV or lavage feedings are given.

Question 31

Which medications are given for drug babies?

Answer 31

Phenobarbital, Paregoric, and Methadone (for heroine).

Question 32

Atresia

Answer 32

2 unconnected segments of organ (esophagus for this module) causing aspiration. Pay attention to the first feedings for complications.

Question 33

Fistula

Answer 33

Abnormal connection of organ (esophagus for this module)

Question 34

Diaphragmatic hernia

Answer 34

Diaphragm does not fuse during development. causing abdominal contents to move into the chest cavity and RESTRICTS LUNG DEVELOPMENT. Place infant on the affected side, elevate health, and assist respiratory status. Baby gets and endotracheal tube, GI decompression, NPO, and sent to surgery.

Question 35

Omphacele

Answer 35

Abdominal contents herniate into umbilical cord. gastric tube is inserted and surgical repair is done. Must maintain a sterile cover and monitor for heat/water loss and infection

Question 36

3 categories of Spina Bifida

Answer 36

Spina Bifida occulta: Dimple on base of spine (hair tuft)
Meningocele: Protrusion of meninges not involving the spine so paralysis does not occur.
Myelmeningocele: Protrusion of membrane covered sac leading to a degree of paralysis and hydrocephalus depending on location of the spinal cord.

Question 37

Early Onset vs Late Onset Sepsis

Answer 37

Early: within 1st week from labor complications, rapid progression, and 15-50% mortality rate related to respiratory problems (pneumonia) and meningitis.
Late: After 1st week from exposure to organisms with slower progression and 10-20% mortality rate affecting CNS

Question 38

Tests for neonatal sepsis

Answer 38

Culture of blood/urine, CBC, glucose, and chest xray. Also Increased IGM to find intrauterine infection

Question 39

Hepatitis B

Answer 39

Transferred through all fluids (including breast milk and across the placenta). Newborn infected will have chronic hepatitis B infection and 90% develop chronic liver disease.
A mother with Hepatitis B should give the baby immunoglobin and 1st HBV immunization in the hospital. They will also have a bath BEFORE the injection and BREAST FEEDING is okay after the immunization