OB - Module 6 Flashcards
Hypotonic contraction interventions
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.
Hypertonic contraction interventions
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.
Ineffective maternal pushing inverventions.
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.
Macrosomia
> 8lbs 8oz. Common in diabetic mothers.
Shoulder dystocia
head passes but shoulders are caught inside.
Turtle sign
Common during shoulder dystocia in which the head retracts back toward the perineum. Risk for cord compression and clavicle fracture and is an emergency.
Fetal presentation interventions
Hands and knees leaning forward, squat/lunge, or side-lying position opposite side of the fetal occiput.
Obstruction intervention
Check bladder for distention hourly
Chorioamniotitis Symptoms
Maternal fever and uterine tenderness.
Nitrazine tests
Checks if fluid is alkaline and fern which indicates true rupture.
What determines whether labor will be induced in a premature rupture of membranes?
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.
Signs of infection
FHR >160, Maternal temp > 100.4, and cloudy or yellow amniotic fluid.
Signs of preterm labor
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.
Fetal fibronectin
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.
Transvaginal ultrasound
Determines cervix length (effacement)
Preterm interventions
Tocolytics if cervix dilation not
Prolonged pregnancy interventions
Non stress test, determine if gestational age is actually correct.
Placenta accreta/increta/
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.
Prolapsed umbilical chord interventions
Position hips higher than head, push with fetal presenting part facing upward, give oxygen 8-10L, tocolytics, and saline towel to moisten chord.
Symptoms of uterine rupture
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.
Symptoms of uterine inversion
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.
Anaphylactoid syndrome
Fluid from fetus (emboli) goes into maternal lungs. Treated with cpr, mechanical ventilation oxygen, IV fluid, and blood replacement.
Primary vs Secondary Apnea
Primary: Stops breathing, but starts to breathe when stimulated. starts after birth
Secondary: Requires support to begin breathing. starts before or after birth
Resuscitation
Begin if HR
