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OB > OB Test 2: High Risk Intrapartum > Flashcards

OB Test 2: High Risk Intrapartum Flashcards

0
Q

What is late preterm?

A

34-36 week

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1
Q

What is preterm?

A

Between 20-37 weeks

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2
Q

What is low birth weight?

A

Less then 2500 grams

5.5 pounds

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3
Q

What is vlbw?

A

Less then 1500 grams

3.51 pounds

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4
Q

What is PROM?

A

Premature rupture of membranes

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5
Q

What are preterm risk factors?

A 
African American
Previous preterm birth
Multiple gestation
Uterine anomalies
Socio economic disadvantage
Smoking
 GU dysfunction
No prenatal care
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6
Q

What are preterm labor symptoms?

A

Backache
Cramping
Pressure
Increased vaginal discharge

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7
Q

What are preterm labor assessments?

A

Cervix 4cm
Rupture of membranes
Infection: urinalysis
Ffn: fetofkbronectin kndicates at risk. Iran
Cervical length: >30mm less likely to deliver

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8
Q

What is treatment of preterm labor?

A

Hold off as long enough to get I. The betsmethasone because helps mature fetal lungs
Glucosteriods of bethmethasone 12mg IM twice a day, 12 hours a part
Tocolytics: stop labor

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9
Q

What are tocolytics?

A

Terbutaline (Brethine) beta adrenergic agonist

  • mimic SNS, relax smooth muscle
  • decrees blood pressure, increase heart rate
  • risk for pulmonary edema and hyperglycemia
  • 0.25 mg SC or IV titration

Magnesium sulfate

  • fewer side effects
  • 4 gram loading dose IV
  • antidote: calcium gluconate
  • toxicity: CNS depression, rate <12
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10
Q

What is PROM?

A

Unknown causes associated with infection and Inflammation

Preterm premature rupture of membrane

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11
Q

What are the risks with PPROM.

A

Chorioamnionitis: infection going to the amniotic fluid

Neonatal sepsis

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12
Q

What is the treatment of PPROM.

A

Expected management

Wait, monitor infection, no vaginal exams, antibiotic

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13
Q

What are labor complications?

A

Dystocia: ineffective labor pattern, give sedatives and encourage rest

  • hypertonic contractions: uterine tachsystole, to fast, stop pitosin
  • hypotonic contractions: not strong enough, augment labor

Precipitous labor: labor beginning to end is less then 3 hours big pelvis
- risk: meconium stained amniotic fluid, low APGAR, mom risk hemorrhage

Precipitous birth: sudden and doctor was not there

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14
Q

What is version?

A

External cephalic version: turn breech cephalic position, done in hospital, pt and monitor and non stress test. Ultrasound used to visualize baby and turned
- risks ROM, placental rupture, monitor 1 hour

Internal podalic version: reach into uterus, grab feet and pull out

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15
Q

What are the indications for labor induction?

A 
Post maturity: over 42 weeks
Preeclampsia: only cure is delivery
Prolonged ROM
Maternal diabetes: increase stillbirth
Fetal demise: mom risk for DIC 
IUGR: intrauterine growth restriction
History of rapid labor
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16
Q

What are labor induction contraindications?

A

Abnormal presentation
Uterine tachsystole
Fetal distress
Placenta previa: massive hemorrhage
Prior classical uterine incision: vertical incision into fundus. Scar in part of active fundus in labor
Active genital herpes: if active heroes lesion you need c-section

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17
Q

What is induction and augmentation?

A

Induction: stimulation of labor contractions before they begin
Augmentation: labor Dystocia (not strong enough)

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18
Q

What are the different elements of bishop score?

What bishops score do you want?

A 
Dilation: cervix >4 good indication
Efface net: good sign
Station: baby moving down and engaged
Cervical consistency: softness
Cervical position: starts out firm and posterior and during labor it softens up and goes anterior

0-10 score and if 10 good indicator that induction will work

19
Q

What are cervical ripening agents?

A

Prostaglandins

  • PGE2 inert (cervidil)
  • PGE2 gel (prepidil)
  • PGE1 (cytotec)
20
Q

What are prostaglandins insert?
Gel?
PGE1?

A

Left in place 12 hours on side
Gell, squirt into cervical oz but cannot be removed
PGe1: tablet orally or placed around cervix

21
Q

What’s re the risks of cervical ripening agents?

A

Uterine tachsystole

Fetal distress

22
Q

How do you fix cervical ripening agents?

A

Pull out cervidil and get terbutaline

23
Q

How can you stimulate labor?

A

Stripping membranes: in doctor office, strip fetal membranes from uterine wall and irritate causes uterus to soften
Sexual intercourse: semun contains prostaglandins
Nipple stimulation: cause oxytocin release
Herbal preparation
Castor oil: mom gets rain diarrhea
Balloon catheters: foley inserted cervix to stretch out, irritate and ripen

24
Q

What is amniotomy (AROM) advantages? Disadvantages?

A

Advantage: rupture membranes stimulate labor and evaluate color
Disadvantage: risk of infection, pre-mature labor, prolapsed cord

25
Q

What is important about Pitocin medications?

A

Continuous EFM
Position: on side for good uterine blood flow
Maintain IV fluid:!balance salt solution, lactated ringers with glucose

Mis pitosin per protocol

  • 20 units of pitosin in 1000ml LR
  • 3 ml/hr = 1 mU/min

IVPB to maintain IV via pump so you can take pitosin out and keep fluids going
-start at 0.5-1 mU/min

26
Q

What are complications of Pitocin?

A

Uterine tachsystole:

  • more then 5 contractions In 10 minutes
  • contraction duration is over 2 minutes
  • less then 1 minute between contractions

Pitosin has water retention quality so can cause water intoxication

If these occur discontinue pitosin

27
Q

What is the advantage of forceps-assisted birth?

A

Good if mom is exhausted or if have heart disease, baby OP and not coming down.

Strong epidural or spinal. Decrease need for Caesarian

28
Q

Why are the disadvantages of a forceps assisted birth?

A 
Metal (cause tissue damage to vagina)
Skull injury to fetus
Bruising 
Lacerations
Facial palsy (droops)
29
Q

What is the nursing care to do deal with forceps-assisted birth?

A

Explain why is going to happen
Needs good anesthesia
Assess and document fetal heart tones before applied and during the use
Assess for injury

30
Q

What is vacuum extraction?

A

Same idea as forceps

Soft suction cup applied at vertex of head and suction applied. Suction no more then 40-60 mm/Hg

Cookie cutter scalp injury results from the cut of skin via suction cup

31
Q

What are the indications of cesarean birth?

A

Preserve life and health of mom and baby

32
Q

What are the complications of Caesarian birth?

A

Increase maternal mortality
Hemorrhage
Bladder dysfunction
With c section only have 3 children

33
Q

What are the cuts for c-sections?

A

Classical: cut uterine fundus. Used for placenta previa and severe fetal distress. Fastest.
Low transverse
Low vertical

34
Q

What is the nursing care for Caesarian?

A

Teach and support: amount time, feeling, acknowledge feeling, no activan or Valium
Informed consent
ID band and allergies
Lab work: HgB, Hct, postassiu
Surgical team: surgeon, 1st assist, pediatrician, anesthesia, circulating nurse, scrub nurse, baby nurse
Equipment: all working, must have ground pad for cotorize
IV: risk for hemorrhage
Medication: acid neutralizer, no anxiety meds
Foley: empty bladder
Shave
Positioning: tilt bed, legs strapped and arms strapped on arm board
Immediate care of newborn
Post operative care: PACU or unit recovery
Postpartum care

35
Q

What’s re the indications for VBAC?

A

Want experience
Traumatized by previous c section
No other uterine scar, first one was low transverse
OB and anesthesia present in case of crash c sectio. Within 39 minutes

36
Q

What is the cause if shoulder Dystocia?

A

Should impacted and caught behind symphysis

37
Q

What are the signs of shoulder Dystocia?

A

Head goes out and comes back in “turtle”

38
Q

What is the treatment of shoulder Dystocia?

A

McRoberts maneuver: pull legs up and out to open pelvis wider
Supra pubic pressure: physicians will push shoulder down

39
Q

What do you never do in labor?

A

Give fundal pressure during birth because rupture wounds and kill baby

40
Q

What I juri occur with shoulder Dystocia?

A

Break clavicle
Petechia: bruise face
Brachial pelvis injury

41
Q

What is a prolapsed could and it’s risk factors?

A

OB emergency
Cord in front of baby will come down and baby compresses it
This is what we worry about when water breaks
Do emergency c-section and hold baby off cord until the surgery is done
Once water breaks check to e if head is engaged and if it is not they need to stay in bed

Risk factor: adverse fetal lie & abnormal fetal presence

42
Q

What is the nursing care for a prolapsed cord?

A

Prevention: watch multigravida
Relieve cord compression
C section

43
Q

What is an amniotic fluid embolus?

A

Bolts amniotic fluid, blocks blood vessels and body acts with I flammatory response to shock and die,

44
Q

What’s re the symptoms of amniotic fluid embolus?

A 
Dyspnea
Chest pain
Dry cough
Hemopoesis 
Cyanosis
Tachycardia
Syncope
Hypertension
Cardiac arrest
45
Q

What is the treatment of amniotic fluid embolus?

A 
Be supportive 
Give O2 
Elevate head of bed
Cheat x ray
IV Heprin 
Emboliectomy (pull out clot)

OB (10 decks)

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