OB Test 2: High Risk Intrapartum Flashcards
What is late preterm?
34-36 week
What is preterm?
Between 20-37 weeks
What is low birth weight?
Less then 2500 grams
5.5 pounds
What is vlbw?
Less then 1500 grams
3.51 pounds
What is PROM?
Premature rupture of membranes
What are preterm risk factors?
African American Previous preterm birth Multiple gestation Uterine anomalies Socio economic disadvantage Smoking GU dysfunction No prenatal care
What are preterm labor symptoms?
Backache
Cramping
Pressure
Increased vaginal discharge
What are preterm labor assessments?
Cervix 4cm
Rupture of membranes
Infection: urinalysis
Ffn: fetofkbronectin kndicates at risk. Iran
Cervical length: >30mm less likely to deliver
What is treatment of preterm labor?
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
What are tocolytics?
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
What is PROM?
Unknown causes associated with infection and Inflammation
Preterm premature rupture of membrane
What are the risks with PPROM.
Chorioamnionitis: infection going to the amniotic fluid
Neonatal sepsis
What is the treatment of PPROM.
Expected management
Wait, monitor infection, no vaginal exams, antibiotic
What are labor complications?
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
What is version?
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
What are the indications for labor induction?
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
What are labor induction contraindications?
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
What is induction and augmentation?
Induction: stimulation of labor contractions before they begin
Augmentation: labor Dystocia (not strong enough)
What are the different elements of bishop score?
What bishops score do you want?
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
What are cervical ripening agents?
Prostaglandins
- PGE2 inert (cervidil)
- PGE2 gel (prepidil)
- PGE1 (cytotec)
What are prostaglandins insert?
Gel?
PGE1?
Left in place 12 hours on side
Gell, squirt into cervical oz but cannot be removed
PGe1: tablet orally or placed around cervix
What’s re the risks of cervical ripening agents?
Uterine tachsystole
Fetal distress
How do you fix cervical ripening agents?
Pull out cervidil and get terbutaline
How can you stimulate labor?
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
What is amniotomy (AROM) advantages? Disadvantages?
Advantage: rupture membranes stimulate labor and evaluate color
Disadvantage: risk of infection, pre-mature labor, prolapsed cord
What is important about Pitocin medications?
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
What are complications of Pitocin?
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
What is the advantage of forceps-assisted birth?
Good if mom is exhausted or if have heart disease, baby OP and not coming down.
Strong epidural or spinal. Decrease need for Caesarian
Why are the disadvantages of a forceps assisted birth?
Metal (cause tissue damage to vagina) Skull injury to fetus Bruising Lacerations Facial palsy (droops)
What is the nursing care to do deal with forceps-assisted birth?
Explain why is going to happen
Needs good anesthesia
Assess and document fetal heart tones before applied and during the use
Assess for injury
What is vacuum extraction?
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
What are the indications of cesarean birth?
Preserve life and health of mom and baby
What are the complications of Caesarian birth?
Increase maternal mortality
Hemorrhage
Bladder dysfunction
With c section only have 3 children
What are the cuts for c-sections?
Classical: cut uterine fundus. Used for placenta previa and severe fetal distress. Fastest.
Low transverse
Low vertical
What is the nursing care for Caesarian?
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
What’s re the indications for VBAC?
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
What is the cause if shoulder Dystocia?
Should impacted and caught behind symphysis
What are the signs of shoulder Dystocia?
Head goes out and comes back in “turtle”
What is the treatment of shoulder Dystocia?
McRoberts maneuver: pull legs up and out to open pelvis wider
Supra pubic pressure: physicians will push shoulder down
What do you never do in labor?
Give fundal pressure during birth because rupture wounds and kill baby
What I juri occur with shoulder Dystocia?
Break clavicle
Petechia: bruise face
Brachial pelvis injury
What is a prolapsed could and it’s risk factors?
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
What is the nursing care for a prolapsed cord?
Prevention: watch multigravida
Relieve cord compression
C section
What is an amniotic fluid embolus?
Bolts amniotic fluid, blocks blood vessels and body acts with I flammatory response to shock and die,
What’s re the symptoms of amniotic fluid embolus?
Dyspnea Chest pain Dry cough Hemopoesis Cyanosis Tachycardia Syncope Hypertension Cardiac arrest
What is the treatment of amniotic fluid embolus?
Be supportive Give O2 Elevate head of bed Cheat x ray IV Heprin Emboliectomy (pull out clot)
