OB test 4 Flashcards
When is it considered preterm labor?
20-37 weeks
How many contractions is a sign of preterm labor?
4 or more in one hour
2 s/s of premature labor
change/increase of vaginal discharge, intestine cramps/diarrhea
what is the protein and the rule with PTL
Fetal fibronectin ; if found 22-34 weeks, strong indicator that you will deliver in the next 2 weeks. does not work after 34 weeks.
what is normal length of a cervix?
3-4 cm
fibronectin
relax uterus
PTL treatment 2 non pharm
Empty bladder, hydration
4 meds for preterm labor
Terbutaline, Nifedipine, magnesium sulfate, betamethasone
Terbutaline M/A one thing Route Adverse effects 2 Complications 5
Smooth mm relax
Not first line
SQ/IV/PO
Epi respiratory edema
arrhythmias, hypotension, hypokalemia, hyperglycemia, ketoacidosis
Nifedipine MA SE 4 one thing route
ca channel blocker decreases contractions
Hypotension, HA, Tachy, flushing
can use with terbutalin not with mag
PO
Magnesium sulfate MA and why that works SE 2 One good thing when to use? route
Calcium antagonist (Needed to produce prostaglandin) Depressant, decrease urine output and Neuro protection for babe prior to 32 weeks IV
betamethosone
MA and how that helps?
route
When to use 3 things
Glucocorticoid
IM-Increases surfactant
up to 37 weeks, at least 24 hours before delivery, 2 doses 24 hours apart.
What is something to remember about preterm delivery and pharm intervention
Avoid opioids.
Contraindications to arresting PTL 7
o Fetal infection o Chronic fetal distress o IUGR o Intrauterine death o Pulmonary maturity o Maternal distress o Placental abruption
5 ps
powers, passageway, passenger, psyche, position
Contraction rule
Every 2-5 mins lasting at least a min but less than 2
What is hypertonic labor?
High frequency, low amplitude UC in first stage in early phase
How do we assess hypertonic labor?
Cervix and fundus Very painful
What is hypotonic labor?
• Etiology: weak, irregular, ineffective UC’s
3 causes of hypotonic labor
o Over distended uterus, bowel, bladder
o Secondary inertia
o Excessive analgesia
4 ways to help hypotonic labor
o IV fluids
o I&O
o Augmentation
o Assess P’s
3 Passageway issues
Cephalo-pellvic disproportion
placental previa
bowl bladder distention
tx of passageway obstruction
4
pelvimetry trial of error delivery route positioning empty bowl/bladder
Passanger dystocia causes 7
Multi-fetal preg mal presentation occiput post macrosomia shoulder dystocia hydramnios chorioamnionitits
What do we document with FHR
baseline
variability
accelerations
decelerations
What do we document with UC?
Frequency, strength, duration
What is a normal fetal heart rate?
110-160
what might bradycardia on a fetal monitor mean? 3
o Congenital heart defects, maternal medication, prolonged hypoxia
What would tachy mean on a fetal monitor 4
Maternal fever, dehydration, drugs, early fetal hypoxia
What is variability?
Irregular fluctuations in the baseline FHR which is measured in beat/minute (bpm)
One thing about variability
Indicates absence of metabolic acidosis.
How is variability measured? give numbers
Absent
minimal-1-5 bpm
Moderate 6-25bpm
Marked- >25bpm q
Acceleration
Greater than or equal to 15 bmp for 15 seconds but less than 2 mins
What kinds of deceleration can you have
Early
variable
late
prolonged
What is an early deceleration? 2
Smooth dip in baseline FHR greater than or equal to 30 seconds to the nadir.
returns before or with UC
What does early deceleration mean? 5
Fetal head compression, SVE, Pushing, FSE application, ROM
what is a early late and variable deceleration mean?
E-Normal
L-placenta
v-umbilical cord
What is Variable deceleration 2
sudden drop greater than or equal to 15 seconds but less than 2min
less than 30 seconds to nadir
Veal Chop
Variable Cord compression
early head compression
accel Okay
late Placental insu
what do we do for uterine resuscitation 5
Change position, give o2 at 10lt pr min with non-rebreather mask, turn of oxy
IV fluids
Call provider
late deceleration
Smooth dip greater than 30 seconds to the nadir begins at or after the peak of the contraction
2 things to remember with late decelerations
Beats don’t matter
they always go with contractions
prolonged deceleration
Decrease of at least 15 bpm
lasts 2 mins but less than 10
How to measure frequency of a contraction
beginning of one contraction until the beginning of the next
Frequency at the beginning and end of labor
10-20mins
2-3 mins
Duration of contraction is measured
beg and end of same contraction
Values for frequency beginning and end of labor
15-25 seconds
45-90 seconds
What is tachysystole give value
Greater than 5 UC in 10mins or contraction lasting longer than 2 mins.
How is frequency measured?
Beginning of one contraction until the beginning of the next. measured in mins ranging from sm to larg in 10 min window
documentation of frequency for low risk and high risk
LR-1st stage-30mins
2nd stage-15 mins
HR-1-15min
2-5mins
physical considerations to teen moms 4
PreE
cephalopelvic disporportion
nutrition
anemia
How does an mother abused infant respond? 5
irritable, easily startles, lack of responsiveness, failure to thrive, developmental delays.
3 reasons why we dont need to report abuse
if they are 18 and say no
if it is not something we already need to report
the injury is not a serious bodily injury
Four things about reporting abuse
we need to document the clients request
always refer to victim services
If reported to authorities we must make an effort to let the victim know first
When do we do chronic villus sampling
8-12 weeks
What is the risk for chronic villus sampling percent
1-2 percent fetal damage, limb defects
What do we test for chronic villus sampling
1-3
and 1 it does not
chromosomal defects, hemophilia, sickle cel, sex link disorders
no nerotube defects
What is chronic villus sampling?
Removal of small tissue specimen from the fetal portion of the placenta, which reflects the fetal genetic makeup;
procedure for Alpha fetoprotein
A sample of the woman’s blood is drawn to evaluate plasma protein that is produced by the fetal liver, yolk sac, and GI tract, and crosses from the amniotic fluid into the maternal blood
What if alphafetoprotein in high? 7
Increased levels might indicate a neural tube defect, Turner syndrome, tetralogy of Fallot, multiple gestation, omphalocele gastroschisis, or hydrocephaly.
What if alpha fetoprotein is low?
downs
when can we get serum from mom to test for alphfetoprotein?
15-18 weeks
When is amniocentesis done
give three and why
15-20 weeks-AFP chrom
20+ fetal surveillance
3rd tri for maconium-stress
How is amniocentesis done? 3 things
Ultrasound guides a needle and 20ml of fluid local anesthesia is used
Two more things that amniocentesis can be used for
Asses fetal lung maturity
levels of bilirubin
Biophysical profile
uses US over 30 min determines fetal well being
Where do we put fetal monitoring over 2
Toco over fundus and ultrasound over back
What are the two internal monitors
Fetal scalp electrode and intra-uterine pressure catheter
When is a Non-stress test reccomended?
Currently, an NST is recommended twice weekly (after 28 weeks’ gestation) for clients with diabetes and other high-risk conditions, such as intrauterine growth restriction (IUGR), preeclampsia, post-term pregnancy, renal disease, and multifetal pregnancies
How do we document a fetal non-stress test and what is good?
Reactive/nonreactive
reactive is good
What is the criteria for a non-stress test?
Needs to be 32 weeks
2 movements with accelerations over 15 beats above baseline for 15 at least seconds
What is the contraction stress test
Tests for 2
how is it done
02 reserves and utero/placental insufficiency
Mom is hooked up to fetal monitor and given oxytocin until we get 3 contractions in 10 mins
Interpretation of contraction stress test
What is good?
What indicates bad?
Can we retest?
Negative is good
Late decelerations with 50 percent is positive and c section is likely
can be repeated in 24 hours if inconclusive.
Occult prolapse
Hidden can’t be seen or felt by SVE
Cord prolapsed in front of head
Can’t be seen but can be felt
Complete cord prolapse
Can be seen
Umbilical cord prolapse associated with 6
ROM, PROM, long umbilical cord, breech births, post dates, multiples
FHR monitoring with cord prolapse 4 things that would show up.
Bradycardia, variable decelerations possible late decelerations, SVE
What position for cord prolapse
Trendelenburg
What statute do we use for abuse
HB171322
Earliest day to get elective induction
not before 39 weeks
4 contraindications of induction
Over distended uterus, placenta previa, fetal distress, previous vertical incision
What is bishop score? what is a high score indicative of?
cervix readiness for Induction
higher is more favorable.
what criteria is in the bishop score? 5
and ranked
Dilation, effacement, station, consistency, position
0-3
What do we do if there is a low bishop score?
use ripening agents
What are the two pharm interventions used as ripening agents.
Cytotec prostaglandin
What are the 2 risks associated with pharm interventions for ripening
tachysytole and post part hem
What do we use for mechanical methods for ripening 2
Cervical ripening baloon
lar seeweed
2 things to know about cervical ripening balloon
how long?
when removed?
One thing about it
For 12-24 hours
removed 4-5cm
have to be dilated to get in but not ROM
What is amniotomy?
Breaking membranes with amni hook
What are the risk/considerations of aminotomy 3
Prolapsed cord, stress on babe, need IV
Big consideration for amniotomy
Head engaged
Risks for oxytocin
HypoTN, water intoxication, tachy, edema, pulm edema, uterine rupture.
Four reasons for obstetric hem in first half of preg
SAB, Ectopic preg, Gestational trophoblastic disease, cervical insufficiency
2 reasons for obstetric hem for second half of preg
Placenta previa, placental abruption
What are the biggest causes of obstetric hem? 2
Denial and delay
Maternal diseases that can be a problem with Obstetric hem 5
Hypothyroidism, diabetes, thrombophilia’s PCOs. hypertension
3 reasons fetal demise in 1st trimester
Genetic abnormalities, faulty implantation, endocrine imbalances
2nd and 3rd trimester fetal demise
Uterine anomalies, infections, maternal disease, substance abuse.
SAB classifications with detail
Threatened bleeding cramping low back pain but cervix is closed
imminent.inevitable- increased but with dilation
incomplete not all tissue out
habitual greater than or equal to 3
What is cytotech used for
Ending a pregnancy
When do we have symptoms for ectopic preg?
6-8 weeks
ectopic pregnancy statistics
1-100
s/s of ectopic preg 3
Amenorrhea, ab pain, with or without bleeding
What happens with hCG in ectopic preg
If it won’t double may indicate ectopic
What drug do they use with ectopic pregnancy?
mathotrexate
Stats for gestational trophoblastic disease
1 in 1500
How to diagnose gestational trophoblastic disease 3
no fetal heart tones at 12 weeks and high hCG levels, high fundal height
How do we diagnose Gestational trophoblastic disease?
How do we treat it 2 and what to watch for 2
Ultrasound
Oxy and cytotech
DIC and hemorrhage
When do we notice cervical insufficiency
16-24 weeks
What is cervical insufficiency
Premature dilation of the cervix in the absence of uterine contractions
rate of cervical insufficiency
500 in 1000
How do we treat cervical insufficiency?
Cerclage
when do we do a cerclage when do we clip
up to 28 weeks
36 weeks
what is placenta previa and 3 things it can cause
abnormal placement of placenta
Abruption, hemorrhage, accreta
What is accreta?
Placenta growing into the uterine mm
placenta previa stats
1-200
placenta previa risk factors 5
Previous c section, multi-parity, smoking, infertility treatment, AMA
S/s of placenta previa 5
Thin, bright red vaginal bleeding, painless, with or without contraction, soft non-tender abdomen, FHR WNL
Placenta previa management 6
bed rest, NPO, Fetal monitoring, NO SVE, tocolytics, csection
What is placental abruption?’
when?
One big risk
Premature separation of placenta
greater than 20 weeks
Having had it before
Causes of placental abruption 6
HyperTN PreE DM short umbilical cord decompression of uterus AMA
Symptoms of placental abruption
Dark red thick blood (if any)
Stron contractions
Ridged tender ab
Shock symptoms
placental abruption complications 2
Renal fail, DIC
What kinds of placental abruptions are there
Marginal, partial, complete
