Obstretics Part 3 Flashcards
How to know if Delivery is imminent
Contractions q2 min, PT distressed, bearing down, passing stool, Perineum bulging, can see crowning, not her first baby, hx if rapid delivery’s, sitting on one cheek
Multiple Gestations stats
Occur in about 3% of all pregnancies. Usually due to fertility drugs
How often are mothers multiple gestation pregnancy
1 in 80
Dizygotic Twins
Fraternal twins
Monozygotic Twins
Identical (think mono = one)
Most common Twin pregnancy type
1 Placenta/2 Amniotic sacs (monochorionic-diamniotic)
2nd most common twin pregnancy type
2 Placentas/ 2 Amniotic sacs (Diachronic , Diamniotic)
Rare twin Pregnancy Type
1 Placenta / 1 Amniotic Sac (Monochorionic , Nonoamniotic)
What are two risks for when the second twin is born
1.Cord prolapse, 2. Abruptio Placenta
When do contractions return after the first twin is born
5-10 min the continue. Then you can expect the second baby to be born in 15-45min USUALLY
When is the placenta Delivered with twins
USUALLY after BOTH twins are out. There are special circumstances of course
What should you do after the first twin is born
Clamp the umbilical cord immediately to prevent exsanguination of the undelievered twins unclamped cord
What position should patient be in to deliver a baby outside the hospital
Semifowler, woman’s torso propped up to a high fowlers if possible.
What are 8 supplies to have for delivery
1.Sterile Scissors/Scalpel 2. Suction 3. Two clamps 4.Blue pads/paper sheet/ paper towel / warm blankets /towels layered 5. 4x4’s and abdominal pads 6.plastic apron 7.two plastic bags 8. Foil blanket
Rupture of Membranes
Can happen with no labour. Labour can start within 12 hours of rupture. Note time colour amount and door. Look for prolapsed cord.
1st stage of delivery : Dilation Stage
From onset of regular contractions to fill dilation. Contractions start 15-20 seconds every 5-10 min then progress to 60 seconds every 1-3 min
Dilation of Cervix
NORMALLY 2-3cm long. Contractions cause it to thin and dilate up to 10cm for delivery
Second Stage of delivery (Expulsion Stage)
Full dilation of cervix. Contractions at there strongest 60-70 seconds every 2 min. Pt will have urge to push.
Vertex Position
Head first face down
3rd stage of delivery (Placenta Stage)
Delivery of baby ends to delivery of placenta 5-20min.
How many hours is the First stage of labour compared from Nullipara to Multipara
Nulli: 8-12 hours Multi: 6-8 Hours
How many hours is the Second stage of labour compared from Nullipara to Multipara
Nulli: 1-2 hours Multi: 30 min
How many hours is the Third Stage of labour compared from Nullipara to Multipara
Nulli: 5-60 min Multi: 5-60 min
Meconium
Consists of undigested debris from swelling amniotic fluid. Greenish black and viscous. Babies do this when they have diminished supply of oxygen. Suspect if breech. (Basically newborn poop)
Fetal Heart Rate Montering
110-160BPM , listen for one min immediately following a contraction. If HR decreased change position, give oxygen, look for a cord presenting, give an IV bolus
How to transport mother in active delivery
Left Lateral/Semi fowlers. IV’s (not at joints). Oxygen. IF anticipating delivery position pt on stretcher backwards so you can sit on the airway chair to deliver
Signs of Fetal distress
Determined by Fetal heart rate. Meconium. Foul smelling amniotic fluid. Contractions lasting >2 min. Bleeding
Vernix
Waxy/cheese coating on babies skin post delivery. Helps guide baby through birth canal. Moisturizers skin. Prevents heat loss and environmental stress. Protects against bacteria
How long should you delay cutting the umbilical cord
1-2 min. Clamp cord at 10 and 15 cm and cut in between those two clamps
Immediate care of Newborn
Bundle baby up including head. Let mother do skin to skin and breastfeed if possible.
What do you do if you see Meconium on a newborn
DO NOT STIMULATE BABY TO BREATHE - suction any Meconium out you see for 3-5 seconds THEN dry and stimulate
Lanugo
Fine downy body hair on a new born. Sheds before birth but can last 3-4 months. Anchors vernix to skin
Delivery of Placenta
5-20 min. Let it happen naturally don’t tug anything.
7 Notations at birth
1.Time 2. Presentation-vertex or breech 3. Colour of amniotic fluid 4. Apgar score 5. Sex of baby 5. Time of placenta delivery 6.Any unusual occurrences or treatments
What to do if the mother presents as stocky post delivery
Lay flat and bolus with IV fluid
PPH (Post Partum Hemorrhage)
Causes: Placental Tissue remaining, Uteirne Antony (uterus doesn’t contract after delivery). Large baby or multiple birth. Perineal/Cervical tears
Average, Moderate and Severe blood loss in delivery’s in mL
Average: 500mL Moderate: 500-1000mL Severe: 1000mL+
Post partum Hemorrhage Treatment
- IV 500mL bolus to 90 mmHg systolic. 2.Fundal massage while supporting uterus above the pubis 3.encourage breast feeding 4.encourage urination 5.lay flat/trendelenberg 6.NOTE AMOUNT OF BLOOD LOSS AND SIZE OF CLOTS
Uterus Inveresion
Uterus turning inside out. Ligaments and blood vessels are torn causing life threading hemorrhage. Approx 800-1800mL fluid loss. USUALLY OCCURS DUE TO PULLING ON CORD
Management of Uterine Inversion
1.CALL OLMC 2. Two large bore IVs 3.cover uterus with moist sterile dressings
TTTS : Twin to Twin Transfusion System
One twin get more nutrients than the other
