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Special Populations > Obstretics Part 3 > Flashcards

Obstretics Part 3 Flashcards

1
Q

How to know if Delivery is imminent

A

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

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2
Q

Multiple Gestations stats

A

Occur in about 3% of all pregnancies. Usually due to fertility drugs

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3
Q

How often are mothers multiple gestation pregnancy

A

1 in 80

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4
Q

Dizygotic Twins

A

Fraternal twins

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5
Q

Monozygotic Twins

A

Identical (think mono = one)

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6
Q

Most common Twin pregnancy type

A

1 Placenta/2 Amniotic sacs (monochorionic-diamniotic)

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7
Q

2nd most common twin pregnancy type

A

2 Placentas/ 2 Amniotic sacs (Diachronic , Diamniotic)

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8
Q

Rare twin Pregnancy Type

A

1 Placenta / 1 Amniotic Sac (Monochorionic , Nonoamniotic)

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9
Q

What are two risks for when the second twin is born

A

1.Cord prolapse, 2. Abruptio Placenta

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10
Q

When do contractions return after the first twin is born

A

5-10 min the continue. Then you can expect the second baby to be born in 15-45min USUALLY

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11
Q

When is the placenta Delivered with twins

A

USUALLY after BOTH twins are out. There are special circumstances of course

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12
Q

What should you do after the first twin is born

A

Clamp the umbilical cord immediately to prevent exsanguination of the undelievered twins unclamped cord

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13
Q

What position should patient be in to deliver a baby outside the hospital

A

Semifowler, woman’s torso propped up to a high fowlers if possible.

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14
Q

What are 8 supplies to have for delivery

A

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

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15
Q

Rupture of Membranes

A

Can happen with no labour. Labour can start within 12 hours of rupture. Note time colour amount and door. Look for prolapsed cord.

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16
Q

1st stage of delivery : Dilation Stage

A

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

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17
Q

Dilation of Cervix

A

NORMALLY 2-3cm long. Contractions cause it to thin and dilate up to 10cm for delivery

18
Q

Second Stage of delivery (Expulsion Stage)

A

Full dilation of cervix. Contractions at there strongest 60-70 seconds every 2 min. Pt will have urge to push.

19
Q

Vertex Position

A

Head first face down

20
Q

3rd stage of delivery (Placenta Stage)

A

Delivery of baby ends to delivery of placenta 5-20min.

21
Q

How many hours is the First stage of labour compared from Nullipara to Multipara

A

Nulli: 8-12 hours Multi: 6-8 Hours

22
Q

How many hours is the Second stage of labour compared from Nullipara to Multipara

A

Nulli: 1-2 hours Multi: 30 min

23
Q

How many hours is the Third Stage of labour compared from Nullipara to Multipara

A

Nulli: 5-60 min Multi: 5-60 min

24
Q

Meconium

A

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)

25
Q

Fetal Heart Rate Montering

A

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

26
Q

How to transport mother in active delivery

A

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

27
Q

Signs of Fetal distress

A

Determined by Fetal heart rate. Meconium. Foul smelling amniotic fluid. Contractions lasting >2 min. Bleeding

28
Q

Vernix

A

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

29
Q

How long should you delay cutting the umbilical cord

A

1-2 min. Clamp cord at 10 and 15 cm and cut in between those two clamps

30
Q

Immediate care of Newborn

A

Bundle baby up including head. Let mother do skin to skin and breastfeed if possible.

31
Q

What do you do if you see Meconium on a newborn

A

DO NOT STIMULATE BABY TO BREATHE - suction any Meconium out you see for 3-5 seconds THEN dry and stimulate

32
Q

Lanugo

A

Fine downy body hair on a new born. Sheds before birth but can last 3-4 months. Anchors vernix to skin

33
Q

Delivery of Placenta

A

5-20 min. Let it happen naturally don’t tug anything.

34
Q

7 Notations at birth

A

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

35
Q

What to do if the mother presents as stocky post delivery

A

Lay flat and bolus with IV fluid

36
Q

PPH (Post Partum Hemorrhage)

A

Causes: Placental Tissue remaining, Uteirne Antony (uterus doesn’t contract after delivery). Large baby or multiple birth. Perineal/Cervical tears

37
Q

Average, Moderate and Severe blood loss in delivery’s in mL

A

Average: 500mL Moderate: 500-1000mL Severe: 1000mL+

38
Q

Post partum Hemorrhage Treatment

A
  1. 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
39
Q

Uterus Inveresion

A

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

40
Q

Management of Uterine Inversion

A

1.CALL OLMC 2. Two large bore IVs 3.cover uterus with moist sterile dressings

41
Q

TTTS : Twin to Twin Transfusion System

A

One twin get more nutrients than the other

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