Partution ii

Question 1

Fetal monitoring

Answer 1

Auscultation
-Periodic assessment of fetal heart rate at abdominal surface (Doppler transducer)

External monitoring – belts around abdomen

• Fetal heart rate (Doppler)
• Length of contractions

Internal monitoring

• Electrode placed on baby’s scalp – monitors fetal heart rate
• Intrauterine pressure catheter – monitors contractions

Stress? (detection of abnormal heart rate)

• Position change
• Cesarean OR forceps with vacuum extraction (1 out of 20 births)

Question 2

Medications during labor

Answer 2

General anesthesia

• unconscious during delivery
• dmergency use only

Local anesthesia

• allows participation during delivery
• pain releif - lack of sensations
• motor control maintained - can help push with contractions

Question 3

epidural

Answer 3

numbs from belly button to thigh region
still feel pressure though
b/t L3 and L4

Question 4

different kinds of blocks

Answer 4

spinal (saddle) block: blocks both sensory and motor functions

Pudendal block: injection into pudendal nerves on each side of vagina (eases pain, but still feel contractions)

Paracervical block: injection on both sides of cervix (eases pain, but can still feel contractions)

Question 5

Forcep and vacuum extraction asisted delivery

Answer 5

curved metal instruments used to guide baby’s head through vagina

Requirements:

• proper head position in pelvis
• membranes are ruptured
• max cervical dilation

Cup shaped extractor applies suction to top of baby’s head
-labor long and not progressing

Question 6

Breech birth

stats too

Answer 6

Heat down is safest position for birth –> most babies turn to head down in 3rd trimester

Breech = 3-4% of births
Feet or butt is against cervix
-can try to turn baby with external pressure
-can be delivered vaginally, but there’s risk of umbilical cord compression
-most opt for a C-section

Transverse lie

• 1/200 births
• always requires a C-section

Question 7

Cesarean Delivery stats and reasons

Answer 7

in 1970 5.5%
Now 33%

Why?

• practice to delivery subsequent babies after 1st C-section
• increased fetal monitoring
• more multiple births
• older moms
• maternal complications: obesity and diabetes
• takes less time
• decreases fetal and maternal deaths
• liability

Question 8

Steps to C-section

Answer 8

spinal or general anesthesia required

1. abdominal incision
2. uterine incision
3. baby removal

Question 9

Indications that a C-section is needed

Answer 9

• transverse or breech baby
• size issues (small pelvis or big baby)
• fetal distress
• umbilical cord compression –> decreases oxygen supply to fetus
• difficult vaginal deliveries that jeopardize motehr or baby’s health
• placenta previa
• placental abruption (premature placental separation from uterus)

Question 10

Multiple births: stats
how much earlier are they born?
Which races are more likely to have multiple births?

Answer 10

1: 71 twins
- hereditary factors for fraternal, not identical
- race: black > white > Asian

1: 6400 triplets
1: 512,000 quadruplets

Average 22 days earlier delivery

Question 11

Preterm births: definition and causes

Answer 11

<37 weeks gestation - 12% of pregnancies
-low birth weight < 5.5 lbs

Common causes:

• premature rupture of amnion (30%)
• elective/necessary (15-20%)
• unknown (45-50%)

Question 12

Preterm births: risks and survival rates

Answer 12

Greater risk of death and disability

• 70% of neonatal deaths; 50% of congenital neurological disabilities
• cerebral palsy - brain development –> affects body movement and muscle coordination
• chronic lung disease (no surfactant)
• deafness and blindness
• learning disabilities

Survival
-38 weeks >99%
-27 weeks 90%
-25 weeks 50-80%
-23 weeks 10-35%
<22 weeks <1%

Question 13

Risk factors of premature births and prevention

Answer 13

Risks:

• 1st baby was premature
• multiple births
• fetal birth defects
• maternal disorders

Prevention

• bedrest
• no sex
• relax uterus w/ progesterone, calcium-channel blockers, anti-PGs, oxytocin receptor inhibitors
• only delays for a few days

Question 14

Stillborn: definition and interventions

percent?

Answer 14

die after 20 weeks gestation

• happes in 1% of births
• most die before labor begins

Interventions

• none - usually go into labor within 2 weeks of death
• induction
• C section
• D&E (dilation and evacuation)

Question 15

Causes of stillborn

Answer 15

Infections in mom or baby

• herpes or fifth disease
• STDs: genital herpes and syphilis
• listeriosis = food poisoning
• toxoplasmosis - undercooked meat and cat poop

Pregnancy complications
>42 weeks, preterm labor
-maternal conditions: diabetes, obesity, hypertension, preeclampsia, autoimmune disorder, thyroid problems
-fetal conditions: birth defect, fetal growth restrictions, Rh disease
-trauma/injury

Question 16

placenta or umbilical cord problems

Answer 16

knot or compression in cord - decreaes oxygen delivery

• placental abruption - placenta separates from uterine wall
• placental infections, inflammation: problems with blood vessel

Question 17

placental abruption

Answer 17

placenta detatches from uterus causing either internal bleeding or blood clot

Question 18

Hemolytic disease of the newborn

Answer 18

can be prevented with blood typing and medication to prevent antibody production in mom

Happens when mom is Rh negative, but baby is Rh positive, so mom makes antibodies which attack the next Rh positive kid