Partution ii Flashcards
Fetal monitoring
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)
Medications during labor
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
epidural
numbs from belly button to thigh region
still feel pressure though
b/t L3 and L4
different kinds of blocks
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)
Forcep and vacuum extraction asisted delivery
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
Breech birth
stats too
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
Cesarean Delivery stats and reasons
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
Steps to C-section
spinal or general anesthesia required
- abdominal incision
- uterine incision
- baby removal
Indications that a C-section is needed
- 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)
Multiple births: stats
how much earlier are they born?
Which races are more likely to have multiple births?
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
Preterm births: definition and causes
<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%)
Preterm births: risks and survival rates
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%
Risk factors of premature births and prevention
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
Stillborn: definition and interventions
percent?
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)
Causes of stillborn
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
placenta or umbilical cord problems
knot or compression in cord - decreaes oxygen delivery
- placental abruption - placenta separates from uterine wall
- placental infections, inflammation: problems with blood vessel
placental abruption
placenta detatches from uterus causing either internal bleeding or blood clot
Hemolytic disease of the newborn
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
