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Women's Care > PeriNatal Care > Flashcards

PeriNatal Care Flashcards

1
Q

Cat I FHR

A
  • Baseline rate: 110-160 beats per minute (bpm)
  • Baseline FHR variability: moderate
  • Late or variable decelerations: absent
  • Early decelerations: present or absent
  • Accelerations: present or absent
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2
Q

Cat II FHR

A

> Baseline rate:
-Bradycardia not accompanied by absent baseline variability
-Tachycardia
Baseline FHR variability
-Minimal baseline variability
-Absent baseline variability not accompanied by recurrent decelerations
-Marked baseline variability
Accelerations
-Absence of induced accelerations after fetal stimulation
Periodic or episodic decelerations
-Recurrent variable decelerations accompanied by minimal or moderate baseline variability
-Prolonged deceleration ≥ 2 minutes but < 10 minutes
-Recurrent late decelerations with moderate baseline variability
-Variable decelerations with other characteristics, such as slow return to baseline, “overshoots”, or “shoulders”

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3
Q

Cat III FHR

A 
Absent baseline FHR variability and any of the following:
o Recurrent late decelerations
o Recurrent variable decelerations
o Bradycardia
 Sinusoidal pattern
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4
Q

When to push?

A

@full cervical dilation vs. descent of presenting part (“laboring down”)

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5
Q

NSVD steps

A
  1. slow, controlled pushing as infants head crowns; support perineum
  2. Perineum eased over fetal head; allow head to restitute
  3. Gentle downward traction on head to deliver anterior shoulder
  4. Gentle upward traction while pinning arms to deliver body and onto maternal abdomen
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6
Q

Indications for IOL

A

•Risks (to mother or fetus) of continuing Preg outweigh the risks a/w effecting deliv, &
no contraindication to vaginal birth
• Labor should not be electively induced prior to 39 w gest. due to significantly elevated neonat morbidity

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7
Q

Methods of cervical ripening/IOL

A
  • Oxytocin => IOL
  • Misoprostol => CR or IOL (vaginal or oral)
  • Dinoprostone => CR or IOL
  • Amniotomy alone
  • Balloon catheter
  • Membrane stripping
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8
Q

FHT Accelerations definition

A

-Increased FHR ≥15 bpm for ≥15 s
-Time from baseline to peak HR is <30 s.
-Prolonged acceleration lasts
2–10 min

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9
Q

FHT Decelerations

A 
Early = Nadir w/ peak of contraction. Baseline to nadir takes >30 s
Late = : Nadir after peak of contraction. Baseline to nadir >30 s.
Variable = ↓ ≥15 bpm from baseline lasting at least 15 s. Baseline to nadir <30 s
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10
Q

Early decels vs. Late vs. Variable indications

A
  • Early = head compression
  • Late = hypoxemia/uteroplacental insufficiency
  • Variable = cord compression
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11
Q

Common causes of fetal tachy

A
  • Fetal hypoxia
  • Maternal fever
  • Hyperthyroidism
  • Maternal or fetal anemia
  • Parasympatholytic drugs
  • Sympathomimetic drugs
  • Terbutaline (Bricanyl)
  • Chorioamnionitis
  • Fetal tachyarrhythmia
  • Prematurity
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12
Q

Non-reassuring FHTs

A
  • Fetal tachycardia
  • Fetal bradycardia
  • Saltatory variability
  • Variable decelerations associated with a nonreassuring pattern
  • Late decelerations with preserved beat-to-beat variability
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13
Q

Ominous FHTs

A

Persistent late decelerations with loss of beat-to-beat variability

Nonreassuring variable decelerations associated with loss of beat-to-beat variability

Prolonged severe bradycardia

Sinusoidal pattern

Confirmed loss of beat-to-beat variability not associated with fetal quiescence, medications or severe prematurity

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14
Q

OB Criteria for Admission in Pre-Term Labor

A
  • persistent and painful contractions; ~>6 ctx/hr
  • rupture of membranes
  • vaginal bleeding
  • dilation >3cm and/or effacement >80%
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15
Q

Indications of ROM

A
  • hx: “sudden gush” or “fluid running down legs”
  • speculum: pooling in vagina
  • nitrazine: pH>6.5, blood/semen/BV assoc. w/false positive
  • amnisure test
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16
Q

OB admission criteria in normal laboring patients

A
  • cervical dilation >3-4cm w/reg and painful ctx
  • ruptured membranes
  • bloody “show” or complete cervical effacement w/regular and painful ctx
17
Q

Subjective components of L&D admission

A
  • CC
  • HPI w/s/sx of labor, ABDCDE, pain plan, BF, birth control
  • Dating criteria
  • OB hx
  • GYN hx: stds/surg/paps
  • PMhx
  • Meds
  • Allergies
  • FHx
  • Social
  • ROS
18
Q

Objective components of L&D admission

A
  • Vitals
  • PE: HEENT, neck, CV/pulm, Abd (EFW), pelvis (cervix, position, membranes), extremities (edema, DTRs)
  • FHTs
  • Labs
  • US/imaging
  • Prenatal labs
19
Q

A/P and Problem List for L&D admission

A
  1. [xxx] IUP: assessment of tracing/labor
  2. main reason for admission (e.g. medical problem/pre-e vs. active labor)
  3. induction if applicable
  4. OBGYN problems
  5. medical problems: DM, thyroid, etc.
  6. GBS
  7. feeding/birth control
  8. other problems

Women's Care (8 decks)

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