Presentation Material Flashcards
Shoulder Dystocia
Failure of the anterior fetal shoulders to deliver after the fetal head
Two biggest risk factors for shoulder dystocia?
Abnormalities in maternal pelvis and macrosomia
What are some signs of shoulder dystocia?
Slow second stage of labor and fetal head emerging and retracting (turtle sign)
What is a top cause of malpractice claims?
Shoulder dystocia that results in permanent fetal injury
The McRoberts manuever
moves the sacrum and synthesis pubis to decrease the angle of inclination
What is the preferred method of shoulder dystocia?
Done with epidural anesthesia
How do you dislodge fetal shoulders from the pubic bone in the McRoberts manuever?
Apply suprapubic pressure directly above the symphasis pubis
Fetal Non-Stress Test
a normal fetus prouces characteristic heart rate patterns in response to fetal movement, uterine contractions, or stimulation
What is the most common reason for the absence of FHR accelerations?
quiet fetal sleep state
How will a woman be placed for a NST?
In a relining chair to allow optimal uterine perfusion and to prevent supine hypotension
What is a NST looking for?
signs of fetal activity and a concurrent acceleration of FHR
A reactive test means
there were two accelerations of their heart rate in a 20-minute period
A non-reactive test interventions may include
Giving the mother orange juice, vibroacoustic stimulation, and music
The disadvantage of Fetal non stress test is that there is a
high rate of false positive nonreactive tests
What is Rh?
A protein on the surface of RBC’s
What are Rh- blood types?
O+, O-, A-, B-, AB-
What is one way a mom may have the antibodies?
If Rh- mom has previously had a Rh+ baby
What is necessary to test for mother to know if there may be an incompatability?
Mothers blood type and if mother has antibodies to Rh protein
How can a Rh+ baby cause a mother to produce antigens?
Baby’s Rh blood can enter mother’s circulation and cause mother’s body to produce antibodies that attach Rh+ RBCs
What is the biggest worry in a first pregnancy incompatability?
Rh sensitization in future pregnancies
What is Rh sensitization?
Occurs when mother’s antibodies cross the placenta and attack Rh+ RBC’s in baby
What does Rhogam do?
prevents maternal blood from producing antibodies that attack Rh+ RBC’s by binding to Rh+ and removing them from circulation
When should Rhogam be given?
28 weeks and within 72 hours of delivery
What is circumcision?
the removal of all or part of the foreskin of the penis
Health benefits of NMC:
prevention of UTI, reduced risk for penile cancer, and reduced risk for STI’s, particularly HIV
What are some reasons parents choose to have NMC?
hygiene, religious conviction, tradition, culture, social norms
Why is NMC not performed immediately after birth?
danger of cold stress and decreased clotting factors
How do you prepare for a NMC?
penis is cleaned with soap and water or antiseptic solution, draped to provide warmth and sterile field
Gomco clamp
surgical removal, minimizes blood loss., ned petroleum gauze dressing for 24 hours after
PlastiBell
fitted over glans, suture tied around rim of bell, and excess foreskin is cut away; plastic rim falls off when it heals, petroleum gauze is not necessary
How often do you check for bleeding in NMC?
Every 15 - 30 minutes for first hour and then hourly for next 4 - 6 hours. Then with every diaper change thereafter
What do you do if bleeding occurs in NMC?
apply gentle pressure with a folded sterile gauze square
How often should an infant have a wet diaper after NMC?
2 - 6 times per 24 hours the first 1 - 2 days, then 6 - 8 times per 24 hours after 3 - 4 days
How to keep area clean after NMC?
Change diaper and inspect every 4 hours, wash penis with just water (no soap or baby wipes), apply petroleum with each diaper change, apply diaper loosely
What is the goal of cord care?
prevent or decrease the risk for hemorrhage and infection
The cord should be kept
clean and dry
The umbilical cord consists of
two arteries and one vein
How do you clean the cord?
Give sponge baths, cleanse with water at the base of the cord where it joins the skin
How frequently does cord get assessed and cleaned?
Every diaper change; if cord is soiled clean it with water and dry it thorougly
When is the cord clamp taken off?
when the cord is dried; about 24 - 48 hours
When should the cord fall off?
10 - 14 days to 3 weeks
What happens to the cord about day 3?
It becomes black, dry, and shriveled
What might happen when the cord separates?
There may be a few drops of blood from the umbilicus
What should a woman do for lactation suppression?
wear w well-fitted support bra continuously for the first 72 hours
What should the mother avoid when suppressing lactation?
breast stimulation, running warm water over breasts, newborn suckling, expressing milk
How can a woman manage engorgement of breasts?
application of ice packs, cabbage leaves, a mild analgesic or anti-inflammatory medication
