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Women's Health > Quiz 9 > Flashcards

Quiz 9 Flashcards

1
Q

Dystocia

A

Abnormal or difficult labor

Progress of labor deviates from normal

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2
Q

Risk factors for dysocia

A 
Epidural analgesia/excessive analgesia
Multiple gestation
Hydramnios
Maternal exhaustion
Ineffective maternal pushing technique
Occiput posterior position
Longer first stage of labor
Nulliparity, short maternal stature
Fetal birth weight over 8.8 lb.
Shoulder dystocia
Abnormal fetal presentation or position
Fetal anomalies
Maternal age over 35 years
High caffeine intake
Overweight
Gestational age over 41 weeks
Corioamnionitis
Ineffective uterine contractions
High fetal station at complete cervical dilation
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3
Q

Causes of dystocia (probs with powers)

A

Hypertonic uterine dysfunction (never relaxes)
Hypotonic uterine dysfunction (relaxes too much)
Protraction disorders (slower than normal progress)
Dilation
Descent
Arrest disorders (complete cessation of progress)
Precipitate labor (

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4
Q

Causes of dystocia (probs with passengers)

A 
Occiput posterior position  
Breech presentation
Shoulder dystocia
Multi-fetal pregnancy
Macrosomia and CPD
Shoulder Dystocia & Brachial Plexus Injury
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5
Q

Causes of Dystocia (Problems With the Passageway)

A

Pelvic contraction

Obstructions in maternal birth canal

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6
Q

Preterm Labor

A

Regular uterine contractions with cervical effacement and dilation between 20 and 37 weeks’ gestation
One of most common obstetric complications

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7
Q

Preterm labor: nursing assessment

A

Risk factors
Contraction pattern (4 contractions every 20 minutes or 8 contractions in 1 hour)
Cervical effacement >80% & dilation >1cm
Laboratory and diagnostic testing:
CBC
Urinalysis
Amniotic fluid analysis
Fetal fibronectin (R/O diagnosis of PTL)
Cervical length via transvaginal ultrasound (R/O dx of PTL)

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8
Q

Preterm Labor: Therapeutic Management

A

Tocolytic drugs: there are no clear first-line drugs to manage preterm labor; may prolong pregnancy for 2 to 7 days
Corticosteroids can be given to improve fetal lung maturity
Antibiotic prophylaxis for women with group B streptococcus

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9
Q

Magnesium Sulfate

A

Relaxes uterine muscles

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10
Q

Indomethacin

A

Inhibits prostaglandins (which stimulate contractions)

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11
Q

Nifedipine

A

Blocks calcium movement into muscle cells (inhibits uterine activity)

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12
Q

Post-term labor

A

pregnancy continuing past end of 42 weeks gestation

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13
Q

Post- term pregnancy: nursing assessment

A

non-stress test twice weekly
Daily fetal movement counts
amniotic fluid analysis
weekly cervical examinations

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14
Q

Labor Induction: Therapeutic Management

A

Cervical ripening is the softening of the cervix and the 1st step in the process of effacement and dilation.
Ripe cervix = shortened, centered(anterior), softened, and partially dilated
Unripe cervix = long, closed, posterior, & firm
Bishop Scoring System –> Identifies which women will likely achieve a successful induction
>8 = successful vaginal birth

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15
Q

What is Labor induction

A 
Stimulating contractions via 
Medical means (cervical ripening, & induction of contractions)
Surgical means (stripping the membranes & performing an amniotomy)
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16
Q

What is Labor augmentation

A

Enhancing ineffective contractions after labor has begun

17
Q

Labor induction methods

A 
Nonpharmacologic Methods:
Herbal agents
Castor oil, hot baths, enemas
Sexual intercourse with breast stimulation
Mechanical methods:
Indwelling catheter
Surgical methods:
Stripping membranes
Amniotomy
Pharmacologic Agents:
Cervidil
Cytotec
Pitocin
18
Q

Umbilical cord prolapse

A 
Obstetric emergency (50% perinatal mortality rate)
Pathophysiology: partial or total occlusion of cord with rapid fetal deterioration
19
Q

Labor Induction & Augmentation: Nursing Management

A

Nurse:patient ratio should not exceed 1:2
Explanations
Simple, clear, thorough
Informed consent signed
Oxytocin Administration
10 units oxytocin in 1000mL of LR
Follow hospital protocols for infusion & dilution
Continuously monitor maternal & fetal status
Record I&O and encourage bladder emptying every 2 hours
Pain relief and support
Medications
Non-pharmacologic measures

20
Q

Uterine rupture

A

Obstetric emergency; onset marked by sudden fetal bradycardia
Nursing Management:
Preparation for urgent cesarean birth
Continuous maternal and fetal monitoring for:
V/S
Hypotension
Tachycardia

21
Q

Amniotic Fluid Embolism

A

Obstetric Emergency (86% mortality rate)
Sudden onset of hypotension, hypoxia, and coagulopathy
Pathophysiology:
Amniotic fluid enters the maternal circulation
Amniotic fluid embolus obstructs the pulmonary vessels  respiratory distress & circulatory collapse

22
Q

Amnioinfusion Indication

A

Severe variable decelerations due to cord compression
Oligohydramnios due to placental insufficiency
Postmaturity or rupture of membranes
Preterm labor with premature rupture of membranes
Thick meconium fluid

23
Q

Amniofusion procedure

A

250-500 mL warmed normal saline or LR is administered over 20-30 mins

24
Q

Puerperium

A

period after delivery of placenta, lasting for 6 weeks

25
Q

Uterus adaptations

A

involution: contraction of muscle fibers; catabolism; regeneration of uterine epithelium
afterpains

26
Q

Cervix adaptation

A

gradually closes and returns to its pre pregnant state by week 6
never regains its pre pregnant appearance
cervical os close and return to normal by 2 weeks
external os widens and never appears the same- changes from a circle to a jagged slit-like opening

27
Q

Lochia adaptations

A

amount is roughly equal to the amount occurring during a heavy menstrual period
fleshy scent is normal
an offensive odor indicates infection
Passes through three stages (rubra, serosa, alba)

28
Q

Rubra

A

dark red

3-4 days

29
Q

Serosa

A

pinkish brown

4-10 days

30
Q

Alba

A

Whitish yellow

10-28 days

31
Q

Vagina adaptation

A

returns to approximate pre-pregnant size by 6-8 weeks postpartum
rugae returns as the mucosa thickens by 3 weeks pospartum
will always remain a bit larger than before pregnancy
normal mucus production and thickening of the vaginal mucosa usually return with ovulation

Women's Health (10 decks)

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