Test 2 - Powerpoints Flashcards
Baseline FHR
110-1160
Causes of bradycardia
maternal depressant drugs, prolonged fetal hypoxia, hypercapnia, acidemia (low pH)
Causes of tachycardia
maternal fever; maternal stimulants; prolonged fetal hypoxia
Variability
Absent, minimal, moderate
Absent variability
no discernible variation around baseline
Minimal Variability
<5 bpm variation around baseline
Moderate Variability
6-25 bpm variation around baseline (good)
Marked Variability
>25 bpm
Acronym for Acels and Decels to causes
V - C
E - H
A - O
L - P
VEAL
V - Variable (can happen, not good if Ix doesn’t change)
E - Early Decel (kinda good)
A - Acel (good)
L - Late Decel (always bad,3 tolerated but if Ix don’t work must c-section)
CHOP
C - Cord compression (kinked garden hose)
H - Head compression (women feels pressure in pressure)
O - Oxygenated baby (kicking, moving, “good”)
P - Placental insufficiency (Hemorrhage, HT, smoking, etc)
Acceleration description
At least 15 bpm high and 15 sec long (1.5x1.5 boxes)
Variable Deceleration Actions
TOONDA -
Turn pt
Open mainline IV (bolus)
Oxygen (8-10 L masks)
Notify HCP
Document
Amnioinfusion (if ordered)
Late Deceleration actions
pTOONDA -
Pitocin off
Turn pt
Open mainline IV (bolus)
Oxygen (8-10 L masks)
Notify HCP
Document
Assess
Rapid repeating Variable deceleration cause and Ix
most likely because of a cord prolapse (passes through the vagina and can wrap around the head while the station is high and bag gushing causing the cord to go first)
Requires an emergent c-section
Cord prolapse Ix
Stick hand into vagina, and hold the cord from the head squishing it
Is variable = variability
No
Cause of Absent variability
infection or drugs in system
causes of minimal variability
decreased O2 - infection - drugs - baby sleeping (tolerated for 20 min then IxTOONDA) - negative response to something
How soon should late decels resolve?
with in minutes but report if not with in normal in 20 min; if not c-section would be needed
What variability accompanies late decels
minimal or absent
What does mom feel on early decels
pressure
Infertility
lack of conception despite 12 months of unprotected intercourse
Subfertility
prolonged times to conceive, or can conceive but just takes longer
sterility
inability to conceive
Infertility affects
10-15% (6.1 mil) of reproductive age population, increases with age esp women >35 yrs
RF related to female infertility
Age - smoking - EtOH - caffeine - stress - poor diet - athletic training - over/underwt - STIs - hormonal disorders
RF related to male infertility
EtOH - drugs - smoking - age - environmental factors - medicines - radiation - medical conditions - Kidneys or hormonal problems - obesity - excessive exposure to heat
Male Structural Infertility
Undecended testes (child assessed at birth, more likely to occur preterm, referral) - Hypospadias (opening of the penis is on the underside rather than the tip)- Varicocele (varicose veins of the scrotum)
Male Hormonal Infertility
Low testosterone - Azoospermia - oligospermia
Azoospermia
no sperm produced
Oligospermia
low sperm count
Assessment of male
semen analysis - ultrasonography
Assessment of couple
Postcoital test (PCT)
Intrauterine Insemination (IUI) Therapeutic Insemination
artificial insemination directly into uterus - bypasses vagaina - cheapest artificial method ($300-500) - useful if hostile muscs in vagina
In Vitro Fertilization (IVF)
fertilization of eggs in tube/petri dish and implantation - emotionally/financially burdensom bc can take ~3 sesson/cycles each being 12k
Other options of childbearing
Surrogacy (keep prts nearby or next room during delivery) or adoption (therapeutic communication and respect decisions of mother for giving up baby)
Augmentation vs induction
Augmentation: jump starting something that has already started (suas giving pitocin/cervidil/breaking water when labor has slowed down)
Induction: artificial staring of labor (reasons: Diabetic mom at 39 or sooner weeks because they tend to have bigger babies, high BP: preeclampsia, fetal demise, if baby stops growing inside)
Amniotomy
Augmentation - deliberate rupturing of the amniotic sac - first priority is to assess FHR then fluid TACO
Pitocin
synthetic oxytocin - stims uterine contractions - titrated slowly in milliunits (usually 2mU/15 or 30 min)
Always observe how zi responds to pitocin, stop if poor reponse
tachysystole
contractions at <2 min - risks cutting fetus from O2
Ideal is 2-3 min
Dysfunctional labor = dystocia
difficult labor and/or delivery (painful or non-progressive labor, start-stop ctx Ix[stop pitocin, turn pt])
precipitous delivery
hypertonic labor dysfunction
antepartum
before delivery - such as if woman is in preterm labor woman would go into antepartum unit and monitor
intrapartum
during labor
postpartum
after delivery
Q to ask couple about infertility
How long have they been trying - how often (diluted sperm counts) - how often she ovulates - pt Hx (DM, HT, hypothyroidism) - financial status (for IUI or IVF)
Secondary Infertility
inability to conceive after one or more successful pregnancies or cannot sustain a pregnancy
precipitous delivery
Delivery that takes total of <3H - face of infant is bruised because it was forced through too quickly (this can cause jaundice) - for mom delivery can cause tears/lacerations from uncontrolled delivery
Structural causes of female infertility
hostile mucus, cervical obstruction, fibroids, fallopian tube blockage caused by scar tissue or escaped eggs, inadequate egg production (women over 35 make less eggs)
Female structural abnormalities
- from birth or surgery, makes pregnancy harder
- mks it hard for eggs to grow bc of septum
3/4. can have 2 babies at the same time that are not twins
Sperm abnormalites
abn in head/tail number, size, length, bend, point
Level of fertility testing (least invasive to most)
Detection of ovulation - hormone analysis - Ultrasonography - timed endometrial biopsy - hystero-salpingo-graphy - laparoscopy
detection of ovulation
OTC test on woman
hormone analysis
blood test on man and woman
ultrasonography
for structural abn on man and woman
timed endometrial biopsy
biopsy to determine if more tests needed on woman
hysterosalpingography
looking into structure of fallopian tubes and uterus
laparoscopy
in depth look at internal anatomy
fertility testing done in its order because
more invasive procedures can cause scar tissues
semen analysis
sample to check sperm quality and quantity
postcoital test (PCT)
planned and timed intercourse: have sex and come into office within 8 hours to test mucus/semen levels and see how its working together for any stressors
IVF ethical complications
usually 3-4 eggs injected since RF them dying off and due to expense- Parental ethics of how many eggs if they all take whether they can afford the children or selective abortion; there is increased RF disabilities if multips;
Tachysystole Ix
STOP PITOCIN if running
if not pitocin use terbutaline to slow contrations (MgSO4 supposedly works too but terbutaline is the one mentioned)
Assisted delivery
forceps or vaccum - baby must almost/already crowning and mother unable to puch enough
Assisted delivery process
(MD)? very gently pull while woman is pushing
3 times, 3 attemps is the maximum then C-section other risks permanent damage
Forceps risks
damage to brachial plexus nerve (temp or perm) but usually none
Vaccum delivery risks
scalp lacerations, bruising, swelling - all begnin but very rare to have permenant damage
Natural tear vs episiotomy
Natural >> episiotomy
natural tears only what is necessary, episiotomy is only useful when it is necessay to birth baby faster
Tear care
massage perinium before birth?
ice tear for first 24 hr, (witch hazel, dermaplast spray, anesthetics)
Version
manual turning of the baby from breach or transverse in urtero when mother wants to deliver vaginally instead of by c-section - done at 39? wks however the baby is already large and there is very small room
Version procedure
- Start IV access for fluids or in case of emergency
- Toco and US for FHR (always ensure reassuring FHR mod acel before starting)
- Give terbutaline (increases HR, CI if over 120 BPM) when ready bc it has 20 min life (given to relax uterus it’ll start to contract once started)
- US to confirm fetus positioning
- Reassure mother
Shoulder dystocia
head out but shoulder stuck - child losing circultion bc of cord compression
shoulder dystocia Ix
call rapid response because time is of the essance
- apply supraspubic pressure by fist above pelvis bone pushing down shoulder of child so MD can pull on head while woman is pushing
- Episiotomy likely, woman set into McRoberts position
- RN on stepstool so that appropriate force can be applied
umbilical cord prolapse
cord is compressed by the head or cervix
emergency c-section within 10 min
cord prolapse Dx
many variable decels - checking if they go away upon Ix
vag exam to determine prolapse
cord prolapse Ix
stick hand in to protect child head from crushing cord
woman is to assume a chest-knee position (knees and elbows on the floor with hips elevated and thigh-hips at right angles)
Uterine rupture
Life threatening for mother and baby
Uterine rupture SS in mom
Internal bleeding - Rigid and hard abd (differentiated by constant/persistant ctx) - uterus will not relax - increase in HR (before change in BP) - shock
Uterine rupture SS in baby
late decels by placental insufficency with absent/minimal variablity
Uterine rupture Ix
IV fluid bolus and emergency C-S
Check FHR response
Cesarean Birth
Vertical and Low Transverse
Vertical Cesarean Birth
Emergency procedure - faster, painful with longer recovery period (increased risk for dehiscence) - prevents future vaginal births bc insicion will not be able to handle stress of ctx or pitocin - more visible - better for obese women
Pfannenstiel Cesarean Birth (Low Transverse /Bikini cut )
takes longer but more ideal - less visible when healed - less risk for dehiscence - will be able to give vaginal birth in future
Cesarean Birth OR
Anesthesiologist gives spinal block , OB MD, assisting MD, neonatologist, RNs to deliver/receive baby
Surgical time out - allergies, why Hx
Know blood type, have set of heart tones, have foley in for the anesthesiologist to know if the bladder has been nicked via blood in the urine
Postpartum complications
PP Hemorrhage
PP infection
Mastitis
PP hemorrhage causes
Lacerations of the genital track (lacerations of the cervix, vagina or perineum) from Precipitous birth, Macrosomia (big baby), Use of forceps or vacuum, Uterine atony
PP hemorrhage - uterine atony
=boggy uterus
causes: macrosomia (big baby), dyfunctional labor, induction of labor (can dev. tol to pitocin Ix is to intermittantly stop pitocin), grand multip (>4 births), preeclampsia, retained placenta, placenta previa (placenta grows over cervix), assisted deliveries
EBL in PP hemorrhages
500 cc in vaginal birth
1000 cc in c-s
meds used in PP hemorrhage
Ocytocin/Pitocin
Methergine
Hemabate
Cytotec
Pitocin CI
long labor induction
Methergine CI
high blood pressure, preeclampsia
Hemobate CI
Asthmatics
Hemobate SE
near immediate major diarrhea
Cytotec facts and CI
used in 0.25 ug to induce
800 ug rectally to ctrl hemorrhage
CI: when has 4° tear
PP hemorrhage Ix
MASSAGE - weigh pads to determine blood loss (1g=1ml) - express any clots - start another IV access - insert foley to empty bladder (so it doesn’t push uterus and increase loss) - VS q15 min - Assess LoC - Doc each Ix - comm with MD
Puerperal Infection
Infection of the reproductive tract associated with childbirth - endometritis - most common infection of the uterine lining
Puerperal infection / Endometritis SS
Fever >100.4 lasting over 24H after delivery
Abd pain - extreme tenderness to the touch
malaise
flu-like symptoms
foul smelling lochia
Puerperal infection Ix
treat with ATB after the 24 hr mark of fever, not before because it can be a response to labor
Asses perinium for foul smelling lochia
