theresa maurer Flashcards
When is the first time fetal heart tones are heard by the doppler?
10-12 weeks
Molly is newly pregnant. She has two children living at home. A third child died of birth defects at 4 days of age. She has never had an abortion or miscarriage. Which of the following accurately describes her now?
Gravida 4 para 3 AB 0
Excessive use of antibiotics may result in a vaginal infection with
Candida albicans
study of anatomy
the study of the structure and shape of the body and the body parts, and their relationship to one another
study of physiology
the study of how the body and its parts work or function
Immediately following fertilization, the fertilized egg is called a
zygote
During what period of pregnancy is the baby most susceptible to teratogens (from conception)
2-12 weeks
A typical human gestation from conception is:
266 days
typical human gestation from LMP
280
low lying placenta may result in
labor induction
TPAL
Term births -Preterm births - Abortions - Living children
FPAL
full term, pre-term, aborted, living
fetal presentation
presenting part
cephalic, breech, shoulder
cephalic
vertex, sinciput, brow, face
attitude characteristic
well flexed, extended
straight sinciput with straight attitude aka
military attitude
fetal lie
relationship of long axis of fetus to long axis of mother
longitudinal, transverse, oblique
position of fetus
ROA, LOA, RST…
variety of fetus
same arbitrarily chosen point on the fetus in relation to mothers pelvic
anterior
posterior
transverse
vertex
head down
most popular is the occipital bone as leading part
breech types
frank- legs up near head
complete- both legs crossed
incomplete- one leg crossed
footling- one foot down
complete breech
both legs crossed
frank breech
legs at or near to head
incomplete
one leg crossed
kneeling breech
This is a very rare position in which the baby is in a kneeling position, with one or both legs extended at the hips and flexed at the knees.
ventouse
vacuum extraction in 2nd stage of labor alt. to forceps or csection
uterine souffle
A blowing sound, synchronous with the cardiac systole of the mother
placental souffle
a hissing souffle synchronous with fetal heart sounds, probably from the umbilical cord.
engagement
station 0 level of ischial spines
synclitism
sagittal sutures is midway between the symphysis pubis and sacral promontory
asynclitism
sagittal suture is directly toward the symphysis pubis or or sacral promontory
anterior or posterior
woods maneuver
screw maneuver
lightening
two weeks before labor, descent of present part in true pelvis decrease in dysnpea increased urination pelvic pressure leg cramps venous stasis causing edema position is similar to 8 months
proteinuria
1+ 2+ on stick, .1 or higher in urine culture
glucosuria
2+ to 4+ glucose, diabetes
supine hypotension
when women lay on back it puts pressure on vena cava and thoracic aorta shutting blood flow to heart, fainting
chloasma
pregnancy mask, coloration from extra hormones
asepsis
no bacteria present
antisepsis
the practice of using antiseptics to eliminate the microorganisms that cause disease
sterile
free from bacteria or other living microorganisms
sequelae
condition that is the consequence of a previous disease or injury
Iatrogenic complication
caused by a medication or physician.
Cranial sutures
saggital suture, coronal, lambdoidal
Fontanelles
ossification is not complete and the sutures not fully formed
anterior - Diamond
posterior-Triangle
“Id rather be holy then have diamonds” 1
bandls right
A pathological retraction ring of the uterus is a constriction located at the junction of the thinned lower uterine segment and the thick retracted upper uterine associated with obstructed labor.
contraction
muscle shortens and stays short
retraction
muscle lengthens
muscles in between ribs pull upward signaling trouble breathing
Leukorrhea
a profuse, thin or thick vaginal secretion that begins in the first trimester
what percent of women have PROM?
12%
what percent of women start labor in 24 hrs after PROM?
80 %
blood show is a sign of labor within
24-48 hours
when does an energy spurt happen before labro
24-48 hours before
best way to listen to a ctx
start midpoint between two ctx listen through to midpoint after the next
listen in 5 second intervals
when do you listen to contractions to establish a baseline
in between ctx
1st stage : latent phase
start of labor to progressive dilation
3-4 cm
every 10-20 minutes lasting 20 seconds
1st stage : active phase
active progression of dilation to complete dilation
ctx every 5-7 minutes lasting 40 secs or every 5 minutes lasting 60 sec 411, 511
3/4 cm to 10 cm
progressive descent occurs in what stages
end of active labor and 2nd stage
primigravida entering labor V/E
50-60% effaced, 1 cm dilated (paper thin active)
multipara entering labor V/E
1-2 cm dilated no effacement
acceleration phase of labor
starts at active phase of labor
true labor can be intensified by walking T or F
true
walking will calm a false labor T or F
true
maximum slope phase of labor
stage 1 most rapid dilation from 3/4 cm to 8 cm
decleration phase of labor
end of the active phase, transitional phase, ctx 2-3 mintues lasting 60 seconds
8-10cm
constant dilatin, average 3 cm an hour
triple gradient pattern
40-50 mmHg at acme and return to rest of 10 mmHg
transition s/s
shaking legs, belching, burping, nausea, vomit, restless, cant comprehend directions, decreased modesty, toes curl, severe low back pain
hydrocephaly palpation
breech presentation
to determine base FHR listen when?
in between ctx
3 phases of uterine ctx
increment- longer
acme-strongest
decrement
contractions constrict placenta blood flow T or F
true
contractions of muscle fiber
muscle fibers contract and shorten an dont return to original lenght, the fundus gets thicker to expel fetus
retraction of uterine fibers
lengthen and dont return to original shape, lower segment of uterus, thins and becomes part of upper segment
effacement
shortening of cervical length
dilation
enlargement of the external os, amniotic fluid hydrostatic pressure as dilating wedge
engagement
widest part of the fetal head has passed through the pelvic inlet
station 0
ischial spines
widest diameter of fetal head
biparietal 9.5 cm
largest diameter of fetal head
occipitomental brow presentation 13.5cm
most common diameter presenting
suboccipitobregma- vertex presentation 9.5cm
military or siniciput presentation diameter
occipitofrontal- 11.5cm
face presenation
submentalbregma 9.5 cm
percent of breech presentations
3 - 3.5%
% of breech before 32 weeks
50%
molding
change in the shape of head-bones overriding and overlapping
caput
dilating wedge, edemateous swelling CROSSING suture lines
cephalhematoma
bleeding beneath periosteam over more than one bone DOES NOT CROSS sutures
FHT eval based on
combo of rate and pattern
periodic fetal heart rate
changes in FHR associated with uterine contractions
baseline fetal heart rate
HR between contractions
FHR 161-180
tachycardia
Bradycardia
FHR 110-119
normal FHR
120-160 bpm
baseline change if
must be at new level for at least 10 minutes
marked bradycardia
below 100 bpm
abormal FHR
no variablity
marked variabilty
brady/tachy
periodic fetal heart rate changes
internal fetal monitor
most reliable comprehensive data of all methods
maternal changes stage 1 labor
increase metabolic activity that: increases temp 1-2 degrees (max at delivery) increase BP 10-20+/5-10 mmHg increase respiration- hyper = alkalosis polyuria- empty every 2 hours decrease gast motility increase WBC decrease blood sugars
short term variability
beat to beat
long term variabilty
rhythmic waves in cycles - 5 min readings
Friedman
acceleration- start of dilation
max slope- 4-8 cm active labor
deceleration- 8-10 cm transition
pulse rate through contaction
increment- increase
acme- decrease
decrement- increase
IV indication
gravida 5, overdistended uterus, multip, polyhydraminos, SGA, induction, Hx PPM hemorrhage, dehydration, meds
125 cc per hour, or 300cc initial for dehydration then 125 cc per hour
positions for risk of cord prolapse
supine, lateral recumbent(left side lying), knee chest
stadol
sedating with pain relief, active labor
risk of prolapse cord
SGA, polyhydraminos, transverse lie, PROM
demoral
pain relief, active labor
nubain
pain relief, active labor
phenergan
vistaril
atartic, anti anxiety, early and active labor
reasons for enema
stim labor, clean field, womens desire
vitals in Active labor frequency
FHT - every 30 minutes
BP- every 1 hour
Temp/pulse/resp- every 2 hours
Bladder- void every 2 hours
distention of bladder signs of
needing to void, posterior baby
bulge above symphysis pubis
risks of AROM
indications
management
inc risk of infection, cord prolapse, cord compression, head compression, limited mobility
indications: active labor, 4-5 cm, cephalic vertex
management: leave fingers in til next ctx to see effect, check for cord prolapse, FHT, get mother standing to apply head
VE indications
initial for baseline, verify pushing, after ROM w/suspected cord prolapse, if decels and suspected prolapse
progressive relaxation
tighten muscles group let go and relax-promotes sleep
controlled relaxation
keep one muscle group relaxed while other group is contracted
what happens between 1st and 2nd stage
a lull
- lull
- bearing down until head does not retract
- perineal crown to birth
early decel cause
head compression, cord compression
late decel cause
uteroplacental deficiency
FHT eval frequency in 2nd stage
every 5-15 minutes
position for extreme varicosities
dorsal (on back slight knees bent)
mechanisms of labor 8
engagement biparietal diameter passes inlet
descent- forces
flexion-meets resistance-cervix, sidewalls, pelvic floor
internal rotation- 45 degrees to anterioposterior position of midplane pelvis-shoulders in oblique
birth of head- by extension curve of carus
restitution-45 degrees right angle to shoulders
external rotation
birth of shoulders
internal rotation 45 degrees to the ______position
anterioposterior
birth of the head by______________
extension
restitution 45 degrees to the ___________position
OA, occiput anterior postion, L or R,
sagittal suture oblique, shoulders other oblique
external rotation 45 degrees to the
LOT, ROT position, bisacromial aligns with anteroposterior diameter of outlet
birth of the shoulders by____________
curve of carus and lateral flexion
PICA can indicate deficiency in
iron
when do braxton hx begin
6 weeks gestation
station of a well flexed cephalic baby landmark
occipital bone
most positive sign of ROM
visualizing amniotic fluid escaping os
majority of progressive descent take place
(deceleration phase)end of 1st stage and 2nd stage labor
impending 2nd stage s/s
increase bloody show, rectal pressure, bear down, ROM, rectal bulging, expulsive grunt at exhale
most common position at onset of labor
LOT
exam ROT and sagittal suture is tilted toward the symphysis pubis
posterior asynclitic
normal labor the head usually enters inlet with moderate
posterior synclitic
changes in FHR associated with ctx
periodic changes
fetal scalp ph for immediate delivery
second reading of pH less than < 7.2
no VE following
prolonged walk or period in shower
how much water daily in pregnancy
2 quarts daily
sims position
lie on their left side, left hip
variable decels thought to be from
cord compression
innominate bones of pelvis
ischium, illeum, pubis
attitude
relationship of head to trunk how flexed or extended compared to body straight body sinciput curved body vertex arched body face
The lithotomy position is when the mother
flat back in stirrups
When performing an emergency episiotomy, the midwife must cut
during a contraction as head crowns
Respiratory distress in a newborn is evidenced by
fever
If the client continues to hemorrhage in third stage, the most important thing is to
get placenta out
If a baby is delivering in face presentation, he must rotate to:
mentum anterior position
abrupt persistent bradycardia is a sign of
uterine rupture
VBAC’s at risk for what placenta complication
placenta accreta
preterm/premature labor how many weeks
any labor after 20th weeks before 37 weeks
preterm birth accounts for what percent of perinatal deaths
70%
preterm birth predisposing factors
non white, low status, poor nutrition, previous hx, hx of baby less than 2500, 1+ SAB 2nd trimester, multip, drugs, no prenatal care, uterine anomalies, DES, incompetent cervix, UTI, GBS. STD’s, chorioamnionitis, palcenta previa/abrupto, polyhydraminos
previous preterm has a % chance of recurring preterm
20-40 % chance
diagnosis of preterm labor
between 20-36 weeks
ROM, ctx 5-8 mins apart, 4 ctx in 20 minutes, 8 ctx in 60 minutes.cervical progressive change, 80% effaced.
tocolytics may be used for preterm labor when ?
the women is less then 34 weeks
less then 4 cm dilated
tocolytics may stall labor for how long
24-48 hours or
3-7 days
contraindications to tocolytics
chorionamnionitis, fetal maturity, fetal distress, cervix more then 5 cm
tocolytic agents
magnesium sulfate
deta adrenergic
extremely toxic w side affects
PROM
2- 17% incidence
ferning is from protein in amniotic fluid
if term: 12 hours start induction
if preterm: repeat, weekly GBS screening and 2 x a week BPP and NST
FHR in chorioamnionitis
s/s
tachy above 160
high WBC
foul, tinged waters
progressing fever
febrile morbidity
100.4 degrees
amnionitis & chorioamnionitis
s/s
treatment
amnion-inflammation of the amnion and sac
chorio- inflammation of chorion, amnion and sac
highest risk of developing A or C is PROM over 24 hours
fever, tachycardia maternal and fetal, tender uterus, vag walls hot to touch, foul smell, WBC increased
treatment- IV antibiotics unless delivery is 1-2 hours away, otherwise IV antibiotic after delivery, baby is cultured.
infection rate of PROM
within 24 hours- 1.6 to 29 %
increases when more then 24 -72 hours
management of PROM
assess temp every 4 hours fhr every 1 hour no V/E unless prolapse or induction hydration color/odor of fluid
cesection rate for women at term induced to deliver in 24 hrs from PROM
30-50%
frank cord prolapse
through cervix
occult
alongside presenting part but not out cervix
ROM immediate action
FHR, and vag exam to rule out cord prolapse
cord prolapse immediate action
put whole hand in vag and hold presenting part up off cord
get mom into knee chest- trendleburg
call transfer STAT
FHT
if cord is out wrap with warm, sterile saline
do NOT remove hand until csection
fetal sleep cycle average
80 minutes
fetal distress
fetus is intermittently experiencing hypoxemia
definition reserved for hypoxic fetus
intermittent late decels
variable decels with average variability and normal baseline
chronic fetal stress
secondary to uteroplacenta insufficiency
late decels and prolonged decels
acute fetal distress
variable decelerations with:
with ctx
cord compression, decreased AFI
rapid descent
when fetal distress occurs in 2nd stage management depends on anticipated delivery which should be…and…
30 minutes
color of fluid (mec)
fhr (baseline, variability, progressive decels)
management of fetal distress
transfer IV oxygen left side lying FHT csection
depression of the autonomic nervous system can be identified by what kind of FHR
marked variability or absent variability(hypoxia, acidosis)
acceleration FHR
fetal movement, stimulation, partial cord occlusion,
deceleration patterns
periodic fetal heart rate changes associated with uterine contractions
type of decelerations
early, late and intermittent decels
early decels
head compression 4-7cm -uniform shape-ends when ctx end
not under 100 bpm
normal baseline of 120-160
no intervention
late decels
uteroplacental insufficiency
uniform shape with ctx
occurs in acme or decrement
intervention
causes of uteroplacental insufficiency
fetal anemia Rh sensitized maternal sickle cell IUGR, maternal hypertension, abnormal placenta, previe, vasa previa, infection PIH hypotension postmaturity hypertonic uterus placental abruption
management of late decels
prepare transfer IV oxygen assess length of delivery correct hypotension, elevate legs terbutaline to quiet uterus
variable decels caused
caused by cord compression
seriousness of variable decels depends on
frequency, depth, rate of return to baseline, effect on baseline, and variability
shape of variable decels
V, U , W
variable shape
different times in ctx
characteristics of variable decels
shoulders- small accelerations come before decel and right after decel- reassuring
overshoot-blunt acceleration at end of decel with slow return to baseline- immediate delivery nonreassuring
FHR during decels
decreases to below 100 and as low as 50-60 bpm
management of variable decels
change position
VE check for cord prolapse, rapid descent
IV
oxygen
prolonged deceleration pattern
decels lasting longer then 60-90 seconds
if it does not recover transfer
factors of prolonged decelerations
cord compression, profound uteroplacental insuff, hypertonic ctx, maternal hypoxia, maternal shock, maternal valsalva, rapid head descent.
Valsalva pushing
When this technique is used, a woman is instructed to take a deep breath at the beginning of the contraction, to hold her breath and push as long and hard as she can in synchrony with her contractions.
can cause prolonged decels
sinusoidal pattern
undulating repetitive uniform fhr equally distributed and below baseline for more then 10 minutes, no relationship to ctx or fetal movement ominous sign, immediate transfer Rh sensitizion fetal anemia fetal hypoxia placenta abruption
lambda pattern
immediate acceleration followed by a decel, benign, risk is confusing with other FHR
wandering baseline
late development of progression of fetal distress
within in normal 120-160 but NO short term variability
ominous right before fetal demise
immediate delivery
CPD body types
shoulders wider than hips, short square short broad hands and feet history of pelvic injury spinal deformity large fetus malpresentation malposition only TRUE test is labor dysfunctional labor pattern deep transverse arrest, poor flexed head, caput, asynclitic, molding
CPD management of
risks of
position change, ROM, walking, IV hydration, increase uterine activity, epidural,
may cause fetal damage, brain damage, death, infection, uterine rupture, maternal death
deep transverse arrest
s/s
management
platypelloid and android pelvis
sagittal suture of the fetus in transverse diameter
2nd stage hypotonic dysfunction
extendsive molding, caput
leopolds 4th maneuver for presentation
maternal hydration, position change, left side lying, improved ctx, good pushing positions, squat, kneel
uterine dysfunction
a prolonged stage of labor beyond expected length
progression measurements
dilation, effacement, descent
efficacy of ctx
hypotonic uterine dysfunction
follows gradient patter with no pain, or intensity or tone
stalled labor
infrequent short mild ctx
lack of progress in dilation or descent
limits of normality of labor
primi- latent phase 20 hrs, active-less than 1 cm an hours, second stage- 2 hours
multip- latent 14 hrs active- less than 1.5 cm an hour
second stage 1 hour
management of hypotonic
environment and stress factors
correct maternal exhaustion, hydration
fears, concerns, walking, bath, enema(improves 1 hrs)
ROM-(effective if ctx increase within 2 hours)
nipple stim
pitocin
epidural
hypertonic uterine dysfunction
distorted gradient pattern, midpoint of uterus contracts most, exhaustion!, cause uteroplacental problems leading to fetal problems
occurs in primips, latent phase, freq irregular ctx, lack of progress.
slow ctx, with induced rest period, terbutaline
uterine rupture
predisposed risks
% of mortality
s/s
uterine surger of fundus or corpus, classical cesarean, removal of fibroids, too much pitocin,
5% maternal mortality, 50% fetal mortality
s/s cry out, sharp shooting pain, sudden cessatoin of uterine ctx, slight bleed or hemorrhage
fetus outside uterus, dramatic fetal position change, head unengages, parts easily palpated, violent movement to cessation of fhr.
shock
shock
s/s
elevated pulse, rapid, thready, hypotension, pallor, cold clammy, short breath, restless, visual disturbance
quiet uterine rupture
hematuria, tender ab, pain, hypotonic, lack of progress, faint, bledding, rapid pulse
uterine rupture management
IV 16 gauge two routes-electrolytes (ringers), blood transfusion
oxygen
immediate surgery, hysterectomy
aortic compression and pitocin
diagnostic of shoulder dystocia
anterior shoulder wedge above symphysis pubis
posterior shoulder jammed at sacral promontory or jammed on sacrum.
key to defining is anterior shoulder
fosters shoulder dystocia
if shoulders attempt to enter the true pelvis with shoulders in anteroposterior of the pelvic inlet instead of the oblique diameter which is larger then the AP diameter in the inlet
the oblique diameter is the roomiest diameter in the outlet.
true
the anterior posterior diameter is roomiest in the pelvic inlet
true
baby usually enters the inlet in ROT LOT position then turns to oblique in true pelvis/outlet
true
differential diagnosis of shoulder dystocia
true, snug shoulder, or bed dystocia
turtle sign
retraction of the head snug on perineum
exaggerated lithotomy
legs elevated and knees drastically bent with mom on her back
snug shoulders
slow to birth head, no turtle sign, restitution present, external rotation present, make sure shoulders are oblique light suprapubic pressure ex lithotomy position hands and knees
fowlers postion
propped upright lying in bed
bed dystocia
baby being born down
soft bed
elevated hips, reduce upright angle, bring buttocks to edge of bed, hands and knees
erbs palsy
brachialplexus damage from delivery of SD
Shoulder dystocia incidence
1% .1-.6%
shoulder dystocia increases when what is present
increased fetal weight, prolonged 2nd stage, midpelvic delivery (forcepts, venthouse extract)
delivery times of shoulder dystocia
3 minutes best outcome
5 minutes to 10 depending how compromised
management of shoulder dystocia
have someone call for immed transfer
request full newborn resus
request immediaton ppm hemorrhage support
tell the mother NOT to push!
McRoberts maneuver
rotate shoulders to oblique with 2 hands on both sides
suprapubic pressure
— 45 SECONDS TO
catheterize, episotomy,
VE- short cord, enlarged fetal ab, twins, bandl ring,
Attempts-
Woods Corkscrew- 180
Deliver posterior arm
Suprapubic pressure and downward outward
pressure on head
still no delivery- rotate 180 degrees again
NO delivery
break clavicle
Zavanelli Maneuver- replace head!- csection
snug shoulders= side lying, hands and knees to deliver posterior arm
McRoberts
mother on back, knees to chest, close together widens the outlet, pushes pubis back and horizontal to free anterior shoulder, straightens sacrum
Woods corkscrew (Rubin)
degrees two hands, only back up. clockwise. hands on back pushing forward, hand on chest pushing back toward posterior shoulder
posterior shoulder substituted for anterior shoulder, baby rotated, 180 degrees
not delivered go counter clockwise 180 degrees
Delivery of posterior arm
find arm, if extended press cubital space to cause flexion
if extended and jammed splint lower arm and sweep across the babys abdomen, grasp hand, deliver arm
flip FLOP Gaskin Maneuver
Flip into hands and knees knees in, Lift leg to running start, rotate to Oblique, remove posterior arm
Face presentation
occipital bone prominent! head feels large
no fontanelles and face
anterior fontanelle and face
brow presentation VE landmarks
feel brow only and maybe anterior fontanelle
movements of face presentation and delivery
Mentum leads the way!
LOP or ROP converts to RMA or LMA as it deflexes
70% enter true pelvis as MA or MT
30% enage as MP
Mentum in posterior CANNOT be delivered
Mentum in anterior can be delivered with extension and flexion of the birth of the head
before delivery of breech
complete dilation empty bladder effective pushing prep for resus position mom at edge of bed hands off until umbilicus
Pinard Maneuver for breech
follow posterior thigh
press on in the popliteal fossa causing leg to flex at knee
draw leg down sweeping across ab for delivery
% of Frank breech
70 %
movements of breach delivering head
head HAS to be in occiput anterior to deliver
keep head flexed-supra pubic pressure or Smellie Veit manuever
apply downward outward traction on body until occiput
the upward traction to deliver chin
Twins
deliver baby as presentation and position quickly clamp and cut cord determine presentation of 2nd baby extreme FHR, signs of bleeding optimal time for 2nd is 3-15 minutes deliver 2nd baby before placenta separates rule out cord prolapse ROM with no pressure from ctx or fundal maternal pushing
Hemorrhage likely
monozygotic twins
one placenta, one chorion and two amnions
3rd Stage of Labor - 2 parts
first phase- placental separation
2nd phase- placenta expulsion
retroplacental hematoma
forms behind placenta when uterine size decreases along with placenta site
placental separation
happens as result of decrease in size of uterine cavity
signs of placental separation
sudden trickle
cord lengthens
discoid to globular shape uterus
uterus displaced upward
schultz mechanism
separations begins central
fetal side up, majority of bleeding is not seen until after delivery because of inverted placenta
duncan
eparations begins margin
blood escapes between membranes
maternal side up
mismanagment of 3rd stages is biggest cause of hemorrhage
true
management of 3rd stage
evaluate progress of labor and mothers condition
guard uterus so not to massage
do not massage before placenta separation
do not pull cord before separation
do not attempt delivery before complete separation
collect cord blood-
Brandt Andrews
to check placenta separation
hold cord taut with other hand put fingers close together and push straight down into low ab of mother just about pubis sym,
if cord recedes= not separated
if cord elongates spearated
OR follow cord with hand to placenta, if it extends into cervix it is not separated, if it is at external os or upper vault it is separated
facilitating placenta birth
place one hand palm surface on uterus above sym pubis and press down and up towards umbilcus check it is contracted
exert cord traction
ask mom to push
follow carus downward and upward
never exert cord traction if uterus is not contracted
true
methergine IM can be given to a mother PPM
false
retained placenta definition
not separated and no visible bleeding
not delivered after 30 minutes
3rd stage placenta timing
average 5-10 minutes, normal for longer
gestational age and placenta separation
lower gestational ages longer 3rd stage
most preterm delivery= manual removal
management of retained placenta
baby to breast, nipple stim, squatting, privacy for oxytocin effects, empty bladder
intraumbilical oxytocin injection with solution of 10 IU diluted with 20cc of normal saline
third stage hemorrhage
from partially separated placenta call for transfer thoroughly massage- only with hemorrhage cause by non separation uterine ctx combined with cord contraction usually releases IV position for shock- check pulse and BP catheterize 10 IU of Pitocin
Pitocin causes
intermittent contractions, upper segment
methergine
sustained contraction, lower segment
placenta accreta
abnormal or partial or total adherence of the placenta to uterin wall. adhered to myometrium with little to no decidua in between.
definitive diagnosis- microscopic
placenta increta
chorionic villi goes farther than myometrium to uterine wall
placenta precreta
chorionic vill go through all the way to the uterine wall and to the serosa layer
placenta acreta increased incidence with
placenta accreta, previa, previous csection, or unexplained elevated MSAFP
second stage is known as
expulsion stage
average length of second stage for primip according to Friedmans curve
1 hour
which cephalic presentations means that the largest diameter will be presenting
brow
which mechanism occurs without
descent
external rotation accomplishes what?
brings the bisacromial diameter of the fetus into alignment with the anteroposterior diameter of the pelvic outlet
internal rotation accomplishes what
brings the anteoposterior fetal head into alignment with the anteroposterior diameter of maternal pelvis
if the baby enters in the ROP position how many degrees does it have to rotate for internal rotation to be occiput anterior?
135 degrees
generally an accepted frequency of blood pressure checks in 2nd labor is
every 15 minutes
lithotomy for delivery is contraindicated for which condition
varicositites
Ritgen maneuver
to control fetal head at birth
the best gauge for the perineal body
22 gauge
primary disadvantage of local lidocain
distorts local tissue
Which one of the following is the most important nutrient of the pregnant and lactating woman by helping to build strong muscles, adequate blood volume, and healthy skin?uter
protein
A rubella titer of <1:10 indicates:
non immunity
What is the most frequent reason for seizures in the neonatal period?
hypoxic-ischemic encephalopathy
Which of the following findings of fetal heart assessment is most ominous
repeated late decelerations with loss of short-term fetal heart variability
The basic shape of the android pelvis is:
heart
uterine atony is the major cause of immediate ppm hemorrhage
true
immediate ppm size of uterus
2/3 3/4 between pubis and umbilicus
uterus above the umbilicus
clots need to be expelled
above umbilicus and to one side after immediate ppm
full bladder
hard to pee after birth
trauma caused by pressure and compression on bladder and urethra
vital signs after birth
every 15 minutes or more until stable at prelabor levels
BP=- prelabor
Temp-slightly elevated
pulse- prelabor
average blood loss of vag delivery
500ml
average blood loss of csection
1000ml
PPM hemorrage definition
500ml +
80-90% of immediate PPM hemorrhage cause
uterine atony from incomplete placenta
80-90% of immediate PPM hemorrhage cause
uterine atony from incomplete placenta
cervical lacerations
vag perineum lacerations
methergine
ergot prep of methylergonovine
tetanic sustained ctx
increase in blood pressure -vaso constrict peripheral
acts directly on myometrium
0.2 mg oral, 0.2 injection
repeat in 2-4 hours if needed
pitocin
synthetic oxytocin no inc in blood pressure IM
10 USP units
hembate
contracts smooth muscle of uterus and other parts of body-increasesBP
contraindicated for PID, asthma, cardiac,hepatic disease
may work if others havent
before 1900 what percent of women gave birth in hospital?
5%
Postpartum assessments after leaving
24hours, check pediatrician appt, 2 weeks, 6 weeks
60-70% women will give vag birth after cesection and or CPD diagnosis
true
The cord is wrapped around the baby’s neck approximately 1 out of every 3 births
true
A respiratory rate consistently higher than 60 breathes per minute wth or without flaring grunting or retractions is abormal at 2 hours of life
true
clamping the cord or (dave clarke) :) physiological occlusion of the cord shuts down the low pressure system, the newborn circ is now freestandingand is a….
closed, high pressure system, with a rise in resistance. The foreman ovale shuts ductus arteriosus shuts, blood now goes to the lungs and travels to all tissues
fetal circluation is defined as a …..
low pressure system
thermoregulation in a newborn is not completely stable until?
2 days
subcutaneous fat helps insulate
neonate generates heat 3 ways
shivering, voluntary muscle activity, non shivering thermogenesis
non shivering thermogenesis
utilizing brown fat for heat production
brown fat energy resource
glucose and glycogen help cells produce energy that converts fat into heat
hypoglycemia thermoregulation
doesnt happen because of inadequate glucose to convert fat into heat
heat loss in newborns, sequelae
hypoglycemia, hypoxia, acidosis
normla newborn temp
97.7-99.5
glucose levels for newborn
60-70 mgdL
from 4-72 hours
signs of hypoglycemia in newborn
jittery, apnea, cyanosis, weak cry, lethargy, limp, not feeding
low glucose blood level
< 40-45 and should be followed up with blood draw check
rbc lifespan of newborn
8o days
6% of newborns will need some form of resuscitation
true
asphyxia the most common reason for resus
true
adequate ventilation is the most important part of resuscitation of the newborn
true
ABC of resuscitation
Airway, Breathing, Circulations
common reasons for resuscitation
TAMM
trauma, asphyxia, medications, malformations
atleast 30 seconds of effective PPV is given before chest compressions
true
heart rate above 100 bpm
no PPV
heart rate below 100 bpm
PPV
gasping with labored breather or lack of
PPV
compressions are postitioned where on the newborn
Xiphoid
PPV count
breath, 2, 3 breath 2, 3
assess HR every 15 seconds
chest compressions
90 compressions + 30 PPV += 120 events
90 compressions per minute
one and two and three and BREATHE AND one and two and three and BREATHE AND
3:1
reassess after 60 seconds of effective compressions to check HR
true! dont pause
stop chest compressions when HR is 60pm or above and continue PPV
true
ET tube
3.5-4 mm, 13 inches long
% of babies that pass meconium before birth
10-30%
healthy newborns spend 60% time sleeping
true
healthy newborns gain 1 oz a day and 1 inch per motnh
true
breastfed babies may gain less than 1 oz a day
true
during the first 3-5 days newborns may lose 5-10% of their birth weight
true
By 10 days after birth the baby should be atleast at birth weight
true
physiological jaundice
not in 24 hours
seen 3-4 days at peak at 13 mg
not seen after 10 days
pathological jaundice
visible in first 24 hours
rises quickly > 13 mgdL
visible after 7 days
tachynpea
> 60 respirations per min
nasal flare
retraction
respiratory disease
mec aspiration, pneumonia, pneumothorax, tachypnea
signs of mec aspiration
uneven breath sound, barrel chest, rales cyanosis,
TTN transient Tachy newborn
inadequate fluid lung absorption 48-72 hours
rales, tachy, nasal flare, intercostal retract
late onset bacterial infection
after a few days, problems sucking, lethary, color apnea, abnormal temps
most common sign of neurological disease
seizure
hernias
unilateral, decreased left side breath sounds, heart sounds on right, resp distress
IDM infants of Diabetic Mothers
increased birth weight, hypoglycemia, jitters, early jaundice, resp distress
maternal ppm pulse rate above 100 bpm
abnormal
postpartum blues occur
3- 5 days ppm,
B12 deficiency in what diet
vegetarian
peurperal morbidity
100.4 temp in first 10 days or 24 hours
endometritis diagnosis
urine and lochia cultures
postpartum depression
can start within a year after birth
Placenta succenturiate
lobes extending from main area of placenta
Placenta circumvallata
a ring from amnion and chorion around placenta
battledore
cord insertion on margin
velamentous
blood vessels separate and leave the cord
vasa previa
unprotected blood vessels covered only covered with amnion and chorion
1/3 rd of babies born with one um artery have malformation
true
largest muscle of pelvic floor
levator ani
