Unit 13

Question 1

What is placenta previa?

Answer 1

Improperly implanted placenta in the lower uterine segment near or over the internal cervical os

Question 2

What is the difference of marginal, total, and low-lying placenta previa?

Answer 2

Marginal - 2.5cm or closer to internal cervical os
Total - internal cervical os completely covered
Low-lying - exact relationship of placenta to internal cervical os hasn’t been determined

Question 3

What are manifestations of placenta previa?

Answer 3

Sudden onset of PAINLESS bright red vaginal bleeding
Uterus is soft, relaxed, and nontender
Fundal height may be more than expected for gestational age

Question 4

What is management of placenta previa?

Answer 4

Avoid vaginal examinations
Ultrasound and get FHR and VS
Administer IV fluids, blood products, or tocolytic meds as prescribed - treat signs of shock

Question 5

What is abruptio placentae?

Answer 5

premature separation of the placenta from the uterine wall after the 20th week of gestation

Question 6

What are s/s of abruptio placentae?

Answer 6

Dark red, PAINFUL bleeding
Uterine pain
Abdomen board-like
Signs of fetal distress

Question 7

What is retroplacental abruptio placentae?

Answer 7

The most severe type; blood is hidden behind the placenta

Question 8

What are interventions for abruptio placentae?

Answer 8

Maintain bed rest
Trendelenburg position (decrease fetal pressure on placenta) or lateral position with HOB flat (hypovolemic shock)

Question 9

What are types of dysfunctional labor?

Answer 9

lneffective uterine contractions (power)
Alterations in pelvic structure (passageway)
Fetal causes (anomalies, malposition, malpresentation, multiples)

Question 10

What is precipitous labor?

Answer 10

<3hr in labor
Causes: preterm, hx of fast labor, HTN
Complication: risk for uterine rupture, increased risk of laceration, fetal distress, hemorrhage, amniotic fluid embolism

Question 11

What are the indications of induction

Answer 11

HTN
Preeclampsia
Eclampsia
Fetal death
Chorioamnionitis (infection)
Postterm
IUGR
PROM with fetal maturity
Diabetes

Question 12

What are contraindications for induction?

Answer 12

Fetal distress
Presenting part floating
Uncontrolled hemorrhage
Multiple gestations
CPD
Breech position
Placenta previa
Lack of ability to monitor FHR throughout labor

Question 13

What is the purpose of the BISHOP score?

Answer 13

evaluate maternal readiness for labor, higher the score the better

Question 14

What are risk factors for a cesarean birth?

Answer 14

multifetal
Dystocia
Maternal age
Diabetes

Question 15

What are indications of a c-section?

Answer 15

CPD
Hx of c-section
Breech
Genital herpes
Previa/Abruptio
Cord prolapse
(think about the contraindications for inductions)

Question 16

What are complications of a c-section?

Answer 16

dehisce incision
injury to baby
hemorrhage
injury to mom

Question 17

What is postpartum care management for a c-section mom?

Answer 17

Analgesics given before fundal massage
Splint abdomen with pillows
Clear liquid diet
IV fluids continued until liquids were orally tolerated
Avoid gas-forming foods, ice chips, carbonated beverages, using a straw = prevent gas pains
Ted hose, pillows under knees

Question 18

What are causes of shoulder dystocia?

Answer 18

Size of fetus

Question 19

What are s/s of shoulder dystocia?

Answer 19

Diabetes
Prolonged stage 2
Turtle necking
Fractured clavicle/humorous

Question 20

What are maneuvers for shoulder dystocia?

Answer 20

McRoberts - legs towards the abdomen
Suprapubic - pushing down on the shoulder with a fist
Gaskin - hand and knee position
No Fundal Pressure - not effective; placental complications