Week 5 Flashcards
What is the purpose of the Ritgens manever?
To achieve fetal extension. It assists mother when bearing down.
What is the maximum amt of licocaine that may be administered ?
10ml
Indications for an episiotomy?
- maternal exhaustion
- fetal distress
- forceps or vacuum delivery
- progress has ceased
- bleeding occurs around the head indicating a vaginal laceration
- previous 3rd degree or scarring
- the need for deeper hand maneuvers (shoulders)
What do you repair an episiotomy with?
2-0 or 3-0 with a rounded needle
Describe the steps to suturing an epis
- anchoring stitch above apex
- close the deep area with locked stitches above the hymenal ring and running stitches below it
- close the skin edges with a subcuticular stitch
What does a first degree laceration involve?
- vaginal mucosa
- post. forchette
- perineal skin
What does a second degree laceration involve?
- vaginal mucosa
- post. forchette
- perineal skin
- BULBOCAVERNOSUS MUSCLE
- SUPERFICIAL AND DEEP TRANSVERSE PERINEAL MUSCLES
What does a third degree laceration involve?
- vaginal mucosa
- post. forchette
- perineal skin
- Bulbocavernosus muscle
- Superficial and deep transverse perineal muscles
- ENTIRE THICKNESS OF RECTAL SPHINCTER
What does a fourth degree laceration involve?
- vaginal mucosa
- post. forchette
- perineal skin
- Bulbocavernosus muscle
- Superficial and deep transverse perineal muscles
- Entire thickness of rectal sphincter
- ANERIOR RECTAL WALL
3 facts about chromic
- absorbs easily
- strong strength
- less synthetic than vicryl
3 facts about vicryl
- less skin reactions
- easier to use
- takes longer to absorb
The lower the number the ______ the suture
thicker
What would you use a 4- 0 chromic on a small needle for?
periurethral, periclitoral
What would you use a 2-0 for?
vaginal wall, cervical lacerations, deep interrupted when repairing pelvic muscles
What would you use a 3-0 for?
vaginal mucosa, subcutaneous tissue, subcuticular tissue
GBS is present in ________% of all women
15-40%
What is the leading cause of newborn morbidity?
GBS infection
If a women has GBS in urine early in pregnancy what is the course of action?
She is treated in pregnancy AND in labor. She is NOT retested at 37 weeks
What are the two exceptions to GBS screening at 35-37 weeks?
- the woman tested positive during pregnancy
2. the woman had a baby previously who HAD gbs disease
What is the DOC for GBS?
PCN
What is the dosage of PCN when treating GBS?
Pen G 5 million units IV then 2.5 units every 4 hours till delivery
OR
Ampicillin 2gm then 1gm every 4 hours till delivery
What can be given for GBS if PCN allergy?
Cefazolin 2gm then 1gm every 8 hours
Clindamycin 900mg every 8 hours
Vancomycin 1gm every 12 hours
What do endorphins do?
provide a sense o relaxation. They are increased during pregnancy, labor, and several days pp.
What will pain meds do to endorphins?
they will suppress the mothers own endorphins
Where is the origin of pain in the first stage?
VISCERAL
- uterus
- cervix
- adnexa
- pelvic ligaments
- fetal descent
Where is the origin of pain in the second stage?
- distention of perineal structures
2. further fetal descent
Activity in the upper uterine segment is often felt ________ and is present during _________
lower abd.
efficient labor
Pain in the back s related to __________-
tension in the lower uterine segment and cervix
In normal labor when is back pain felt?
early labor
What is one PROMINANT reason for back pain in labor?
posterior position
What are the 7 pain theories?
- dissociation
- cognitive control
3 interference - gate theory
- Endogenous pain control theory
- Hawthorne effect
- relaxation
What is dissociation? example?
Focusing on a non-painful element of the contractions. EX: motion o the contraction, downward movement of the baby
What is cognitive control and an example
physiological strategies: attempting to focus on other mental activities instead of the pain EX: cards, tv
What is interference and a example?
having stimulation outside of the pain that interferes with the completion of the transmission of the pain EX: *may be passive (cards, tv) or active (breathing techniques, visualization)
What is the gate theory
Since pain signals are transmitted through small fibers to the substantia galatinosa, pre synaptic inhibition is accomplished by stimulating large fibers.
What so the large fibers in the gate theory?
conduct the stimulus to the brain and the closes the gate to pain perception one stimulus at a time.
Reactivation of the gate occurs when _________
changing the sit or type of stimulation
How long must habituated fibers rest?
15-20 minutes
What is the endogenous pain control theory of 1975?
Increasing the body’s natural endorphins decreases perception of pain.
Endorphins are _____like substances from the ______
morphine, pituitary
Endorphins travel to _______ ______ where they _____ pain transmission
opiate receptors, inhibit
What is the Hawthorne effect?
When someone performs better when positively reinforced, praised, and encouraged.
Describe the relaxation theory
trying to decrease # of catecholamine’s because they increase pain and anxiety.
cord length is a function of ________ ________
fetal activity
thin cord are related to ….
lesser amt of amniotic fluid
Cord thickness is related to
volume of amniotic fluid
thicker cords are found with
premature births
cord has _____ artery
2
cord has ______ vein
1
In chorio, absesses originate from ______ vessels and migrate into _____ and ______
maternal
chorion and amnion
In funisitis, absesses originate from ______ vessels of the umbilical cord and migrate into the ____ _____
fetal
whartons jelly
When does the 4th stage of labor occur?
1 hour pp
