Weeks 5 and 6 - labour

Question 1

we want to encourage position changes every ____

Answer 1

20-30 minutes

Question 2

which opioids do we offer during labour for systemic analgesia?

Answer 2

morphine and fentanyl

Question 3

side effects of nitrous oxide

Answer 3

nausea, vomiting, dizziness

Question 4

can we combine nitrous oxide with other pain meds?

Answer 4

yes

Question 5

what do we teach with nitrous oxide?

Answer 5

take slow deep breaths for best effect, tight seal, breathe in during contraction and off in between, self administer ONY

Question 6

at what point can we give morphine?

Answer 6

in EARLY labour. not remotely close to delivery (duration is 4-5 hours)

Question 7

what would happen if the newborn had signs of respiratory depression due to opioids?

Answer 7

we can give them narcan (or just oxygen)

Question 8

what routes is morphine given?

Answer 8

subcut, IM, or IV

Question 9

what routes are fentanyl given in labor?

Answer 9

IV or PCA

Question 10

what would be put in an epidural?

Answer 10

bupivicaine and fentanyl

Question 11

can someone receive an epidural when they’re fully dilated?

Answer 11

yes, if they can sit upright and sit still

Question 12

what lab will the anesthesiologst want before epidural?

Answer 12

CBC for platelets

Question 13

what not great thing can we anticipate happening when we give an epidural?

Answer 13

vasodilation leading to hypotension

Question 14

why would we give a fluid bolus right before starting an epidural?

Answer 14

because we want to keep their BP up

Question 15

what are the cons or side effets of an epidural? (6)

Answer 15

hypotension
prolonged 1st and 2nd stage
increased temp (not huge)
limited mobility
urinary retention
postdural puncture/spinal headache

Question 16

teach patient about risk of ______ before epi

Answer 16

spinal headache

Question 17

get patient to ____ before epidural

Answer 17

void

Question 18

if dermatome check reveals that they are numb up to T4, what would we do (in labor)?

Answer 18

probably bump down med and get them to sit up

Question 19

what do i want to score my epidural patient for motor function?

Answer 19

0 (no block for feet/legs)

Question 20

when can we give fent in the second stage of labour?

Answer 20

passive phase only (so not when pushing)

Question 21

what is a pudental block?

Answer 21

blocks sensations of perineum - used for assisted birth or extensive repair of perineal laceration

Question 22

length of gestation matters more than ______

Answer 22

weight

Question 23

what do we call a low weight baby before they are born?

Answer 23

IUGR (intrauterine growth restriction)

Question 24

what is considered a low birth weight?

Answer 24

less than or equal to 2500g

Question 25

what do we call a baby born at 36 weeks?

Answer 25

“late preterm”

Question 26

what is acrocyanosis? is it concerning?

Answer 26

blue hands a feet, normal for term babies

Question 27

what are some reasons for indicated pre-term?

Answer 27

-Diabetes
-Hypertensive disorders of pregnancy
-Placental disorders & other obstetrical disorders
-Medical disorders
-Fetal disorders
-Oligohydramnios or polyhydramnios
-Fetal hydrops, ascites, blood group alloimmunization (usually d/t rh incompatibility)
-Birth defects
-Fetal complications of multifetal gestation

Question 28

what do we buy time to do when we give tocolytic agents for pre=term labour?

Answer 28

-Transport to a facility with an NICU
-Administer glucocorticoids for fetal lung maturity to decrease neonatal morbidity and mortality
-Administer MgSO4 for fetal neuroprotection
- may need to administer Abx

Question 29

considerations for giving mag sulph for pre-term

Answer 29

maximum 24 hours of therapy and then d/c, give 4g load and 1g/hr maintenence until birth

Question 30

biggest risk factor for neonatal death

Answer 30

preterm labour and birth

Question 31

what is recommended in active labour with BMI >35?

Answer 31

EFM

Question 32

high priority indications for labour induction (6)

Answer 32

Pre-eclampsia >37 weeks
Significant birther disease
Significant but stable antepartum hemorrhage
Chorioamnionitis
Suspected fetal compromise
Term prelabour rupture of membranes (PROM) with GBS colonization

Question 33

what is measured by bishops score?

Answer 33

ripeness of cervix

Question 34

first thing we do if we note a shoulder dystocia

Answer 34

note the time!

Question 35

mom has sudden onset of severe abdominal pain and fetal heart rate stops picking up. what might this be?

Answer 35

uterine rupture

Question 36

pt has sudden acute onset of hypoxia, hypotension,CV collapse. what obstetric emergency could this be>

Answer 36

amniotic fluid embolism

Question 37

risk factors for amniotic fluid embolism

Answer 37

Advanced age, non-White race, placenta previa, pre-eclampsia, forceps-assist/C-section