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Spec Sit L&D
MAMC exam 9 special situations in labor & delivery (shear basics)
| Question | Answer |
|---|---|
| define amniotomy | (AROM) artificial rupture of the membranes (amniotic sac) by using a disposaable plastic hook (amnihook) |
| purpose of amniotomy | usually performed to allow internal electronic fetal monitoring |
| complications of amniotomy | prolapse of the umbilical cord infection abruptio placenta |
| amniotomy nursing considerations | identifying complications promoting comfort |
| define induction of labor | artificial initiation of labor |
| define augmentation of labor | artificial stimulation of contractions that hae begun spontaneously but become slowed or stopped |
| indications to induce labor | pregnancy more hazardous for mom & fetus than delivery reasons: conditions where the intrauterine environment is hostile to fetal well-being; HTN; PROM; post-term pregnancy; chorioamnionitis; abruptio placenta; fetal problems; fetal death |
| contraindications to induce labor | placenta previa, vasa previa umbilical cord prolapse high station of the fetus active herpes abnormal size/structure of mother's pelvis abnormal fetal presentation previous classic cesarean incision |
| induction/augmentation techniques | amniotomy cervical ripening: medical, mechanical |
| most common oxytocin induction/augmentation of labor | pitocin |
| risks of pitocin | hypertonic uterine activity uterine rupture maternal water intoxication |
| external cephalic version (ECV) | changes fetal position from a breech, shoulder, or oblique presentaion |
| internal version | malpresentation in twin gestations is usually managed by C section, but internal version is sometimes used for vaginal birth of 2nd twin |
| most common type of version | ECV |
| version contraindications | uterine malformations previous C section with a vertical uterine incision fetal size >4000g disproportion between fetal & maternal pelvic size placenta previa multifetal gestation oligohydramnios ruptured membranes cord around fetal crowning |
| version risks | fetus may become entangled in the umbilical cord, causing cord compression abruption placenta may occur mixing of fetal & paternal blood C-section for fetal compromise |
| operative vaginal births - forceps definition | curved, metal instruments with 2 curved blades that can be locked in the center |
| operative vaginal births - vacuum extractor definition | uses suction to grasp the fetal head while traction is applied not for nonvertex presentation also not used for very preterm fetus |
| maternal operative birth indications | exhaustion inability to push effectively cardiac & pulmonary disease |
| fetal operative birth indications | non-reassuring FHR patterns failure of the fetal part fo fully rotate & descend in the pelvis partial separation of the placenta |
| operative birth contraindications | fetal condition mandates more rapid birth |
| operative birth risks | trauma to maternal/fetal tissues |
| define episiotomy | surgical enlargement of the vagina during birth |
| define laceration | tear in cervix, perineum, or vagina |
| 1st & 2nd degree laceration | usually uncomplicated & heal quickly because they don't affect the rectal sphincter |
| 3rd degree laceration | extend to rectal sphincter |
| 4th degree laceration | extends completely through the rectal sphincter |
| risks of epistiomy & lacerations | infection primary extension of the episiotomy w/ a laceration into or through the rectal sphincter |
| when operative Cesarean birth performed | awaiting vaginal birth would compromise mom/fetus/both |
| indications for operative Cesarean birth | dystocia cephalopelvic disproportion HTN maternal diseae active genital herpes some previous uterine surgery persistent non-reassuring FHR prolapse umbilical cord fetal malpresentation hemorrhagic conditions |
| contraindications for operative Cesarean birth | fetal death fetus that's too immature to survive maternal coagulation defects |
| risks that increase Cesarean birth rate | 1st baby or 1st baby induced older gravidas EFM prompts concerns presistent breech presentation high litigation threat Cesarean on maternal request |
| operative Cesarean birth maternal surgical risks | infection hemorrhage urinary trauma UTI thrombophlebitis paralytic ileus atelectasis anesthesia complications |
| operative Cesarean birth infant surgical risks | inadvertent preterm birth transient tachypnea persistent pulmonary HTN injury: lacerations, bruising, fractures |
| abnormal labor | problems with Powers of Labor: may not be adequate to expel the fetus because of ineffective contractions or ineffective maternal pushing efforts |
| hypotonic labor dysfunction definition | uterine contractions too weak to be effective during labor |
| when hypotonic labor dysfunction most likely to occur | women with over-distended uterus |
| medical treatment for hypotonic labor dysfunction | doctor may do amniotomy augmentation of labor IV or oral fluids |
| define hypertonic labor dysfunciton | contractions that are uncoordinated & erratic in their frequency, duration & intensity |
| medical treatment for hypertonic labor dysfunction | mild sedation warm showers & baths tocolytic drugs (terbutaline) may be ordered |
| reasons for ineffective maternal pushing | use of incorrect pushing technique/positions fear of injury due to pain & tearing sensations regional anesthesia may reduce the natural urge to push |
| types of abnormal fetal presentation | rotation deflexion breech face brow |
| problems with breech birth | fetal injury prolapsed umbilical cord low birth weight fetal anomalies complications secondary to placenta previa or Cesarean birth |
| how multifetal pregnancy may result in dysfunciton labor | uterine over-distention which contributes to poor contraction quality abnormal presentation of 1 or all fetuses |
| hydrocephalus | fluid collection on the brain, causes enlargement of the fetal head |
| spina bifida | hernial protrusion of the meninges of the spinal cord hernial sac contains CSF & sometimes nervous tissue |
| 4 basic pelvic shapes | gynecoid antrhopoid android platypelloid |
| PPROM | preterm, premature rupture of the membranes (before end of 37th week) |
| PROM | membranes repture at term (38 weeks+) |
| define preterm labor (PTL) | occurs after 20th week & before end of 37th week |
| risk facotrs of PTL | PPROM overdistention of uterus maternal hormone changes recent sexual intercourse maternal stress or low socioeconomic status maternal nutritional deficiencies |
| signs & symptoms of PTL | contractions that may be either uncomfortable or painless feeling baby "balling up" menstrual-like cramps pelvic pressure change in vaginal discharge ABD cramps thigh pain "just feeling bad" "coming down with something" |
| define prolonged pregnancy | lasts longer than 42 weeks |
| define prolapsed umbilical cord | cord slips downward after the membranes rupture, subjecting it to compression between the fetus & pelvis |
| causes/risk factors of prolapsed umbilical cord | fetus high in pelvis when membranes repture very small fetus breech hydramnios |
| define uterine rupture | tear in the uterine wall that occurs if the uterine muscle cannot withstand the pressure against it. may precede labor's onset |
| variations of uterine rupture | complete incomplete dehiscence |
| causes of uterine rupture | previous surgery on the uterus many previous births intense contractions blunt ABD trauma |
| signs & symptoms of uterine rupture | may be asymptomatic shock due to bleeding into ABD ABD pain pain in chest cessation of contractions abnormal or absent FHR palpation of the fetus outside the uterus |
| define uterine inversion | occurs when the uterus completely or partly turns inside out, usually during the 3rd stage of labor. uncommon but potentially fatal |
| causes of uterine inversion | fundal pressure during birth pulling on umbilical cofrd before placenta detaches from the uterine wall fundal pressure on an incompletely contracted uterus after birth increased intraabd pressure abnormally adherent placenta weakness uterine wall |
| define amniotic fluid embolism | occus when amniotic fluid, with its particles, enters the maternal circulation & obstructs pulmonary vessels |
| amniotic fluid embolism possibly have a _____% maternal death rate during the acute episode | 50 |
| DIC is likely with amnotic fluid embolism because | thromboplastin-rich amniotic fluid interferes with normal blood clotting |
Created by:
ealongo
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