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OB Exam 2
| Question | Answer |
|---|---|
| What is true labor? | contractions that occur regularly and increase in frequency, duration and intensity AND cause changes to cervical dilation and effacement |
| What is false labor? | irregular contractions without cervical change |
| What three important assessments are obtained during a SVE? What do each mean? | dilation, effacement, station |
| How many stages of labor are there? | 4 |
| What is the transition phase of labor? | during 8-10 cm dilated |
| What are the 5 P's of labor? | powers, passage, position, passenger, psyche |
| Acoustic stimulation | a non-invasive obstetric technique that uses a device on the maternal abdomen to produce sound/vibration, inducing a fetal startle reflex or heart rate acceleratio |
| Augmentation | speeding up the process after labor starts on its own |
| Dystocia | a slow, stalled, or physically blocked birth where the fetus cannot pass through the pelvis |
| Episodic | not associated with contractions |
| Induction | inducing labor |
| Leopold maneuvers | our, non-invasive, systematic abdominal palpation techniques used during the third trimester to determine fetal lie, presentation, and position |
| Multipara | a woman who has had more than one pregnancy resulting in viable offspring. |
| Nullipara | a woman who has never given birth to a live infant or a viable child, including cases of miscarriage or stillbirth |
| Nonstress test | a safe, non-invasive prenatal test used after 28 weeks gestation to check a baby's heart rate in response to their movement |
| Perineal body | a critical fibromuscular anchor point between the vagina/vulva and anus |
| Periodic | associated with contractions |
| Polyhydramnios | a critical fibromuscular anchor point between the vagina/vulva and anus |
| Primapara | a woman who is giving birth for the first time |
| Pyrexia | a woman who is giving birth for the first time |
| Vena cava syndrome | a condition where the enlarged pregnant uterus compresses the inferior vena cava and aorta while the patient is supine |
| Compounding fetal presentation | head first with one arm up |
| Breech fetal presentation | feet first |
| O | occiput (head down) |
| M | Mentum (head up) |
| S | sacrum (breech) |
| A | shoulder |
| Complete breech | regular breech |
| Frank breech | fetus is crunched criss cross applesauce |
| Single foot breech | fetus has one leg protruding |
| Engagement | The fetal head passes into the pelvic inlet |
| Descent | The baby moves down into the pelvis |
| Flexion | The chin tucks toward the chest to present the smallest diameter. |
| Internal rotation | The head rotates to align with the pelvis |
| Extension | The head passes under the pubic bone |
| External rotation and restitution | The head rotates to align with the shoulders and the baby is delivered |
| Emergent c-section | immediate need to deliver fetus (usually within 30 minutes) |
| Urgent c-section | need for rapid delivery of fetus, but patient and fetus are stable (within an hour to couple of hours) |
| Non-urgent c-section | need for delivery related to complications during labor (that shift or that day) |
| TOLAC/VBAC | trial of labor after cesarean, vaginal labor after cesarean |
| When is an analgesic agent administered? | When cervical change has occurred |
| What happens if an analgesic is given too early? Too late? | Prolonged labor, respiratory depression of the newborn |
| What can be used to reverse the side effects of respiratory depression in a newborn? | Narcan |
| Nitrous oxide | "laughing gas" inhaled into the bloodstream but does NOT affect the baby |
| Local anesthesia | injected into the perineum (usually lidocaine) to treat pain after a laceration/episiotomy |
| Pudendal block anesthesia | injected into the pudendal nerve to numb the perineum usually used in the second stage of labor before delivery |
| Epidural anesthesia | injected into the epidural space used commonly for vaginal deliveries |
| What is the most common complication of an epidrual? | hypotension |
| Spinal anesthesia | injected into the subarachnoid space, commonly used for c-sections |
| General anesthesia | IV injection or inhalation that renders consciousness used mainly for emergency c-sections |
| What is intermittent monitoring done with? How often? With risk factors? | Doppler, every 30 min in the active first stage and every 15 min during the second stage. Every 15 min during the first stage, every 5 min in the second |
| FHR baseline? | 110-160 |
| Sinusoidal FHR pattern could be a sign of? | severe fetal anemia/RH immunization, placental abruption, fetal-maternal hemorrhage, fetal acidosis |
| Pseudosinusoidal FHR pattern could be a sign of? | thumb sucking, narcotic administration, and usually lasts less than 20 min` |
| Variability | fluctuations within baseline based on oxygenation and CNS function |
| What can be done to correct poor variability? | O2 administration |
| Accelerations | abrupt to peak rise in less than 30 second intervals, lasting at least 15 seconds long |
| What do accelerations indicate? | a well-oxygenated fetus |
| Variables | abrupt decrease of less than 30 seconds to nadir |
| What do variables indicate? How do you fix them? | umbilical cord compression, position changes or amnioinfusion |
| Early decelerations | a gradual decrease that mirrors the contraction peak |
| What do early decelerations indicate? | fetal head compression |
| Late decelerations | a gradual decrease that occurs after the peak of the contraction and doesn't end until the start of the next contraction |
| What do late decelerations indicate? | uteroplacental insufficency |
| How to correct late decels? | Position changes (left lying), IVF bolus, O2, stop pitocin and proceed with c-section |
| Who must be notified for late decels? | the HCP, but also document findings |
| Frequency of contraction | time from the beginning of one contraction to the beginning of the next contraction |
| Duration of contraction | time from the beginning of the contraction until relaxation until relaxation |
| Intensity of contraction | the strength of contractions (cannot be measures externally) |
| Toco | an external monitor used to measure the frequency and duration of contractions |
| Ultrasound transducer | an external monitor used to measure FHR but is likely to pick up other sounds |
| IUPC | can be used after ROM to measure the strength of contractions and add amniofusion PRN |
| FSE | fetal scalp electrode that accurately picks up FHR |
| POISON FHR Management | position changes, oxygen delivery, IVF bolus, SVE, oxytocin off, notify HCP |
| What are the indications for inducing a patient? | post-term gestation, fetus is at least 39 weeks gestation, if there are maternal/fetal comorbidities or concerns |
| What are the indications for augmenting a patient? | insufficient uterine activity/dysfunction or prolonged ROM |
| What mechanical devices can be used to enhance cervical ripening? | foley bulbs, cook catheter, dilapan |
| What pharmacological medications can be used to enhance cervical ripening? | Cervidil and cytotec `(not for TOLAC/VBAC patients) |
| Sweeping/stripping of membranes | digital separation of the chorionic membrane from the wall of the cervix and lower uterine segment during an SVE to stimulate labor |
| Amniotomy | AROM using an amnihook (done by HCP) |
| Amniofusion | warm sterile saline or LR solution into the uterus through an IUPC that is used to relieve cord compression and thin meconium in fluid |
| Pitocin | the most common induction agent that is considered a high risk medication when used during IP because it can cause tachycardia and lead to fetal distress |
| Precipitous labor | rapid labor or birth that lasts less than 3 hours from onset |
| Prolonged labor | more than 20 hours for first time pregnancy or more than 14 after previous pregnancy |
| CPD | cephalopelvic disproportion where the pelvis is small or abnormal causing delayed descent of the fetal head |
| ECV | external cephalic version, the HCP turns the fetus using external manipulation |
| What are the indications of an ECV? | breech/shoulder/transverse presentation, 36 weeks of gestation or greater, NST reactive, breech is not engaged |
| Vacuum assisted delivery | vacuum cup is applied to the fetal head with negative pressure and should only be attempted 3 times before going or the OR for a c-section |
| How far along in gestation does a fetus have to be in order to perform and operative vaginal delivery? | at least 34 weeks |
| Forceps assisted delivery | forceps blades are placed over the parietal lobes of the BP |
| Post-term pregnancy | greater than 42 weeks gestation which increases risk for stillbirth |
| If a stillborn is less than 28 weeks gestation, how should labor be induced? | with misoprostol |
| Chorio | an intraamniotic infection |
| Shoulder dystocia | an emergency due to the difficulty in delivering the shoulders secondary to the anterior shoulder becoming impacted on the pelvic rim |
| What is the first sign of shoulder dystocia? | immediate retraction of the fetal head against the perineum after extension, known as a "turtle head" |
| How long should the HCP try and deliver the newborn before going to the OR for an emergency c-section? | 5 minutes |
| What can providers do to fix shoulder dystocia? | episiotomy, woods screw, deliver posterior arm, break anterior clavicle, zavanelli |
| What can the nurse do to fix shoulder dystocia? | mcroberts position, gaskins position, straight cath, suprapubic pressure |
| Umbilical prolapse | an emergency when the umbilical cord lies between or bedside the presenting part which compresses blood flow to the infant |
| Vasa previa | an emergency where abnormal fetal blood vessels run through the fetal membranes over or near the cervical opening |
| Uterine rupture | an emergency due to the laceration of the uterine walls tearing and extending to uterine vessels leading to hemorrhage |
| Complete uterine rupture | direct opening from uterine cavity to peritoneal cavity |
| Incomplete uterine rupture | rupture to peritoneum lining, but not through the uterus |
| Dehiscience | partial separation of old uterine scar |
| AFE | amniotic fluid embolism, a very rare emergency where a small tear in amnion or chorion that causes a small amount of amniotic fluid to leak into the chorionic plate and enter the circulatory system |
| What occurs during the first stage of labor? | regular contractions to full dilation |
| What occurs during the second stage of labor? | full dilation to the delivery of the infant |
| What occurs during the third stage of labor? | delivery of the placenta |
| What occurs during the fourth stage of labor? | postpartum (1-4 hours after delivery) |
| How long after birth should the placenta be delivered? | within 30 minutes |
| When should the infant's APGAR score be tested? | 1 and 5 minutes after birth, again at 10 minutes if abnormal |
| 7+ APGAR | reassuring |
| 4-6 APGAR | reassess |
| 3 or less APGAR | resuscitation measures likely |
| Nubain | an opioid used for moderate-to-severe pain managemen |
| Stadol | a narcotic analgesic used for short-term relief of moderate-to-severe pain |
| Demerol | an opioid analgesic sometimes used for pain management during labor |
| Fetal tachycardia is commonly due to? | Maternal fever |
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