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ob quiz 3
| Question | Answer |
|---|---|
| PROM | rupture > or = 37 wks before labor, its normal;physiologic |
| PPROM | rupture before 37 wks; not normal; higher risk of infection |
| COAT ASSESSMENT | COLOR(should be clear/straw= normal, green= meconium), ODOR (foul smell=infection), AMOUNT, TIME (time of rupture) |
| NITRAZINE TEST | 6.5-7 PH -> turns blue = the membrane rupture |
| FERNING TEST | seeing the aminiotic fluid under microscope |
| PRETERM LABOR | regular contractions, cervical change before 37 |
| PRETERM KEY SIGNS | pelvic or low back pressure, changes in vaginal discharge, mild or irregular contractions, rupture of membrane |
| PRETERM LABOR Treatment | delay for at least 48 hrs, antenatal steriod can work |
| betamethsone | promotes fetal lung maturity |
| MGSO4 | give before 34 wks, helps with brain neuroprotection |
| tocolytics | given in preterm labor, this helps with contractions (indo, nife, terb) |
| Magnesium toxicity | monitor every hour, theraputic is nausea/flushing normal, loss of DTR= hold call provider, Respiratory aresst = STOP and give calcium gluconate STAT |
| Chorioamnionitis | intrauterine infection |
| chorioamnionitis diagnosis | fever + one or more symptoms (fetal tachycardia, uterine tenderness on palpation, foul smelling fluid, elevated wbc) |
| chorioamnionitis management | broad spectrum anitbiotics immediately (ampicillin + gentamic), delivery is the definite treatment, continous EFM and temperature q2h |
| risk factors chorioamnionitis | PPROM or PROM, multiple vag exam, prolonged labor |
| POSTTERM PREG | > or = 42 weeks, fetal risks macrosomnia, shoulder dystocia, meeconium aspiration, maternal risk C/S, PPH, dystocia, infection |
| postterm treatment | survillence twice weekly NST + AFI starting @ 40-41 wks |
| BISHOP SCORE | < 6 cervical ripen first, you can give prostagladin (AVOID if had uterine scar), then oxytocin after cervical favorable (WATCH OUT FOR TACHYSYSTOLE) |
| TACHYSYSTOLE | too much contractions, >5 contractions in 10 min |
| AMNIOTOMY | artifical rupture of membranes |
| AMNIOTOMY purpose | augment and induce labor when cervic is favorable or to have internal monitoring on fetus |
| AMNIOTOMY RISK | CORD PROLAPSE TO MAKE SURE TO CHECK FETAL STATION BEFORE PROCEDURE, AND CHORIOAMNIONITIS (RISK INCREASE W TIME) |
| AMNIOTOMY NURSING CARE | monitor for FHR for 1 min and more to check for any sudden fetal decelerations as it can indicate cord prolapse |
| Placenta previa | painless, bright red vaginal bleeding, soft, nontender uterus, FHR usually normal (CANNOT BE DELIVERED VAGINALLY) ALWAYS C-SECTION, NO DIGITAL EXAM ALLOWED, one exam can trigger catastrophic hemorrhage |
| placental abruption | placenta separating from uterus, PAINLESS, DARK RED BLEEDING (CAN BE CONCEALED), RIGID, BOARD LIKE UTERUS, SEVERE TENDERNESS, ALWAYS ASSESS FOR CONCEALED BLEEDING |
| placental abruption nursing response | IV, TYPE CROSSMATCH, CBC, CONTINUOUS EFM, PREPARE EMERGENCY C/S |
| VASA PREVIA | FETAL VESSEL LYING OVER THE VAGINAL OS, ROM CAUSES FETAL EXSAGUINATION (BLEEDING OUT WITHIN MINUTES), NEVER DO VAGINAL EXAM, C/S @ 34-35 WKS |
| DISSEMINATED INTRAVASCULAR COAGULATION (DIC) | ALWAYS SECONDARY TO ANOTHER CONDITION- treat the clotting cascade and causes simulatenous clotting and BLEEDING |
| DIC TRIGGERS OB | placental abruption most common, PPH, preclamspai/HELP/AFE/SEPSIS/prolonged ftal demise |
| DIC nursing assessment | petechia, oozing IV, hematura, epistaxis (blood everywhere) |
| DIC nursing treatment | treat the cause and replace blood products (FFP, CYROPRECIPIATE, PLATELETS) |
| GBS | group b streptococcus |
| GBS what is it | harmless to adults- life threatening to newborns |
| GBS screening | @ 35-37 wks, GBS positive pts treat w/ IV pencillin G in labor, @ least 4 hr before birth, treat empirically dont wait for results (PRETERM) |
| neonatal risk if untreated with gbs | pneumonia, sepsis, meningitis |
| malpresentation | breech + ECV |
| ECV | external cephalic version (flips the baby manuelly 50% works) |
| breech | babies head ontop of stomach (frank, complete, single footling, double footling) |
| occiput posterior position | fetus faces up, longer and more painful labor , nursing: hands-knees or lunging position to rotate |
| CPD | heads too large for pelis, adequate contractions + no proress in 4-6 hrs, EMPTY BLADDER FIRST (it can mimic CPD), you wanna do birth by C/S |
| Shoulder dystocia | baby shoulder is stuck, "turtle sign", brain injury within 4-5 minutes (baby not getting enough oxygen) |
| risk factor of shoulder dystocia | Macrosomia or maternal diabetes Prior shoulder dystocia Prolonged second stage |
| what not to do in shoulder dystocia | put pressure on fundus or pull the neck/head of fetus |
| shoulder dystocia HELLPER response | Help, episiotomy, Legs= mcroberts, pressure= superpubic (pushing shoulder down lateral), enter internal rotation, remove arm, roll |
| episiotomy | Surgical cut to enlarge vaginal opening Midline vs. medio-lateral incision |
| episiotomy indications | indicated : Prolonged Stage 2/ non-reassuring FHR Shoulder dystocia maneuvers Complication: Chronic pelvic pain/worst tear for next baby |
| vaccum extractions | you give 3 pulls, 3 popoffs, <20 mins, if fail -> c/s (DO NOT DO FORECEPS AFTER) |
| forceps | put on each side of head -> pull |
| C/S EMERGENCY indications | Failure to progress (active labor) Non-reassuring FHR remote from delivery Cord prolapse or placental abruption Uterine rupture |
| Planned C/S | Placenta previa or prior classical incision Active herpes, transverse lie |
| uterine incision types | low transverse= safe for VBAC classical (vertical)= cannot do VBAC |
| uterine rupture risk factors | TOLAC (trying vag birth after c/s) Oxytocin hyperstimulation (too much oxytocin) Grand multiparity or abdominal trauma Can cause death to mom or baby |
| uterine rupture warning signs | Sudden Category II or III FHR Scar pain between contractions (extreme pain) Contractions suddenly stop Loss of fetal station |
| uterine rupture | consider an emergency c/s needed |
| umbilical cord prolapse | cord drops below presenting part -> compressed -> fetal hypoxia within minutes |
| umbilical cord prolapse response | push the presenting part up- DO NOT REMOVE YOUR HAND, CALL FOR HELP STAT, KNEE CHEST OR STEEP TREDELEBURG POSITION, emergency c/s |
| Amniotic fluid embolism (AFE) | amniotic fluid enters maternal circulation, RARE, morality rate is high |
| Amniotic fluid embolism (AFE) signs | Sudden hypotension + respiratory failure Seizures and cardiac arrest DIC / coagulopathy within minutes Can occur up to 48h after delivery |
| Amniotic fluid embolism (AFE) nursing response | Activate CODE team immediately CPR · vasopressors · massive transfusion Emergency C/S if baby not yet delivered (extremely high morality rate) |
| Retained placenta | Impairs uterine contraction → PPH risk May wait another 30 min if no heavy bleeding Provider attempts manual removal Nursing: large-bore IV · VS monitoring · catheterize |
| perineal lacerations | 1, skin only, 2 skin + muscle, 3, anal, 4 rectum |
| perineal lacerations prevention | perineal massage and warm compression @ stage 2 of labor |
| where do births happen | hospitals, birth center, home birth |
| five p of labor | passenger, passageway, power, psyche, position |
| power | uterine contractions (primary), maternal ability to push (secondary) |
| passageway | bony pelvis shape, size, soft tissue, cervical dilation |
| passenger | fetal head size, presenation, lie, attitude, and station |
| psyche | pt fear, anxiety pain tolerance, support system |
| position | maternal position- up right & mobile promotes fetal descent |
| passageway prefered | gynecoid pelvis shape |
| fetal presentation | cephalic (vertix), breech (cause of many c-sections), transverse (shoulder/sideways -> CANNOT BE DELIVERED VAGINALLY) |
| fetal atttiude | ideal= full flexion (chint o chest) |
| fetal lie | longitutdinal (vertical) vs transverse ideal: baby antierior back close to mom stomach |
| fetal station | -3 to -1 = on top 0= middle +3 to +1 = closer to vaginal CROWING = +3 |
| true labor | Contractions → progressive cervical change Regular, increasing frequency & intensity Starts in low back, radiates to abdomen Persist or worsen with walking Labor only ends with delivery of placenta |
| false labor | braxton hicks Contractions WITHOUT cervical change Irregular, do not intensify over time Felt in abdomen/groin — may decrease with activity Resolve with hydration, position change, or rest |
| premonitory signs of labor | lightening (↓ 2 wks before), bloody show (prelabor cervical change, pludgent mucus (mucus w blood)), nesting (get things ready for baby), GI upset, weight loss 1–3 lb, regular contractions | Labor confirmed by cervical change |
| first stage of labor | dilation & effacement (0-10cm) Latent: 0–6 cm (mild cramping, longest phase) Active: 6–10 cm Transition: 8–10 cm (pt loses control, agitated, etc) |
| second stage of labor | birth of baby (pushing-> delivery) 20 min – 4 hrs Cardinal movements Urge to push ↑ (the longer ppl push they more likely risk of hemorrhage ) |
| third stage of labor | placental delivery (5-10min) cord lengthening, blood gush, urge to push |
| 4th stage of labor | recovery, > or = 4 hr or stable VS q15 × 1 hr Fundus/lochia Brief & breastfeed (baby should be skin to skin, gold hour very important for bonding and breast feeding) -> Heaviest risk time for hemorrhage 1k cc for vag birth |
| assessing ROM (first stage of labor) | USE THE COAT ACRONYM |
| second stage (cardinal movement) | engagement, descent, flexion, internal rotation, extension, resitution, explusion |
| fetal monitoring external | Internal only done if we cant do external thing and/or we worried about d cells, can also use to monitor contractions (strength) -fetus scalpolecture (put on fetus head)-> (we don’t use it when infection from mother (e.g. hep b or hiv positive) |
| fetal monitoring baseline | assessed over 10 min normal : 110-160 bpm tachycardia: >160 bradycardia: <110 |
| variability depends on baseline | absent = 0 = concerning minimal: <5bpm = monitor closely moderate: >6 - 25 = NORMAL/REASSURING marked: >25 bpm: investigate closely |
| accelerations | reassuring: term > or = 15 bpm lasting 15 seconds or greater |
| monitoring frequency | Active phase (low-risk): q30 min (1st stage); q15 min (2nd stage) High-risk: q15 min (1st stage); q5 min (2nd stage) Continuous EFM is standard practice in the US |
| categories | Category I (normal) = reassuring. Category II = indeterminate, close watch. Category III = abnormal, immediate action |
| fetal monitoring | a baseline heart rate is assessed over 2 minutes in a 10-minute period and is normally between 110 and 160 bpm. Variability is the irregular fluctuations in the baseline fetal heart rate. Moderate variability has an amplitude of 6 to 25 bpm and is asses |
| FHR decelerations | VEAL CHOP |
| variable decel= cord compression | PATTERN IS U,V,W SHAPED, nursing want to reposition, D/C oxy, o2, notify HCP |
| Early decel= head compression | normal just document |
| acceleration= ok | normal just document |
| late decel= placental insufficeny UPI (baby not geting enough o2) | resposition, correct hypotension, IV FLUID BOLUS, d/c oxy, notify provider |
| FHR accerlation -> normal pattern | signifies fetal well being |
| sinusodial pattern | associated with fetal anemia reflecting the fetus’ attempt to compensate for reduced O2 carrying capacity of its blood, very nonreassuring |
| prolonged deceleration | associated with fetal anemia reflecting the fetus’ attempt to compensate for reduced O2 carrying capacity of its blood |
| labor pain management | nonpharm first then pharm (opiods, mixed agonist/antagonists, nitrous oxide, regional analgesia) nursing: monitor VS + FHR with ALL MEDS |
| epidural block | continuous infusion or intermittent injection; Combined spinal–epidural block (CSE |
| Intrathecal (spinal) analgesia/anesthesia | (during labor and cesarean birth) |
| General anesthesia generally used for emergency deliver | General anesthesia generally used for emergency deliver |
| Local infiltration | (usually for episiotomy or laceration repair) |
| Pudendal block | (usually for second stage, episiotomy, or operative vaginal birth) |
| third stage of labor | Signs of placental separation: cord lengthens, gush of blood, urge to push Uterus contracts to close open decidual vessels Uterine atony = PRIMARY cause of PPH Oxytocin given after delivery to promote contraction (never pull on the cord of placenta!!) |
| fourth stage of labor | VS & fundus q15 min × 1 hr, then q30 min × 1 hr Assess lochia: rubra (bright red), amount, clots Encourage void — full bladder displaces uterus Skin-to-skin, initiate breastfeeding Pain management; warm blanket |
| uterine involution | Immediately postpartum: fundus at umbilicus → descends 1 fingerbreadth/day → non-palpable by day 10. A boggy uterus = MASSAGE NOW; if displaced to the side = empty bladder first. |
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