Birthing Process
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| found in cat feces of cats who live outside and hunt birds and mice with parasite | toxoplasmosis
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| how is toxoplasmosis transmitted | hand to mouth
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| you can get toxoplasmosis by eating what | raw meat of sheep/cattle
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| associated with pre-term births | hepatitis B
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| if this if + on culture at time of delivery cannot deliver vaginally | Gonorrhea
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| may be asymptomatic | Hep B
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| how do we treat infants that have been delivered to + gonorrhea on mom | treat with erythromycin ointment to prevent blindness
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| If baby has been treated with the erythromycin ointment and is at further risk what is it treated with also | erythromycin syrup
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| with hep B infants are most commonly infected at birth w/mom secretions but fetuses can also be infected thru what | placenta
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| if mom is on VDRL, RPR or serology what can this cause | congenital syphilis
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| when do we need to treat mom for this and if we don't what can this lead to of the fetus | 1st 20 weeks - if not treated can lead to abortion or stillborn
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| if syphilis is treated after the 1st 20 weeks then this can cause changes in what | placenta, liver, spleen, kidney, adrenal glands, bone covering and marrow, CNS, teeth, cornea (congenital cataracts)
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| if mom was treated and newborn is born how often do we need to ck antibody level | every 2 weeks for 3 months
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| what is the usual tx for syphilis | pcn
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| which infection is usually treated with pyrimethamine (teratogenic) and sulfonamindes (which may cause kernicterus and need for exchange) | toxoplasmosis
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| how is toxoplasmosis usually dx | with elevated IgM in cord blood
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| which infection causes serious perinatal mortality and morbidity; mental retardatin, severs psychomotor problems and visual problems, preterm birth, IUGR, microcephaly, hydrocephaly | toxoplasmosis
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| which infection can cause opthalmia neonatorum, neonatal gonococcal arthritis, septicemia meningitis, vaginitis and scalp abscesses | Gonorrhea
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| for rubella mom should have titer of what value | >1:8
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| if baby is infected with congenital rubella is this usually seen at birth | it may not be seen at birth but later on
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| what is the most common concern with rubella | hearing loss-congenital cataracts, CV and IUGR
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| an intracellular bacterium causes neonatal conjunctivitis and pneumonia | chlamydia
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| what do we tx chlamydia with | erythromycin ointment
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| if the chlamydia is chronic how do we tx | with the erythromycin ointment for 2-3 weeks
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| infants who are at further risk - how are they treated for chlamydia | with oral erythromycin syrup
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| which infection is the common cause of neonatal sepsis and meningitis in the US | Group B Strep
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| how soon before delivery if mom is + on culture for group B strep should we tx | want 6hrs tx before delivery
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| if a baby is infected with HIV at birth do we usually see s/s | no usually seen 3-6 months
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| what may we seen in the 1st year | FTT or developmental delays
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| an infection which is from a virus found in the environment | CMV
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| if CMV is not seen at birth what may be seen later on in infant | hearing and learning disabilities
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| how is CMV transmitted | thru breast milk
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| if mom is HIV + and is treated with meds this can reduce incidence of Nbn developing to what % | <3%
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| is HIV transmitted thru breast milk | yes-also thru placenta and maternal blood and secretion (20-35% of transmission)
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| which infection is transmitted thru placenta or ascends by way of birth canal; direct contamination from personnel, significant other, family etc | Herpes simplex virus
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| when does transmission usually occur from mom to fetus | at ROM
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| if mom is identified early with having herpes and has active lesions when do we need to deliver | prior to ROM
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| what do we treat herpes with | antiviral meds
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| if mom has hepatitis B when should the nbn be treated and with what | should be treated with hep B immune globulin (HBIG) asap or w/in 12 hrs
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| what else is nbn usually treated with | hep vaccine
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| where is the hep vaccine usually given | in a different spot than the HBIG
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| when is a 2nd dose due of the hep vaccine | @1 month
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| when is the 3rd dose due of the hep vaccine | @6 months
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| in 1988 CDC recommended all preg women to be tested for what | Hepatitis B
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| The 4 P's of the birth process | Power, Passage, Passenger, and Psyche
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| Powers | uterine contractions, maternal pushing
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| Passage | bony pelvis, soft tissue
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| Passenger | fetus, fetal head
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| Psyche | expectations of birthing process tend to have longer labors if anxious or high anxiety
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| effacement | thinning of cervix %
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| dilation | opening of the cervix in cm
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| Phases of contractions | increment, peak, decrement
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| Increment | period of increasing strength
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| Peak | period of greatest strength
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| decrement | period of decreasing strength
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| 10cm | COMPLETE (no longer palpable)
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| frequency | beginning of one contraction, to the beginning of another
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| Duration | beginning of a contraction until the end of the same contraction. <90sec
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| tetonic contraction | >90sec (slowing blood flow to the fetus, baby lacks oxygen and become stressed)
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| Intensity | strenght of contraction
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| Interval (recovery time) | amount of time uterus relaxes between contractions
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| TRUE LABOR | while walking contractions become more intense
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| maternal pushing | only push when fully dilated to prevent problems to the pelvis and the muscle
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| molding | bones overlapping in the head during the birth process
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| fetal lie | determine a vaginal delivery or not. how the baby lays inside the mothers uterus.
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| longitudinal lie | the baby lies up and down-parallel spine
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| transverse Lie | the baby lies crosswise in the uterus-shoulder tries to come out first
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| Oblique Lie | the baby lies diagonal in the uterus (/)
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| Breech | BUTT first
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| Vertex | head fully flexed
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| military | niether flexed or extended
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| brow | partially extended- head partially back
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| face | head is fully extended 9head all the way back)
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| Frank breech | legs extended toward the shoulder
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| Complete breech | butt first with flexion of head and extremities. baby sitting cross legged
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| footling Breech | one foot dangling
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| Double footling Breech | both feet dangling
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| Attitude | normal one of flexion- chin on their chest-well flexed best for birth
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| Engaged | largest diameter of baby is at both the ischial spines
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| Early deceleration of FHR | FHR slows when contraction occurs
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| Late deceleration of FHR | BAD---looks like early deceleration, dip doesn't stop until contraction is over. uterol-plcental diffiency due to baby being stressed.
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| Variable deceleration of FHR | up, down, up, down pattern of FHR, cord compression, shut off oxytocin. C-section if FHR tones go down
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| Accerlerations of FHR | GOOD viable baby
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| Dilation and effecement | onset of contraction, ends with complete cervical dilation
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| Latent Phase | dilation of cervix 0-3cm
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| Active Phase | dilation of the cervix 4-7cm. more intent and INTENSE. too late to stop labor, able to recieve narcotic now
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| transition | dilation of the cervix 8-10cm. sweat on upper lip, very uncomfortable.
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| Stage 2 | 10cm (complete) --to-- birth. voluntary contractions, mom is able to push baby out
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| Stage 3 | Birth --to-- Delivery of the placenta (norm 20-30min)
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| Stage 4 | highest risk for hemmorhage. blood loss is usually 250ml-500ml. mom may experience chills
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| epidural block | above the dura-anesthiesiologist cause hypotension. monitor B/P keep bladder empty
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| Spinal block | spinal anesthetic, just below the breasts on down for a C-section, cannot move legs or toes until it wears off, may have decreased sensation to bladder.
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| Intrathecal block | remain in a better ability to push
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| local infiltration | episiotomy--used to stitch up, relieve pain
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| Pudendal block | anesthetic on both sides of the cervix-makes pain and contractions go away, able to push tho
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| General anesthesia | Used for crash c-section, baby's heart tones go down drastically (60's) baby is out immediately. <1min. medicine relaxes uterus, can reach in and pull placenta out
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| Narcan | given to reverse respiatory depression caused from an opiate
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| Induction | stimulation of uterine contractions before they begin spontaneously
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| Augmentation | stimulation of contractions after spontaneously beginning but with unsatisfactory progress (dilation doesn't increase)
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| Induction via Amniotomy | artificial rupture of membranes
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| Oxytocin (Pitocin) | given to induce the labor
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| prolapsed cord | the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby.
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| Care of the infant | Airway Breathing Ciculation warmth
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| Apgar Score | 1.mother's B/P before admin of oxytocic med 2 .fundus firm, midline, below umbilicus 3. maternity/vaginal pads are applied 4. mother and infant allowed to bond
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| The 4 P's of the birth process | Power, Passage, Passenger, and Psyche
🗑
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| Powers | uterine contractions, maternal pushing
🗑
|
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| Passage | bony pelvis, soft tissue
🗑
|
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| Passenger | fetus, fetal head
🗑
|
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| Psyche | expectations of birthing process tend to have longer labors if anxious or high anxiety
🗑
|
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| effacement | thinning of cervix %
🗑
|
||||
| dilation | opening of the cervix in cm
🗑
|
||||
| Phases of contractions | increment, peak, decrement
🗑
|
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| Increment | period of increasing strength
🗑
|
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| Peak | period of greatest strength
🗑
|
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| decrement | period of decreasing strength
🗑
|
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| 10cm | COMPLETE (no longer palpable)
🗑
|
||||
| frequency | beginning of one contraction, to the beginning of another
🗑
|
||||
| Duration | beginning of a contraction until the end of the same contraction. <90sec
🗑
|
||||
| tetonic contraction | >90sec (slowing blood flow to the fetus, baby lacks oxygen and become stressed)
🗑
|
||||
| Intensity | strenght of contraction
🗑
|
||||
| Interval (recovery time) | amount of time uterus relaxes between contractions
🗑
|
||||
| TRUE LABOR | while walking contractions become more intense
🗑
|
||||
| maternal pushing | only push when fully dilated to prevent problems to the pelvis and the muscle
🗑
|
||||
| molding | bones overlapping in the head during the birth process
🗑
|
||||
| fetal lie | determine a vaginal delivery or not. how the baby lays inside the mothers uterus.
🗑
|
||||
| longitudinal lie | the baby lies up and down-parallel spine
🗑
|
||||
| transverse Lie | the baby lies crosswise in the uterus-shoulder tries to come out first
🗑
|
||||
| Oblique Lie | the baby lies diagonal in the uterus (/)
🗑
|
||||
| Breech | BUTT first
🗑
|
||||
| Vertex | head fully flexed
🗑
|
||||
| military | niether flexed or extended
🗑
|
||||
| brow | partially extended- head partially back
🗑
|
||||
| face | head is fully extended 9head all the way back)
🗑
|
||||
| Frank breech | legs extended toward the shoulder
🗑
|
||||
| Complete breech | butt first with flexion of head and extremities. baby sitting cross legged
🗑
|
||||
| footling Breech | one foot dangling
🗑
|
||||
| Double footling Breech | both feet dangling
🗑
|
||||
| Attitude | normal one of flexion- chin on their chest-well flexed best for birth
🗑
|
||||
| Engaged | largest diameter of baby is at both the ischial spines
🗑
|
||||
| Early deceleration of FHR | FHR slows when contraction occurs
🗑
|
||||
| Late deceleration of FHR | BAD---looks like early deceleration, dip doesn't stop until contraction is over. uterol-plcental diffiency due to baby being stressed.
🗑
|
||||
| Variable deceleration of FHR | up, down, up, down pattern of FHR, cord compression, shut off oxytocin. C-section if FHR tones go down
🗑
|
||||
| Accerlerations of FHR | GOOD viable baby
🗑
|
||||
| First Stage of Labor |
🗑
|
||||
| Dilation and effecement | onset of contraction, ends with complete cervical dilation
🗑
|
||||
| Latent Phase | dilation of cervix 0-3cm
🗑
|
||||
| Active Phase | dilation of the cervix 4-7cm. more intent and INTENSE. too late to stop labor, able to recieve narcotic now
🗑
|
||||
| transition | dilation of the cervix 8-10cm. sweat on upper lip, very uncomfortable.
🗑
|
||||
| Stage 2 | 10cm (complete) --to-- birth. voluntary contractions, mom is able to push baby out
🗑
|
||||
| Stage 3 | Birth --to-- Delivery of the placenta (norm 20-30min)
🗑
|
||||
| Stage 4 | highest risk for hemmorhage. blood loss is usually 250ml-500ml. mom may experience chills
🗑
|
||||
| epidural block | above the dura-anesthiesiologist cause hypotension. monitor B/P keep bladder empty
🗑
|
||||
| Spinal block | spinal anesthetic, just below the breasts on down for a C-section, cannot move legs or toes until it wears off, may have decreased sensation to bladder.
🗑
|
||||
| Intrathecal block | remain in a better ability to push
🗑
|
||||
| local infiltration | episiotomy--used to stitch up, relieve pain
🗑
|
||||
| Pudendal block | anesthetic on both sides of the cervix-makes pain and contractions go away, able to push tho
🗑
|
||||
| General anesthesia | Used for crash c-section, baby's heart tones go down drastically (60's) baby is out immediately. <1min. medicine relaxes uterus, can reach in and pull placenta out
🗑
|
||||
| Narcan | given to reverse respiatory depression caused from an opiate
🗑
|
||||
| Induction | stimulation of uterine contractions before they begin spontaneously
🗑
|
||||
| Augmentation | stimulation of contractions after spontaneously beginning but with unsatisfactory progress (dilation doesn't increase)
🗑
|
||||
| Induction via Amniotomy | artificial rupture of membranes
🗑
|
||||
| Oxytocin (Pitocin) | given to induce the labor
🗑
|
||||
| prolapsed cord | the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby.
🗑
|
||||
| Care of the infant | Airway Breathing Ciculation warmth
🗑
|
||||
| Apgar Score | 1.mother's B/P before admin of oxytocic med 2.fundus firm, midline, below umbilicus 3.maternity/vaginal pads are applied 4.mother and infant allowed to bond
🗑
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