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OB chpt 8
| Question | Answer |
|---|---|
| What is an amnioinfusion? | injection of warmed sterile saline or lactated Ringer's solution into the uterus via intrauterine pressure cath during labor after ROM |
| What are the indications for an amnioinfusion? | Oligohydramnios, cord compression resulting from lack of fluid, reduction of variable de-cels in FHR, Dilution of mecomium stained amniotic fluid |
| In what 2 ways can amnioinfusion be administered? | One-time bolus q1hr or as continuous infusion |
| Nursing care for amnioinfusion | cont. monitoring of uterine activity, FHR, change underpads as needed for pt. comfort, document color, amt, any odor expelled from vagina |
| Why would AROM be performed (2 indications) | 1. stimulate contractions to start labor 2. permit internal fetal monitoring |
| What are the 3 complications associated with ROM? (artificial OR natural) | 1.Prolapsed umbillical cord 2.Infection 3.Abruptio placentae |
| Observing for complications after ROM | 1. Record FHR for 1 min 2. Record color, amt, character of fluid 3. Take woman's temp q2-4 h |
| Induction | Initiation of labor before it begins naturally |
| Augmentation | stimulation of contractions after they have begun naturally |
| what 2 tests are performed before an induction? | L/S ratio & Bishop Scoring |
| What L/S ratio indicated fetal lung maturity in non-diabetic mother? In diabetic? | 2:1/3:1 |
| A Bishops score of at least ___ indicates a favorable prognosis for induction | 6 |
| When (generally) is induction of labor indicated? | when continuing the pregnancy is hazardous to the mother or the fetus |
| what are the clinical indications for labor induction? | Gestational HTN, ROM without spontaneous onset of labor, infection within uterus, medical problems in the woman that worsen during pregnancy (i.e. heart disease) Fetal problems such as IUGR, blood incompatability, placental insufficiency, fetal death |
| When is induction of labor contraindicated? | Placenta previa, umbilical cord prolapse,abnormal presentation, high station of fetus, active herpes infection in birth canal, abnormal size/structure of pelvis, previous classic c-section incision |
| what is prostaglandin used for? | Ripens the cervix |
| What type of IV should a mom have in place during cervical ripening and why? | A Hep-Lock with saline or heparin sodium should be in place in case uterus hyperstimulation occurs and IV tocolytics are needed |
| Nursing care after insertion of prostaglandins | bedrest for 1-2h, monitor contractions, VS, FHR |
| When can Oxytocin induction be started | when insert is removed-usually 6-12 hours |
| signs of uterine hyperstimulation | contractions longer than 90 seconds/more than 5 every 10 minutes |
| Narrow cone of substance that absorbs water and is known as an "osmotic dilator" | laminara |
| What is the vehicle for administering Pitocin? | IV piggyback into non-medicated IV solution, regulated by infusion pump |
| What is the usual method to assess and record fetal and maternal responses to oxytocin? | Continuous Electronic Fetal Monitoring |
| what are the most common complications r/t overstimulation of contractions? | Fetal compromise and uterine rupture |
| what rare complication may occur if large amounts of oxytocin and IV fluids are given during labor? | water intoxication |
| If your pt. is on IV infusion of Oxytocin and the FHR is 95 with a pattern of late decels and poor variability, what do you do? | stop the oxytocin, increase the non-medicated IV infusion, change woman's position, give oxygen by face mask at 8-10L/min, notify HCP, administer tocolytic if contractions do not quickly decrease (if there is an order for it!) |
| What maternal-fetal conditions contraindicate a version? | cephalopelvic disproportion, abnormal size/shape of uterus or pelvis, abnormal placental placement, previous c-section with vertical incision, active herpes virus infection, inadequate amniotic fluid, poor placental function, multifetal gestation |
| what is the main risk to the fetus during a version? | cord compression |
| when is external version done? | 37+ weeks, before onset of labor |
| what tests are performed before external version? what drugs are given? | NST, biophysical profile/ Tocolytics during procedure, RhoGAM if indicated after |
| First degree laceration | involves superficial vaginal mucosa or perineal skin |
| Second degree laceration | Superficial vaginal mucosa, perineal skin, deeper tissues of perineum |
| Third degree laceration | same as second degree but also involves anal sphincter |
| Fourth degree laceration | Extends through anal sphincter into rectal mucosa |
| A woman who has had a 3rd or 4th degree laceration should have a diet high in... | Fiber! To avoid constipation... |
| Episiotomy extending directly from lower vaginal border to anus | Median |
| Episiotomy extending from lower vaginal border to left or right | Mediolateral |
| Which type of episiotomy is easier to repair and heals neatly? | Median |
| A vacuum extractor can only be used if the fetus is in what position? | occiput |
| What conditions must be present for forceps or a vacuum extractor to be used? | membranes ruptured, fully dilated, bladder empty, fetal head engaged and at +2 station |
| circular edema on infants scalp caused by vacuum extractor | chignon |
| Why is a woman cathed before forceps or vacuum extraction? | to prevent trauma to the bladder |
| Labor that does not progress | dysfunctional labor |
| "difficult" labor | Dystocia |
| frequent, cramplike contractions that are poorly coordinated | hypertonic labor dysfunction |
| Hypertonic Labor dysfunction usually occurs during what phase of labor? | latent |
| what types of drugs might be used for hypertonic labor dysfunction? | tocolytics, mild sedatives |
| Define Hypotonic labor | Labor starts normally but contractions diminish during active phase |
| what conditions make it more likely for hypotonic labor to occur? | anything that over-distends the uterus-i.e. macrosomia, multifetal pregnancy, etc. |
| Macrosomia | fetus over 4000g (8.8 lbs) |
| Complications of shoulder dystocia | newborn-broken clavicles, deformities of bones, woman more at risk for uterine atony, hemorrhage |
| Average rate for cervical dilation during active phase of labor: Primagravida | 1.2cm/hr |
| Average rate for cervical dilation during active phase of labor: Multigravida | 1.5cm/hr |
| Average rate of descent: Primagravida | 1.0cm/hr |
| Average rate of descent: Multigravida | 2.0cm/hr |
| used to graph progress of dilation and descent | Freidman curve |
| Birth completed in less than 3 hours | Precipitate birth |
| Premature rupture of membranes | ROM at term (38 weeks) more than 1 hour before labor begins |
| Preterm rupture of membranes | ROM before term with or without contractions |
| PROM has been associated with what type of deficiency? | copper and ascorbic acid |
| how is oligohydramnios measured | AFI, less than 5cm |
| oligohydramnios less than 24 weeks gestation can cause what abnormalities? | pulmonary and skeletal defects |
| What happens if PROM occurs at 36+ weeks gestation | labor is induced within 24 hours |
| After PROM the nurse should observe, document and record what? | Maternal temp higher than 38 (100.4), fetal tachycardia, tenderness over uterine area |
| Fibronectin test | presence in vaginal secretions between 22-24 weeks is predictive of preterm labor |
| hormone that increases significantly in the weeks before preterm labor | CRH |
| diagnosis of preterm labor is based on | cervical effacement, 2+ cm dilated |
| Maternal symptoms of preterm labor | uncomfortable/painless contractions, feeling fetus is "balling up", menstrual like cramps, constant low backaches, pelvic pressure, change in vaginal discharge, pain/discomfort in vulva/thighs |
| drug of choice for stopping labor | magnesium sulfate |
| why should the newborn nursery be informed if magnesium sulfate was used in labor? | interactions with aminoglycocydes used for neonatal infection can cause weakness or paralysis |
| B-adrenergic drugs to stop labor | terbutaline (Brethine), Ritodrine (Yutopar) |
| terbutaline (Brethine) | Given sub-q, can increase B/P and pulse rate, Propranolol should be available to counter effects |
| Ritodrine (Yutopar) | Given IV, can cause hypotension, cardiac arrythmia, pulmonary edema, woman with diabetes should be monitored |
| Prostaglandin synthesis inhibators | indomethacin, can be given orally or rectally, causes reduction in amniotic fluid, can stimulate ductus arteriosus to close prematurely causing fetal death |
| Calcium Channel Blockers | nifedipine (Procardia) PO to stop labor contractions, causes vasodilation: maternal flushing and hypotension can be side effect |
| why is antibiotic therapy usually initiated in women in preterm labor | sub-clinical chorioamnionitis is often present-prevents from being spread to fetus |
| Contraindications for tocolytic therapy | preeclampsia, placenta previa, abruptio placentae, chorioamnionitis, fetal demise-would not improve obstetric outcome to delay birth |
| What drug speeds fetal lung maturity | 24-34 weeks, glucocorticoids, esp. Betamethasone-2 IM injections 24 hrs apart |
| found to enhance pulmonary maturation in fetuses younger than 28 weeks | tRH |
| 3 types of prolapsed cord | complete, palpated, occult |
| risk factors for prolapsed cord | fetus high in pelvis when membranes rupture, small fetus, abnormal presentation, hydramnios |
| what positions reduce cord pressure? | knee-chest, Trendelenburg, side lying with hips up on pillow |
| what drugs might be given for a woman with a prolapsed cord? | tocolytics and oxygen |
| Hole through uterine wall from uterine cavity to abdominal cavity | complete rupture |
| uterus tears into nearby structure, such as ligament, but not all the way into the abdominal cavity | incomplete rupture |
| an old uterine scar separates | dehiscence |
| type of c-section incision least likely to rupture | low transverse |
| maternal signs of uterine rupture | shock caused by bleeding in abdomen (vag. bleeding may be minimal), abdominal pai |
| Premature rupture of membranes | ROM at term (38 weeks) more than 1 hour before labor begins |
| Preterm rupture of membranes | ROM before term with or without contractions |
| PROM has been associated with what type of deficiency? | copper and ascorbic acid |
| how is oligohydramnios measured | AFI, less than 5cm |
| oligohydramnios less than 24 weeks gestation can cause what abnormalities? | pulmonary and skeletal defects |
| What happens if PROM occurs at 36+ weeks gestation | labor is induced within 24 hours |
| After PROM the nurse should observe, document and record what? | Maternal temp higher than 38 (100.4), fetal tachycardia, tenderness over uterine area |
| Fibronectin test | presence in vaginal secretions between 22-24 weeks is predictive of preterm labor |
| hormone that increases significantly in the weeks before preterm labor | CRH |
| diagnosis of preterm labor is based on | cervical effacement, 2+ cm dilated |
| Maternal symptoms of preterm labor | uncomfortable/painless contractions, feeling fetus is "balling up", menstrual like cramps, constant low backaches, pelvic pressure, change in vaginal discharge, pain/discomfort in vulva/thighs |
| drug of choice for stopping labor | magnesium sulfate |
| why should the newborn nursery be informed if magnesium sulfate was used in labor? | interactions with aminoglycocydes used for neonatal infection can cause weakness or paralysis |
| B-adrenergic drugs to stop labor | terbutaline (Brethine), Ritodrine (Yutopar) |
| terbutaline (Brethine) | Given sub-q, can increase B/P and pulse rate, Propranolol should be available to counter effects |
| Ritodrine (Yutopar) | Given IV, can cause hypotension, cardiac arrythmia, pulmonary edema, woman with diabetes should be monitored |
| Prostaglandin synthesis inhibators | indomethacin, can be given orally or rectally, causes reduction in amniotic fluid, can stimulate ductus arteriosus to close prematurely causing fetal death |
| Calcium Channel Blockers | nifedipine (Procardia) PO to stop labor contractions, causes vasodilation: maternal flushing and hypotension can be side effect |
| why is antibiotic therapy usually initiated in women in preterm labor | sub-clinical chorioamnionitis is often present-prevents from being spread to fetus |
| Contraindications for tocolytic therapy | preeclampsia, placenta previa, abruptio placentae, chorioamnionitis, fetal demise-would not improve obstetric outcome to delay birth |
| What drug speeds fetal lung maturity | 24-34 weeks, glucocorticoids, esp. Betamethasone-2 IM injections 24 hrs apart |
| found to enhance pulmonary maturation in fetuses younger than 28 weeks | tRH |
| 3 types of prolapsed cord | complete, palpated, occult |
| risk factors for prolapsed cord | fetus high in pelvis when membranes rupture, small fetus, abnormal presentation, hydramnios |
| what positions reduce cord pressure? | knee-chest, Trendelenburg, side lying with hips up on pillow |
| what drugs might be given for a woman with a prolapsed cord? | tocolytics and oxygen |
| Hole through uterine wall from uterine cavity to abdominal cavity | complete rupture |
| uterus tears into nearby structure, such as ligament, but not all the way into the abdominal cavity | incomplete rupture |
| an old uterine scar separates | dehiscence |
| type of c-section incision least likely to rupture | low transverse |
| maternal signs of uterine rupture | shock caused by bleeding in abdomen (vag. bleeding may be minimal), abdominal pain, pain between shoulder blades or with inspiration, abnormal or absent fetal heart tones, cessation of contractions, palpation of fetus outside the uterus |
| uterus turns inside out after infant is born | uterine inversion |
Created by:
RebekahB
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