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37 Cards in this Set

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Premature Labor: definition
labor occurring prior to 37 weeks gestation
# weeks
Premature labor: risk factors
maternal infection, multiple gestations, polyhyramios, hypertension, third-trimester bleeding, premature ruputre of membranes, incompetent cervical os
7 risk factors
Premature labor: clinical manifestations
contractions occuring in increasing frequency and intensity, premature ruputre of the membranes
2 clinical manifestations
Premature labor: what maternal conditions indicate delivery?
diabetes, preeclampsia, hemorrrhage
3 maternal complications
Premature labor: what is the purpose of giving betamethasone (Celestone) when delivering a premature infant?
prevents respiratory distress in newborn. Given IM, contraindicated if maternal diabetes, infeciton, hypertension, of gestational age greater than 34 weeks.
How does it help the newborn? What gestational age is appropriate?
Premature labor: what delivery position should be used? Why?
left lateral Sims' position to promote placental perfusion.
Dystocia: definitions
1. Uterine dysfunction
2. Cephalopelvic disproportion
2 main types of dytocia
Dystocia due to uterine dysfunction: Types
1. prolonged/arrested labor (more than 24 hours after reg. contractions) --> may lead to intrauterine infection, postpartum hemorrhage, fatigue, dehydration in mother
in fetus may lead to fetal distress and infection
2. precipitous delivery (2-4 hours) can lead to maternal trauma to the soft tissues of cervix, vagina, and perineum, loss of self control.
fetal complications: fetal hypoxia.
3. hypotonic contractions: slow, infrequent, weak contractions (more than three minutes apart and less than 40 seconds long)
caused by uterine overdistension due to large ftus or twins, polydydramnios, and grandmultiparity
complications: related to prolonged or arrested labor.
4. Hypertonic contractions: frequent, strong, painful contractions (2-3 minutes apart, 60+ seconds long)
caused by misuse of oxytocin, mechnical obstruction, or cephalopelvic disproprotion or abnoromal fetal position
4 subtypes
Dystocia due to cephalopelvic disproportion (disproportion between the size of the fetus and that of the birth canal)
causes:
1. contracted pelvis
2. types of pelvic contractions
a. inlet contractions (vitamin d deficiency)
b. midpelvic contraction - prolongs labor
c. outlet contraction (usually requires forceps and episiotomy)
3. excessive size of fetus
a. fetus over 10 lbs, fetal macrosomatia due to maternal diabetes or postmaturity
b. hydrocephalus
c. featal malformations: abdominal distension, incomplete twinning
Dystocia due to faulty presentation
1. persistent occiput position
2. face, brow, or breech presentation
3. transverse lie--shoulder presentation
Dystocia treatments
A. mechanical dystocia related to CPD, faulty presentation --> c-birth
B. Hypotonic uterine contractions or prolonged labor --> IV pitocin
C. Hypertonic uterine contractions --> sedation and rest
3 types of treatments
Supine Hypotensive Syndrome:
definition
supine hypotensive syndrome, aka venocaval syndrome occurs when the weight of the uterus causes partial occlusion of the vena cava, leading to decreaed venous return to the heart.
Supine Hypotensive Syndrome: assessment, risk factors, intervention
presents as shock-like symptoms when pregnant woman assumes a supine position.
Risk factors: nullipara with strong abdominal muslces, gravidas with polyhydramnios or mulitple pregnancies, obese women
Intervention: mother turn to left side (removes pressure from vena cava)
oxygen if needed
assess fetal heart rates
Placenta Previa: definition
abnromal implantation of the placenta in the lower uterine segment; it occurs in less than 1% of pregnancies
Types of placenta previa
1. Complete (placenta totally ocvers internal cervical os)
2. Partial
3. Margina/low-lying (placenta appropraches rim of internal os but does not cover it)
Diagnosis of placenta previa:
intrapartum
bright vaginal bleeding, ultrasound shows position of placenta
what instrument is used? Color of bleeding?
Treatment of placenta previa: intrapartum
if gestation is less than 37 weeks, rest, monitoring hamoglobin and hematocrit, if fetus mature, delivery via c-birth (possible vaginal delivery if marginal placenta previa)
Abruptio Placentae (intrapartum): definition and types
premature separation of a normally implanted placenta, leading to hemorrhage.
1. external: blood escapes from the vagina with separation of the placenta
2. concealed or internal: hemorrhage occurs within the uterine cavity
3. partial separation: may occur with exernal bleeding or be associated with concealed bleeding
4. complete separation: most severe, with profound symptoms of shock
4 types of abruptio placentae
Abruptio Placentae (intrapartum) risk factors
pregnancy-induced hypertension, trauma, polyhydramnios, multipel pregnancies and increaed parity of mother
Abruptio Placentae (intrapartum)clinical manifestaions
hemorrhage, board-like abdomen, cramp-like abdominal pain, hypovolemic shock, coagulation problems
Abruptio Placentae (intrapartum)treatment:
medical: treatment of blood loss and shock
surgical: emergency c-birth
Ruptured Uterus: definition
tearing or splitting of the uterine wall during labor; it is usually a result of a thinned or weaked area that cannot withsatnd the strain and force of uterine contractions
Ruptured Uterus: risk factors
multiparity, obstructive labor, improper use of pitocin, large fetus, weakened, old cesarean section scar, external forces such as trauma
Ruptured Uterus: clinical manifestations
1. pain above the symphysis pubic
2. sudden, acute abdominal pain during a contraction
3. vaginal bleeding, shock; fetal distress

Warning signs:
no indiction of labor progress
ballooning out of the lower uterine segment (looks like full bladder)
apperance of a pathologic retraction ring
Ruptured Uterus: treatment
Medical: blood transfusion, prophylactic antibiotics
Surgical: laparotomy to remove fetus followed by s hysterectomy
Amniotic Fluid Embolism: defiintion
occurs when amniotic fluid enters the maternal circulation through open venous sinuses inthe placenta, at an area of placental separation, or through cervical tears under pressure from the contracting uterus. The fluid travels to the maternal pulmonary arterioles; prognosis is poor and mortality is etremely high for the mother
Amniotic Fluid Embolism: Risk factors
increaed incidie in multiparas, increased incidience ina difficult, rapid labor
Amniotic Fluid Embolism: clinical manifestations
sudden respiratory distress (dyspnea, cyanosis, pulmonary edema), profound shock and vascular collapse
decreaed fibrinogen and DIC (disseminated intravascular coagulation)
Amniotic Fluid Embolism: treatment
similar to pulmonary embolism treatments.
Meds: fibrinogen erplacement and IV heparin
Insertion of CVP line, blood transfusions, and CPR
Abnormal Fetal Po: occiput-posterior position
Assessment: dysfunctional labor pattern, prolonged active phase of labor, intense back pain
Assement of occipt-posterior position
Abnromal Fetal Position: Breech
RISK FACTORS: remature birth, placenta previa, polyhydramnios, multiple pregnancies, grand multiparity
**watch for: passage of meconium, FHR above umbilicus, increaed danger of prolapsed umbilical cord
Abnromal Fetal Position: Transverse lie
(Shoulder presentation)
increaed incide with placetna previa, neoplasma, fetal anomalies, and preterm labor.
Abnormal Fetal Position: Treatment
1. Occiput-posterior, may requrie forceps. IF CPD then c-birth.
2. Breech, usually c-birth
3. transverse lie usually c-birth
Prolapsed Cord: definition
washing down of the cord in front of the presenting part
Prolapsed Cord: risk facotrs
shoulder presentation, footling breech presentation, increaed incidence with prematurity
Prolapsed Cord: clinical manifestations
common after ruputre of the membranes, cord is washed through birth canal with a gush of amniotic fluid,
visualization of the cord: FHR decread with variable decelerations
Prolapsed Cord: Treatment
Medical: o2 to mother, IV, Traendelenburg position (head of bed or table is lowered) or knee-chest position, insertion of finger into vagia to lift fetal head of the cord to relieve pressure, if cord is outside the vagina keep moistend with saline soaked gauze
Surgical: if incomplete dilation, c-birth