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39 Cards in this Set

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Elective inductions with favorable conditions (cervix ripe) 84% deliver in
12 hours
What is involved in the induction procedure?
Amniotomy
Oxytocin
Why amniotomy?
ROM stimulates labor.
Why oxytocin?
stimulates contractions.
where is oxytocin produced?
By hypothalmus and stores in pituitary. Released by baby sucking.
How is pitocin given?
Pitocin is dangerous before delivery so give milliunits on secondary line of pump.
What are the nurses responsibilities?
Continuously monitor progress of labor.
What are the nursing/legal responsibilities?
watch for reaction to pitocin. If problem you can turn it off. MD must be in hospital and available.
What are precautions-adverse reactions?
ruptured uterus; strong, frequent contraction without good rest period - fetal distress. Placenta might abrupt.
What are contraindication for induction?
any reason baby shouldn't deliver vaginally
Preemie - 32 weeks safe
overdistended uterus
granmultip
What drug should you start with if cervix green before induction?
Cervidil
What is a cause of a failed induction?
doesn't respond to oxytocin > have to do c-sections. Bishop score: Score of inducibility.
what 5 factors are scored for the Bishop score?
Cervical dilitation
effacement
cervix position
station of head
(0-3 pts. each)
9 & > ok to be induced.
5 or < not ready to be induced.
What are some operative procedures for L & D?
Forceps
vacuum extractor
version
What are indications for forcep delivery?
medical condition where pushing not good for mom (heart disease), intrapartal disease; baby - fetal distress suddenly with baby low enough.
Elective use of forceps to speed up delivery.
What are the 2 positions for forceps delivery?
Mid forcep: head has to be at least engaged- usually used to rotate on.
Low forcep: (outlet forcep): head on perinium.
What is a vacuum extractor?
Suction device applied to presenting part. Doesn't have to be engaged or completely dilated. Must need to know exact position to place on parietal bones.
What is version?
Turning presentation for delivery. Can do abdominally or intrauteral.
What are 2 versions?
Cephalic(external) - presenting breech-8 mths. try to turn baby or during delivery, turn.
Podalic (internal)- Alter position to a breech (twins ex.) pull second baby down by feet.
What are 3 methods of version?
external
internal
combined
C section operative procedure -
Low-segment - corpus - transverse or vertical incision.
Classical: fundus. She should never be allowed to labor. Will rupture. Schedule C section before due date so doesn't labor.
What are the types of episiotomies?
midline
medio-lateral
midline episiotomy -
most are this kind.
1st degree - into peritoneum
2nd degree - a little further
3rd degree - into anal spinchter
4th degree - thru anal spincter into lumen of bowel
medio-lateral episiotomy -
left or right side of vaginal orifice. Leaves a more obvious scar, heels slower, bleeds more, takes longer to heel.
Complications of delivery
amniotic fluid embolus
abnormal uterine muscle action
abnormal presentations, positions etc.
What could cause an amniotic emboli?
rupture can cause release of amniotic fluid emboli into mothers bloodstream.
What are abnormal uterine muscle contractions?
Hypertonic - looks more like false labor. Strong, frequent contractions. Rapid dilitation of cervix - is seen in first phase.
Hypotonic - occurs during 2nd, active phase.Prolonged labor, risk of hemorrhage and infection.
What are abnormal presentations?
Breech - 3-4% - longer labor
Have piper forceps in delivery room
Brow Attitude - Won't deliver as is - converts to vertex or face.
Face Attitude - Mentum anterior; mentum posterior, must rotate
What are other abnormal positions?
Transverse Lie - Neoplasms, prematurity, lax muscles.
OP - Occiput posterior - may need 4th degree episiotomy if delivered. Back pain for mom
Compound presentation - 2 presenting parts
Macrosomia - very large baby > 4000 grams. Diabetic mom, large parents
What are some other complications?
CPD-overdistention of uterus
Prolapsed cord
multiple pregnacy
retained placenta
amniotic fluid embolism
inversion of the uterus
ruptured uterus
What is prolapsed cord?
Umbilical cord that precedes the presenting part. Decreases oxygen to fetus if compressed.
what are the 2 types of retained placenta?
Placenta accrete - chorionic ville attach directly to myometrium of uterus.
Couvelaire's uterus -hemorrhage caused by abrupti placentae - uterus turns blue-after baby born difficulty contracting - hysterectomy often
What is amniotic fluid embolism?
bolus of amniotic fluid enters maternal circulation, then lungs
What is inversion of uterus?
prolapse of uterine fundus to or thru cervix so uterus is turned inside out after birth - hemorrhage.
What is difference between complete and incomplete ruptured uterus?
Complete - includes entire thickness of uterine wall.
Incomplete - dehiscense of surgical wound where visceral peritoneum stays intact.
What are cord abnormalities?
Velamentous cord insertion
Vasa previa
cord lengths
true knot
Velamentous cord insertion -
the vessels of the cord divide some distance from the placenta in the placental membranes. Occur more in multiple gestations than single.
Vasa previa -
fetal vessels course through the amniotic membranes and are present at the cervical os - high fetal death rate.
cord lengths -
avg lenth 55 cm.
short cords assoc. with umbilical hernias in the fetus, abruptio placentae, and cord rupture.
Long cords tend to twist and tangle around the fetus, causing transient variable decelerations.