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74 Cards in this Set
- Front
- Back
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Maternal blood reaches the placenta via ___ |
the spiral arteries
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Exchange of oxygenation/nutrients occur in what part of the placenta?
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the intravilious space
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Deoxygenated blood reurns to maternal circulation via the ___.
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endometrial veins
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What are the mechanisims of transport across the placenta? What crosses the placenta by each mechanisim?
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passive diffusion - oxygen, CO2, fat-soluble vitamins, narcotics facilitated diffusion (helped by carrier molecules)- glucose |
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Describe the progesterone deprivation theory of labor initiation. |
progesterone is high and estrogen is low in early pregnancy, this ration reverses later in pregnancy, promoting calcium mobilization into the muscle and facilitating contractions |
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The greatest risk for preterm labor is ___.
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previous preterm delivery |
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What are risk factors for preterm labor? How do they work to initiate labor? |
infection, stress, placental ischemia, uterine over distension initiate phospholipid breakdown, leading to production of prostaglandins |
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What is fetal fibronectin? How is it collected? |
protein found in fetal membranes and decidua in 1st trimester collection of cervicovaginal secretions between 24-34 weeks |
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How effective is fetal fibronectin screening at pre dicing preterm delivery? |
99% negative predictive value within 7 days 14% positive predictive value |
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What can cause a false-positive fetal fibronectin screen? |
sexual intercorse within 24 hours, cervical exam within 24 hours, vaginal bleeding, intra-amniotic and/or vaginal infections, use of douches |
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What does nitrazine testing look for? What indicates a "positive" result? |
testing for possible rupture of membranes amniotic fluid is a basic solution, so a pH of 6.5-7.5 will turn the swab blue and indicates rupture |
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What can cause false-positive nitrazine test? |
blood, bacterial vaginosis, urine |
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Amniotic fluid causes a ___ pattern under the microscope. |
ferning |
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What does amnisure screening test for? What indicates a positive result? |
presence of PAMG-1 protein in fluid, indicating rupture 2 lines on the strip indicates positive results, 1 indicates negative, 0 indicates inconclusive/control strip not present |
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What is the goal of tocolytics in preterm labor? |
delay delivery at 48 hours to allow for maternal steroid administration and enhancement of fetal lung surfactant production |
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What is the mechanism of action of terbutaline? What are its side effects and contraindications? |
beta-sympathomimetic drug that stimulates B-2 receptors, causing smooth muscle relaxation maternal/fetal tachycardia, pulmonary edema, maternal hyperglycemia (and possible neonatal hypoglycemia) cardiac disease, hypertension, dysrhythmias, chorioamnionitis |
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What is the mechanism of action of indomethacin? When is it contraindicated?
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prostaglandin inhibitor maternal NSAID allergy, peptic ulcer disease, and after 32 weeks/for use > 72 hours due to risk of oligohydramnios, premature closure of PDA |
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When is betamethasone indicated? How is it given? What are some maternal considerations? |
between 24-34 weeks and at risk for delivery within 7 days to enhance fetal lung surfactant 12mg IM given 12-24 hours fluid retention, elevated glucose, elevated blood pressure, immunocompromise |
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A cervical length of < ___ mm indicates a risk of preterm labor. |
15-20 |
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How does magnesium affect uterine activity? |
inhibits calcium uptake, acting as a smooth muscle relaxant |
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How does nifedipine affect uterine activity? |
is a calcium channel blocker, decreasing uterine activity |
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A postdates pregnancy is __ weeks or more. |
42 |
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What are possible complications of a postdates pregnancy? |
decreasing placenta function, oligohydramnios, cord compression, meconium passage, thickening/stiffening of umbilical cord |
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What is the pathophysiology of meconium aspiration syndrome? |
mechanical airway obstruction, chemical pneumonitis, inactivation of surfactant, pulmonary vasoconstriction |
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Explain GFPAL. |
Gravida: total of pregnancies Para: pregnancies competed at 20+ weeks Term: pregnancies completed at 37+ weeks Preterm: pregnancies completed at < 37 weeks Abortions: therapeutic or spontaneous losses at < 20 weeks Living: total living children |
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What is Nagele's rule? |
used to estimate due date 1st day of LMP - 3 months + 7 days |
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How do you distinguish between true and false labor? |
true labor: regular contractions that increase in frequency/intensity/duration and produce cervical change false labor: braxton hick's contractions - irregular and intermittent, begin after 28 weeks |
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At __-__ weeks, fundal height should correlate with gestation. |
21-36 |
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What are the stages of labor? |
1st stage: onset of labor to 10cm 2nd stage: 10cm to delivery of infant 3rd stage: delivery of infant to delivery of placenta |
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What are the phases of labor? During which stage do they occur? |
during the 1st stage latent phase: cervical softening/effacement, 3-4 cm dilation active phase: 4cm-10cm |
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What is transition? |
dilation from 8-10cm |
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What is the latent phase of the 2nd stage of delivery? |
laboring down, passive movement of the fetus by uterine activity |
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What is the Ferguson's reflex? |
the strong urge to push |
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What are the cardinal movements of the fetus in labor? |
engagement descent flexion (chin to chest) internal rotation (OT to OA) extension (allows occiput to present first) external rotation (head/shoulders realign) expulsion (delivery of anterior shoulder) |
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The placenta usually separates within ___ minutes of delivery. |
30 |
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What are signs of placental separation? |
lengthening of cord, sudden gush of vaginal bleeding, change in shape of funds from discoid to globular |
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What is the indication for external version? What are contraindications? |
to change fetal position to vertex for vaginal delivery placenta previa, IUGR, nuchal cord, multiples, ruptured membranes, fetal anomalies, maternal diabetes/hypertension |
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What are the criteria for external version? |
U/S confirming presenting part and placenta location, lack of engagement of presenting part, at least 36 weeks gestation, reactive NST |
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What are the risks of external version? |
abruption, uterine rupture, amniotic fluid embolism, fetal distress, preterm labor |
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What are the indications for operative vaginal delivery?
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fetal compromise, maternal benefit, heart disease, lung injury, intrapartum infection, maternal exhaustion
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What are risks to the mother in the event of operative vaginal delivery?
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lacerations, bladder injury, hematomas
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What are the risks to the infant in the event of operative vaginal delivery?
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brusing, facial lacerations, nerve injuries, caput succedaneum, cephalahematoma
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What is caput succedaneum?
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soft tissue swelling that crosses suture lines caused by pressure restring venous and lymph return, resolves winthin 24-48 hours
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What is a cephalahematoma?
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collection of blood between the periosteum and cranial bone causing swelling that does not cross suture lines
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What is a subgleal hemorrhage?
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tearing of blood vessels beneath the fascial sheath that can result in severe blood loss
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What is a bishop's score?
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a 13 point system measuring cervix favorability
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A bishop score of ___ or more is equal to labor.
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8
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Which methods of induction are contraindicated in VBACs? |
Cytotec, Cervidil, Prepidil |
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How is Cervidil stored? |
in the freezer until ready for usge
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Oxytocin is a hormone secreed from the ___ gland.
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posterior pituitary
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Why is it important to monitor blood pressure when administering Pitocin? |
it may cause severe hypotension if too much is given too quickly |
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What are the benefits of amniotomy in labor? |
increases conversion of prostaglandins, may enhance labor progression, allows for assesment of amniotic fluid
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What are the risks of AROM/SROM? |
cord prolapse, ruptured vasa previas, intraamniotic infection
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What is the indiction for barbituates (phenobarbital, nembutal, secobarbital) in early labor? |
do not provide pain relief but may induce sleep, rest, and relaxation |
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What is the indication for narcotics in labor?
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moderate pain relief
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What can the nurse do while administering Fentanyl to minimize exposure to the fetus? |
administer during a uterine contraction
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What are the fetal/neonatal risks of giving Fentanyl in labor?
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decreased variablity on the FHR tracing, possible respiratory depression, hypotonia, hypothermia |
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What is a pudendal block? What are the advantages/disadvantages? |
local anesthetic injected throug the vaginal wall, blocking nerve impulses to perineal muscles gives quick pain relief to perineum/lower vagina/rectum, no risk of hypotension maternal hematoma, fetal bradycardia |
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What are the advantages of a combined spinal epidural? |
better pain control, minimal nerve block, less hypotension
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What are contraindications to spinal/epidural analgesia?
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thrombocytopneia, infection, uncorrected hypovolemia, increased intracranial pressure, local anesthetic allergy, spinal anomalies
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What is the purpose of the test dose? What causes a positive test dose? |
identify if epidural meds are being injected intravascularly/intraspinally epinephrine given intravascularly causes heart palpitations, tachycardia, tinnitus, metallic taste in mouth lidocaine given intraspinally will cause sudden onset of analgesia |
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What is the most common side effect of epidurals? Why?
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hypotension caused by decreasing systemic vascular resistance from vasodilation, decreased venous retur, and decreasd cardiac output
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What effect does epidural analgesia have on the fetus?
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effects secondary to maternal hypotension poor placental perfusion, decreased variability, late decelerations, bradycardia |
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What is the effect of a dura puncutre during epidural placement?
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CSF leakage, potential for a spinal headache |
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What is the treatment for a spinal headache?
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supine position, caffeine, blood patch
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What causes pyrexia in the presence of an epidural?
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decreased sweat production leading to diminished heat loss, may have a fever up to 100.4*F
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What are the maternal and fetal risks of general analgesia?
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maternal: aspiration, increased uterine relaxation and postpartum hemorrhage fetal: respiratory depression, hypotonia, acidosis |
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What kind of pain is present in the first stage of labor?
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visceral pain from muscle hypoxia, cervical dilation, stretching of lower uterine segment
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What kind of pain is present in the second stage of labor?
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somatic pain from pelvic floor distention, pressure of bladder/rectum/urethrea
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What are the side effects of pain in labor?
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rapid breathing leads to O2/CO2 impalance, decreased blood flow to uterus and brain, epinephrine release leads to blood vessel constriction, elevation of maternal glucose, tightnening of pelvic flor inhibiting fetal descent, elevated HR/BP |
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What is the theory behind the Bradley method?
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birth is a natural process
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What is the theory behind the Lamaze method?
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empowerment by childbirth education
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What is effleurage?
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massage by circular stroking
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What is disassociation relxation?
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sensation of contracting and relxaing voluntary muscle groups
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