Ob - Antepartal Complications

Front 1

Test to determine a person at risk for preterm delivery. Positive result shows risk of preterm.

Back 1

Fetal Fibronectin Assay

Front 2

PIH diagnosed when?

Back 2

After 20 weeks gestation only and after 48hrs PP

Front 3

PIH cure?

Back 3

Delivery of the baby

Front 4

Pre-eclampsia definition

Back 4

Hypertension at least 2 occasions
6 hrs apart +30mm or 140/90
at rest on left side
Know baseline

Front 5

Eclampsia

Back 5

Pre-eclampsia + grand mal seizures

Front 6

PIH abnormality

Back 6

Arteriolar Spasm

Front 7

Arteriolar Spasm affects:

Back 7

Hypertension
Reduced blood flow to uterus, kidneys, liver, brain

Front 8

S/SX of PIH CNS irritability

Back 8

headaches
visual disturbances
Grand mal seizures

Front 9

PIH plasma
Less or more in blood?

Back 9

Less; causes less clotting and the appearance of edema. HCT rises

Front 10

PIH S/SX

Back 10

High B/P, generalized edema, proteinuria

Front 11

PIH Treatments

Back 11

Left sided bedrest, diet modifications (high protein, low salt), plenty of H2O, frequent dr. visits, assess DTRs (hyperreflexive 3-4+)

Front 12

Severe pre-eclampsia S/SX

Back 12

B/P 160/100+, 3-4 proteinuria, high HCT, HA, visual disturbances, N/V, hyperreflexia, irritable, oliguria, epigastric pain (late)

Front 13

Severe pre-eclampsia TX

Back 13

Complete bedrest, decreased stimuli, seizure precautions, may need IV fluids, central lines, strict I&O, daily wgt, VS, DTRs, Mag Sulfate

Front 14

Magnesium Sulfate for severe pre-eclampsia

Back 14

CNS depressant
causes B/P to decrease slightly
loading dose 1st- get very flushed
maintenance dose (4-7mEq/L)

Front 15

Magnesuim Toxicity S/SX

Back 15

9 mEq/L or more, flushed, slurred speech, absent DTR or 1+, hypothermic,

Front 16

Mag Toxicity antidote

Back 16

Calcium Gluconate

Front 17

PIH C/S delivery procedures

Back 17

Avoid vena cava syndrome, so lay on their side, caution w/ epidural, Code Pink team on delivery, continue meds till 48hrs PP

Front 18

PIH signs of recovery

Back 18

Diuresis

Front 19

Eclampsia S/SX

Back 19

Grand mal seizures, rise in T, strokes, abruptio placenta

Front 20

Grand Mal seizures procedures

Back 20

Break seizure 1st w/ valium, then Mag sulfate

Front 21

Lasix usage?


(2)

Back 21

Heart failure, pulmonary edema

Front 22

HELLP Syndrome

Back 22

Hemolysis Elevated Liver function tests Low Platelet count
Arterial Spasm
Extreme low platelet counts

Front 23

B/P high post 6 wks PP

Back 23

Chronic Hypertension

Front 24

Chronic HTN Goals of care


(2)

Back 24

Prevent superimposed PIH (diet)
Prevent uteroplacental insufficiency (Low O2, Low nutrients)
Methyldopa - HTN drug for pregnancy

Front 25

Diabetes in Pregnancy
insulin requirements ?

Back 25

1st TM: less needed (N/V)
2nd 3rd TM: insulin need rises
L&D: insulin coverage for D5W IV
PP: abrupt decrease; some no insulin

Front 26

Effects of diabetes

(6)

Back 26

perinatal mortality, hyperglycemia, polyhydramnios, PIH, infections from glycosuria, congenital abnormalities

Front 27

Care of Diabetes w/ Preg

Back 27

Preconception counseling, prenatal vit.,folic acid, HbA1c glycohemoglobin measurement s/b 6 or less (avg. over 4-12 wks)

Front 28

Preg. Diabetes Calories

Back 28

1st TM: 25-30/kg
2nd 3rd TM: 30-35/kg
3 meals, 3 snacks , last snack is vital
(eat peanut butter)

Front 29

When to deliver early if diabetic

Back 29

If HbA1c comes back high
If suspect LGA

Front 30

Insulin requirements when
Breastfeeding?

Back 30

more calories required so more insulin required

Front 31

Glucose Challenge Test
normal levels

Back 31

24-48 weeks
Normal less than 140

Front 32

3 hr Oral Glucose Tolerance Test

Back 32

High carb diet 2 days then NPO
100 grams glucose wait 3 hrs
FBS: 95 or less 1 hr:180 or less
2 hr:155 or less 3 hr: 140 or less
Any two abnormal or any >200

Front 33

S/SX of Diabetes

Back 33

Frequent urination
Polydipsia
Polysphasia
Wgt loss

Front 34

Gestational Diabetes Mgmt

Back 34

Diet-controlled
Abnormal: insulin or glyburide
F/U 6 weeks PP

Front 35

Cardiac Decompensation

Back 35

Functional Classification level rises
crackles, tachy, dyspnea, orthopnea, moist cough 28-32 weeks (cardiac output rises in plasma volume)

Front 36

Congenital Heart Defects

Back 36

Given SBE prophylaxis (antibiotics) to prevent bacteria into heart

Front 37

Mitral Valve Prolapse (MVP) S/SX, Tx

Back 37

fatigue, dizziness, palpitations, arrhythmias,
No caffeine, SBE antibiotics at delivery,

Front 38

Rheumatic Heart Disease Mgmt

Back 38

High nutrient (Fe, folic acid), restrict NA, increased rest, heparin

Front 39

Peripartum Cardiomyopathy Mgmt

Back 39

digitalis, diuretics, anticoagulants, bedrest, may need heart transplant

Front 40

AP care of Cardiac Pts

Back 40

Decrease anxiety, high nutrient diet, low Na, adequate calories, avoid URIs, frequent visits,

Front 41

IP & PP Care of Cardiac Pts

Back 41

Position w/ head & shoulders raised, O2, short 2nd stage, watch 48 hr PP (cardiac output increases), longer hosp stay, increase rest, limit visitors

Front 42

Rh Incompatibility
What causes opening of barrier?

Back 42

Infection
Trauma
Abruptio Placenta

Front 43

Rhogam
when to give?

Back 43

If mom is antibody (-)
Cannot give if already (+)

Front 44

ABO Incompatibility
Mother O
Baby A or B

Back 44

causes jaundice in baby

Front 45

Abortion

Back 45

expulsion of POC (products of conception) 20 weeks or early

Front 46

Threatened spontaneous AB

Back 46

Bleeding first 1/2 pregnancy
need pelvic rest

Front 47

Inevitable spontaneous AB

Back 47

SROM
Cx dilates
painful contractions
increased bleeding

Front 48

Complete AB

Back 48

All POC expelled
D&C not needed

Front 49

Incomplete AB

Back 49

partial expulsion of POC (placental tissue)
need D&C

Front 50

Missed AB

Back 50

fetal death, but POC retained for long period
D&C or can wait it out 6 weeks (at risk for DIC)

Front 51

Ectopic Pregnancy
#1 cause

Back 51

PID (pelvic inflammatory disease)

Front 52

Ectopic pregnancy
pain location?

Back 52

referred pain on wrong side or shoulder

Front 53

Ectopic pregnancy S/SX

Back 53

pain over site, abdomen tender, cervical motion tenderness, bluish tinge to umbilicus, low RBC, high WBC,

Front 54

Ectopic preg Tx

Back 54

Tuboplasty
Methotrexate
Antibiotics

Front 55

Placenta Previa
Types?

Back 55

Total - covers whole cervix
Partial - covers part of cervix
Low lying - doesn't cover but sits low

Front 56

Placenta Previa
Classic sign?

Back 56

Intermittent painless bleeding

Front 57

Placenta Previa Mgmt

Back 57

No vaginal exams
Maintain bedrest ( causes constipation; give stool soft.)
C/S required for partial or total

Front 58

Abruptio Placentae

Back 58

Premature separation (after 20 weeks)
usually caused by HTN, abd trauma, short umbilical cord

Front 59

Abruptio Placentae S/SX
Mgmt

Back 59

Vaginal bleeding with constant abdominal pain
<250 blood loss: bedrest, observe
>250 blood loss: C/S

Front 60

Hyperemesis Gravidarum
Mgmt

Back 60

excessive N/V; beyond 1st TM
correct F/E imbalances
IV:glucose, vit.B1, elect.
Zofran, Reglan

Front 61

Labor Loop

Back 61

stretching of cervix----
increase in oxytocin----
increase in myometrial activity

Front 62

To attempt VBAC,
you must have had...

Back 62

Lower segment transverse

Front 63

Effacement of cervix

Back 63

Taking up of the internal os and cervical canal into uterine sidewalls

Primi: usually must efface before dilation

Front 64

Dilation of cervix

Back 64

Longitudinal muscle fibers pull over baby's head

Front 65

Pushing
When to start?

Back 65

Once completely dilated only or can cause tearing

Front 66

Natural physiologic anesthesia

Back 66

Less blood to area=thinning of perineal area

Front 67

Premonitory signs of Labor

Back 67

Lightening, Brax.Hicks, Bloody show, ROM, Nesting Instinct
Other= wgt. loss, N/V,

Front 68

Cervical Ripening
Can you induce to ripen cervix?

Back 68

No. Induction will not work until cervix is fully ripened.
Can use ripening balloon to help

Front 69

What is an Amniotomy?

Back 69

AROM

Front 70

Release of prostaglandins causes?

Back 70

Increased contractions

Front 71

Chorioamnionitis

Back 71

Infection of both layers of BOW
Foul-smelling & cloudy amniotic fluid

Front 72

What procedure is performed if unsure that BOW broken?

Back 72

Sterile Speculum Exam

inspect for ferning on litmus paper

Front 73

First nursing action upon BOW braking?

Back 73

Listen to fetal HR to r/o umbilical cord prolapse

Front 74

True labor signs

Back 74

1. cervix effaces/dilates progressively
2. contractions regular, closer, longer, stronger
3. Pain in back and abdomen
4. ambulation intensifies

Front 75

Stages of Labor

Back 75

1st: True labor --10 cm
2nd: 10 cm -- birth of neonate
3rd: Birth -- birth of placenta
4th: First 1-4 hr after delivery

Front 76

5 Critical Factors in Labor

Back 76

Passageway
Passenger
Powers
Psyche
Position

Front 77

Most adequate pelvis for birth?

Back 77

Gynecoid

Front 78

Most desirable position of baby?

Back 78

Occiput Anterior

Front 79

Only breech presentation that may be delivered vaginal?

Back 79

Frank breech presentation

*No preemie breech can be delivered vaginal

Front 80

Who can apply forceps?

Back 80

A MD only; although nurse midwives can use vacuum

Front 81

Upright and lateral position in labor causes...?

(4)

Back 81

1. contractions more intense, not pain
2. fetal head descends quicker
3. labor may be shorter
4. fetal diameter best with pelvic dia.

Front 82

1st Stage of Labor---3 Phases

(3)

Back 82

1. Latent Phase (early labor)
2. Active Phase
3. Transitional Phase

Front 83

Labor begins when contraction are..?

Back 83

3 cm and contractions 5-7 min apart lasting 30 seconds apart and moderate

Front 84

After BOW breaks how often do you take mother's T?

Back 84

Every hour along with pulse to assess for infection of BOW.

Front 85

Latent Phase pain meds?

Back 85

Vistaril IM to calm

No narcotics

Front 86

Active Phase
Acceleration?

Back 86

Should progress 1 cm per hour

Front 87

Active Phase Mgmt

Back 87

Mouth care
Stroke arms and legs firmly
Encourage efforts
Drain bladder; full impedes descent

Front 88

Active Phase pain meds

Back 88

Narcotics can be given now

Nubain IM to "take the edge off" or epidural

Front 89

#1 concern with epidural

Back 89

Hypotension from vasodilation
**over hydrate with 1000 cc to avoid
**assess B/P q 5 min

Front 90

Transition Phase

Back 90

Dilation to last 8-10 cm
Biggest issue is descent

**Fear of abandonment

Front 91

Physical sensations during transitional phase

Back 91

N/V, belching, chills, trembling, sweating, hyperventilation

Front 92

Is an increase in bloody show normal in transition phase?

Back 92

Yes.

Front 93

Feeling felt when head is crowning

Back 93

"Ring of Fire" sensation

Front 94

Cardinal Movements

(8)

Back 94

Engagement, Descent
Flexion, Internal Rotation
Extension, External Rotation (head)
Shoulder Rotation, Expulsion

Front 95

Placenta should be removed by what time after birth?

Back 95

5-30 minutes

Front 96

Fourth Stage of Labor
VS?

Back 96

B/P returns to prelabor level
Pulse slightly lower than labor level
Pt. very thirsty and hungry

Front 97

Leopold's Maneuvers

**feeling for baby's position and presentation

Back 97

1st: feeling fundus for head (breech)
2nd: checking which side back is
3rd: feeling pubic symphosis for head
4th: how dipped into pelvis is head

Front 98

Where baby's heart beat is?

Back 98

Should be below umbilicus, if above umbilicus it may be breech

Front 99

Oxytocin Challenge Test OCT

Back 99

Give Pitocin, assess 3 contractions of 40" in 10 minutes
If 50% are late decel.=(+) test= BAD
*cannot give if pt. cannot push

Front 100

What is amnioinfusion?

Back 100

Injection of fake amniotic fluid to give more room for fetus to move off of cord

Front 101

Biophysical Profile BPP

5 components
8-10 WNL, <6=hypoxia

Back 101

1. NST s/b reactive
2. U/S fetal breathing
3. U/S fetal movement
4. U/S fetal muscle tone
5. U/S amt. of amniotic fluid

Front 102

Positive OCT
Nursing Mgmt

Back 102

Change pt. position
Administer O2
Turn off pitocin
Raise IV rate
Administer tocolytics

Front 103

Fetal Scalp pH test

Back 103

Assesses for fetal acidosis

*If <7.20= acidosis

Front 104

Hypotonic Labor Patterns
causes

Back 104

Polyhydramnios
Multigravida
Grandmulti
Macrosomnia

Front 105

Hypotonic Labor Mgmt

Back 105

AROM
Void
Pitocin

Front 106

Preterm Labor S/SX
20-37 weeks

Back 106

contractions q 10 min
leaking clear, pink, brown fluid
feeling baby push down,
low, dull backache

Front 107

PTL Tx

Back 107

Tocolytic drugs to stop labor until term or for corticosteroids (to strengthen lungs)

Front 108

Terbutaline (tocolytic) SE

Back 108

*relaxes uterus
Tachycardia, diastolic drop, palpitations, N/V, HA, SOB, high pulse ***pulmonary edema

Front 109

Magnesium Sulfate (tocolytic) SE

Back 109

*relaxes smooth muscle (uterus)
Mag Toxicity, pulmonary edema, resp. depression

Front 110

Other tocolytics

Back 110

Calcium antagonists - (no edema risk)
Prostaglandin Inhibitors
Oxytocin Antagonists