Ob Final Part

Front 1

what are problems associated with MECHANICAL dystocia? (5)

slide 2

Back 1

1. Problem with Passenger (baby) or Passage (pelvis)

2.Contracted Pelvis – diameters less than 10 cm. or smaller than head diameters;

3. android pelvis

4.Obstructive Tumor that blocks canal

5.Abnormal Presentation/Position

Front 2

what is the ideal fetal position?
p. 192

Back 2

flexed with occiput in the right or left anterior quadrant of maternal pelvis

Front 3

failure to rotate with an occiput posterior position is called? p. 192

Back 3

persistent occiput posterior

Front 4

maternal risks of fetal malpositions (OP) are? (4) p. 192

Back 4

1. prolonged labor
2. potential for operative delivery
3. extension of epsiotomy
4. 3-4th laceration of the perineum

Front 5

symptoms of OP fetal malpositions are? (5) p. 192

Back 5

1. intense back pain in labor
2. dysfunctional labor
3. prolonged active phase
4. secodary arrest of dilatation
5. arrest of descent

Front 6

persistent occiput transverse positions occurs as a result of? p. 192

Back 6

ineffective contractions or flattened bony pelvis

Front 7

how can baby come out with OT? p. 192

Back 7

vaginal delivery is possible with forceps and pitocin

Front 8

what are interventions to promote rotation with a fetal malposition p. 192

Back 8

1. have mother lay on side opposit from the fetal back
2. bring knee to chest
3. pelvic rocking

Front 9

what might happen with forceps? p. 193 (5)

Back 9

1. fetal ecchymosis
2. facial edema
3. transient facial paralysis
4. maternal lacerations
5. episiotomy extension

Front 10

what are vertex malpresentations caused by?

Back 10

failure of fetus to assume a flexed attitude

Front 11

what are some vertex malpresentations? (3) p. 193

Back 11

1. brow
2. face
3. sincipital (military)

Front 12

if the baby is in face presentation, they are at risk for? (2) p. 193

Back 12

1. increased risk of prolonged labor
2. edema and bruising of eyes, face

Front 13

what is sincipital presentation? p. 193

Back 13

when the lager diameter of the babys head is presented

Front 14

what is complete breech? p. 193

Back 14

where sacrum is presenting part, knees flexed

Front 15

how is frank breech? p. 193

Back 15

where sacrum is in presenting part, and legs are extended

Front 16

what is incomplete breech p. 193?

Back 16

where one or both feet are presenting, increasing the risk of umbilical cord prolapse

Front 17

what is the mother who has a baby in a breech position at risk for? (4) p. 193

Back 17

1. prolonged labor because of the decreased pressure exerted by the breech
2. PROM
3. c-section or forceps
4. PP hemorrhage

Front 18

if a baby is in breech position, what are they at risk for? (4) p. 194

Back 18

1. compression or prolapse of cord
2. trapping of head because cervix is not fully dilated
3. aspiration and asphyxia
4. trauma from forceps

Front 19

how is external cephalic version done? (4) p. 195

Back 19

1. pt gets external monitor
2. iv started
3. adminster terbutaline to relax uterus
4. ecv

Front 20

what is the most common compound presentation?

Back 20

when the hand or arm prolapsing behind head

Front 21

to help for shoulder dystocia, what maneuvers may be used? (3) p. 199

Back 21

1. mcroberts
2. manzanti
3. zavenelli

Front 22

explain mcroberts maneuver. why is it used? o. 199

Back 22

woman flexes thighs on abdomen

Front 23

what is uterine inertia?

Back 23

means "cant contract

Front 24

what is functional dystocia?

Back 24

1.Problem with Powers (contractions)

2.Patterns of contractions that deviate from normal

Front 25

what can shoulder dystocia be caused by? (3)

Back 25

Malformation of the Baby
Examples: Hydrocephaly, Gastroschisis, Spina Bifida, 1.conjoined twins
2.Excessive Size of the Baby (Macrosomia)
3.Cephalopelvic Disproportion (

Front 26

what is hypertonic uterine dysfunction?

Back 26

freq contractions with decreased intensity and increased uterine tone p. 202

Front 27

what is hypotonic uterine dysfunction?

Back 27

infreq contractions with decreased intensity

Front 28

what are the risks for hypertonic uterine dysfunction for maternal?

Back 28

1. prolonged or nonprogressive labor
2. pain
3. fatigue
p. 202

Front 29

what are the risks for baby in hypertonic uterine dysfunction?

Back 29

1. hypoxia

Front 30

what is the tx for hypertonic uterine dysfunction?

Back 30

1. hydration
2. monitor I/O
3. sedation for stopping the contractions

Front 31

what are the risks for hypotennc uterine dysfunction for maternal?

Back 31

1. nonprog labor
2. prolonged rupture of the membranes
3. freq vaginal exams leading to infx

Front 32

what is the tx for hypotonic uterine dysfunction? (3)

Back 32

1. rule out CPD
2. augmentation of labor
3. stimulation by pitocin

Front 33

what is the manifestation of uteirne ring dystocia?

Back 33

when women complains of pain without contractions. contractions cause extreme pulling of the uterus

Front 34

explain soft tissue dystocia. what do you do?

Back 34

cervix will not dilate

-should use prostaglandins gel to facilitate birthing

Front 35

what is PPROM?

Back 35

rupture of membranes 1 or more hours before labor starts before the baby is term (less than 37wks)

Front 36

what should you be concerned about with PPROM? in mother and baby?

Back 36

mother:
1. infx
2. preterm labor

baby:
1. infx
2. prematurity
3. incr. risk of perinatal mortality

Front 37

what should you do with PPROM?

Back 37

take an ultrasound and assess gestational age and presence of infx

Front 38

what do you do if you found bacteria in PPROM?

Back 38

give abx and deliver baby asap

Front 39

what do you do if you did not find bacteria in PPROM? (6)

Back 39

Give all
1. abx
2. celestone
3. tocolytics
4. monitor temp q2-4hr
5. check for wbc climb
6. check amnio

Front 40

when is preterm labor?

Back 40

between 20 to 37 wks

Front 41

what is bandl ring?

Back 41

a pathological retraction ring that forms when labor

Front 42

what is bandl ring can be caused by?

Back 42

cpd

Front 43

what happens in bandl ring?

Back 43

1.upper segment thickens
2.lower segment distend
3.uterus may rupture
4.c-section indicated

Front 44

name 6 s/s of premature labor? o. 203

Back 44

1. contractions every 10 min or less with or without pain
2. low ab cramping w/ or w/o diarrhea
3. intermittent sensation of pelvic pressure, urinary freq
4. low backache (intermittent or constant)
5. increased vaginal discharge
6. leaking amniotic fluid

Front 45

what do you do as a nurse if you suspect someone is experiencing premature labor? (5) p. 203

Back 45

1. empty their bladder
2. assume side (left preferred) position lying
3. drink 3-4 cups of water
4. palpate uterine contraction/fhr
5. rest for 30 min then slowely resume activity if no s/s

Front 46

when should you contact md if you suspect someone with premature labor?

Back 46

labor contraction phases or if s/s of premature labor do not subside within 1 hr

Front 47

when is it important to get pregnant woman to the hospital by?

Back 47

before she is in active or transition phase

Front 48

what test indicates ptl?

Back 48

fetal fibronectin

Front 49

when should labor not be delayed/when should you not give tocolytics? (5)

Back 49

1. cervical dilation of greater than 8
2. severe preeclamp/ eclampsia
3. chorioamnionitis
4. hemorrhage
5. fetal dealth (unless twin alive)

Front 50

explain nursing care for preterm labor according to ppt? (9)

Back 50

1. bedrest
2. npo (restrict fluids for first few days)
3. i/o
4. efm
5. tocolytics
6. screening test
7. monitor vs
8. monitor contraction
9. observe for s/s s of active labor or incr. cervical mucus

Front 51

name 4 drugs that are tocolytics?

Back 51

1. yutopar
2. terbutaline
3. mag sulfate
4. nifedipine

Front 52

what is a common s/e premature labor?

Back 52

1. pulmonary edema
2. tachycardia
3. n/v

Front 53

what drugs are beta adrenergics of tocolytics?

Back 53

1. yutopar
2. terbutaline

Front 54

celestone is given when?

Back 54

must be given 24 to 48 hours before delivery

Front 55

when is celestone given?

Back 55

between 24 to 34 wks

Front 56

what are the tests of preterm labor? (9)

Back 56

1. fetal fibronectin
2. amniostata
3. L/S ratio
4. ultrasound
5. amnioscentesis
6. nst
7, cst
8. biophysical
9. afv

Front 57

what are 3 labs for preterm labor?

Back 57

1. mg
2. k
3. ca levels

Front 58

what is the goal of preterm labor?

Back 58

reach 34-35wk lung maturity

Front 59

what is postterm pregnancy?

Back 59

after 42 complete wk

Front 60

what fetal risks associated with post-maturity? (7)

Back 60

1. hypoglycemic
2. hypoxic
3. meconium aspiration
4. polycythemia
5. congenital abnormality
6. seizures
7. cold stress (d/t inadequate brown fat)

Front 61

when is delivery recommended in oligohydramnios?

Back 61

5cc or less

Front 62

what are tx for oligohydraminos? (3)

Back 62

1. amnioinfusion (thru intrauterine catheter)
2. inj of fluid prior to deliver thru amnio
3. drinking po fluids

Front 63

what to assess in post-maturity pregnancy? (3)

Back 63

1. nst
2. kick counts
3. biophysical profile

Front 64

what is postterm pregnancy?

Back 64

more than 294 days

or more than 42 wk since LMP

Front 65

postterm pregnancy maternal risks? (6)

Back 65

1. incr chance of LGA or mcrosomic baby
2. incr chance of using forceps or vacuum
3. incr chance of getting perineal damage
4. incr of maternal hemorrhage
5. incr for c-section
6. anxiety

Front 66

postterm pregnancy fetal risk? (5)

Back 66

1. risk of umbilical cord compression
2. SGA if decreased circulation
3. LGA or macrosomic if adequate circulation
4. LGA-birth trauma or shoulder dystocia, prolonged labor
5. mceonium staining

Front 67

infant born after 42 wks are more likely to have (2)?

Back 67

1. low umbilical artery ph
2. lower apgar 5min

Front 68

2 neonatal complications of postterm?

Back 68

1. hypoglcemia
2. rr distress

Front 69

what do practitioners do when they suspect postterm? (3)

Back 69

1. nst
2. biophysical
3. modified bpp for measure of amnio

Front 70

what should the nurse do if she notices variable decels? why?

Back 70

help laboring woman change position to take pressure off cord

Front 71

what are complications that could happen with pitocin? (10)

Back 71

1. abruptio placentae
2. impaired uterine blood flow
3. transverse fetal lie
4. possible lacerations
5. uterine atony
6. uterine rupture
7. water intoxic
8. hyperbilirubinemia
9. trauma from rapid birth
10. hypoxia from maternal hypotension or hypercoag which decrease 02 supply to fetus

Front 72

what is the recommend dosage of pitocin?

Back 72

0.5-2milliunits/min at the beginning

then 1-2milliunits every 15-60min

Front 73

what is the max dosage rate for pitocin?

Back 73

40 milliunits per minute

Front 74

what do you need to do before administering pitocin? (5)

Back 74

1. bishop score (dilate, efface, station, cervical consistency, position of cervix)
2. efm
3. VS
4. i/o
5. contractions freq and inten

Front 75

what is the concentration of pitocin and mixed with what when adminstering?

Back 75

5, particularly 10, or 20 units into 1L of balanced saline fluid such as LR in a piggyback

Front 76

a pregnant women in labor has n/v, low bp, tachycardia, what would you suspect and therefore do?

Back 76

may suspect water intox from pitocin---so pitocin should not be given too rapidly or given in an electrolyte free solution

Front 77

you want to start pitocin at 0.5 milliunits/min, what would you set the infusion pump to deliver?

Back 77

3ml/hr

Front 78

you want to set pitocin at 1 milliunit/min, what set infusion pump?

Back 78

6ml/hr

Front 79

you want to set pitocin at 2 milliunits/min, what should you set the infusion pump with?

Back 79

12ml/hr

Front 80

when should pitocin be stopped?

Back 80

1. if contractions are closer than 2 min or last longer than 90 sec

2. fetal distress

Front 81

what are contraindications to pitocin (aka induction of labor) (6)

Back 81

1. complete placenta previa, vasa previa, abruptio placenta
2. acute fetal distress/bradycardia
3. previous uterus surgery
4. pelvic structure abnormality
5. active herpes infx
6. invasive cervical cancer

Front 82

when is external cephalic version done?

Back 82

38 wks typically

Front 83

what is needed along with external cephalic version?

Back 83

ultrasound and tocolytics and efm before and after procedure

Front 84

what is placenta accreta?

Back 84

attached of placenta to surface of myometrium

Front 85

what is placenta increta?

Back 85

attached in myometrium

Front 86

what is placenta perceta?

Back 86

placenta is attached to outer uterine wall

Front 87

what is used for placenta accreta, increta, perceta? (meds) (3)

Back 87

1. oxytocics
2. anti-inflam
3. abx

Front 88

what ar eth erisks of placeta accreta, increta, percreta? (3)

Back 88

1. previous placenta previa
2. pp hemorrhage
3. c-section

Front 89

when are the conditions that a woman is permitted to have a tolac (trial of labor) (3)

Back 89

1. adequate hospital staff
2. 24hr anesthesia team
3. low uterine segment c-section before

Front 90

what are the conditions that CONTRADICT c-section? (3)

Back 90

1. not for people with previous ruptured uterine incision or classical incision

2. not for those hospitals w/o 24hr anesthesia team

3. can only habve a max of 1 low transvere c-section

Front 91

what are the conditions that permit a vaginal birth if baby is breeched?

Back 91

1. baby is less than 8 lbs
2. if woman has normal pelvic diameters
3. baby can be frank breech
4. ecv at 38wks

Front 92

what are the preop care for c-section? (7)

Back 92

1. assess npo
2. explain procedure and get consent form
3. perform ab prep
4. insert foley
5. start an iv
6. administer IV or PO antacid to decreased lung damage from aspirating acidic gastric contents
7. administer abx

Front 93

what are some maj indications for c-section? (5)

Back 93

1. dystocia
2. cpd
3. fetal distress
4. breech
5. previous c-section

Front 94

what are maternal risks in c-section? (6)

Back 94

1. aspiration
2. hemorrhage
3. infx
4. injury to bowel/bladder
5. thrombophlebitis
6. pulm embolism

Front 95

what are fetal risks of c-section? (3)

Back 95

1. prematurity
2. injury at birth
3. rr problems r/t delayed absorption of fetal lung fluid

Front 96

what does it mean to have the classical c-section?

Back 96

cut throught the upper uterine segment

Front 97

what s/s may occur if baby is in occiput posterior?

Back 97

back pain

Front 98

what may be needed in occiput posterior delivery?

Back 98

forceps, manual rotation, or vacuum

Front 99

what should you do if baby is in occiput posterior position (nursing interventions)?

Back 99

1. apply sacral pressure
2. put hot packs on sacral area
3. assist mother into hands and knee position
4. do pelvic rock exercises
5. change position, even sit on toilet

Front 100

what may occur with brow presentation?

Back 100

labor may be longer but can potentially make it all the way thru

Front 101

when is a c-section indicated when baby is in brow presentation?

Back 101

if cpd is suspected or labor is arrested

Front 102

what is wrong if baby is in face presentation?

Back 102

then the risks of cpd and prolonged labor are increased

Front 103

when is vaginal birth possible in face presentation?

Back 103

if mentum (chin) is anterior


-if chin is posterir, may need c-section

Front 104

breech vaginal birth is at risk for? (9)

Back 104

11.prolapsed cord
2.facial edema
3. throat bruising which may compromise breathing
4. brachial plexus
5. intracranial hemorrhage
6. entrapment of head if cervix not completely dilated
7. aspiration
8. asphyxia
9. birth trauma from forceps

Front 105

when is ecv possible?

Back 105

around 38 wks

Front 106

what should you do if you notice nonreassuring s/s after pitocin induction? (5)

Back 106

1. stop oxytocin
2. infuse primary line
3. assume side lying
4. monitor for hypotension
5. give oxygen

Front 107

what are the maternal risks in breech delivery? (4)

Back 107

1. prolonged labor
2. prom and infx
3. c-section/forceps usage
4. pp hemorrhage

Front 108

what is the process when there is an external cephalic version?

Back 108

1. pt placed on external fetal monitor
2. iv started
3. terbutaline adminstered to relax uterus
4. fhr monitored

Front 109

shoulder presentation delivery?

Back 109

vaginal delivery not possible in termed infant

Front 110

what would you do if you noticed late decels? (5)

Back 110

1. put mother on left side
2. administer o2 8-10L/min
3. increased IV fluids
4. discontinue oxytocin if labor was induced
5. notify md

Front 111

what to do if you noticed severe variable decels or prolonged bradycardia (cord compression)?

Back 111

1. reposition mother on either side
2. adminster o2 8-10L/min
3. put in trendelenburg or knee-chest
4. perform vag exam and apply upward digital pressure on the presenting part to relieve the pressure on the umbilical cord

Front 112

what are the maternal risks for shoulder dystocia? (2)

Back 112

1. lacerations and tears
2. pp hemorrhage

Front 113

what are some neonatal risks for shoulder dystocia? (3)

Back 113

1. hypoxia
2. fx of clavicles
3. injury to neck/head

Front 114

who is at risk for shoulder dystocia? (5)

Back 114

1. obese
2. increased fundal ht
3. hx of macrosomia
4. gest dm
5. prolonged 2nd stage labor

Front 115

what is the bishop score assess? (5)

Back 115

1. dilate
2. efface
3. station
4. cervical consistency
5. position of cervix

Front 116

what are 3 significant s/e of terbutaline and ritodrine?

Back 116

1. tachycardia
2. pulmonary edema
3. n/v

Front 117

bascially all drugs used to prevent premature labor will do what?

Back 117

may cause pulmonary edema

Front 118

what are the contraindications for vbac? (5)

Back 118

1. a previous classical incision
2. large infant (>4000 grams)
3. malpresentation
4. pelvic measurements
5. fetal problem

Front 119

what are s/s of uterine rupture? (5)

Back 119

1. signs of shock and hemorrhage
2. ripping or tearing feeling
3. cessation of contractions
4. abruptonset of fetal distress
5. may be easier to palpate baby now

Front 120

in hypertonic labor, what may be considered?

Back 120

oxytocin infusion or amniotomy

Front 121

what is protracted labor?

Back 121

less than 1 cm dilation per hour

Front 122

what is arrest of progress?

Back 122

no change in cervix dilation for 2 hours

Front 123

when should amniotomy should not be performed during?

Back 123

if the presenting part is not well applied to cervix because this increased the risk of cord prolapse

Front 124

what are some indications of c-section? (6)

Back 124

1. hydrocephaly baby
2. gastroschisis baby
3. spina bilfida baby
4. macrosomia
5. CPD
6. conjoined twins

Front 125

what is macrosomia?

Back 125

4000 gms (8.5lb)

Front 126

how is mechanical and functional dystocia different?

Back 126

functional has to deal with contractions

Front 127

what are some signs of placenta separation?

Back 127

within 3-5 min, the cord will slack and you may see a small gush of blood

Front 128

if you see brighr continuous blood from vagina, what would you suspect if it was PP?

Back 128

lacerations

Front 129

for PP hemorrhage, what do you do if massaging doesn't work? (7)

Back 129

1. get an IV access with 2 lines, always give NS or LR
2. draw blood for cross match
3. administer meds
4. o2 at 10-12 L
5. insert foley
6. VS with lungs and LOC q15 min
7. transfuse blood

Front 130

if giving blood, what is important to know? (3)

Back 130

1. give blood products needed, not whole blood
2. always transfuse with NS
3. doesn't give cold blood

Front 131

what are some signs of transfusion rxn? (9)

Back 131

1. chills
2. fever
3. tachy
4. hypotension
5. sob
6. muscle cramps
7. itching
8. convulsions
9. cardiac arrest

Front 132

what is late PP hemorrhage?

Back 132

more than 500cc after first 24hr to 6 wks PP

Front 133

what are some r/f of late PP hemorrhage? (3)

Back 133

1. bleeding d/o
2. placental fragments
3. immunologic factors

Front 134

subinvolution means?

Back 134

uterus is not going down to its size