Ob Test 4

Front 1

A maternal factor of preterm labor is...

Back 1

Infection

* especially UTI - pyleonephritis

Front 2

A fetal factor of preterm labor is...

Back 2

Overstretched uterus

Front 3

A psychosocial/economic factor of preterm labor is...

Back 3

Excessive physical or emotional stress

Front 4

OB history factors of preterm labor are...

Back 4

Previous preterm labor or delivery
Previous abortion
< 1 year since last delivery

Front 5

Medicinal management of preterm labor

Back 5

Tocolytic medications:
Ritodrine (Yutopar)
Terbutaline (Brethine)

These cause uterine muscle relaxation & vasodilation (hypotension and compensatory increased HR)

*Used to stop preterm labor and delay delivery for at least 48 hours for glucocorticiod administration to help fetal lung maturation

Front 6

Nursing care for preterm labor

Back 6

*Bedrest
*Fluid restriction to 2400cc/day
*Check VS, lung sounds and contractions Q15min. (PULSE SHOULD NOT GO ABOVE 140)
*Continuous FH monitoring (DON'T LET GO ABOVE 180)
Drugs can cause fetal tachycardia, hypoxia and acidosis so have the antidote INDERAL ready (blocking agent

Front 7

Non-tocolytic medicinal management of preterm labor:

Back 7

*Nifedipine (Procardia) : Calcium channel blocker, relaxes smooth muscle
*Indomethacin : Prostaglandin inhibitor, relaxes smooth muscle
*Magnesium Sulfate : Can supress uterine contractions
*Glucocorticoids : Dexamethasone (Decadron) or
Betamethasone accelerate lung maturation so decrease severity of RDS

Front 8

Home management of preterm labor:

Back 8

*Left side bedrest (BRP)
*Drink 2-3 quarts/day (NO caffine)
*No sex or nipple stimulation
*Oral tocolytic meds (Ritodrine) Take pulse first and report: P>120, palpitations, tremors, nervousness
*Report: Cx Q10min. or closer for 1 hr., cramps, low backache or pelvic pressure for one hr., increase or change in vaginal discharge

Front 9

Reasons for not stopping preterm labor:

Back 9

*Dilated to 4cm or more
*Severe PIH
*Prolonged ROM
*Cardiac
*DM

Front 10

If preterm labor cannot be stopped...

Back 10

Limit analgesics and continue EFM

Front 11

Risks of premature ROM:

Back 11

*Increased chance of infection (chorioamnionitis)
*Increased risk of cord prolapse

Front 12

Management of premature ROM:

Back 12

*Monitor amount and smell of amniotic fluid
*Bedrest with BRP
*Temp QID
*No sex, douching or tampons
*WBC every other day

Call MD FOR:
Fever, uterine pain or contractions, foul vaginal D/C or increased leakage of fluid

Front 13

Uterine inertia means:

Back 13

Sluggishness of contractions

Front 14

Causes of uterine inertia:

Back 14

*Abnormal fetal position
*CPD (cephalo-pelvic disproportion)
*Inadequate uterine cx
*Overdistention of uterus
*Analgesics given too early or too much
*Regional given too early
*Exhaustion
*Unripe cervix

Front 15

Interventions for uterine inertia:

Back 15

*Promote rest
OR
*Stimulate labor: encourage ambulation; hydration; squatting; nipple stimulation; prostaglandins; pitocin

Front 16

Problems with inadequate uterine relaxation:

Back 16

Placental perfusion is decreased during cx - tolerable by a healthy fetus as long as the uterus relaxes AT LEAST 1 MIN. between cx and if CX NOT >90SEC.

Front 17

Pathological retraction ring:

Back 17

Bandl's Ring

*can be relieved by IV morphine

Front 18

Precipitous Delivery:

Back 18

L&D <3hrs.

*if uterus contracts with unusual vigor before delivery, likely to be HYPOTONIC after delivery (Prone to HEMMORAGE - give PITOCIN)

Front 19

This occurrs when amniotic fluid is forced into an open maternal uterine blood vessel...

Back 19

Amniotic fluid embolism

Front 20

Inversion of uterus can happen when...

Back 20

Delivery of baby pulls on placenta or if attampts are mede to deliver the placenta before the uterus is contracted (by pushing on uterus and pulling on cord)

Front 21

If a woman has "borderline" pelvis...

Back 21

MD may allow a trial labor - proceeds as long as:
dilation, descent, FH and cx are good

Front 22

A CHANGE in Ph can...

Back 22

Tell a problem before ABNORMAL Ph occurs

Front 23

After ROM...

Back 23

Check FH immediately to R/O cord prolapse

Front 24

Rx for cord prolapse:

Back 24

*Relieve pressure on cord (Knee-chest or Trendelenberg)
*O2 at 8-12 L/min. via mask
*Apply sterile saline compresses to exposed cord to prevent drying and atrophy
*Dont push cord back in (may kink)

Front 25

Postpartum risk of multiple gestation:

Back 25

More prone to hemorrage R/T excessive uterine distention and uterine atony

Front 26

If in this position, the infant has to rotate further, labor longer, causes back pain...

Back 26

Occiput posterior position

*Sacral pressure, hands/knees position help relieve back pain

*Long labor = more prone to uterine atony (then more prone to pp hemorrage and infection

Front 27

To change position of breech presentation:

Back 27

Use tilt board or version

*After version, fetus can turn back to breech

Front 28

With face presentation:

Back 28

Baby often has facial edema and bruising, lip edema may prevent sucking

Front 29

Causative factors of PIH:

Back 29

*Poor protein intake/water soluble vitamin deficiency (seen more often in low socioeconomic class)
*Family tendency or obesity
*Vascular disease
*Primigravida (esp. <17 or >35) first time exposure to chorionic villi
*Exposure to many chorionic villi (i.e. twins)

Front 30

Basic symptoms of PIH:

Back 30

Hypertension
Proteinuria
Edema
*Edema increases as more protein is lost (colloidial osmotic pressure lost) - Increased edema causes rapid weight gain

Front 31

*BP 140/90 on 2 occasions at least 6 hrs. apart
*Proteinuria 1 or 2+
*Upper body edema
*Reflex 3+
*Transient H/A

Back 31

Mild Pre-Eclampsia

Front 32

*BP S 160 or above or D 110 or above (2x 6 hrs. apart)
*Proteinuria 3 or 4+
*Extensive edema + rapid weight gain (abdominal edema causes n/v, pain)
*Pulmonary edema (rales and dyspnea - can lead to CHF)
*Cerebral edema (severe H/A, CNS irritability, blurred vision, spots)
*Oliguria (400-600ml/day)
*Increased Hct as fluid leaves vessels
*DIC (coagulation failure)
*IUGR (growth restriction)

Back 32

Severe Pre-Eclampsia

*Severe H/A or epigastric pain when convulsions imminent

Front 33

Cerebral edema so severe, convulsions occur

Back 33

Eclampsia

Front 34

Interventions for mild pre-eclampsia:

Back 34

*Bedrest
*High protein diet
*Mild salt restriction
*Emotional support

Front 35

Immediate bedrest on L side w/ seizure precautions; pad rails; quiet/dimly lit room (noise/light can trigger convulsions; calm approach; only supportive visitors

Back 35

Interventions for severe pre-eclampsia

Front 36

Foley assessment for severe pre-eclampsia:

Back 36

Q1H : check amt., protein and specific gravity

Front 37

Assessment for severe pre-eclampsia:

Back 37

Check for all s/s: edema, LOC, H/A, visual disturbances, epigastric pain, n/v, lung sounds (pulmonary edema)

Front 38

Rules for magnesium sulfate administration in severe pre-eclampsia:

*DECREASES CHANCE OF SEIZURES

Back 38

*Keep blood levels at 4-8 mEq/L
*Earliest sign of Mag overload: decreasing knee jerk
*Do NOT give unless:
R>12
deep tendon reflexes present
output at least100cc/4hrs.

Front 39

Signs of magnesium sulfate overdose in severe pre-eclampsia:

Back 39

*Depressed respirations
*Absent DTR (reflex)
*Decreased output
*Flushing, nausea, slurred speech

Front 40

Antidote for magnesium sulfate:

Back 40

Calcium gluconate

Front 41

Effects of magnesium sulfate on newborn:

Back 41

Depression (esp. respiratory depression)

Front 42

HELLP syndrome assessment for severe pre-eclampsia:

Back 42

H = Hemolysis RBC
EL = Elevated Liver enzymes
LP = Low Platelets

*So check CBC, platelets, liver enzymes (SGPT, SGOT)

Front 43

What to do during the tonic phase of eclampsia

Back 43

*Turn on left side to drain secretoions (& best for placental perfusion)
*NO tongue blade
*O2 via mask

Front 44

What to do during the clonic phase of eclampsia

Back 44

Give magnesium sulfate

Front 45

For a PT in the postictal state with eclampsia (coma)

Back 45

*Watch closely, labor could begin and woman couldn't tell you
*Painful cx could cause another seizure
*Monitor continuously for cx, FHR and vaginal bleeding
(convulsion could cause abruptio placenta)

**Remember: hearing is the last sense lost and the first regained

Front 46

Postpartum pre-eclampsia and eclampsia can occur...

Back 46

Up to two weeks pp (usually two days)

Include assessments for pre-eclampsia and eclampsia in pp assessments

Front 47

For postpartum pre-eclampsia and eclampsia, check BP:

Back 47

At least Q4H

**No ergot products (R/T increased BP)

Front 48

For postpartum pre-eclampsia and eclampsia, give:

Back 48

Magnesium sulfate up to 48 hrs. pp

**Uterus may be boggy with increased lochia (R/T mag sulfate)

Front 49

Most spontaneous abortions (miscarriages) occur due to ...

Back 49

Fetal or placental defects

Front 50

A threatened miscarriage is characterized by...

Back 50

*Small amount of bleeding/cramps
*Cervix closed

Front 51

An inevitable miscarriage is characterized by...

Back 51

*Moderate amount of bleeding/cramps
*Cervix open

Front 52

An incomplete miscarriage is characterized by...

Back 52

*Heavy amount of bleeding/cramps
*Part of products of conception passed

Front 53

A complete miscarriage is characterized by...

Back 53

*Entire products of concepltion passed, then bleeding stops

Front 54

Complications of spontaneous abortions include:

Back 54

*Hemmorrage (esp. w/ incomplete AB - do D&C so uterus can contract)

*Infection (often endomitritis s/s are fever, pain, foul D/C)
Often seen with hemorrage due to debilitating effects of blood loss)

Front 55

In 95% of ectopic pregnancies (implantation outside the uterus), implantation occurs where?

Back 55

In the tubes

**Any obstruction (scar tissue from infection or surgery) prevents the fertilized egg from moving down tube

Front 56

Assessment for ectopic pregnancy

Back 56

*Has missed 1 or 2 periods
*Gets n/v
*At 6-12 weeks - tube rupture (closer to uterus = more bleeding) expelled into pelvic cavity
*Sharp, stabbing unilateral pain in lower abdomen
*Dark vaginal spotting (not bleeding)

Front 57

Diagnosis and treatment for ectopic pregnancy

Back 57

*Detected by u/s
*If possible, remove before rupture

*If PT has had one ectopic pregnancy - more likely to have another than other women

Front 58

Rx for uterine rupture:

Back 58

Immediate c/s with general anesthetic

Front 59

Symptoms of hydatiform mole

Back 59

*Uterus larger than it should be for gestational age
*Excessive n/v
*No FH
*Blood or urine test strongly positive (even after day 100 - *also seen w/ mult. pregnancy)
*PIH symptoms before 24 weeks
*Brownish-red vaginal D/C at 12 -16 wks. (then D/C of fluid filled vesicles)

Front 60

Rx for hydatiform mole

Back 60

*Do repeat D&C and biopsy for choriocarcinoma (a mole can convert to this uterine Ca)

*Check blood or urine for HCG every month for a year to see if new villi developing (negative for a year = free of complications of mole)

*NO pregnancy for one year

Front 61

When are purse string sutures put in for incompetent cervix?

Back 61

14-18 weeks

Front 62

After cervical purse string sutured put in place...

Back 62

*Monitor for cx & FHR
*Make sure patient knows s/s of labor
*Notify MD if contractions or bleeding begins

Front 63

Total placenta previa

Back 63

Implantation totally blocks os

Front 64

Low placenta previa

Back 64

Implantation in lower rather than upper uterus

Front 65

Symptom of placenta previa

Back 65

Abrupt, painless bleeding

Front 66

NSG care for placenta previa

Back 66

*O2 for distress
*Monitor bleeding

Front 67

How is placenta previa diagnosed?

Back 67

Ultrasound

Front 68

Risks of placenta previa

Back 68

More prone to infection and hemorrage

Front 69

Predisposing factor for placenta abruptio

Back 69

Hypertensive disease

Front 70

Symptoms of placenta abruptio

Back 70

*Heavy bleeding
*Hard abdomen
*Sharp stabbing pain high in fundus on initial seperation
*Shock symptoms
*Late decels on monitor R/T placental insufficiency
*If bleeding extensive, fibrinogen is used up trying to clot blood = *DIC

*Suspect if bruising, petechiae or venipuncture sites bleeding 15 min. later

Front 71

NSG care for placenta abruptio

Back 71

Same as placenta previa (O2 & monitor bleeding) + check fibrinogen levels QH till delivery

Front 72

NSG care for hemorrage

Back 72

Amount of bleeding (most important)
Save pads & weigh
Save and report clots or tissue passed

Also:
Amt. and location of pain/cramps
Check VS & s/s of shock
Monitor FHR & fundal height
O2 prn
RhoGAM if needed

Front 73

Meds often used for hemmorage

Back 73

oxytocin, antibiotics, analgesics

*Check for infection pp R/T debilitating effects of blood loss

Front 74

TORCH infections stands for:

Back 74

T - Toxoplasmosis
O - Other (Syphilis, gonorrhea, chlamydia, AIDS, hep B or C)
R - Rubella
C - Cytomegalovirus (CMV)
H - Herpes simplex II

Front 75

Toxoplasmosis is transmitted by..

Back 75

Eating poorly cooked meats or spread hand-to-mouth via kitty litter/animal feces

Front 76

Prmary symptoms of syphilis

Back 76

Asymptomatic for three wks. post-infection, then blister (chancre) to painless ulcer, oozing fluid highly contagious

Front 77

Secondary symptoms of syphilis

Back 77

Occur 3-6 wks post-infection (maybe 5 mos.) RASH (esp. genital area - also palms and soles) Highly infectious lesions

Front 78

Latent stage of syphilis

Back 78

No symptoms

Front 79

Tertiary symptoms of syphilis

Back 79

Begin years after initial infection. Lesions (gummas) may grow anywhere and cause destruction (aorta, heart valves)

Front 80

If mom infected with syphilis early in pregnancy (before 18 wks.)...

Back 80

Disease won't cross placental barrier - if treated, fetus not affected

Front 81

When is the blood test for syphilis (VDRL) done?

Back 81

First prenatal visit and third trimester

Front 82

Effects of congenital syphilis

Back 82

*Enlarged liver and spleen
*Snuffles
*Rhagades (scars around mouth)
*Hydrocephaly
*Corneal opacity (can leaf to blindness)

Front 83

Symptoms of gonorrhea

Back 83

Maybe none

Early - Lower UTI symptoms: dysuria, frequency,purulent green-yellow D/C

Late - Symptoms of upper UTI: abd. pain, n/v, fever, PID

Front 84

Treatment for gonorrhea

Back 84

Mom and partner get penecillin (if allergic erythromycin)

Front 85

If gonorrhea present at time of delivery:

Back 85

Mom - risk for infection (endometritis, PID)

Baby - Conjunctivitis & pneumonia

Front 86

Symptoms of chlamydia

Back 86

Often none

Vaginal or urethral (male) D/C, pain, and burning on urination

Front 87

Rx for chlamydia

Back 87

Erythromycin or tetracycline

Front 88

Chlamydia during pregnancy can cause

Back 88

Fetal death or preterm labor

(Also, like gonorrhea, if mom infected at time of delivery - conjunctivitis or pneumonia for baby)

Front 89

If the mother takes this, it will reduce the cance by 2/3 that the baby will be infected with AIDS

Back 89

Zidovudine (ZDV, AZT) from the fourth month of pregnancy on

** May cause anemia in newborn

Front 90

How can infection with AIDS affect early fetal development?

Back 90

*Microcephaly
*Prominent, box-like forehead
*Increased distance between inner canthus of eyes
*Flat nasal bridge

Front 91

All newborns have antibodies to HIV from HIV+ mom, true or false?

Back 91

True

*If uninfected, will revert to negative after passive antibodies gone (by age 1 1/2 yrs.)

Front 92

NSG care for HIV+ newborn

Back 92

*Bathe early to remove maternal blood
*No skin punctures till bathed
*No internal monitor
*No breast feeding

Front 93

Signs of HIV in a newborn are usually seen at...

Back 93

6 mos. old

Front 94

Hepatitis B or C

Back 94

Breast feeding not allowed

Front 95

If mom has rubella during first trimester...

Back 95

Fetus may have malformation of heart, eyes (cataract, glaucoma) and ears (deafness)

Front 96

If mom has rubella after first trimester...

Back 96

Fetus has rash, systemic infection, IUGR

Front 97

Rubella-induced thrombocytopenia can cause

(Post first trimester infection)

Back 97

Blueberry muffin morula R/T decreased platelets

(Infants may have CP or MR)

Front 98

Percentage chance of congenital anomalies if mother gets rubella during the first month...

Back 98

50%

Front 99

If mother not immune - OK to give rubella vaccine during pregnancy?

Back 99

No. Give after pregnancy (no pregnancy for 2-3 mos. after given)

Front 100

Symptoms of cytomegalovirus

Back 100

Usually asymptomatic or mild symptoms

(Problems arise in the immunosuppressed - NB, elderly, chemo)

Front 101

Cytomegalovirus is one of the leading causes of...

Back 101

Hearing impairments in children

Front 102

Herpes simplex II is spread by...

Back 102

Breaks in skin (usually sex) during shedding

(Can be spread hand-genital-face, etc)

Front 103

Symptoms of Herpes simplex II

Back 103

Painful, clustered, pinpoint vesicles which drain and ulcerate

Front 104

If mother with Herpes simplex II is shedding at time of labor...

Back 104

Do C/S within 3 hrs. of ROM

Front 105

If pregnant mother has history of Herpes simplex II...

Back 105

Cervical culture done Q2 weeks from 32-36 and then weekly - viral shedding possible without symptoms

**Unless negative - deliver C/S

Front 106

Herpes simplex II treatment for mom:

Back 106

Acyclovir (Zovirax)

Front 107

Herpes simplex II cervical lesions can lead to...

Back 107

Cancer

Front 108

Hiatal hernia during pregnancy...

Back 108

Often gets worse as uterus pushes stomach against diaphram

Front 109

Mothers with peptic ulcers...

Back 109

Have fewer symptoms during pregnancy

Front 110

Severe intractable vomiting during pregnancy is called

Back 110

Hyperemesis gravidarum

Front 111

Hyperemesis gravidarum is seen in...

Back 111

Psychologically stable women who frequently respond to stress with GI problems

Front 112

Assessment for hyperemesis gravidarum

Back 112

*Vomiting
*I&O
*Daily weight
*Skin turgor
*Mucous membrane
*Jaundice
*Bleeding
*IV
*Fundal height
*FHT
*Emotional status

Front 113

Rx for hyperemesis gravidarum

Back 113

*Hospitalization
*IV fluids & electrolytes
*Vitamins
*Dry diet of 6 small feedings with clear liquids an hour after

Front 114

90% of anemias during pregnancy are...

Back 114

Iron deficiency anemia

Front 115

True anemia is an Hct of...

Back 115

30 or below

Front 116

In iron deficiency anemia we see...

Back 116

Small (microcytic) and hypochromic RBCs

Front 117

Rx for iron deficiency anemia

Back 117

PO iron supplements

Front 118

Folic acid deficiency is associated with...

Back 118

Neural tube defects

**Prenatal vitamins contain folic acid or can just give folate

Front 119

Sickle cell hemoglobinopathy is...

Back 119

A recessive, hereditary hemolytic anemia

Front 120

Pregnancy complications of thalassemia:

Back 120

Low birth weight infants

Front 121

Epileptic seizures during pregnancy...

Back 121

May be more frequent or severe

(Decreased blood levels of antiepileptic meds caused by physiological changes of pregnancy)

Front 122

If a woman has n/v - she still needs to take seizure meds True or False

Back 122

True

Front 123

Postpartum, antiepileptic medication blood levels will...

Back 123

Increase drastically if not adjusted

Front 124

A mother with myasthenia gravis will...

Back 124

Usually tolerate labor well (already have some degree of muscle relaxation)

**Relapses often occur pp

Front 125

During pregnancy, symptoms of rheumatoid arthritis may...

Back 125

Improve due to circulating levels of corticosteroids

**Symptoms return after delivery

Front 126

For a mother with systemic lupus erythematosus...

Back 126

If disorder active, or she develops vascular or renal complications (nephritis) - pregnancy usually makes it WORSE

**Give predinisone throughout pregnancy

Front 127

If an asthma attack occurs...

Back 127

Use Demerol if needed (relieves bronchospasm)

Front 128

Chance of developing ARDS increases as...

Back 128

Trauma of pregnancy and delivery increases

Front 129

Vein distention + obstruction of venous blood returning from lower extremeties (large uterus) + increased coagulation factors =

Back 129

Prone to clots
Can lead to pulmonary embolism
If occurs - give O2

Front 130

Rx for tuberculosis

Back 130

INH & Rifampin for 9 months

**Give Vitamin B6 with INH to prevent fetal neurotoxicity

Front 131

UTIs can cause:

Back 131

Pyleonephritis and/or preterm labor

**Women with previous UTIs are most prone

Front 132

Rx for UTI during pregnancy

Back 132

Antibiotic for 2-3 wks.
*Sulfa drugs interfere with protein binding of billirubin = hyperbillirubinemia in baby

Knee-chest for 15 min BID
*frees ureters from weight of uterus & allows drainage (also preventative!)

Front 133

Symptoms of cardiac decompression

Back 133

*Increased fatigue with usual exertion
*Increased pulse
*Generalized preogressive edema

Front 134

Class I Heart Disease

Back 134

No limitation of physical activity

Front 135

Class II Heart Disease

Back 135

Slight limitation of physical activity

**Often admitted near term for evaluation

Front 136

General care for all classes of heart disease during pregnancy

Back 136

*Increase rest on L side to decrease burden on heart
*Gain enough weight for a healthy pregnancy - but not so much that supplying addtl. cells w/ nutrients overburdens heart
*Prevent, report and treat infections immediately

Front 137

For a mother with heart disease in labor...

Back 137

*Semi-fowlers on side (facilitates breathing and relieves pressure on inferior vena cava = increased blood return to heart)
*Prophylactic penecillin during labor and through early pp (to prevent bacterial endocardiditis)

Front 138

For a mother with heart disease during vaginal delivery...

Back 138

*Lessen need to push (strains heart) with an epidural or pudendal block to shorten second stage
*No ergot products (Methargine) after delivery (increases BP)

Front 139

Postpartum care for a mother with heart disease

Back 139

*Heart must make a rapid adjustment post-delivery of placenta (Blood volume increases 20-40% in 5min)
*Routine pp check + VS, I&O, daily weight, initially bedrest & BRP
*Progressive ambulation (check pulse and color before and after walking)
*Regulate IV rate carefully
*No straining with BM

Front 140

Infection of genital tract in 28 days pp:

Back 140

Puerperal infection

Front 141

Predisposing factors for a Puerperal infection

Back 141

*Prolonged ROM
*Retained placental fragments
*PP hemorrhage

Front 142

General symptoms of puerperal infection:

Back 142

*Temp of 100.4 or above for 2 or more days (not incl. first 24hrs. pp)
*Chills
*Malaise
*Anorexia
*Elevated WBC

Front 143

General symptoms of puerperal infection PLUS perineal pain, pressure, feels hot, inflammation or drainage of suture line:

Back 143

Perineal infection

Front 144

S&S of endometritis:

Back 144

*Often seen 3-4 days pp
*General symptoms of puerperal infection PLUS:

*Abdominal tenderness
*Uterus painful and not well contracted
*Lochia dark brown and foul smelling (maybe increased amt.)

Front 145

Rx for puerperal infections:

Back 145

*Handwashing to decrease spread
*Change pad often
*Culture and use of appropriate antibiotic
*Increase fluids
*Semi-Fowler's promotes lochia drainage (esp. endometritis)

Front 146

Mastitis can occur...

Back 146

When infant a week or months old (often 2-4 weeks pp)

Front 147

Symptoms of mastitis:

Back 147

*Flu-like symptoms
*Pain
*Breast hot, red, hard
*Fever
*Joint pain
*Scant breast milk
*Bloody, foul D/C from nipples
*Malaise
*H/A
*Enlarged axillary lymph nodes

Front 148

Rx for mastitis:

Back 148

Broad spectrum antibiotics

*Preventable by proper BF, prompt Rx of cracked nipples, good handwashing

Front 149

Symptoms of superficial vein thrombophlebitis:

Back 149

*Reddness
*Warmth
*Tenderness
*Palpation of a hardened vein
*Fever

**No need for anticoagulants unless condition persists

Front 150

Symptoms of deeper vein thrombophlebitis:

Back 150

Redness + warmth (or pale + cool) limb
Pain
Swelling
Edema
Temp.
Pos. Homan's sign

**Some have no symptoms

Front 151

Rx for thrombophlebitis:

Back 151

*Reduce inflammation
*Prevent embolism (bedrest, elevate leg, no valsalva maneuver)
*Elastic stockings
*Relieve pain
*Anticoagulants
(Heparin antidote - Protamine sulfate)
(Coumadin antidote - Vit. K)

*Coumadin takes up to 3 wks to become effective, start before stopping heparin, goes through breastmilk

Front 152

Most frequent cause of pp hemorrhage:

Back 152

Uterine atony

Front 153

Predisposing condition of uterine atony:

Back 153

Over-distention of uterus

Front 154

Symptoms of uterine atony:

Back 154

Boggy uterus and increased bleeding

Front 155

Rx for uterine atony:

Back 155

Bladder full & uterus boggy?
*Void first then:
*Massage uterus
*Nipple stimulation
*Void often
*IV Oxytocin (Pitocin) (uterotonic agent - quick onset, may be given immediately after delivery for at-risk PT)
*Methergine (uterotonic agent - slower onset, longer action)

Front 156

Anytime uterus is contracted but there is increased bleeding, suspect:

Back 156

Laceration

Front 157

Perineal lacerations are classified...

Back 157

1st degree - 4th degree

Ice first 24 hrs - then heat (sitz)

Front 158

If a vaginal hematoma occurs later...

Back 158

Mom complains of pressure or pain in vagina or perineum

Front 159

With a perineal hematoma mom complains of...

Back 159

Severe pain, pressure or fullness of perineum

Front 160

If retained fragment of placenta large...

Back 160

Bleeding seen immediately pp

Front 161

If retained fragment of placenta small...

Back 161

Bleeding may not be seen until a week or more pp (instruct mom to call MD if any change back to rubra)

Front 162

A deficiency in clotting (low fibrinogen)
Often occurs with abruptio placenta
Suspect when puncture sites, uterus, etc. continue to bleed

Back 162

DIC (disseminated intravascular coagulation)

Front 163

PP anterior pituitary necrosis

**Occurs after hemorrhage

Back 163

Sheehan's syndrome

Front 164

NSG care after hemorrhage:

Back 164

*Woman exhausted for weeks
*Usually put on iron
*Check for s/s of infection & decrease exposure to
*Can still BF
*Let others help

Front 165

Cervix favorable for induction (pitocin administration) if...

Back 165

*Anterior
*Soft
* > 50% E
*At least 3cm D
*Fetal head at -1 - +1 station or lower

Front 166

Contractions should be...

Back 166

< 90 sec. with at least 1 min. rest in between

Front 167

If cx are > 90 sec. or < 1 min. in between...

Back 167

*Turn on L side
THEN:
*Turn off pitocin
*O2 at 8-12 L via mask

*Call MD if position change doesn't work

Front 168

Pitocin has this effect on diuresis

Back 168

Antidiuretic

So you get decreased urine output - can cause water intoxication

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Pitocin can predispose baby to...

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Hyperbillirubinemia

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After induction started, baby may not be born for...

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2-3 days

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Forceps can cause...

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Facial paralysis

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With vacuum extraction...

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Infant often has marked area of pressure under cap

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Most common reason for c/s:

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CPD (cephalopelvic disproportion)

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Reasons besides CPD for c/s:

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*Malpresentation
*Dystocia
*PIH
*Unsuccessful induction
*Herpes
*Placenta previa or abruptio
*Cord prolapse
*Fetal distress

*C/s done to ensure safety of fetus

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Baby may have difficulty breathing post-c/s because...

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Chest not compressed during delivery

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Pros of the newer, bikini incision:

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*Decreased infections and blood loss
*Less likely to rupture during future labors (lower uterus more passive)
Don't need c/s next time (VBAC)