Ob 2300 Exam 2

Front 1

Define the intrapartal period

Back 1

Contraction of the cervix to dilate, through delivery of neonate, placental, and 1st 1-4 hours after delivery

Front 2

What are the 4 theories of labor onset?

Back 2

1. progesterone deprivation
2. oxytocin
3. fetal endocrine control theory
4. prostoglandin theory

Front 3

Describe the progesterone deprivation theory

Back 3

As pregnancy progresses, the ratio of estrogen increases vs progesterone right before labor, which leads to labor.

Front 4

Describe the oxytocin theory

Back 4

Oxytocin stimulates uterine contraction, but uterus isn't sensitive until closer to term, there fore oxytocin unlikely to work on it's own though

Front 5

Describe the Fetal Endocrine Theory

Back 5

Fetal steroids stimulate release of precursors to prostaglandins, which then stimulate uterus to contract

Front 6

What are prostaglandins?

Back 6

lipid substances found in variety of tissues

Front 7

What are they used as in L&D?

Back 7

Induce contractions at any point in pregnancy; they can be used IUFD in suppository form, induced abortion, cervical ripening.
Possible final major pathway for labor onset

Front 8

What is Labor?

Back 8

Labor is a feedback loop, stretching of the cervix causes increase oxytocin, which increase myometrial activity

Front 9

Describe what occurs in a true labor

Back 9

In true labor, uterus divides with the upper segment being the active and contractile, thickens as the labor progresses.
The lower segment and cervix; the passive portion, thins and expands as labor progresses

Front 10

Where do most c/s occur?

Back 10

C/s are mostly lower segemtn transverse aka LST/LCT.

Front 11

Can a woman who has had a LST have a vagina birth?

Back 11

IF the previous birth was via a LST c/s then yes, but only with this incision other wise you can dehis the surgery scar and the fetus will be found in the abdominal wall not the vagina.

Front 12

Why do vertical uterine incisions occur?

Back 12

These J & T shaped incisions occur b/c of the high risk pregnancy or size of the patient (obese).

Front 13

What is effacement of the Cervix?

Back 13

it is the taking-up of internal os and cervical canal into the uterine sidewalls. Usually precedes dilation in primigravidas. This expressed in percentages

Front 14

What is the dilation of the cervix?

Back 14

This when the longitudinal muscle fibers of the uterus pull upward over babys head. Combined with pressule from BOW. Cervix dilation is measure 0-10 cm.

Front 15

What are some of premonitory signs of labor?

Back 15

1. lightening
2. braxton-hicks
3. cervical ripening
4. bloody show
5. ROM
6. Nesting instincts
7. weight loss, more backache and sacro pressure
8. N/V and diarrhea

Front 16

What happens in lightening?

Back 16

Lightening---the fetus settles into inlet, uterus seems to move downward, allowing for easier breathing, but more pelvic pressure, leg cramps/pain, and venous stasis.

Front 17

What are braxton-hicks?

Back 17

These are irregular, intermittent contractions, experienced throughout pregnancy, the purpose of is to allow for cervical ripening. Multiparous women experience these more often

Front 18

Why is it important to allow the cervix to ripen?

Back 18

No cervical ripening = no induciton.

Front 19

Describe the Bishop scoring scale

Back 19

if women has a score of 6 or > she will be favorable for labor induction

Front 20

What is a way to induce cervical ripening?

Back 20

Cervical ripening balloons, placed in the cervix to aid in the ripening.

Front 21

What is bloody show?

Back 21

This is when the mucus plug is expelled, causing capillaries to bleed. This a bloody mucus looking expression. Labor usually begins 24-28 hours after, this can be confused if a vaginal exam was recent

Front 22

If there is a prolonged ROM and labor what is the mother in danger of?

Back 22

Infection---anytime ROM > 24 hours infection can ascend the vagina leading to chorioamnionitis; infection of the BOW.

Front 23

what are the s/s of chorioamnionitis?

Back 23

fever, tenderness, foul-smelling and cloudy amniotic fluid

Front 24

What is the positive sign on the Nitrazine paper for a ROM?

Back 24

the yellow paper turns blue

Front 25

What is umbilical prolapse?

Back 25

An OB emergency, s/s can be a low FHT after ROM, pt might desribe a wetness and heaviness as if something is hanging between legs

Front 26

How do you treat umbilical prolapse?

Back 26

Reposition the patient or insert hand to push vagina up ward.

Front 27

What is nesting instinct?

Back 27

sudden burst of energy 24-48 hours prior to labor, remember to warn the pt not to over-exert one self.

Front 28

What are the 5 P's of labor?

Back 28

1. passageway
2. passenger
3. powers
4. psyche
5. position

Front 29

Which pelvis is the best to have to deliver a baby?

Back 29

Gynecoid; only 50% of women have this. Platypellod is the worst.

Front 30

What is the most preferred position of the baby as it is being delivered?

Back 30

OA ---occiput anterior

Front 31

What is the ideal measurement of the inlet and why?

Back 31

9.5 cm across and 11.5 diagonally, 9.5 cm across b/c that is the average head diameter, and 11.5 diagonally b/c that is the shoulder breadth.

Front 32

What type of positional lie can a fetus be in before birth?

Back 32

1. longitudinal---normal birth
2. transverse--flip flops
3. oblique---breach babies

Front 33

Define fetal attitude

Back 33

refers to posturing of joints and relation of fetal parts to one another

Front 34

What is normal attitude?

Back 34

flex inward all parts

Front 35

Which breach position is available for vaginal delivery?

Back 35

The frank breech--but it is on case by case.

Front 36

What are the risks associated with breech deliveries?

Back 36

Increased risk of hypoxic events/ cerebral palsy, increased risk of umbilical prolapse

Front 37

What is a compound presentation?

Back 37

More than 1 part presenting during delivery; ie hand and foot

Front 38

What is malpresentation during delivery?

Back 38

Anything other than cephalic presentation

Front 39

How can you prevent malpresentation?

Back 39

repositioning; breech tilt excercises or knee-chest postion; moxibusion

Front 40

What are the traditional methods of malpresentation?

Back 40

External version; must give tocolytics to do this and then give petoicin.

Front 41

Define Engagement

Back 41

Widest diameter of presenting part reaches or passes through inlet, this confirms adequacy of inlet and usually occurs 2 weeks before term for primigravida, other wise during or before labor

Front 42

Define station

Back 42

this is the relationship of the head to ischial spines, confirms adequacy of midpelvic plane

Front 43

When are vacuum/forceps extractions appropriate?

Back 43

Only if fetus descends to "0" station and it is prolonged. Mother must be completely dilated, this is only done if 1. fetal distress
2. maternal exhaustion
3. material cardiac disease
4. poor pushing

Front 44

Define Dystocia

Back 44

Difficult or painful birth

Front 45

What is the difference between Hypertonic vs. Hypotonic uterine contractions?

Back 45

Hypertonic is when uterus doesn't relax sufficiently between contractions.

Hypotonic is when the uterus doesn't contract strongly enough to be effective

Front 46

On the Friedman labor curves which curve is the most dangerous for mother and fetus?

Back 46

Where there is an arrest of labor and failure to progress

Front 47

How do catechololamines effect labor?

Back 47

These are stress hormones that get released causing:
constricted blood flow to uterus
increased labor pain
Oxytocin is blocked causing prolonged labor

Front 48

How do endorphines effect labor?

Back 48

These are morphine like substances, they counteract catacholamines, can be released with relaxation, touch, massage, and activity (walking).

Front 49

How does positioning effect labor?

Back 49

1. Lying on back can cause Vena Cava compression, so avoid that.
2. Being in upright and lateral position can aide the fetus into the birth canal.

Front 50

What are the 3 phases of the 1st stage of labor?

Back 50

Latent, active, transitional

Front 51

What should you expect to see during the Latent phase of labor?

Back 51

1. onset of contractions until 3 cm, should be every 10-20 minutes, 15-20 seconds, mild, that becomes moderate 5-7 minutes, with 30-40 seconds of contractions.

2. breathing patterns should slow to 8/min, VS should be hourly and Temp. (Temp only if ROM occurs), fetal activity should still be noted,

3. Bladder should be emptied every 2 hours

Front 52

What meds can be given during the latent phase?

Back 52

Vistirl via IM--a sedative-hypnotic effect, can calm the mother down to be able work with the contractions. PO meds don't work since mom is likely to aspirate it and won't be digested.

Front 53

Describe the Active phase of labor

Back 53

1. Labor is well established, patient dilates from 4-7cm, descent is progressive, contractions are every 2-3 minutes/60 seconds

2. breathing patters are rhythmic, encourage emptying of bladder.

Front 54

What medications are given during the active phase to help with labor?

Back 54

Narcotics such as Nubian (most preferred) and Demorol can be given. Epidurals are usually the most commonly given for of anesthesia at this point.

Front 55

What kind of complications can occur from epidurals?

Back 55

1. Decrease BP
2. Spinal HA
3. Immobility
4. Decrease contractions
5. increase length of 2nd stage of labor
6. Increase likely hood of OP babie
7. Increase need of C/s
8. Unable to void
9. Spotty blocks
10. Itching
11. Maternal fever

Front 56

What occurs during the 2nd stage of labor?

Back 56

This is the active part of labor, pushing sensation, mother should be vocal and pushing.

Front 57

What are the cardinal movements of labor?

Back 57

engagement, descent, flexion, internal rotation, extension, external rotation, eternal rotation of shoulder, expulsion

Front 58

What occurs during the 3rd stage of labor?

Back 58

Baby is born, uterus contracts, placenta is expelled.

Front 59

What could be a cause of Tachycardic FHT?

Back 59

Base line >160
1. maternal/fetal fever
2. infection
3, fetal hypoxia
4. tocolytic drugs

Front 60

What could be a cause of bradycardia of FHT?

Back 60

Baseline <120
1. Fetal hypoxia
2. congenital heart block
3. maternal use of betal blockers

Front 61

Describe short term variability of FHT

Back 61

aka beat to beat variability, is desirable, looks like blades of grass appearance on FHT strip

Front 62

What are the 4 types of long term variable FHT?

Back 62

1. absent ---sign of low 02
2. Minimal---sign of fetal sleep/narcotic
3. Avg/moderate - usual/ideal
4. Marked - not common

Front 63

If you see accelerations on the FHT monitor/strip, what does it mean?

Back 63

Accelerations are good, they are reassuring, they show an intact nervous system, they are associated with fetal movement

Front 64

What results should you see on a Non-stress test?

Back 64

on a 20 min external fetal monitor, should see reactive heart tones, 15bpm x 15 seconds x 2. IF non reactive, then these are non reassuring, warrants additional testing.

Front 65

Which is better Early Decelerations or Late decelerations?

Back 65

Early---early decelerations show better recovery between contractions. These are caused by fetal head contractions and FHT should refelect contractions

Front 66

Why are late decelerations a concern?

Back 66

Late decelerations indicted uteroplacental insufficiency. Need to move onto the OCT (oxytocin challenge test)

Front 67

Explain the Oxytocin Challenge Test? Is a positive result good or bad?

Back 67

1. Mom is placed on external fetal monitor, pitocin is given; 3 contractions of 40" in 10 minutes should be noted.

2. Late decelerations in 50% or > indicated uteroplacental insufficiency. Indicated fetus cannot handle stress of labor. Positive result is non-reassuring.

Front 68

What nursing considerations one might do for a pt who tests positive on the OCT?

Back 68

1. verify it is the FHR
2. change pt's position
3. give 02
4. turn off pitocin
5. raise IV fluid rate
6. get an order for a tocolytic

Front 69

What are Variable Decelerations?

Back 69

These are FHT with variable onset, and variable recovery. These can be non-reassuring. Can be caused by umbilical compression, HR falls out of normal range, 60-90 bpm, with V/U shaped dips.

Front 70

What nursing considerations one might do for a pt with variable decelerations?

Back 70

1. positonal change, get fetus off of cord.
2. increase 02, IV, stop pitocin, use tocolytics
3. amnioinfusion

Front 71

What is considered severe acidosis in a fetus?

Back 71

if scalp pH is < 7.20 = get patient delivered. IF between 7.2 - 7.25, observe and repeat test in 20 minutes to look for trend.

Front 72

Give 3 common dystocias

Back 72

1. hypotonic labor pattern
2. precipitous labor pattern
3. Preterm Labor

Front 73

What occurs in hypotonic labor patterns?

Back 73

During the active phase contractions <2-3 minutes/10 minutes

Front 74

what are the risks associated with a hypotonic labor pattern?

Back 74

mother has increased likelihood of infection, PPH, exhaustion, fetus can get infection and be in distress.

Front 75

What are the SE of Terbutaline?

Back 75

Mat/fetal tachycardia, N/V,HA, SOB, anxiety, warmth, Maternal: hypokalemia, hyperglycemia, sodium and water retention, cardiac ischemia, Pulmonary edema.

Front 76

What are the Nursing considerations of Nifedipine?

Back 76

Check BP and pluse before and 30 minutes after each dose, notify MD if systolic <90, diastolic <50.

Front 77

What are the Nursing considerations for a person on Terbutaline?

Back 77

Daily wts, srtick I&O (3000/24hrs), Frequent Vs, notify MD if chest pain or pulse >12, resp>28, SOB, dyspnea
Bed rest should be left lateral, use docusate

Front 78

What are the nursing considerations of Indomethacin?

Back 78

Give with food, can cause nausea and GI upset, cant cause decreased amniotic fluid volume. Inhibits platelet aggregation, No ASA for mom!

Front 79

what is the purpose of fFN

Back 79

used to test for women who are in preterm labor, seeing how close they are in likelihood of delivering usually done 22-34 weeks gestation.

Front 80

Define Pre-eclampsia?

Back 80

These can be sudden or gradual, and the cure usually is delivery of neonate.

Pre-eclempsia is defined as 2 occasions, 6 hours apart, at rest showing hypertension. either 30 mm HG/15 mm HG or 140-90.

There is a +1 or greater show of proteinuria (after a neg show of UTI)

Possible edema generalized in hand and face and wieght gain greater than 2lbs per week.

Front 81

What is Eclampsia?

Back 81

Pre-eclampsia + grand mal seizures. these are your most common cause of maternal deaths due to a stroke and PE.

Front 82

What are the possible causes of GH?

Back 82

1. age (young and older)
2. primigravidas
3. poverty
4. Family Hx
5. Large placental mass
6. Ethnicity

Front 83

Explain Arteriolar Vasospasm in relation to GH and it's results.

Back 83

Arteriolar Vasospasms due to Hypertension can reduce blood flow to the uterus. This can can cause impaired placental function, reduced blood flow to kidneys, liver, and brain

Front 84

What are the s/s of GH with arteriolar vasospasms?

Back 84

1. decreased GFR, incread BUN
2. proteinuria
3. Right sided epigastric pain
4. Cerebral Edema
5. HA, visual disturbances, Grand Mal Seizures.

Front 85

How is Coagulation affected with GH?

Back 85

There is increased platelet adherence, clotting factors are consumed, may lose ability to clot and develop abnormal bleeding, similar to DIC.

3rd spacing maybe observed, HCT increases

Front 86

What are the s/s of mild GH?

Back 86

rise in PB, generalized edema, proteinuria,

Front 87

what are the nursing consideration of mild GH?

Back 87

bed rest @ left lateral position, diet modification, increase protein, frequent visit to health provider, urine creatinine level checks and Amniocentesis for L/S and PG levels.

Front 88

Describe Severe GH

Back 88

This can develop suddently with BP 160/100 or greater.
Protein in urine 3-4+ = loss of 5 g/24hours
Labs indicate rising HCT, uric acid, serum creatinine,
s/s show HA, visual disturbances, N/V, hyperreflexia, clonus, irritability, and oliguria, Pulmonary edema and cyanosis may develop.

Front 89

What are the nursing treatments for a pt with severe GH?

Back 89

1. complete bed rest w/o stimuli
2. no diet changes
3. F&E replacement
4. I&O with urimoeter foley catheture
5. Daily weight
6. Frequent vs and DTR checkts
7. meds such as Mag sulfate

Front 90

What are the effects of MgSO

Back 90

it is a CNS depressant, decreases the risk of convulsions

Front 91

At what point can MgSO can become toxic and what are the s/s?

Back 91

8.0 mEq/L and >
s/s:
Flushed, slurred speech, DTR 1+ or absent, Hypothermic, Oliguric.
Give calcium gluconate 10%,

Front 92

What is HELLP Syndrome?

Back 92

H-emolysis
E-levated
L-iver
L-ow
P-latelet count

Front 93

What are the s/s of HELLP syndrome?

Back 93

Labs show increased liver enzymes, N/V, malaise, RUQ pain, increased jaundice, abnormal bleeding.