OB Exam 2

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OB Exam 2
2014-03-27 19:41:47

Labor and Delivery...basics
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  1. Edema is ok if it is
  2. BUBBLE assessment
    • Breast
    • Uterus
    • Bladder
    • Bowel
    • LEgs
  3. U/U
    fundus at umbillicus
  4. 1/U
    fundus is 1 cm above umbillicus
  5. U/1
    fundus is 1 cm below umbillicus
  6. What station should the fundus be at to be discharged?
  7. If EBL is greater than this the patient is hemorrhaging
  8. S/S of endometritis
    lochia that has an odor and a tender uterus
  9. S/S of a DVT
    • cool extremity
    • asymmetrical edema
    • pain
  10. If a patient shows a poor patellar reflex what can this mean?
    • pregnancy induced HTN
    • or
    • high BP at hospital
  11. Labs done at admission
    • CBC (red and purple top)
    • Type and Hold
    • Urine sample
  12. #1 priority for the newborn
    keep them warm
  13. 4 things to do at birth
    • dry
    • warm
    • suction
    • stimulate
  14. vessels in the umbillicus
    • 2 arteries (non oxygenated blood)
    • 1 vein (oxygenated blood)
  15. 5 areas of assessment for APGAR
    • HR
    • Resp effort
    • Muscle tone
    • Reflex
    • Color
  16. Apgar-HR
    • 0-absent
    • 1< 100
    • 2> 100
  17. Apgar- Respiratory Effort
    • 0-absent
    • 1- slow, irregular
    • 2- good cry
  18. Apgar- Muscle tone
    • 0-flaccid
    • 1-some flexion
    • 2-active motion
  19. Apgar-Reflex
    • 0-none
    • 1- grimace
    • 2- cry
  20. Apgar-color
    • 0-pale/blue
    • 1- acrocyanosis
    • 2- all pink
  21. Best indicator of true labor (2)
    • contractions that are not slowed or stopped by change in movement or rest
    • progressively get stronger
  22. True Labor
    • consistent contractions
    • begins in lower back
    • increases in duration, frequency, intensity
    • diarrhea, bloody show
    • progressive cervical change
    • presenting part becomes engaged
  23. False Labor
    • inconsistent contractions
    • annoying, not painful
    • no increase in duration, frequency or intensity
    • no significant cervical change
    • presenting part doesn't become engaged
  24. Gravida
    a woman who is or has been pregnant, regardless of the duration or outcome of the pregnancy

    In her 3rd pregnancy= gravida 3
  25. Para
    a birthing experience  of any baby beyond 20 weeks gestation.

    Inclusive of any birthing experience-vaginal, c section, even stillbirth.

    Twins are considered one birthing experience
  26. A patients current pregnancy is counted as a
  27. How to calculate  EDD
    LMP + 7 days - 3 months

    Look at the year
  28. Explain Leopold's maneuver regarding positioning of the fetus
    Tells location and presentation of the fetus

    it is a systemic method for palpating the fetus thru the abdominal wall during the latter part of the pregnancy.
  29. When is Leopolds maneuver done?
    during admission to figure out where to put the FHR monitor
  30. Fetal Lie
    the orientation of the long axis of the fetus to the long axis of the woman

    Longitudinal-vertical, either head or butt is in the pelvis parallel to mom

    Transverse-long axis of the fetus is at right angles to mom, perpendicular to mom

    Oblique-some angle btwn longitudinal and transverse
  31. Fetal position
    the location of a fixed reference point on the presenting part in relation to the 4 quadrants of the maternal pelvis

    • right/left
    • anterior/posterior
  32. Attitude
    normal is flexion, with the head and arms and legs flexed tightly against the trunk

  33. Normal presentation
  34. Which presentation will cause more back pain and a longer delivery?
  35. Mentum
    chin presentation
  36. Sacrum
    breech presentation
  37. Occiput
    cephalic presentation
  38. Dilation
    how wide the cervix has opened up and it is measured in cm's
  39. How does the cervix dilate?
    as the cervix is pulled upward and the fetus us pushed downward it is pushed open
  40. Effacement
    the thinning and softening of the cervix and it is measured in %
  41. How does effacement occur?
    Labor contractions push the fetus downward against the cervix and the cervix pulls upward.  This will cause it to become shorter and thinner as it is drawn over the fetus and amniotic sac
  42. How do you figure out the baby's station?
    The ischial spine is the marker and is at "0".

    above the ischial spine it is -1,-2,-3 (farthest pt)

    below the ischial spine it is +1,+2,+3 (hello baby)
  43. What does fetal monitoring tell us?
    how the baby is doing hemodynamically and with O2
  44. 3 things fetal monitoring keeps track of
    • timing of contractions
    • HR
    • fetal response in relation to stress of contractions
  45. What do contractions do to the fetus?
    with each contraction blood flow thru the uterus slows, if the contraction is strong enough all blood flow will stop and if it is for too long it can cause stress on the baby
  46. Prolonged FHR lower than this can impair brain and heart perfusion
  47. A persistent FHR faster than this decreases cardiac output due to inadequate ventricular filling time
  48. 2 ways to monitor uterine activity (contractions)
    • TOCO transducer (external)
    • IUPC (internal)
  49. What does a TOCO pick up?  What does it look like?
    • maternal movement
    • fetal movement

    uterine contractions look like a bell shape, other movements look like spikes
  50. Where do you place the TOCO?
    over the fundus
  51. Rules of applying a IUPC
    it is internal and measures intra-amniotic pressure.

    • dilated to 2-3cm
    • ruptured membranes
  52. How do you apply an external fetal heart rate monitor?
    it is applied to the maternal abdomen with the transducer over the fetus back for best recording
  53. What does a FHR monitor reflect?
    fetal oxygenation status
  54. How do you apply an internal FHR monitor?
    electrodes are put on the fetus scalp which allows for direct tracing of the HR
  55. Rules of putting on an internal FHR monitor
    • dilated to 2-3 cm
    • ruptured membranes
    • put on the scalp....but avoid the face, fontanelles and genitalia
  56. Baseline FHR
    assessed btwn contractions

    • avg rate for 10 minutes ranges from
    • 110-160bpm
  57. Bradycardia FHR
    FHR baseline is below 110bpm OR

    decreased from previous baseline rate by 20bpm for at least 10 minutes
  58. Tachycardia FHR
    FHR baseline is above 160bpm or increased from previous baseline rate by 20bpm for at least 10 min
  59. Sinusodial FHR
    wave like appearance, alternating small accelerations and decelerations centering around the baseline
  60. When will you see sinusoidal FHR
    in severely anemic fetus and requires immediate attention
  61. What do abrupt decelerations look like?
    V shaped
  62. What do late decelerations look like?
    • they begin after the contraction begins
    • the lowest point is after the peak of the contraction
    • recovery occurs after the contraction has ended
  63. Describe Early Decelerations
    • mirrors the contraction
    • lowest point is at the peak of the contraction
    • recovery is by the end of the contraction
  64. What causes early decelerations?
    head compression...the fetal head is descending in to the pelvic cavity
  65. What causes early decelerations?
    head compression against the mom's pelvis or cervix
  66. How long should decelerations last?
  67. What causes late decelerations?
    fetus is experiencing hypoxia from decreased utero-placental perfusion
  68. What causes utero-placental insufficiency?
    late decelerations= hypoxia
  69. What causes variable decelerations?
    umbilical cord compression
  70. Interventions for early decelerations
    none....no fetal compromise
  71. Interventions for late decelerations
    • position change
    • IV bolus
    • contraction eval
    • if pit on, turn off
    • Tocolytic
    • 100% O2 by face mask at 8-10L/min
    • check mom's VS
  72. Interventions for Variable Decelerations
    • **position change to release cord compression**
    • give O2
    • Amnio-infusion to suspend baby and cord
  73. Intrauterine Resuscitation
    • Have the mom lie on her left side or knees to chest
    • Decrease/Stop Pitocin
    • Initiate tocolyisis to decrease uterine activity and increase placental blood flow
    • IV bolus
    • O2 10-12L/min
    • Apply internal monitors
    • Amnio-infusion
  74. What is the cut off point for intra-uterine resuscitation?
    30 min....possible c section
  75. Babies who need interventions have....
    • Apgar below 8
    • RR below 30 or above 60 w/ retractions/grunting
    • Apical pulse below 110 or above 160
    • Quiet baby
    • Skin temp less than 98
  76. Growth Hormone
    • stimulates growth
    • cell reproduction and regeneration
  77. Thyroids Stimulating Hormone
    stimulates the thyroid gland to produce thyroxine which stimulates metabolism
  78. Adrenocoticotropic Hormone
    secreted during stress to increase production of corticosteroids
  79. Prolactin
    promotes growth of breast tissue and milk production
  80. Luteinizing Hormone
    triggers ovulation
  81. Follicle Stimulating Hormone
    regulates the development, growth, pubertyand reproduction process of body

    stimulates ovarian follicles
  82. Antidiuretic Hormone

    • retain water
    • constrict blood vessels
  83. Oxytocin
    • stimulates uterine contractions
    • and
    • milk ejection reflex
  84. Progesterone
    balances estrogen levels
  85. menstrual cycle covers events in the
  86. When is 1st trimester?

    2 things to think about
    most susceptible to damage from teratogens

    sex differentiation occurs....but not identifiable
  87. What is developing during 4th week of development of embryo?
    • neural tube
    • starting of following structures:
    • face/neck
    • heart
    • lungs
    • stomach
    • liver
  88. When can you see the fetal heart beat and movement on an ultra sound?
    6 weeks
  89. When are the eyelids, ears and tip of nose, arms and legs forming and fingers and toes are there but now just getting longer?
    8 weeks
  90. When is the heart beat audible with a dopler and the baby the size of a walnut?
    12 weeks
  91. What is the main theme of what is occurring in the second trimester?
    body parts are completely formed...but they are now maturing
  92. When will the babys eyes blink?
    Fingers and toes have Fingerprints
    16 weeks
  93. When is the babys heart and blood vessels fully formed?
    16 weeks
  94. When will the woman start to be aware of fetal movements?
    15-18 weeks
  95. When can a gender be determined by ultrasound?
    18-20 weeks
  96. When does the baby hae hair
    moves alot
    sleep/wake pattern
    sucks thumb
    20 weeks
  97. When will the baby have respiratory movements
    response to sound by moving or increase in pulse
    feel hiccups
    can hear
    24 weeks
  98. When are lungs fully developed?
    35-36 weeks
  99. When should the head be positioned down in the pelvis?
    35-36 weeks
  100. When is the pregnancy considered full term?
    37 weeks
  101. Rule of thumb for the primigravida (nulipara)
    UC's q 5  min lasting 1 minute for 1 hour
  102. Rule of thumb for the mulitpara
    UC's q 8-10 min. lasting 1 min for 1 hour
  103. Rule for ruptured membranes
    a gush or trickle of fluid from the vagina should be evaluated even if there aren't any cotnractions
  104. Bleeding vs. normal bloody show
    bright red bleeding that isn't mixed with mucus should be evaluated promptly

    normal bloody show is thicker, pink or dark red and mixed with mucus
  105. Upon admission of a woman what do you do to determine fetal lie
    Leopold's maneuver
  106. Meds administered to newborn at birth
    • V. K
    • Erythro ointment
    • Hep B
  107. What will help to constrict uterine blood vessels and stop bleeding after birth
    Pitocin via IV
  108. Calling time for Apgars
    1 and 5 minutes
  109. Woman getting a c section will have these 2 things
    • IV
    • Foley