OB test 2

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OB test 2
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2015-10-12 23:07:53
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  1. cranial bones overlap under pressure of the powers of labor and demands of unyeilding pelvis
    Molding
  2. largest part of fetal head
    biparietal diameter
  3. area b/w anterior and posterior fontanels
    vertex
  4. what is the shape of the anterior fontanel
    diamond
  5. relation of fetal body parts to one another
    fetal attitude
  6. Normal flexion or "fetal position" (4 things)
    • head flexed
    • chin on chest
    • arms crossed over chest 
    • legs flexed w/thighs on abdomen
  7. the relationship of fetal axis (head to tail) to the mother's spine
    fetal lie
  8. __________ is the ideal fetal lie
    longitudinal
  9. transverse lie
    • fetal spine at right angle to mother's spine
    • Can't deliver vaginaly
  10. Most common lie/presentation/position
    LOA
  11. LOA means
    • fetus spine on mom's left side
    • (Left Occipital Anterior)
  12. _______________ is named according to the presenting part @ cervix and leads through the birth canal during labor
    presentation
  13. the relationship or presenting part to sides of maternal pelvis (what side the of the spine the baby is on)
    fetal position
  14. brow presentation
    • head partly extended
    • Largest AP diameter is presented to pelvis
    • CANT DELIVER
  15. face presentation
    • head is hyperextended
    • CANT DELIVER
  16. all malpresentations require
    c section
  17. frank breech
    • knees are straight
    • butt presents
    • NEED TO KNOW
  18. Complete breech
    • knees and hips are flexed
    • feet present to pelvis
  19. Double footling breach
    • both legs extended and present to pelvis
    • NEED TO KNOW
  20. ___________ occurs when largest part of presenting part reaches or passes through the pelvic inlet
    engagement
  21. When head is flexed and AP diameter is largest part of the skull, said to be?
    engaged
  22. If a fetus is not engaged then they are
    • bollatoble
    • "floating"
  23. the taking up (drawing up) of the internal os and cervical canal into the uterine side walls
    effacement
  24. the relationship of the presenting part to an imaginary line b/w the ischial spines of the maternal pelvis
    fetal station
  25. fetal stations
    • F -3: Floating High
    • I -2: In the right direction 
    • S -1: Settling in 
    • H 0: Halfway There
    • I +1: Inching out
    • N +2: Nearly there
    • G +3: Get the crown
  26. primary force
    • uterine muscle contraction 
    • (complete effacement and dilation of cervix)
  27. Secondary force
    use of abdominal muscles to push during 2nd stage of labor
  28. Uterine contractions
    rhythmic tightening and shortinings of uterine muscles
  29. Time b/w beginning of 1 contraction and the beginning of the next
    frequency
  30. duration is measured from
    the beginning of a contraction to completion of it
  31. intensity
    contraction strength

    Can only be measured with IUPC
  32. normal resting tone
    10-12 mm Hg
  33. contraction peak
    • 25-40 mmHG (early labor)
    • 50-70 mmHG (late labor)
  34. Transition contraction strength
    80-100 mmHG
  35. pushing contraction strength
    >100 mmHg
  36. early signs of labor
    • Lightening
    • Braxton-Hicks Contractions
    • Ripening- softening
    • Bloody show- loss of mucus plug
    • Rupture of membranes
    • Sudden burst of energy "nesting"
    • Wt loss
    • Increased backache
    • Diarrhea, Indigestion, N/V
  37. 1st stage of Labor: Latent (Early)

    How long does it last?
    Cervix dilation?
    Contraction frequency/duration/intensity?
    Mom's mood?
    • Onset of regular contractions
    • 5-7 hrs
    • Contractions increased in duration, frequency and intensity
    • Cervix: 0-3 cm
    • Contractions every 3-30 min
    • Duration: 20-40 sec
    • Intensity: mild-moderate
    • Mom happy, excited
  38. 1st stage of Labor: Active

    How long does it last?
    Cervix dilation?
    Contraction frequency/duration/intensity?
    Mom's mood?
    • 2-5 hrs
    • Cervix: 4-7 cm
    • Contraction every 2-5 min
    • Duration: 40-60 sec
    • Intensity: moderate to strong
    • Mom is anxious, fear, doesn't want to be left alone
    • *Use focal point, back rub, tries to find comfortable position
  39. 1st stage of Labor: Transition

    How long does it last?
    Cervix dilation?
    Contraction frequency/duration/intensity?Mom's mood?
    • approximately 3.5 hours
    • cervix: 8-10 cm
    • contractions every 1.5-3 min
    • duration: 60-90 sec
    • intensity: strong
    • Uncontrollable urge to bare down- distract her until she gets to 10 cm (use breathing)
    • Restless, tired, difficulty coping, yelling, irritable foul language, anger
  40. 2nd stage of birth: Complete dilation (birth)

    How long does it last?
    Cervix dilation?
    Contraction frequency/duration/intensity?Mom's mood?
    • usually 2 hrs after cervix completely dilated
    • urge to push
    • contractions every 1.5-2 min
    • duration 60-90 sec
    • intensity strong
    • increased pain/fear
    • once able to push may feel sense of control
  41. cardinal movements
    mechanism of labor, in which fetus changes positions in order to come through the birth canal

    • Descent
    • Flexion of head
    • Internal rotation
    • Extension of head
    • Restitution
    • External rotation (so posterior shoulder is free first)
    • Expulsion (anterior shoulder is free, rest of body follows quickly)
  42. restitution
    head emerges from canal, untwists and turns to side to align with position of back
  43. 3rd stage of labor: delivery of placenta
    • placental separation
    • membranes separate
    • placental delivery
    • If >30 min elapses, placenta is retained
  44. Why is it a problem if the placenta is retained after birth?
    • uterus can't clamp down in order to prevent hemorrhage 
    • "retained" if placenta is not delivered within 30 minutes of baby
  45. 4th stage of labor
    • 1-4 hrs after birth
    • uterine changes
    • hemodynamic changes
  46. Hemodynamic changes of 4th stage of labor
    • blood loss of 250-500 mL
    • Redistribution into venous beds
    • Moderate decrease in BP
    • Moderate tachycardia
  47. Uterine changes of 4th stage of labor
    • remains contracted and midline
    • fundus 1/2 way b/w umbilicus and symphysis pubis
    • cervix widely spread
    • N/V
    • Thirsty, hungry
    • Shaking, chills: shaking may be due to over extention of muscles
    • bladder hypotonic (can't pee)
  48. True labor signs
    • Contractions @ reg intervals
    • Intervals b/w contractions shorten
    • Contractions increase in duration/intensity
    • Discomfort starts in back and radiates to abdomen
    • intensity increase with walking
    • cervical dilation and effacement progressive
    • contractions dont decrease with rest or warm tub bath
  49. False labor signs
    • contractions irregular
    • no change in interval b/w contractions
    • no change in duration
    • discomfort in abdomen
    • walking has no effect on/or lessens contractions
    • no change in dilation or effacement
    • rest and warm tub bath lessen contractions
  50. Maternal asessment
    • Copy of prenatal records sent to hospital @ 36 weeks
    • May be limited
    • Protect privacy
    • Note history of depression (elevates risk of postpartum depression)
    • Assess for intimate partner violence
    • honor cultural beliefs
  51. Minimal Assessment of mother (MUST HAVE)
    • VS
    • Contraction-frequency/intensity
    • Dilation
    • Effacement
    • Station
    • Membrane status
    • Fetal presentation/position
    • FHT
    • Fetal movement
    • Labs- RPR, Rubella, syphilis, Rh
  52. What is the risk with premature rupture of membranes
    baby not in adequate station which results in a risk of cord prolapse
  53. Fetal behavior response to labor
    • sleep and active states
    • decreased fetal movement, breathing movements and variability during sleep (usually 40 minutes)
  54. hearing is fully developed when
    • 28 weeks
    • begins 23-24 weeks
  55. when a baby is full term they are aware of
    touch
  56. Fetus is sensitive to
    light
  57. Leapolds maneuver
    • 1. Palpate upper abdomen with both hands
    • 2. Determine location of back, palpate abdomen deep
    • 3. Determine what fetal part is above inlet. Grasp lower portion of abdomen just above symphasis pubis
    • 4. Stand at head, move fingers slowly down sides of uterus toward pubis
  58. Intermittent doppler
    just as effective as toco if nurse pt ratio is 1:1, pt low risk and nurse stays with patient
  59. Doppler
    • count for 30-60 seconds
    • Listen before, during, and after contractions
    • Can't ID variability
  60. Palpating contractions
    • place fingers of 1 hand at the top of uterus
    • Apply gentle pressure
    • During peak estimate firmness:
    •    Mild: tip of nose
    •    Moderate: chin
    •    Strong: forhead
  61. Advantages of palpating uterus
    • noninvasive
    • readily accessible
    • hands on 
    • allows mother freedom
  62. Disadvantages of palpating contractions
    • cant measure pressure
    • no record
    • doesnt work on obese
  63. Things to check for in a vag exam
    • presentation
    • position
    • station
    • flexion of fetal head
    • swelling of scalp
    • dilation
  64. 3 cm dilated is about the size of
    slice of banana
  65. 5 cm dilated is about the size of
    ritz cracker
  66. 7 cm dilated is about the size of
    soda can
  67. 10 cm dilated is about the size of
    bagel
  68. TOCO
    • External
    • Measures frequency and duration
    • Noninvasive
    • can be removed
    • continous
    • must palpate intensity
    • uncomfortable and needs constant adjustment
    • DOES NOT MEASURE INTESNITY
  69. IUPC
    • measures intrauterine pressure
    • measures intensity 
    • measures resting tone
    • 2 lumens- fluid filled
    • membranes must be ruptured 
    • invasive
    • increased infection risk
  70. The joint commission required standardized terms r/t
    fetal monitoring
  71. baseline fetal heart rate
    110-160
  72. Fetal tachycardia
    • idiopathic
    • Maternal related: fever, dehydration, anxiety, anti-tocolytics (medicines that decrease contractions)
    • Fetal factors: early fetal hypoxia, fetal anemia, infection, prematurity, arrhythmias
  73. Fetal bradycardia
    • <110 for 10 min
    • can be sign of significant fetal compromise
    • stimulation of vagus nerve can cause it
    • fetal heart block= caused by systemic lupus
    • accidental monitoring of maternal HR
  74. Sinusoidal pattern
    • smooth, wavelike
    • can be benign or serious
    • usually always nonreassuring (not sure if baby is ok)
    • causes could be : fetal anemia, twin to twin transfusion, umbilical cord occultion, CNS malformation
    • IMMEDIATE INTERVENTION
  75. Wandering baseline
    • smooth, meandering pattern
    • fluctuates in normal baseline without variability
    • indicates congenital defect or metabolic acidosis
    • IMMEDIATE INTERVENTION 
    • imminent delivery
  76. Fetal arrhythmias
    • mostly benign 
    • if occasional its ok
    • if consistent then concerned
  77. baseline variablity
    measure of fetal cardiac and neurological well-being to the push and pull of sympathetic and parasympathetic nervous system

    baby has good response
  78. short term baseline variability
    difference between successive heart beats
  79. long term baseline variability
    large rhythmic fluctuations
  80. Absent variability
    amplitude undetectable
  81. minimal variability
    detectable but 5 BPM or less
  82. Moderate variability (normal)
    amplitude range of 6-25 bpm
  83. Marked variability
    amplitude range > 25 bpm
  84. accelerations in fetal heart tones
    • abrupt increase in baseline
    • has a peak and returns to baseline
    • episodic accels are REASSURING
    • associated with fetal movement or any kind of stimulation
    • indicates fetal well being
    • associated with stimulation of SNS
  85. epsiodic accels are
    Reassuring
  86. Nadir
    lowest point
  87. Early decels
    • uniform 
    • mirrors contraction pattern
    • due to head compression
    • normal, no nursing action needed
  88. late decels
    • Nadir after peak of contraciton
    • Ominous
  89. Cause of late decels
    placental insufficiency
  90. Immediate nursing actions for late decels
    • turn mom from side to side
    • oxygen to mother
    • stop oxytocin
    • may give fluid bolus
    • notify provider
    • prep for C section
  91. prolonged decels last
    2-10 minutes
  92. variable decel
    • onset, depth duration varies with contractions
    • severe if below 60 for >60 seconds
    • Due to cord compression
    • turn mom
    • o2
    • fluid bolus
  93. Categories of FHT
    • 1. Normal "Reasurring"
    • 2. Indeterminate- iffy (not predictive of acid-base status of fetus)
    • 3. Abnormal- nonreassuring (Predictive abormal acid-bae balance at time of delivery)
    • requires prompt eval
  94. VEAL CHOP
    • V: variables     C: cord compression
    • E: earlies         H: head compression
    • A: accels         O: okay
    • L: late decels   P: placental insufficency
  95. scalp stimulation
    press fetal scalp with fingers during vag exam to elicit accel
  96. Acoustic stimulation:
    • place sound device on maternal abdomen to elicit accel
    • If accel: reactive
    • Absence: nonpredictive, further evaluate
  97. Indications for cord blood analysis
    • significant abnormal FHR
    • Meconium staining amniotic fluid
    • Depression at birth 
    • only if APGAR >7 @ 5 minutes
    • Can determine if fetal academia due to cord compression or placental insufficiency
    • 8-10 inch sample
  98. mother should go to hospital if
    • Rupture of membranes
    • decreased fetal movement
    • regular, frequent contractions (q 5 min for first time moms, every 6-8 min for multi)
    • any vaginal bleeding
  99. positive relationship
    coach, advocate, continuous support
  100. Laten stage of labor interventions
    • BP, HR, RR q1hr
    • temp q 4 hr
    • Palpate contractions  q 1hr
    • vag exam only when management changes
    • FHT q30 min if normal (no decels)
    • talk and teach
    • encourage ambulation (if no bleeding, normal FHT, ROM if head is engaged)
    • Clear liquid/ice chips
    • Oral care if vomiting
  101. Active stage of labor interventions
    • palpate contractions q15-30 min
    • watch for bloody show
    • encourage frequent voiding
    • FHT q30 min (15 if high risk)
    • VS q1hr
    • IVF
    • Note ROM
    • If FHT drop- do immediate vag exam
  102. transition stage of labor interventions
    • may see heavy bloody show
    • palpate contractions q15 min
    • sterile vag exam
    • VS q30 min (15 if high risk)
    • FHT q30 min
    • At end of contractions, deep breath, blow out, relax
    • Quite environment
    • Mom has body diffusion
    • Less aware of environment
    • May not want to be touched
    • May be unable  to speak in sentences
    • Feels increased rectal pressure and perineal burning
    • HELP HER NOT TO PUSH
  103. What happens if mom in complete stage of labor
    • passage of gas/stool
    • voice deepen
    • moan-guttural
    • change in vocalization
    • discomfort-pain, sweaty, hot, tired
    • reaction of pain: BP, HR up, pupils DILATE, muscle tension builds
    • Avoid holding breath
    • Frequent position changes q1hr
    • Encourage ambulation
    • Rocking, leaning, pillow under mid-back
    • Avoid pressure behind knees and calves (DVT)
  104. Comfort measures during complete stage of labor
    • Change pads frequently 
    • wash perineum w/warm soap and water
    • Fresh, smooth, dry linens
    • Clean fresh gown
    • Cool washcloths
    • Empty bladder q1-2 hr
    • vaseline for lips
    • socks
    • effleurage, back/neck rbs
    • breath through nose and out mouth 
    • birthing ball
  105. Birthing ball slow rock
    widens pelvis, helps fetal decent
  106. birthing ball hands on knees, leaning forward
    helps fetus go from OP to OA
  107. Anxiety not r/t pain interventions
    • express confidence in her abilities
    • assit with breathing
    • demonstrate genuine concern
    • praise efforts
  108. anxiety in support person
    • keep informed
    • assure them of normal sounds/behaviors
    • explain equipment and procedures
    • praise efforts
  109. Anxiety in women of rape
    • assess every woman
    • be alert for unexplained anxiety, unrelenting pain, intense fear during vag exam
  110. Slow paced lamaze
    • 1-1000, 2-1000, 3-1000...
    • until contraction over
  111. modified paced lamaze
    • 1&2, 2&2, 3&2...
    • Exhale on number, in on &
  112. lamaze pattern paced
    • in & out through mouth "hee-hoo"
    • begin with 3:1, progresses to hee hoo
  113. Breathing bradley (abdominal)
    • deep and rhythmic
    • slow
    • quick: pant-pant-blow
    • Count aloud to encourage slow breaths
    • ID beginning, peak, and descent of contraction
  114. 2nd stage of labor interventions
    • vag exam to determine onset
    • assess fetal descent
    • HR, BP q5 min
    • FHT q5 min
    • Utterances indicate change in coping
    • DO NOT PUSH UNTIL dilated 10 cm and feels urge to push
  115. Stirrups
    • padded
    • puts legs up at same time
    • adjust for mothers legs
    • avoid pressure points
  116. recumbent
    • most popular 
    • convienent
    • easy to maintain sterile field
    • easy for episiotomy
    • decreased BP
    • increased aspiration risk and perineum pressure
    • interferes with contractions
  117. squatting
    • use of gravity
    • increased pelvic outlet size
    • difficult balancing
  118. left lateral sims
    • deceases frequency of contractions
    • increases intesnsity
    • more comfortable for mom
    • less aspiration risk
    • less risk for shoulder dystocia
    • easier to deliver baby if OP
  119. birthing chair
    • vanished due o childbed fever
    • becoming more popular
    • stronger, more efficient contractions
    • may diminish or eliminate sever back pain
    • mom able to see birth
  120. woman may be asked to pant or blow to prevent
    too rapid of a descent
  121. when shoulders appear, the BA grasps the newborn head and pulls
    down gently to release the anterior shoulder
  122. if a cord clamp is delayed, position the infant
    below the level of the vagina
  123. if there is only one artery in cord, think
    GU abnormalities
  124. when is cord clamp removed?
    about 24 hrs if the cord is drying
  125. stem cells are extracted when?
    after cord is clamped but before placenta is expelled
  126. Issues with stem cell storage
    • mostly done by pro-profit agencies
    • cost often prohibitive
    • annual fee for storage
  127. When drying infant, begin with ________ and immediately remove...
    • head
    • wet blankets/towels form bed
  128. APGAR scores
    • 7-10: Desirable
    • 4-6: moderately depressed
    • 0-3: severe depressed
    • Only 5 minute is associated with long-term neuro outcome
    • If less than 5 at 5 min, continue every 5 min till above 5
    • DOES NOT GUIDE RESUSCITATION
    • MOST IMPORTANT IS HR
  129. Characteristics of infant abductor
    • Female of childbearing age
    • often overweight
    • Usually compulsive
    • relies on manipulation lying & deception
    • Frequently indicates she has lost a baby or is incapable of having one
    • Often married or cohabitating
    • Lives in the community where the abduction takes place
    • Visits nursery & maternity units, asks detailed questions about procedures & floor layout
    • Plans the abductions but seizes any opportunity present
    • Frequently impersonates a nurse or other health professional
    • Becomes familiar with staff cares, work routines, victim’s parents
    • Demonstrates a capability to provide “good” care to the baby
  130. Newborn assessment (3rd stage)
    • size and shape of head
    • posture and movement
    • skin
    • resp effort
    • abdomen
    • heart 
    • cord genitals and anus
    • extremities
  131. attachment interventions (3rd stage)
    • talk in high pitched voice
    • place on moms abdomen
    • first hour, infant is awake and alert-gazes at parents
    • encourage breast feeding
    • dim lights
    • delay interventions, delay visitors
    • avoid loud noises 
    • consult with mother about how much contact she wants
  132. Signs of placental separation
    • uterus rises upward as the placenta settles downward
    • umbilical cord lenthens
    • sudden trickle or spurt of blood
    • uterus changes from discoid
    • check for Ballooning which may indicate uterine relaxation and bleeding
  133. placental expultion
    • have mom bear down
    • controlled cord traction (danges of uterine inversion, snapping of cord, hemorrhage)
    • fundal pressure (uncomfortable for mother)
  134. Medicines after placental expulsion
    • pitocin IV or IM
    • methergine IM (dont give preclamptics)
    • hemabate: IM
    • Cytotec: off label use
  135. bleeding after birth
    • check lochia q15min
    • continuous observation if soaked in 15 min or blood pools
    • should not exceed 1 pad/hr
    • BP q5-15min
    • VS q5-15min
  136. blood returns to mothers circulation from the
    uteroplacental shunt
  137. continous trick of blood with firm, contracted uterus may mean
    vag or cervical tear
  138. Maternal danger to report after birth
    • Tachycardia
    • Hypotension
    • Uterine atony
    • Excessive bleeding
    • fever >100
  139. Visceral pain in 1st stage from
    • Cervical changes
    • distention of lower uterine
    • uterine ischemia
    • Impulses transmitted via T11 & T12 spinal nerve segment & accessory lower thoracic & upper lumbar Sympathetic nerves
  140. somatic pain in 2nd stage
    • intense, sharp, burning
    • well localized
    • results form stretching and distention of perineal tissues and pelvic floor as fetus moves through
    • transmited via pudendal nerve through S2 and S4 spinal nerves and PNS
  141. counterpressure
    pressure of palm on lower back
  142. imagery is only valuble if
    practiced before birth
  143. which prepared childbirth method relies on partner coaching?
    bradley
  144. kitzinger method of prepared childbirth
    • sensory memory
    • stanislavky relaxation
  145. All systemic drugs for pain relief cross
    the placenta
  146. Criteria for pain meds
    • Mother wants it
    • Mother has stable VS
    • FHR 120-160
    • NST reactive
    • Short/long term variability present
    • No late decels
    • no meconium staining
    • established contractions
    • cervix dilated to 4 cm (G1) or 3cm (G2)
    • presenting part engaged
    • progressive descent of presenting part
  147. ______ route not used because its slow and decreases blood flow to GI
    oral
  148. Systemic narcotic drugs
    • Stadol/Nubain
    • Rapid onset, peak 30-60 min
    • SE: resp/cv depression, drowsiness, dizziness, blurred vision, N/V, diaphoresis, urinary urgency
    • Antidote: Narcan
    • ****3 hr lifespan, if given to and effects wear off while drug is still in system, baby will stop breathing, give another dose of Narcan
  149. disadvantages of epidural
    • MATERNAL HYPOTENSION (prevented with dextrose fluid bolus)
    • Can take up to 30 min to work
    • Lengthens 1st and 2nd stage of labor which increases stress to fetus
    • increased c section risk
    • puritus
    • hyperthermia
  150. major complication of spinal block
    total spinal HA


    HA related to CSF leak: do blood patch
  151. Pundendal block
    • for 2nd stage of labor, birth, episiotomy repair
    • Works for delivery pain, not labor pain
    • Injected below pudenal plexus transvaginal
    • Disadvantes: doesnt relieve uterine pain, decrease urge to push, can cause ligament hematoma, perforated rectum
    • Advantage: simple, safe, doesnt lower bp, more direct
  152. Early term is
    37-38 wks
  153. lbw
    <2500g
  154. preterm labor
    labor at 20-37 wks
  155. number one cause of neonatal mortality
    preterm labor

    2x more common in black women
  156. most common lower genital tract infection in women of childbearing age
    • BV
    • roughtine treatment is not indicated, but surveillance is!!!
  157. GBS
    • 20-30% women colonized
    • no assocation between preterm birth and vag colonization
    • preterm women should be screened and treated if possible
  158. UTI
    • risk of 50% preterm birth if not treated
    • Asymptomatic bacteriuria also increases risk
  159. Fetal fibronectin "fFN"
    • Vag washing or AF
    • pos test can indicate SROM
    • presence is abnormal after 20 weeks but returns near term
    • neg results are highly predictive
    • if neg, chance of delivery within 7 days is about 1%
  160. Dont stop PTL if
    • fetal demize
    • severe PIH
    • chorionamnioitis
    • fetal lung maturity
    • <24 weeks
    • nonreactive NST
    • Absent end-diastolic umbilical blood flow
    • repetitive decels
    • lethal fetal anomaly
    • abruption
    • severe IUGR
    • nonreasurring GHT
    • oligo
    • pos CST
  161. Sings of PTL
    • pain
    • menstrual like cramps
    • vag bleeding
    • bloody show
    • pelvic pressure
    • diarrhea
  162. Definition of PTL
    • uterine contractions every 5 min 
    • OR
    • 8 contractions in 60 min
    • AND
    • Documented cervical change or cervical effacement of 80% or more
    • OR
    • cervical dilation greater than 1 cm
  163. Progesterone for PTL
    • Prevent recurrent preterm delivery due to SROM or SPTL
    • begun 16-20 weeks, IM in hip every week until 37 weeks
  164. Tocolytics
    • delay birth by 24-48 hrs
    • allows betamethasone to be given
  165. beta mimetics (terbulatine, ritodrine) for preterm labor
    • IV, IM, subq, or PO
    • SE: decreased BP, increased HR, pulmonary edema
  166. Mag sulfate
    • Do not use with CA channel blockers
    • Bolus 4-6g IV over 20 min
    • Main 1-4 g/hr
    • Titrate to Mg levels (5.5-7.5) and DTRs
    • Maternal SE: flushing, HA, dizzy, nystagmus, nausea, dry mouth
    • Fetal S: hypotonia, Resp. depression, decreased BG, decreased Ca
  167. prostaglandin synthetase inhibitors
    • indomethcin
    • give with antacid or meals
    • do not give if coagulation disorder or kidney disfunction
    • can cause premature DA closure
  168. if mom experiences PTL with activity
    • empty bladder
    • lie on side
    • drink 3-4 cups of fluid
    • soak in warm bath tub with uterus submerged
    • rest for 30 minutes after symptoms have subsided
    • call health care provider if symtpoms persist
  169. Self managemnt of PTL
    2-3 quarts of juice
  170. PROM
    rupture of water after 37 weeks but before labor onset( if labor has not occured within 12 hrs condisdered PROM)
  171. Prolonged ROM
    greater than 24 hrs
  172. causes of prolonged ROM
    • infection
    • amnio
    • previa/abruption
    • hydraminos
    • LEEP
    • 2+ babies
    • maternal genitalia anomalies
    • fetal anomalies
    • connective tissue disease (lupus)
  173. Nitrazine test
    • AF more alkaline than normal vag secretion
    • Normal ph: 2.5-5.4
    • AF pH: 7-7.5
    • False positives: BV, semen, urine, blood, antiseptic soaps
  174. treatment/management of PROM
    • sterile vag exame
    • if labor- digital exam, bear down (gush of fluid) slide shows ferning
  175. couvelaire uterus
    • blood infiltrates uterus
    • Blue
  176. Previa
    DO NOT PERFORM VAG EXAM
  177. Related factors for previa
    • multiparity
    • placenta accrete
    • abnormal blood vessels
    • prior C-section
    • cocain use
    • smoking 
    • recent abortion
    • large placenta
  178. idomethicin
    decreases fetal urine output
  179. oligohydraminos can cause
    pulmonary hypoplasia (life threatening)
  180. induction should never be done before
    37 weeks
  181. goal of oxytocin
    3, 40-60 sec contractions in ten minutes with good relaxation between contractions
  182. if hyperstimulation of uterus occurs due to oxytocin, administer
    terbutaline
  183. protracted labor
    < 1 cm dilation/ hour
  184. Arrested labor
    no change in dilation for 2 hrs
  185. precipitous birth
    <3hr of labor before delivery
  186. women at risk for forceps
    • 1st preg
    • >35 years
    • <4 ' 11
    • >41 wks
    • Epidural
    • Dystocia
    • Large fetal head
  187. leading cause of maternal death in us
    AF embolism
  188. AF embolism s&s
    • SOB
    • hypoxia
    • cyanosis
    • respiratory failure
    • CV collapse
    • Emergency-Code-CPR-C section w/cpr
  189. most common cause of uterine rupture
    previous c section
  190. first sign of uterine rupture
    • nonreassuring FHT
    • bradycardia

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