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217 Cards in this Set
- Front
- Back
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What is the normal contraction frequency in the active phase of labor?
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q 2 to 3 min
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Hyperstimulation is defined as
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Contractions of normal duration occuring within 1 min of each other, a series of single contractions lasting 2 min or more, or a contraction frequency of five or more in 10 min
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Are coupling or tripling ominous signs?
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No. It is a common pattern early in labor and does not usually initiate FHR responses.
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At term, how much cardiac output perfuses the uterus each minute?
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10% to 15% or 600 to 750 ml
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Fetal deoxygenated blood is carried to the placental villi by
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the two umbilical arteries
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How does maternal-fetal exchange of oxygen and other nutrients occur?
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In the intervillous space across the membranes that separate fetal and maternal circulation. Oxygen is exchanged thru passive diffusion (high concentration is maternal side; low concentration is fetal side) and nutrients are exchanged by active transport, facilitated diffusion and pinocytosis.
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The significant factors affecting placental exchange of gases and nutrients for the fetus are
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uterine blood flow, umbilical blood flow, and the amount of placental area available for exchange.
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Why does the FHR slowly drop in normal baseline as the fetus matures?
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The parasympathetic nervous system matures during the second trimester, and the vegas nerve (which slows the HR) gradually becomes dominant over sympathetic stimulation.
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Define FHR accelerations
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An abrupt increase in FHR above baseline. The acme is 15 beats/min above baseline and the acceleration lasts at least 15 seconds but less than 2 minutes. Before 32 weeks accelerations are defined as having an acme of 10 beats/min.
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The causes of sinusoidal FHR patterns include:
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Maternal-fetal hemorrhage, placental abruption or fetal anemia, which can be caused by Rh isoimmunization. Can occur after administration to some narcotics especially Stadol.
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Approx 50% to 60% of mothers whose fetuses exhibit congenital heart block have evidence of having what???
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Connective tissue disease such as systemic lupus erythematosus.
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T/F
Most fetal dysrhythmias convert to normal sinus rhythm shortly after birth |
True
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Most fetal dysrhythmias are not life-threatening, except for ___, which may lead to fetal congestive heart failure
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supraventricular tachycardia
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In the presence of variable decelerations, progresive hypoxemia may be characterized by
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and increase in baseline, loss of variability and the presence of overshoots after the decelerations
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Failure to exercise reasonable care is termed
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negligence
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What is malpractice?
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Negligence by a professional
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Human chorionic gonadotropin (hCG) is secreted by
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blastocysts and the placenta
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hCG stimulates what two hormones until the developed placenta can take over.
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progesterone and estrogen
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When are hCG levels are at thier max?
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between 60 to 70 days gestation and declines after.
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What role does estrogen play in pregnancy?
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Prepares the breasts for lactation, increases blood flow to the uterus and may be involved in the timing and onset of labor.
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What role does progesterone play in pregnancy?
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Plays a crucial role in supporting the pregnancy; it discourages uterine contractions by acting on uterine smooth muscle to inhibit prostaglandin production; it also relaxes venous walls to accommodate the increase in blood volume.
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What role does prostaglandins play in pregnancy?
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Plays an important role in the onset of labor. They are mediators of muscular contractility.
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Why should you not take ibuprofen during pregnancy.
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There is concern with the use of ibuprofen in the third trimester. The greatest
concern is for premature closure of the ductus arteriosus (a vessel in the fetal heart), which can lead to high blood pressure in the fetal lungs (pulmonary hypertension). The use of ibuprofen later in pregnancy may inhibit labor or cause reduced amount of amniotic fluid (oligohydramnios). Therefore, it is recommended that women use ibuprofen only under a health care provider’s supervision during the third trimester. |
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Describe blood volume changes during pregnancy
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Increases early in 1st trimester, reaches max early in the 3rd tri, and returns to normal 2-3 wks post partum. Increases 30 to 50% (1450-1750 ml)
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What causes anemia of pregnancy?
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The expansion in plasma volume is greater than the expansion of RBC's (hypervolemia hemodilution or anemia)
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Describe cardiac output changes during pregnancy
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Increases 30% to 50% (5 to 7 Liters/min) beginning early in 1st tri and peaking at 20-24 wks. In the beginning change results from an increase in stroke volume whereas later, it is from increase in heart rate)
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Describe blood pressure in pregnancy
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Systemic vascular resistance decreases causing a decrease in BP. Returns to prepreg levels in third trimester.
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Why does epidural anesthesia cause a drop in BP?
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Causes a marked decrease in peripheral vascular resistance that may cause a decrease in venous return, resulting in decreased cardiac output.
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During pregnancy there is an increase in which heart sound?
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1st
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List fetal complications that can result from maternal chronic hypertension
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IUGR; Prematurity; Mortality
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Normal Hemoglobin in pregnancy
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12 to 16 g/dl
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Why is pregnancy considered a hypercoagulable state?
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Fibrinolytic activity is decreased.
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Normal Hematocrit in pregnancy
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38% to 47% (less than 35% may indicate iron-deficiency anemia)
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Rubella titer
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More than 1:10 to confirm immunity
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What role does Human placental lactogen (hPL) have in pregnancy
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Decreases maternal metabolism of glucose; inhibits utilization of insulin. Levels rise with placental growth.
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How does the heart change in position, appearance, and function
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Growing uterus exerts pressure on diaphram and displaces the heart upward and to the left. PMI changes from 5th intercostal space to 4th. Increase in blood volume causes heart to enlarge. Ventricular chamber size is increased. Systolic murmur may be heard in approx. 90% to 95%. Any time of diastolic murmur is abnormal.
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What is Nagele's Rule?
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1st day of LMP + 7 days - 3 months + 1 year
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What is Chadwick's sign
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Vaginal mucosa discoloration
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What is Goodell's sign?
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Softening of cervix
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Normal weight gain
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25 to 35 lbs.; 15 to 25 lbs. for overweight woman. 1/2 to 1 lb per week in second and third trimester
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Describe respiratory adaptations during pregnancy
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Diaphragm rises and diameter of thoracic cage increaes; increased O2 demands are met by deeper ventilation rather than more frequent respiration. Progesterone stimulates hyperventilation which results in compensated alkalosis (blow off more CO2
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Respiratory - pregnancy is a state of compensated
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Respiratory alkalosis (hyperventilation effect)
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What are physiologic adaptations of the respiratory system during pregnancy
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Diaphragm rises by 4 cm, transverse dia of thoracic cage increases by 2 cm; progesterone stimulates hyperventilation which results in compensatory mild respiratory alkalosis
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How are increased oxygen demands of pregnancy met?
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By deeper ventilation rather than more frequent respiration. Tidal volume increases - respiratory rate and total lung capacity remains unchanged
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What does oxygen consumption increase by in pregnancy?
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15% - 20%
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Becuz fetal hemoglobin has a higher O2 affinity compared to maternal hemoglobin, when is fetal O2 delivery reduced?
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Not until maternal stats go below 90% (65mm Hg)
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The slight increase in pH that occurs during pregnancy is due to
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An increase in minute ventilatory rate (rate by which gas enters or leaves the lung) due to increase in tidal volume. Respiratory rate and lung capacity remains the same.
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What are symptoms of pulmonary edema?
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Dyspnea and orthopnea, rales and crackles, evidence of hypoexmia
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Pulmonary edema in pregnancy is usually secondary to
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Preeclampsia, tocolytic therapy, massive fluid resuscitation, amniotic fluid embolism, sepsis, cardiac disease
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What is the leading obstetric cause of maternal mortaility
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Pulmonary embolism and deep vein thrombosis
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During pregnancy, serum urea and creatine levels....
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decrease becuz of an increase in glomerular filtration rate
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The sligh increase in pH that occurs during pregnancy is due to
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An increase in ventilatory rate
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What are symptoms of pulmonary edema?
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Dyspnea and orthopnea, rales and crackles, evidence of hypoexmia
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Pulmonary edema in pregnancy is usually secondary to
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Preeclampsia, tocolytic therapy, massive fluid resuscitation, amniotic fluid embolism, sepsis, cardiac disease
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What is the leading obstetric cause of maternal mortaility
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Pulmonary embolism and deep vein thrombosis
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During pregnancy, serum urea and creatine levels....
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decrease becuz of an increase in glomerular filtration rate
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A cardiovascular parameter which normally decreases during pregnancy is
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Systemic vascular resistance
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An expected WBC count during post partum is
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20,000-22,000 mm3
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The hormone released from the anterior pituitary that is responsible for inititating lactation is
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Prolactin
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The hormone crucial in maintaining the endometrium and therefore maintains the pregnancy is
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Progesterone
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Pregnancy is considered a ____ state due to the increase in several essential coagulation factors
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Hypercoagulable
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The pregnant woman is at increase risk for venous thrombus formation due to ___ and ___
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Coagulation changes and venous stasis
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Malpractice is defined as
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Negligence by a professional
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Failure to exercise reasonable care is termed
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Negligence
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By 32 weeks in a normal pregnancy blood volume increases by approx
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30% - 50% or 1450 to 1750 ml
**1500 ml |
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Heartburn is common during pregnancy due to
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Relaxation of the esophageal sphincter (from hormone changes)
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The average blood loss during a vaginal birth is
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500-600 ml
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The average blood loss during cesarean birth is
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1000 ml
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Cardiac output is greatest during which peroid of the birth process?
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Imediately after birth
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The estimated percentage of new mothers who experience "baby blues" is
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70% - 80%
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During which trimester is blood pressure the lowest?
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second
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The time when measurement of fundal height in centimeters should correlate with gestational age is
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After 20 wks.
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An appropriate gestational age for a glucose screening test is at
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26 wks
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Maternal serum alpha-fetoprotein specifically screens for
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Neural tube defects
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If both parents are affected by sickle cell disease, the risk of thier children being affected by sickle cell disease is?
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100%
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The monitoring of fetal activity by "kick counts" is initiated at ____ wks gestation
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28
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Using kick counts, perception of ___ distinct movements in a period of up to 2 hrs is considered reassuring
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10
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The recommended weight gain for an obese women during pregnancy is
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15 lbs.
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Male and female genitalia are recognizable by ___ wks gestation
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12
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Amniocentesis for genetic evaluation is usually done...
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between 15 and 20 wks (completed at this time becus by this age, the amniotic and chorionic membranes have fused, and the risk of rupture of membranes and subchorionic bleeding is reduced.
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The 5 parameters assess in the biophysical profile are
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Fetal tone, movement, breathing, amniotic fluid volume and NST
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A diagnosis of severe preeclampsia is consistent with a 24 hr urine showing protein excretion of
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5.0 g/L (severe)
Significant proteinuria is defined as >300 mg in 24 hrs. (mild) |
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A systolic BP of >/= ___ or diastolic BP of >/== ____ mm Hg on two occasions of at least 6 hrs apart is necessary for diagnosis of severe preeclampsia
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160; 110
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Maternal morbidity from hypertension in pregnancy results from
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Abruption, DIC, hepatic failure; acute renal failure
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Laboratory markers for HELLP syndrome are
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Hemolysis; elevated liver enzymes; low platelets
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Invasion of the trophoblasic cells into the uterine myometrium is termed placenta
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increta
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When the placenta is implated directly into the myometrium it is termed
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Placenta accreta
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Prostaglandin F2a (Hemabate) is most likely to fail to control hemorrhage in women with
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Chorioamnionitis
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A clinical finding with a dehiscence of a uterine scar during a trail of labor after a c/section (TOLAC) is
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FHR variable decelerations
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Vasa previa is the results of a ____ insertion of the cord
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velamentous
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For the fetus to maintain adequare oxygenation the maternal oxygen saturation must be at least
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95%
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The risk factor most predictive of preterm labor is prior
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Preterm birth (not preterm labor)
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A drug that is used for tocolysis but is not classified as a beta-mimetic is
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ritodrine
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The most common life-threatening complication of tocolytic therapy is
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pulmonary edema
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Bedrest has been shown by research to
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cause bone demineralization
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Smoking increases the risk of preterm birth by
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40%
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Women with a history of gestational diabetes with a normal postpartum follow-up test should be tested for overt diabetes
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q 3 years.
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Blood glucose values from reflectance meters are 14% above/below plasma values
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Below
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The preferred non-nutritive sweetener to use during pregnancy is
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aspartame
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PTL in women with diabetic ketoacidosis should be treated with
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Mag sulfate (not terbutaline - causes hyperglycemia)
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Insulin dosage during peroids of nausea and vomiting in pregnant women should be...
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administered with no adjustment
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Weekly NST's should be started in women with vascular disease beginning at the gestational age of
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28 wks.
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Type 1 diabetes occurs as the result of...
Type 2 occurs as the result of |
Autoimmunity directed at the B cells of the pancrease that results in lack of insulin production
Insulin resistance and decreased insulin production |
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What type of insulin is recommended during pregnancy because of the decreased risk of transmitting anti-insulin antibodies to the fetus
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Human
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Four symptoms of hyperglycemia are
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polyuria, polyphagia (excessive appetite; polydipsia (excessive thirst); blurred vision
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The mainstay of asthma therapy is
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corticosteroids
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Dizygotic twinning occurs when
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two or more eggs are fertilized separately
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Monozygotic twinning occurs when
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One fertilized egg divides
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Using the Zavanelli maneuver to resolve shoulder dystocia involves
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elevating the fetal head back thru the vagina
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Uterine hyperstimulation is defined as
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contractions >5 in 10 min
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Macrosomia is usually defined as
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Actual infant weight of more than 4,000 g (8 lbs. 13 oz) or estimated fetal weight of 4,500 g (9 lbs. 15 oz)
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Bradycardia in the second stage of labor following a previously normal tracing may be caused by
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Vagal stimulation
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The primary goal in treatment for late declerations is
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to maximize uteroplacental blood flow
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Findings indicative of progressive fetal hypoxemia are
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Rising baseline rate and absent variability
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Fetal metabolic acidemia is indicated by arterial cord gas pH of 7.18 and base deficit of
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12
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FHR declerations that are benign and don't require intervention are
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early
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FHR decelerations that result from decreased uteroplacental blood flow are
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late
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FHR decelerations that result from umbilical cord compression are
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variable
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A FHR pattern likely to develop with severe fetal anemia is
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sinusoidal
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A work-up for maternal systemic lups erythematosus would likeyly be ordered in the presence of fetal
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complete heart block
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Most fetal dysrhythmias are not life-threatening except for ____, which may lead to fetal congestive heart failure
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Supraventricular tachycardia
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A sinusoidal pattern may develop in the Rh sensitized fetus or the fetus who is
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anemic
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In the presence of maternal and/or fetal risk factors, auscultation of the FHR should occur every ___ min in the active phase and every ___ in the second stage of labor
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15; 5
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In the presence of FHR accelerations greater than 15 bpm above baseline and lasting more than 15 seconds, the fetal condition is comparable to the fetal blood gas pH of at least ____ and is reassuring
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7.20
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To correctly interpret a baseline FHR as tachycardic or bradycardic, the rate must persist for a min of ___ minutes
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10
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The normal range for fetal oxygen saturation (FSPO2) is between ____ and ____
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30% & 70%
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Pain during the first stage of labor is caused by
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cervical and lower uterine segment stretching and traction on ovaries, fallopian tubes, and uterine ligaments
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Pain during the second stage of labor is caused by
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distention of pelvic floor muscles, vagina, perineum, and vulva, pressure on the urethra, bladder, and rectum
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Pain during labor may result in anxiety. Unrelieved anxiety causes the release of maternal catecholamines which show to cause
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Uterine hypoperfusion and decreased blood flow to the placenta
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When pruritus occurs in the presence of an opioid in the epidural infusion, the nurse can correctly tell the patient that this symptom will most likely subside in about
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45 minutes
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Maintaining a horizontal position in labor promotes
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increased perception of pain
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Women with a fetus in an occiput posterior position commonly are more comfortable
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in knee-chest position
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What is Nagele's Rule
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1st day of LMP + 7 days - 3 months +1 year.
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Loss of pancreatic beta cells is the underlying cause of
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Type 1 diabetes
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A combination of insulin resistance to insulin action and inadequate compensatory insulin secretory response
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Type 2 diabetes
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Macrosomia in the infant of a diabetic mother is due to fetal
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hyper insulinemia
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Why do episodes of hypoglycemia occur, in diabetics, early in pregnancy?
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The fetus is constantly using maternal glucose for its growth
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A woman with Class C insulin dependent diabetes is admitted in PTL at 31 weeks. After stablizing on magnesium, the drug she should be weaned to for long term tocolysis is
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nifedipine (procardia) - it is a calcium channel antagonist, not a
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What are the current recommendations for GDM screening in pregnant women?
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>25 yrs old; obesity; family history of type 2 (1st degree relative); ethinic group with high prevalence (blacks, hispanics, asians and indians); history of abnormal glucose tolerance; history of poor obstetric outcome
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What is the GDM testing protocol?
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Glucose tolerance test at 24-28 wks; 50 g of oral glucose without regard to time or last meal; measure plasma glucose 1 hr later >140 requires 3 hr glucose test
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What are the three hour glucose tolerance test protocols?
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Fasting 95 mg/dl
1 hr 180 mg/dl 2 hr 155 mg/dl 3 hr 140 mg/dl *** Diagnosis requires that two or more plasma glucose concentrations be met or exceeded |
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What are the limits of the hemoglobin A1c levels (taken at 4-6 wks)
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Ideal = 2-5%
Goal = <6-7% >6-7 = greater chance of anomalies (cardiac) |
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First half of pregnancy (anabolic) effects of estrogen and progesterone (insulin antagonistic hormones) induce a state of _____ until 24 wks
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hyperinsulinenmia and hypoglycemia (insuline is the fetus growth hormone - delays surfactant production)
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Why is venous plasma readings used during the glucose tolerance testing?
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finger sticks gives lower reading by 14%
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Using Lecithin/sphingomyelin (L/S) ratio, when is lung maturity achieved?
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The chance of lung maturity is 98% if the concentration of lecithin is twice that of sphingomyelin (over 2:1)
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A pregnant A2 diabetic woman is having intermittent N & V. She is lethargic and her finger stick is 38 mg/dl. The most appropriate intervention is
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1 vial of glucagon (with N & V); without N & V give 4oz of fruit juice
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Insulin requirements (increase, decrease, remain the same) during:
Labor Postpartum Breastfeeding |
Increase
Decrease Increase |
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Which tocolytic can cause hyperglycemia and ketosis and therefor not recommended in pregnant diabetics with PTL?
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B-sympathomimetics
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In women with gestational diabetes, what are thier risks for developing overt diabetes later in life?
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Risk of GDM in subsequent pregnancies is 30-60%
60% of women with GDM will become diabetics in thier lifetime, annual screening is recommended) |
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What are two abnormalitites of fetal growth that occur in infants of diabetic mothers?
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IUGR - from compromised blood flow at the uteroplacental vascular bed
Macrosomia - secondary to hyperglycemia (insulin is fetus growth hormone) |
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A woman has elevated blood glucose levels when she is 4-6 wks pregnant, what are the fetal organs that may be affected?
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Cardiovascular (2/3) or CNS
Anencephaly & Spina Bifida; GI, GU & skeletal defects |
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G Largine (Lantus) insulin is replacing NPH, it cannot be combined with other insulins (it is acidic and will precipitate and lose action)
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Given at bedtime; has 1 hr onset and 24 hr action
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Primary goal of diabetes in pregnancy is...
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To achieve near normal plasma glucose - euglycemia. Human insulin only, animal insulin stimulate anti-insulin antibodies that cross placenta and contribute to fetal anomalies & macrosomia. REGULAR INSULIN DURING LABOR
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What two meds are avoided with DKA
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beta agonists, beta-blockers and steroids (benefits should out weigh the risks)
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Diabetic PP - oral contraceptives interfere with glucose metabolism
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low dose pills are only ones safe - **Progestin-only pills
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When should Rh negative women be secreened for antibodies?
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On initial visit blood group, Rh type & indirect Coombs antibody screen. If antibodies are detected a titer is preformed and repeated @ 20 wks and q 4 wks. If titer <1:8 no intervention necessary and Rhogam is given at 28 - 30 wks.
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With Asthma, what medications should be avoided?
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Ergometrine (methergine) & Hemabate can cause bronchospasm and should be avoided. Cervidil & Cytotec OK.
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What is treatment for acute asthma attack?
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O2, B-agonist (terbutaline or epinephrine) inhalation therapy q 20 min, High dose of IV corticosteroids - No hemabate
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How much folic acid (folate) is recommended?
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400 g (0.4 mg)***
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What is adequate wt gain during pregnancy?
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Underweight = 28-40 lbs
Average = 25-35 Overweight = 15-25 |
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How long should a epidural be avoided after a dose of heparin?
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18-24 hrs post last dose
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What medication reverses effects of heparin?
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Protamine sulfate 1 mg/100 u given over 20 minutes
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What are the "rules" for methadone use
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Frequently used to treat heroin addiction - blocks cravings. Is longer acting so stabilizes environment for fetus thus decreases IUGR. Mother may breastfeed. May have pain relief at same level as others but require 70% more analgesic after c/section
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What kind of effects does "huffing" have on the neonate?
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Toluene (huffing) - causes chromosomal damage; in urine 24-72 hrs; SGA & IUGR
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What medications should be avoided with a drug abuser?
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Stadol & Nubain - they act as a narcotic antagonists and with cause severe withdrawal/seizure
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What are the rules of Group B strep?
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Anogenital culture (not spec) at 36 wks. Most common cause of neonatal sepsis. Start PCN/Amp within 3 hours of delivery
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What are the rules for HPV?
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C/Section if lesions and or culture results not returned. No AROM, No vacuum, No scalp electrode, isolate newborn if suspected.
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What are the rules for Hepatitis?
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Minimize exposure, no breast feeding until Tx, room-in. All newborns should received Hep B vaccine. If infant is positive will have positive HBsAg within 2-5 months
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What are the "rule" for Rubella?
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If infected 1st trimester, 50-90% of fetus affected with severe congenital anomalies or death. HAA antibody test is <1:8 (non-immune)
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Why is vit K given to newborns at birth?
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Immature liver is unable to produce several coagulation factors and a sterile GI tract has not begun to produce vit K. Vit K stimulates the liver to synthesize coagulation factors.
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What is the Ferguson reflex?
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Body's response to pressure on the cervix. Stimulates nerve plexus, causing release of oxytocin by maternal posterior pituitary gland
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What are the maternal influences of labor
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Estrogen increases activity in the cervix (20% surge about 9 days before labor); (Progesterone quiets uterus - uterine muscle stretch releases prostaglandin); Activation of the myometrium requires receptor sites, increased production of prostaglandin and formation of gap junctions (provide communication channels)
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What are the proposed fetal contribution to labor
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Fetal membranes release arachadoic acid (precursor to PGE2 - prostiglandin) that softens cervix; fetus secretes oxytocin during labor at approx. 2-3 mu/min
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What is the average size of a pelvis
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Diagonal conjugate 11.0 (adequate for delivery)
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What is engagement?
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the descent of the largest transverse diameter to the level below the pelvic inlet. An occiupt below the ischial spines is engaged.
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Out of the four true pelvic types (Arthropold, Android, Platpelloid, Gynecoid), which one offers optimal dia in all three plans of the pelvis?
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Gynecoid
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What are the phases of labor?
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Latent Phase 0-3 cm, 0-40% effaced, 5-10 min apart, 35-40 sec, mild; Active phase 4-7 cm, 40%-80%, 2-5 min apart, 45-60 sec duration; Transition 8-10 cm; 2nd stage = complete
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What are adaquate contractions when calculating montevideo units?
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150-350 mm/Hg
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What is the normal dilation speed in active labor?
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1.2 cm/hr for primigravida, 1.5 cm for multigravida.
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What is considered a prolonged second stage of labor?
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Nullipara - 2 hr no epidural, 3 hr with epidural
Multipara - 1 hr no epidural, 2 hr with epidural |
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Using the Bishop Score, what number shows a likely successfull induction?
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7 success if likely for primip; 5 success is likely for multip.
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What should be known when administering Demerol?
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Onset of action 10 min IV, 50 min IM, Peak 5-10 min IV, 40-50 min IM; ***Duration 2-4 hrs.
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What is the drug management for prolonged hypotension with epidural placement?
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Ephedrine 3-6 mg IV push
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What are uncommon side effects from intrathecal narcotic injections
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Delayed respiratory depression; 8 hrs with fentanyl, 12 hours with morphine - use pulse oximeter, hourly assessment of respirations.
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Describe open glottis pushing
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exhale pushing 3-5 breaths, held for 4-6 seconds, corresponding with the woman's own perception of sensation - has less impact on fetus
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Describe degrees of vaginal lacerations
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1st degree = perineal skin, vaginal mucous membrane (skin & superficial structures)
2nd degree = above plus muscle, faschia of perineum 3rd degree = above plus anal sphincter 4th degree = above plus rectal mucosa (exposes lumen) |
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Describe forcep assisted delivery
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Outlet forceps = Scalp is visible without spreading labia, fetal skull has reached pelvic floor, rotation >45 degrees
Low Forceps = Leading point of fetal skull is at station +2, have to spread labia to see, rotation <45 degree Mid forceps = Station above +2 cm but head engaged |
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What are the rules of vacuum assisted delivery?
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Empty bladder, no more than 10 min accrued @ max pressure, 20 min total usage, > 3 pop offs discontinue, record numbr of pulls/pop offs.
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What three maneuvers are commonly used with shoulder dystocia
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Suprapubic pressure; McRoberts (knee-chest while supine, HOB down); Gaskin (hands & knees) and Zavenelli (pushed back thru with c/section)
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How do you know the placenta is seperating?
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Gush of blood, lengthening of cord, change in uterus shape. Should happen within 30 minutes.
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When the chorionic villi attach diretly to the myometrium of the uterus, this represents
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placenta accreta; blood vessels of placenta grow into uterin wall.
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Placenta accreta is most likely to occur in a woman with
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Placenta previa
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How do mechanisms transport across the placenta?
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By simple diffusion - passage of substances from a region of higher concentration to one of lower concentration & requires no energy.
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What type of placenta is it when the cord is inserted at or near the placental margin, rather than in the center
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Battledore
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What type of placenta is it when the fetal surface of the placenta is exposed thru a ring of chorion and amnion opening around the umbilical coard (membranes are rolled back)
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Circumvellate
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What type of placenta is it when one or more accessory lobes of fetal villi have developed (increased risk for bleeding)
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Succenturiate
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When fetal vessels separate in the membranes before reaching the placenta (membranes in sac)
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Velamentous insertion of cord
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Associated with velamentous insertion of the cord. The umbilical vessels in the membrane cross the region of the internal os and present ahead of the fetus (danger to fetus if rupture of the membranes is accompanied by rupture of a fetal vessel)
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Vasa Previa
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What is the half life of oxytocin?
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10-12 min.
Takes 30 to 40 min to reach a steady state & achieve max uterine contractile response. |
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Define uterine hyperstimulation
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>5 ctx in 10 min
<1 min between ctx Ctx lasting longer than 2 min |
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What are side effects of oxytocin administration?
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hypotension, huterine hyperstimulation, hyperbilirubinema
Uterine tetany |
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When should cytotec not be used?
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with uterine scar (never use with VBAC), glaucoma, asthma, renal or hepatic dysfunction.
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If hyperstimulation occurs when using cytotec. Should pitocin be used? When?
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No pitocin until 4 hours later if at all.
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When using an APT test for bleeding what are the results usually seen?
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Pink/Red = Fetal cells
Brown = Maternal cells (no fetal cells). Quicker than Kleihauer-Betke. |
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PP - a blood tinged utrine discharge containing shreds of tissue that diminishes and turns reddish brown by 3rd PP day
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Lochia Rubra
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PP - Pink to brownish discharge with serosanguineous quality and fleshy odor that lasts 4-10 days.
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Lochia serosa
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PP - A yellowish-white discharge mostly mucus, leukocytes, epithelial cells that begins at apprx 10-14 days
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Lochia Alba
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What is the recommendation for fundal checks immediatly PP?
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Q 15 min 1st hr, q 1/2 hr x 2, then hourly x 1, then 4 hours for 24 hrs, then q 8 until discharge
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What is the most common organism that causes mastitis?
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Staph Aureus - usually 3-4th week, poss from not washing hands - nipple trauma.
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What is treatment for mastitis?
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Handwashing, breast cleanliness, frequent breast pad changes, supportive bra, air dry nipples, culture then antibiotics (usually Kefzol or dicloxacillin for 7-10 days), increase fluid intake
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What are signs and symptoms of pulmonary embolism?
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History of DVT in 35%, chills, cough, hemoptysis (coughing up blood), fever, abd pain, dyspnea in 80%, chest pain, Tachy, rales
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What is immediate nursing care for a pulmonary embolism?
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Elevate HOB, O2 @ 10L, IV, pulse oximetery, morphine 10 mg sq/IV, dopamine to maintain BP, Digitalization 0.50 mg IV
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Describe post partum blues
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50-75% of new moms, anxiety, mood changes, peaks about 5th day, requires rest & support. If mood destabbilization continues after 2-3 wks consider PP depression.
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If a parent has an autosomal dominant disorder, what chance (%) does the affected individual have with each preg of passing the abnormal gene on to his/her child?
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50% or 1:2
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If a parent has an autosomal Recessive Disorder, what chance (%) does the person have to pass it on to the child?
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25% or 1 in 4
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What are the risks involved with amniocentesis?
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ROM, infection, intrauterine bleeding, puncture of the intestines, direct fetal trauma, puncture of the cord, loss of pregnancy
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Asphyxia
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Hypoxia (decreased O2 in tissue) and Metabolic acidosis. Causes increased lactic acid.
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