Exam 1 Lecture 2

The anxiety-fear-tension pain cycle is as following:

1. Excessive anxiety/fear leads to inc in ____ secretion.

2. This _____ blood flow and inc muscle tension.

3. This decreassed oxygen to _____.

4. This inc stimuli to brain and ___ pain perception

catecholamine; decreases; uterus; magnifies

Pain in the 1st stage of labor includes ____ pain which is pain that originats from internal organs. This pain is described as ____, dull, and aching. This comes from ___ changes and distension of lower uterine segment. Uterine ____ also occurs. This pain generally occurs during ______.

At the end of the 1st stage and going into the 2nd stage of labor, ____ pain occurs which originates from the body’s musculoskeletal system. This is localized and____ pain. This is due to distention/traction, pressure against the bladder and ____, stretching/distention of perineal tissues/pelvic floor, and _____ of soft tissues like the cervix/vagina/perineum.

visceral; deep; cervical; ischemia; contractions; somatic; sharp; rectum; lacerations

Nonpharmacologic pain management includes childbreath prep methods which includes ____ they take and books they read.

Some pain techniques taught include relaxing and ____ techniques. Breathing techniques includes slow, quick, and ____ breathing.

Other techniques includes:

1. _____ which is lighly massaging/rubbing the abdomen

2. Using ___ which is putting pressure in the back

3. Touch and massage

4. Application of ___ and cold.

5. Acupressure and ____

6. Using transcutaneous electrical ____ stimulation (TENS) for relief

7. Water therapy

8. Using ____ water block which is giving water into the back which creates pressure that blocks the pain

9. Aromatherapy, music, and hypnosis.

classes; breathing; patterned; effleurage; counterpressure; heat; acupuncture; nerve; intradermal

Pharmacologic pain management includes:

1. ____ which includes analgesia, amensia, relaxation, and reflex acticity

2. Analgesia is the alleviation of ___ of pain or raising of ____ for pain perception without loss of conciousness. It is determined by the ____ of labor the woman is in and by method of birth planned.

3. Sedatives help to relieve _____ and induce sleep. It is used for woman in a prolonged ___ phase of labor. Barbituates and phenothiazines are ____ used in OB. The choice of sedative are the _______ which can be helpful when given w opioid, but it can disrupt the ____ in newborns.

4. Systemic analgesia includes the use of _____. This can have effects on newborn/fetus due to its ability to cross the ____. They are often given as agonists or a combo of agonist/antagonist. Always have an opioid _____ like Narcan available to prevent excessive ____ depression. If givent o woman who is opiate dependent, the pain will return ____.

5. A ____ block blocks sensation/movement in a specific area. Examples includes:

   1. A local perineal _____ which is when the med is injected into tissues of perineum.

   2. Injection into the ____ nerve which supplies sensation to vagina, vulva, and perineum.

   3. A ____ anesthesia which is when the med is injected into CSF. If the dura is punctured, it causes a severe ___ to occur which is worsened by sitting up. To fix this, use an epidural ____ patch to seal the leak.

anesthesia; sensation; threshold; stage; anxiety; latent; rarely; benzodiazepines; thermoregulation; opioids; placenta; antagonist; CNS; quickly; nerve; infiltration; pudendal; spinal; headache; blood

Early term starts from ____ weeks and ends at 38 6/7 weeks.

Full term starts at 39 weeks and ends at ___ 6/7 weeks.

Late term starts at ___ weeks and ends at 41 6/7 weeks.

Post term is after ____ weeks.

Very preterm is less than ____ weeks.

Moderate preterm is between 32 and ____ weeks.

Late preterm is between 34 weeks and ___6/7 weeks.

Preterm labor needs cervical changes AND uterine ____. this occurs between ___ weeks and 36 wks and 6/7 days.

Preterm birth is birth between that time period. You can have this ____ preterm labor both if cervix is incompetent.

A low birth weight is anything under ____ grams. It could be caused by multiple things including IUGR like interferance with uteroplacental _____.

Spontaneous preterms make up of 75% of all preterm births. There is an ____ of any maternal/fetal illness/birth. Common causes include:

1. An ____ which is the only factor to definitively cause this

2. ____ at placental site

3. Uterine ____ due to multiple babies

4. Decreased progesterone

5. Maternal/fetal ____ and congenital malformations

Indicated preterm make up 25% in which there is maternal/fetal risk with a ____ pregnancy. Common indications include:

1. Chronic ____ and pre-eclampsia

2. Pre-existing or gestational ____ mellitus

3. Previous complications and medical disorders

4. Advanced maternal ____

5. Fetal disorders.

37; 40; 40; 42; 32; 34; 36; contractions; 20; without; 2500; absence; infection; bleeding; overdistention; stress; continuing; HTN; diabetes; age

Narcotic antagonists have a ____ effect on newborn compared to agonist-antagonist combination. Common narcotic agonists used during labor include:

1. ____ which meperidine hydrochloride

2. _____.

Common agonist-antagonist include:

1. _____ which is butorphanol tartrate

2. _____ which is nalbuphine hydrochloride.

greater; demerol; fentanyl; stadol; nubain

During an epidural, have the patient be stitting ____ or have them ____ up to open up the space. The medication/catheter should go into the _____ space.

The most effective pharm pain relief for labor is the use of an ____ anesthesia/analgesia. It removes the pain but not the ____ sensations. If they have no _____, this cannot be used or if they have a SCI.

A combined spinal-epidural analgesia is referred to as _____ epidural although many moms choose not to as the legs feel rather ___ and they are also on sedation. Disadvantages include limited ____, bladder distention, pruritis, and shivering.

Opioids may also be placed in the epidural space or right into the ___ In the subarachnoid space.

Contraindications for subarachnoid/epidural blocks include:

1. Active or anticipated serious maternal ___

2. Maternal _____ and hypovolemia. If the mom has a low BP, give lots of fluid such as a bolus of 1000 to ____ CCs.

3. Maternal coagulopathy, ___ at injection site

4. Increased ____ pressure

5. Allergy, maternal refusal, or inability to ___

6. Maternal cardiac conditions.

upright; curl; subarachnoid; epidural; pressure; platelets; walking; heavy; mobility; CSF; hemorrhage; hypotension; 2000; infection; intracranial; cooperate

For analgesia, ____ ____ can often be used with oxygen and is inhaled at a low concentration. This is ONLY ___ controlled and used during 1st/2nd stages of labor. It is admin at a low dose of ___ percent or less nitrous. It promotes relaxation and gives a sense of ____. It reduces perception of pain. Administration happens via ____ or mouthpiece. It is only inhaled with ____ only and should be removed when it subsides. Observe and assess for N/V, dizziness, and ____.

General anesthesia is used in extreme ___ cases as it readily crosses placenta so be prepared for neonatal ____. A ____ should be used to displace the uterus to prevent supine hypotension. The woman should be premedicated with clear oral ___ to neutralize acid contents of stomach. Exampls include famotidine, sodium ____, metoclopramide. There is a risk for fetal exposure which leads to neonatal ____ which is when the newborn experiences the effects of opioid.

nitrous oxide; patient; 50; control; mask; contractions; drowsiness; emergent; resuscitation; wedge; antacids; citrate; narcosis

Local anesthesia is adminstered in the _____. It is used for an ____ or perineal repair.

A pudendal is adminstered in the ___. It is used for episiotomy, forceps, vaccum, and episiotomy repair.

These are both adminstered in the ____ stage of labor.

These are the meds that end in ____.

A spinal anesthesia block contains local only or may be used in combo with an opioid ____ like fentanyl. It is injected in subarachnoid space and mixes with the ____. It is used for elective _____ delivery but can be used in a vaginal birth, BUT NOT during ____.

A lumbar epidural u

perineum; episiotomy; vagina; second; caine; agonist; CSF; cesarean; labor

Before a spinal/epidural the nurse should:

1. Pre-load with 1000-2000 CCs of ____

2. Assist patient into ___ and support them

3. Monitor VS and FHR every ___ min post admin and be alert to hypotension

4. Check for informed ____

5. Review any history and contraindications

6. Review prenatal labs especially CBC and ____

After administation, the nurse should:

1. Position patient to prevent supine ___

2. Monitor IV rate and FHR

3. Insert foley catheter or monitor ____ for distention if foley not used

4. Administer an IV _____ as needed to keep BP

5. Keep MD/midwife informed

LRs; position; 5; consent; platelets; hypotension; bladder; vasopressor

Cervical length can be a predictor of PTL/PTB as a ____ cervical length means the cervix is becoming effaced and changing prematurely. A length of less than ___ mm is likely to give birth prematurely. A shortened length and a positive fetal _____ (fFN) indicates a higher chance of PTB.

fFN is a glycoprotein that acts as a ____ between the fetal membranes and uterine wall. It is present in the vaginal _____ in the 1st and 3rd trimester. If present between 24-34 weeks, this is a sign of placental ____. A negative test will indicate that the mom will not give birth within the next ____ weeks. You want to swab ___ the vaginal exam and make sure nothing was up there in the last ___ hours.

S/S of preterm labor/birth includes:

1. Contractions occuring less than ____ minutes apart lasting for an hr or more

2. Lower abdominal cramping including ____ pains w diarrhea

3. Dull ____ back pain

4. Pelvic pressure, urinary _____, suprapubic pain, SROM

Medical interventions includes:

1. Giving ____ to help relax the uterus

2. Atenatal ____ promotes fetal lung maturity

3. Tocolytics help to ____ preterm both. They also provide neuroprotection to prevent intracranial ____. Examples include -____ (NSAID), nifedipine, ____ sulfate, and terbutaune.

Lifestyle Modifications include:

1. Activity restriction and ____ acitivty restriction AKA pelvic rest

2. Patients should not be on bed rest as it decreases ___ tone, calcium loss, inc risk of DVTs, etc

shorter; 30; fibronectin; glue; discharge; inflammation; 2; before; 24; 10; gas; intermittent; frequency; progesterone; glucocorticoids; delay; bleeds; indomethacin; magnesium; sexual; muscle

Magnesium sulfate is a _____ and used to delay preterm birth. It causes smooth muscle _____, but can make induction more difficult. It helps to prevent intracranial bleeds and cerebral _____. It can also be given for ____ or high BP that the mom develops.

The antidote is ____ ____ given w 70 cc of a 70% solution, which should be in the room.

When giving this medication, they should be positioned lying on their ____. You need to do checks every ____ including VS, side effects, and fluid balance. they should be limited to fluid intake of 2500-___ mL per day. This medication is excreted via ____. During you assessment, check the deep tendon ___, a urine output of at least ____ mL/hr, and their RR which sohuld be a minimum of ____ breaths per minute. Worry if a woman is hyporeflexic

tocolytic; relaxation; palsy; preeclampsia; calcium gluconate; side; hour; 3000; urine; reflexes; 30; 12

Contraindications of tocolytics include:

1. For the moms;

   1. Having severe features for _______ EXCEPT for magnesium sulfate.

   2. Bleeding w hemodynamic ____

2. For the fetus

   1. If there is intrauterine fetal ____ or death in utero

   2. Lethal anomaly

   3. Fetal ____ tones are bad

   4. ________ which is infection of uterus

   5. Premature ____ of membranes

preeclampsia; instability; demise; heart; chorioamnioitis; rupture

Atenatal glucocorticoids promote fetal ____ maturity. Examples includes:

1. Betamethasone in which each dose has ___mg via IM. This is given within ____ doses 24 hrs apart.

2. Dexamethasone has ____ mg in each dose IM for ____ doses and 12 hrs apart.

These also help to prevent respiratory ___ syndrome, intraventricular hemorrhage, necrotizing _____, or neonatal death.

This medication has a SE that can cause maternal ______ and increased amount of ___ and platelets for the next 72 hrs.

lung; 12; 2; 6; 4; distress; enterocolotis; hyperglycemia; WBC

For preterm birth that are inevitable, give ____ ___ for neuroprotection. These births often happpen quickly and there may be possible _____ like breech through partially dilated cervix. Gather all neonatal ____ supplies and notify ___/NNP.

Consult and discuss ____ of care w pt/family. There is a higher risk of fetal and early neonatal _____

magnesium sulfate; malpresentation; resuscitation; NICU; plan; loss

Prelabor rupture of membranes is a spontaneous rupture before labor at ____ gestational age.

Preterm prelabor rupture of membranes (PPROM) is reupture before the ____ weeks of gestation. The etiology is unknown but often preceded by ____. If it is after 34 weeks, then ___ is the best option. If it is before 32 weeks, then these are managed expectantly and _____. Vaginal exames and sexual activity should be _____ and patients should not be in a tub ____. Do an ____ to check if the membranes have ruptured. Other management includes;

1. Modified bedrest

2. Possible ___- to prevent infection

3. BPP whic is a biophysical profule and a NST which shows how the fetal _____ is affected by movement of baby.

4. Fetal assessment and ____ counts

5. Antenatal glucocorticoids

Prolonged ROM is when it lasts longer than ____ hours. There is an inc risk for infection such as _____.

any; 37; infection; birth; conservatively; limited; bath; ultrasound; antibiotics; HR; kick; 24; chorioamnionitis

Bacterial infection of amniotic cavity is called ______. S/S include maternal _____, maternal/fetal ____ (HR), uterine tenderness, and a foul ____ of amniotic fluid.

Neonatal risks include pneumonia, bactermia, and _____ and possible death.

Treatment includes prompt IV _____ spectrum antibiotics OR the ___ of the fetus.

chorioamnionitis; fever; tachycardia; odor; sepsis; broad; birth

Post-term pregnancy occurs after ____ weeks of gestation. clinical manifestations includes:

1. Decreased ____ size

2. A ____ stained fluid

3. Advanced ____ maturation of fetal skeleton.

Babies here have difficulty with ____ of the head.

Maternal risks include:

1. A _____ labor which may require more interventions

2. As the baby may be larger this can lead to brith ___- trauma

3. C-section or an ____ vaginal birth using tools

4. Postpartum ____ and ingection

5. Possible ____ and psychologic reactions

Fetal risks includes:

1. macrosomia or an abnormally ____ baby

2. ____ dystocia which is when the shoulders get stuck on pubic bone

3. Prolonged birth and birth trauma

4. Affects of ____ plancents.

5. Oligohydramnios which is too ___ amniotic fluid which means less cushioning for cord.

6. Hypoglycemia

7. Polycythemia which is an inc in ____ to compensate for less ozygen

8. Post-maturity syndrome

B/w 41-42 weeks, ____of labor is recommended. More frequent fetal assessments should occur including daily ____ counts, NST for ___ decelerations, and BPP to assess for decreased AFI or the amount of ____ fluid around the baby.

42; uterine; meconium; bone; molding; dysfunctional; canal; operative; hemorrhage; fatigue; large; shoulder; aging; little; RBC; induction; kick; late; amniotic

Dysfunctional labor is called ____. Long, difficult, or abnormal labors are indications for _____ delivery.

You should assess if there is:

1. Progressive ___ and effacement

2. Progressive fetal ____

3. Effective pushing

Potential maternal effects includes:

1. Uterine ___

2. Psychological effects

3. Severe _____,infection, and PP ____

Fetal effects includes:

1. Hypoxia, ____ w meconium aspiration,

2. Infection fetal/neonatal death

The causes via Five P-s include”

1. Powers which includes _____ contractions or bearing down effots

2. Passage - alterations in ___ structure or soft tissue dystocia

3. Passenger - abnormal presentation, position, size ( cephalopelvic ____ or CPD), # of fetuses, etc.

4. Position: infective maternal/fetal position

5. Psychological response like stress

dystocia; cesarean; dilation; descent; rupture; dehydration; hemorrhage; asphyxia; ineffective; pelvic; disproportion

Hypertonic uterine dysfunction is when the uterus is contracting but is not ____ or coordinated enough. This is when the ____ contracts w greater force than fundus. This leads to no ___ and can be very painful. This is common in the latent phase.

Causes include possible ____.

TXT includes IV ____ and using ____ for therapeutic rest.

synchronized; midsection; dilation; abruption; hydration; sedatives

Hypotonic uterine contractions is when the ctx become weak, ____, or stop altogether, They are infreuqnet, have no basal tone, and lead to ineffective ___ change.

Causes include:

1. An _____ uterus as a large uterus cannot contract properly.

2. Fetal _____ which can interfere w descent.

3. Analgesia/epidural

TXT includes:

1. _____ stimulation to release oxytocin

2. Artificial ____ of membranes which can induce labor

3. Pitocin

inefficient; cervical; overdistended; malposition; nipple; rupture

A ____ birth is one that moves very fast. Anticipate the birth and NEVER leave the perineum ____.

Have the patient ___ or pant to overcome the urge to ___. Support the perineum and ___the patient throughout delivery.

Be prepared to ___ the mouth/nose if needed. Check for the _____ cord or the umbilical cord warapped around the neck. Dry and stimulate the baby as needed and do early ___ when stable.

precipitous; unattended; blow; push; reassure; suction; nuchal; breastfeeding

CPD or cephalopelvic disproportin is when the baby’s head is ____.

Fetal risk factors include:

1. Macrosomia

2. Malpresentation such as ___

3. An occipital ____ position which can resolve as baby rotates.

Maternal risk factors include:

1. A ___ pelvis, abnormal shape or past surgery

It may present as:

1. Persistent OP

2. Prolonged ___ stage of labor

3. Severe maternal ___ pain

4. Cannot be preducted accurately

large; breech; posterior; small; second; back

Only a ___ or complete breech can be vaginally birthed. One of the best ways is to have the patient ___ which can be difficult w an epidural.

Risk factors include:

1. ____ fetuses, preterm birth, anomalies

2. Too little/much ___ fluid

3. Genetic disorders

It is DX via _____ palpations, a ___exam, or ultrasound.

Risks that come w breech presentations includes:

1. Umbilcal cord ____

2. Trapping of fetal ____ in which the body may deliver but not the head,

3. Trauma so it is important to take into account provider ____

Criteria for breech births include an estimated fetal weight of 2000 to ____ grams. A ____ shaped maternal pelvis and a ___- fetal head.

frank; standing; multiple; amniotic; leopold; vaginal; prolapse; head; experience; 3800; gynecoid; flexed

When a baby is in breech position, a provider can manually turn the baby in a procedure called ____.

In an external cephalic version, the provider places the hands on the ____ of the mother to gently move the baby. They use an ____ to guide the movements and see the baby’s position. A _____ is used beforehand to make sure the fetus is doing well. Informed ____ should also be obtained beforehand. Contraindications includes C-section, vaginal ____, ruptured membranes, ____ gestation, and any where vaginal delivery is contra.

In internal version, the provider turns the fetus from inside the ____. It carries more of a ____. For a twin gestation, the provider can turn the ____ child after the first one.

version; abdomen; ultrasound; NST: consent; bleeding; multiple; uterus; risk; second

Indiction occurs if continuing the pregnancy is considered too ______.

Maternal indications include:

1. ____ disorders like preeclampsia

2. Fetal ____

3. Chorioamnioitis which is treated w _____

Fetal indications include:

1. DM and HTN

2. Post-term

3. Oligohydramnios which is when there is too ____ amniotic fluid

4. IUGY

5. Infection of the amniotic cavity called ______

6. PROM

Elective reasons for induction are due to ____ and not for any medical reason; however, they have to have a medical reason to do it before ____ weeks and if not they cannot do it. There are risks of:

1. Increased rates of ____ delivery

2. Increased neonatal morbidity

3. Increased cost

4. Iatrogenic ____

dangerous; hypertensive; death; antibiotics; little; chorioamnionitis; convenience; 39; cesarean; prematurity

Contraindications for induction include:

1. Acute, severe fetal ___

2. A ____ presentation, but rly anything but vertex

3. A ____ presenting part in which the head is not engaged.

4. An uncontrolled _____ in which we need to stabilize the mother first.

5. Placenta ____ in which the placenta is covering or close to cervical opening

6. A previous uterine ____ that prohibits trail of labor.

Relative contraindications includes:

1. Grand ____ which inc risk of complications

2. Multiple gestation

3. CPD

4. A ____ presentaiton

5. The inability to monitor fetal heart ____.

A _____ score tells us how ready the cervis is for labor. It shows the likelihood for success of _____. A score of ____ or more is favorable for vaginal birth whether it was induced or spontaneous. If less than 8, then a ____ agent may be needed.

distress; transverse; floating; hemorrhage; previa; incision; multiparity; breech; tones; bishops; induction; 8; ripening

Chemical agents for cervical ripening include:

1. Prostaglandins E1 which is misoprostol or ____. This is a ___ and also stimulates contractions.

2. Prostaglandin E2 which is dinoprostone or _____. This is a vaginal ____ and is removeable.

Mechanical/physical methods include:

1. Using a ___ bulb which is inserted through cervix. It sits against ____ os and acts as dilating wedge.

2. Using ____ dilators which are like sponges that soak up the surrounding moisture and will soften the cervix.

3. The ____ of membranes which is done physically by separating the membranes from the uterus. This stimulates the release of _____.

Alternative methods include:

1. Labor stimulants include ____ cohosh and castor oil.

2. Cervical ripening include black cohosh and evening _____ oil.

3. Acupuncture and pineapples

4. Self-induction including _____ in which semen contains prostaglandins, nipple stimulation, and ____ to have th ehead apply pressure on cervix

An _____ which is a procedure for artificial rupture of membranes can be used for induction. Its important to record the ____ of rupture, the color, odor, consistency and check the fetal heart ____. The maternal temp should be checked every ___ hours. Monitro for presence of meconium.

cytotec; pill; cervidil; insert; foley; internal; hydroscopic; splitting; prostaglandins; blue; primrose; intercourse; walking; amniotomy; time; tones; 2

Oxytocin is a peptide hormone released by the ____ pituitary. It cna be used to induce labor as it stimulates ____.

Goals include:

1. A contraction every ___ to 3 minutes lasting 60-70 seconds.

2. The contraction should feel ___ upon palpation

3. A desired IUP between 50-60 above baseline

4. A minimum of ____ mvu and a max of 400 for 10 minutes.

5. A palpated resting tone of under ___ mmHg.

When given these, these are always ____. Use the ___ IV port to the patient via IV pump. Should start with 1 to ___ mu/minute. Then inc by 1-2 every 15-30 minutes with a max of ____ mu.

There should be ____ EFM and VS should be checked every ____ minutes. Assess for tachysystole, ____ the contractions, carefully titrate, and measure I&O for ____ intoxication.

posterior; contractions; 2; strong; 200; 20; piggybacked; closest; 2; 40; continuous; 15; palpate; water

Uterine tachystole w oxytocin is greater than ___ contractions with 10 min or a series of a single CTX 2 min apart. Its especially dangeous if they are 1 min within each other.

A single contraction greater than 80 mmHg or a value of greater than ___ MVU/10 min or a resting tone > 20mmHg is dangerous.

If the baby is tolerating (category I) it then interventions include:\

1. Have the mom in a ____ lying position

2. Give the mom an IV bolus of 500 mL of ____

3. If UC abnormal after 10 min, reduce oxytocin by ___

4. If UC still abnormal after another 10 min, then ____ the oxytocin.

If category II or III:

1. Discontinue oxytocin _____

2. Side-lying position

3. IV fluid bolus

4. Consider ____ @ 10mL/min if tracing not resolved

5. If no response, may give _____ which relaxes uterus at 0.25mg SQ

6. Notify provider

After resolution, if discontinuted for 30 min, then resume at no more than ___ the previous rate. If d/c for more than 30 min, then resume at __ starting dose.

5; 400; side; LR; half; discontinue; immediately; oxygen; terbutaline; half; initial

Stimulation of contractions after labor has started is called ____ of labor. This is when profress is unsatisfactory or if there are ____ contractions resulting in slow labor progress.

Common methods include:

1. ____ infusion

2. Amniotomy

3. Active management of labor

augmentation; hypotonic; oxytocin

Criteria for use of forceps and vaccum for operative vaginal birth include:

1. Must be completely _____

2. Must have uterine ___ to help w descent

3. Have ____ membranes and the presenting part must be ____

4. No CPD or ___ head

5. The ____ should be empty to make room

6. Should be under adequate ____ to help w pain/discomfort.

For the forceps:

1. Maternal complications include injury and _____, and pain

2. Fetal complications includes bruising, ____ nerve palsy, skull fractures, and lacerations

For forceps, education/reassure family, monitor fetal ____, assist w pushing, anticipate neonatal resuscitaton

The vaccum has the same criteria plus the following exceptions:

1. Moms with ____ gestations

2. Never use in ____ birth of less than 34 weeks

3. Never use in ____ or face presentations

Maternal complications include perineal, vaginal, and cervial ____ as well as soft-tissue ____. Fetal complications include ____, scalp lacerations, risk for hyperbilirubinemia and _____, subdural hematoma.

Know the hospital policy for # of ___ offs, count an document # of pull offs and max pressure used, and do not exceed the ____ zone

dilated; contractions; reuptured; engaged; large; bladder; anesthesia; bleeding; facial; HR; multiple; preterm; breech; lacerations; hematoma; cephalhematoma; jaundice; pull; green

Hard reasons for cesarean birth include:

1. A ___ fetal position

2. Any active ____ vaginal lesions or HIV

3. Health conditions and fibroids

4. Placenta ____ which is when it covers the uterus

5. A prolapse cord and placental ____ which is when it comes off the wall too early

Soft reasons includes:

1. Macrosomia or ____ gestations

2. Previous c-section or uterine survery

3. Failure to progress or ineffective maternal ___

4. Non-reassuring FHT

5. Premature ____ of membranes w/o contraction

6. Maternal exhaustion

For a C-section, the cut on the uterus should be a low horizontal or ____ incision.

transverse; HSV; previa; abruption; multiple; pushing; rupture; transverse

Preoperative care for cesarean birth includes education, informed consent, giving hydration via ___, making sure the patient is of ___ status, using electric clippers to remove small ____ to prevent infection.

Intraoperative care includes assist w ____ for epidural, insert a foley ____, secure pt to OR table, if baby is doing well then ___ cord clamping, adn document.

Immediate postoperative care includes giving ____IV bolus, VS, IV analgesics, and assessing every ____ min.

PostPartum care includes turning, coughing, ___ breathing, splinting, and removing catheter.

Also care for the mom/baby as a unti which is called a ____.

IV; NPO; hairs; positioning; catheter; delay; pitocin; 15; deep; couplet

TOLAC is a ____ of labor after C-section. The initial reason for this would be for a non-_____ cause, previa, abruption, a non- _____ presentation, and non-reassuring FHR.

The risk of uterine rupture is lowest w spontaneous vaginal birth and highest with ____. No ____ cervical ripening can occur.

Contraindication for TOLAC/VBAC includes:

1. A previous ____ incision

2. CPD and contracted pelvis

3. Previous utering surgery

4. Multiple gestatoins and the medication ____ as it can put more pressure on uterine scar

Afterwards, keep a close assessment for ____, uterine rupture, and FHR. Make sure there is an ability to perform emergency C-section within ____ minutes of decision. Have a ___ set up for both c-section and vaginal delivery.

trial; repetitive; vertex; induction; chemical; classical; pitocin; tachysystole; 30; double

A meconium stained amniotic fluid is consisdred an ____. This means a fetus has passed ___ prior to birth. It may appear as a dark ____ color that is thin/thick/particulate. Possible causes include:

1. Normal physiologic function of ____

2. Breech presentaition

3. Hypoxia induced ____

4. Umbilical cord ____ which leads to induced vagal simulation.

Before birth, assess after ROM, gather equipment and make one person capable of performing ____ on the baby present at birth.

Immediately after birth, assess the baby’s RR, HR, and ____ tone. Use a bulb syringe or large catheter to ____ the mouth and nose. If needed suction the ____ to a meconium aspiration device.

emergency; stool; green; maturity; peristalsis; compression; ET; muscle; suction; trachea

The inability to birth infant shoulders after the hea has been delivered is called ____ ____. This is bc the shoulders are stuck b/w pubic symphysis and hallow of ___. The shoulders cannot pass under the pubic arch and they show the ____ sign which is when the baby’s head pulls back.

The dangers include:

1. Entrapment of umbilical ____

2. Inability of fetal chest ___

3. Brachial plexus injury or fractured humerus/clavical

4. Maternal dangers includes PPH and ___ injuries

Risk factors include:

1. Macrosomia, HX of large infants, HX of gestational _____, a ____ maternal statue, prev infant w fractured clavicle

2. Forceps or ___ delivery

3. A prolonged ____ stage (> 2 hrs in primigravida and > 1 for multipara

4. Always be ready as it cna occur anytime

Management includes:

1. If anticipated have an ____ pair of hands

2. Do not leave unattended

3. Lower the height of bead and have ____ stool available.

4. NEVER apply any ___ pressure as it can push teh shoulder agaisnt pubic bone. only apply ____ pressure

5. Use the mcroberts maneuver in which the legs are up and pulled back toward the ____ to change the positon of mom

You should document the time the head is on the ____ until the body is birthed. Also document which type/time each maneuver was attempted.

shoulder dystocia; sacrum; turtle; cord; expansion; rectal; diabetes; short; vacuum; second; extra; step; fundal; suprapubic; head; perineum

A ___ cord is when the cord is below the presenting part. It may be firectly after ROm and can be in the ____ in front of the presenting part. It can occur at any time but most likely to occur _____ AROM/SROm.

Contributing factors includes a ___ cord (> 700mm), malpresentation, a ____ lie, unengaged presenting part, polyhydramnios, and a ___ fetus like preterm.

Common assessment findings include:

1. ____ decelerations

2. Fetal ______ (HR)

3. Pt reports feeling ___ at ROM

4. Cord is seen protruding out

5. Fetal ____ from prolonged compression

6. CNS damage/death

Management includes using a gloved hand to ___ the presenting part off the cord, adminstering _____, FHR assessment, foley cath

You want to position the mom to keep the ___ off the baby.

prolapsed; vagina; after; long; transverse; small; variable; bradycardia; cold; hypoxia; displace; oxygen; pressure

The most frequent causes of rupture of uterus includes:

1. Separation of scar from previous ____ delivery

2. Rupture during TOLAC

3. Uterina ____ from accidents, trauma, etc.

4. Congenital anomaly

5. Labor stimulation

6. An ____ uterus frm macrosomia, multifetal gestation

7. External/internal ___ for malpresentation

8. Difficult ____ assisted birth

9. A ___ interpregnancy interval

10. Multigravidas have greater risk

cesarean; trauma; oversistended; version; forceps; short

An amniotic fluid ___ occurs when amniotic fluid containing particles of debris enters maternal circulation. This obstructs ____ vessels, leading to resp distress and circulatory ____.

It occurs during labor, at birth, or within 30 min of birth.

TXT includes maintaining CO, replacing ___ loss, correct ___ failure, and oxygenate the pt.

embolism; pulmonary; collapse; fluid; coagulation