OB Exam #3

delivery of the placenta

delivery of the placenta

what indicates the third stage of labor?

contraction of the uterus (globular shape), gush of blood, lengthening of cord, vaginal fullness/urge to push

what signs indicate that the placenta has separated?

pitocin, methergine, hemabate, cytobtec

medications that may be administered after delivery of the placenta include -

fundal massage, breastfeeding

what can stimulate the release of oxytocin if medication administration are not capable of being administered?

1-4 hours after birth

how long is the 4th stage of labor?

q15 for the first hour, and q30 for the next hour (temperature hourly)

how often do you assess vitals in the 4th stage of labor?

1st degree perineal laceration

limited to the fourchette, perineal skin, and vaginal mucous membrane

2nd degree perineal laceration

involves the perineal skin, vaginal mucous membrane, underlying fascia, and muscle of the perineal body and may extend upward on one or both sides of the vagina

3rd degree perineal lacerations

extends through the perineal skin, vaginal mucous membranes, and perineal body and involves the anal sphincter; may extend up the anterior wall of the rectum

4th degree perineal laceration (3rd degree laceration with a rectal wall extension)

+ extends through the rectal mucosa to the lumen of the rectum

uterine endometrium

what layer of the uterus does the placenta usually attach?

placenta accrete

chorionic villi attach directly to the uterine myometrium; associated with maternal hemorrhage and failed placental separation after birth

placenta increta

myometrium is invaded by placenta

placenta percreta

myometrium is penetrated by placenta; high incidence of abdominal hysterectomy

succenturiate placenta

accessory lobes develop on the placenta and can cause hemorrhage due to retained placenta parts

circumvallate placenta

a double fold of chorion and amnion from a ring around the umbilical cord on the fetal side of the placenta

late term fetal loss, antepartum hemorrhage and preterm labor, IUGR prematurity and fetal death

fetal risks associated with circumvallate placenta

battledore placenta

the umbilical cord is inserted at or near the placental margin

increased PTL and bleeding, prematurity, non-reassuring FHTs may occur

fetal risk associated with battledore placenta

velamentous insertion

vessels of the umbilical cord divide some distance from the placenta and placental membranes

hemorrhage, nonreassuring FHTs and hemorrhage in the fetus

risks associated with velamentous insertion of the umbilical cord -

30 minutes

at what point following birth will intervention be needed if the placenta has not delivered?

titrate oxytocin; manual removal of the placenta

what are interventions to help remove the placenta?

uterine atony

fundus is boggy, difficult to find, above where expected; lochia is copious, bright red and clotty - what do you suspect?

lacerations

firm uterus, bright red bleeding, continuous stream of blood without clots - what do you suspect?

hematomas

pain, unilateral purplish discoloration, vaginal fullness, rectal pressure, difficulty voiding - what do you suspect?

uterine inversion

pain, hemorrhage, shock, unable to palpate uterus in abdomen - what do you suspect?

fundal massage, medications, IV fluids, uterine tamponade balloon, ligation of uterine vessels, hysterectomy

possible treatments for uterine atony -

call provider to assess repair; hold pressure if bleeding is copious

intervention for lacerations

pain management; ice; sitzbaths, surgical evacuation

interventions for hematomas

check for amount of bleeding

what is the FIRST intervention of uterine inversion?

check fundus and begin fundal massage; call for help, get vital signs, and observe for signs and symptoms of hemorrhagic shock

what are follow up interventions for uterine inversion

pitocin, methergine, misoprostol, hemabate, dinoprostone

what medications are given for uterine atony?

fluids; placement of uterus back in abdominal cavity by MD; administration of oxytocic agents after replacement; treat signs and symptoms of shock

treatment of uterine inversion

color (circulatory changes will fix this)

what part of the Apgar score is commonly not a 2?

97.9

normal newborn temperature:

110-160

normal newborn heart rate -

30-60

normal newborn RR?

precipitous delivery

labor that is less than 3 hours -

postpartum hemorrhage, uterine rupture, lacerations, amniotic fluid embolus

risk of precipitous delivery for the mother -

facial bruising/swelling, respiratory distress, intercranial trauma

risks for fetus associated with precipitous delivery -

rubra

lochia appearance the first 2-3 days following birth

serosa

lochia appearance days 3-10

alba

lochia appearance from day 10 to the cervix closes

70-75 days (for nonbreastfeeding mothers) or 6 months (for breastfeeding mothers)

when does menstruation normally return to normal?

bruises, blisters, cracks, bleeding nipples, engorged breasts

what is an abnormal finding in breasts during a postpartum exam?

boggy, elevated, and deviated

abnormal finding in the uterus in a postpartum assessment

hypoactive

what kind of bowel signs are normal in a postpartum assessment

urinary retention or incomplete emptying

abnormal findings for the bladder during a postnatal assessment?

large, copious clots

abnormal findings for lochia

edema, hematomas, s/s symptoms of edema

what are some signs of infection following an episiotomy

500 more calories than pre pregnancy

how many extra calories should a person consume while breastfeeding?

no

can I use tampons for my postpartum bleeding?

once the bleeding completely stops

am I allowed to take tub bath?

occurs 24 days to 6 weeks postpartum

postpartum hemorrhage

arrest of the involution process (retained placental fragments, placenta acreta, infection, fibroids)

what are common causes of late hemorrhage

grand multiparity, uterine overdistension, C-section, fibroids

risk factors for late hemorrhage

postpartum hemorrhage

patient presents with - prolonged lochia discharge, irregular/excessive uterine bleeding, uterus is larger and softer than normal for the particular period of puerperium, s/s symptoms of infection, pain at uterine border

manual removal of any retained placental fragments, methergine, oxytocin, antibiotics

interventions for postpartum hemorrhage

fever, malaise, abdominal pain, foul-smelling lochia, larger than expected uterus, tachycardia, REEDA

s/s of reproductive tract infections

baby blues

feelings of sadness, anxiety, crying, difficulty sleeping, loss of appetite, symptoms resolve in a few days

postpartum depression

Anxiety, Irritability (key indicator), Poor concentration, Forgetfulness, Sleep difficulties, Appetite change, Fatigue, Tearfulness, Statements indicating feeling failure and self-accusation

postpartum psychosis

rapid onset of bizarre behavior, auditory or visual hallucinations, paranoid or grandiose delusions, elements of delirium or disorientation. This increases the risk of infanticide or suicide

magnesium sulfate to treat seizures

treatment for preeclampsia during postpartum preeclampsia

increased amounts of certain blood-clotting factors

postpartum thrombosis cause

postpartum thrombocytosis

release of thromboplastin substances from the decidua, placenta, and membranes; increased amounts of fibrinolysis inhibitors

virchow triad

hypercoagulability of blood, venous stasis, and injury to the epithelium of the blood vessel

postpartum thrombosis

patient presents with - pain in the leg, inguinal area, or lower abdomen, edema, temperature changes, and pain upon palpation

HIV/AIDS, active tuberculosis, varicella, human T-lymphocyte virus 1, herpes on the breast, illicit drug use, smoking, certain prescription medications, mother has breast cancer, baby has galactosemia

what are some contraindications for breastfeeding?

on demand

when should a breastfed baby be fed?

every 1.5 to 3 hours with 8 to 12 feedings per day

how often should a bottle fed baby be fed?

mechanical stimuli

chest recoil as the chest is compressed in the birth canal

chemical stimuli

first breath is inspiratory gasp that is triggered by increased PCO2 and decrease pH and PO2

thermal stimuli

significant decrease in environmental temperature after birth stimulates skin nerve endings and the newborn responds with rhythmic respirations

increases blood volume by 50%

what is the benefit of delayed cord clamping?

convention

cool air passing over the baby removes their heat

radiation

bassinet is near a large window when its cold outside; placing cold objects within the crib

evaporation

wetness on skin; amniotic fluid or wet towels holding the dampness

conduction

cold objects touching the infant; cold stethoscopes, placing infant on cold surface

physiologic jaundice

accelerated destruction of fetal RBCs and increased reabsorption of bilirubin by the liver

normal

is physiologic jaundice normal or abnormal?

after 24 hours

when does physiologic jaundice occur?

maintain newborn temperature, make sure feeds are adequate, make sure newborn is stooling and voiding, indirect sunlight

what would you teach a mother taking home a newborn with physiologic jaundice?

vitamin k

what medication is given to help the newborn create clotting factors?

IM dose of .5 mg

how much vitamin K is given to a newborn?

4 weeks

how long dose newborn passive immunity last in the newborn

IgG immunoglobulin crosses the placenta

how dose a newborn acquire passive immunity?

breastfeeding

how does a newborn acquire active immunity?

IgA and IgM

what immunoglobins are acquired by the newborn for active immunity?

passive immunity is only acquired during 3rd trimester

why are pre-term babies more at risk for infection?

1 and 5 minutes

when should an APGAR be done?

cephalohematoma

collection of blood between the cranial bone and periosteal membrane

caput succedaneum

collection of fluid, swelling of the scalp

65-85/45-55

normal BP

110-160

normal pulse

30-60

normal RR

greater than 20 seconds

when is apnea concerning?

10% of birth weight

what is the max amount of weight loss allowed?

increased calorie consumption, low blood sugar

what occurs in an infant who is too cold?

the first five days should equal the number of wet diapers

how much should an infant void?