OB Exam 2

What 3 things is hydrotherapy contraindicated in?

bleeding, meconium, oxytocin induction

What position should mom be in before getting pharmacological pain meds?

lateral

What should baseline FHR be?

110-160 bpm

What is the “sweet spot” dilation for an epidural?

4-7 cm

What are the 3 main adverse rxns of an epidural?

low BP, bladder distention, respiratory distress

How is nitrous oxide delivered to the mom?

face mask with 50% O2

What does contraction frequency measure?

the start of one contraction to the start of another

What does contraction duration measure?

the start to end of one contraction

How is 0% effacement measured?

2 knuckles

How is 50% effacement measured?

1 knuckle

How is 100% effacement measured?

<1 knuckle

The 5 Ps of the birthing process

1. powers

2. passage

3. passenger

4. position

5. psyche

What are the powers of the birthing process?

contractions and pushing

Vertex Presentation

full flexion of head with posterior fontanel and occiput visible

Military Presentation

half flexion, half extension of head with anterior fontanel visible

Brow Presentation

partial extension of head with anterior fontanel and brow line visible

Face Presentation

full extension of head with face fully visible

What should be assessed first when the water breaks?

FHR

What happens to contractions in true labor?

get worse with activity

What happens to contractions in false labor?

get better with activity

Where is discomfort felt in true labor?

back to front

Where is discomfort felt in false labor?

abdomen

What is the only way to confirm true labor?

effacement and dilation

Which pelvic stations are not engaged?

-1, -2, -3

Which pelvic stations are engaged?

1, 2, 3

Dilation in the latent stage of labor

0-3 cm

Dilation in the active stage of labor

4-7 cm

Dilation the transition stage of labor

8-10 cm

What happens in the second stage of labor?

pushing from 10 cm to birth

What happens in the third stage of labor?

deliver placenta

How long is the fourth stage of labor?

1-4 hrs PP

Moderate variability

6-25 bpm amplitude

Minimum variability

<5 bpm amplitude

Marked variability

>25 bpm amplitude

Accelerations

15 bpm increase for 15 seconds

True or False: early decels are okay but late decels are not

true

Using the VEAL, CHOP, MINE method, what causes variable decelerations?

cord compression

Using the VEAL, CHOP, MINE method, how are variable decelerations managed?

maternal repositioning

Using the VEAL, CHOP, MINE method, what causes early decelerations?

head compression

Using the VEAL, CHOP, MINE method, how are early decelerations managed?

identify labor progress

Using the VEAL, CHOP, MINE method, what causes late decelerations?

placental insufficiency

Using the VEAL, CHOP, MINE method, how are late decelerations managed?

execute interventions

What 3 circumstances would an amnioinfusion be used?

oligohydraminos, cord compression, meconium

What 5 things does a Bishop score measure?

1. dilation

2. effacement

3. consistency

4. cervix positioning

5. presenting station

What does a high Bishop score mean?

ready for birth

What Bishop score indicates readiness for a multiparous birth?

5 or higher

What Bishop score indicates readiness for a nulliparous birth?

7 or higher

What are the two contraindications for induction and augmentation?

cord prolapse and history of uterine surgery

What med is given for cervical ripening?

cytotec

How is pitocin given?

PB IV with NS

How often should VS be assessed on a mom getting pitocin?

every 30 minutes and every dose change

How often should FHR and contractions be assessed on a mom getting pitocin?

every 15 minutes and every dose change

What is the ideal contraction duration for a mom getting pitocin?

40-90 seconds

What is the ideal contraction frequency for a mom getting pitocin?

2-3 minutes

Side effects of pitocin (PITOCIN mnemonic)

1. Pressure increases

2. Intake and output

3. Tetanic contractions

4. O2 decrease in fetus

5. Cardiac arrhythmia

6. Irregular FHR

7. N/V

Tachysystole

>5 contractions in 10 minutes

What position is the goal when performing an external version?

cephalic lie

When should an external version not be performed?

when vaginal delivery is contraindicated

What position should pt be for a c section?

supine with wedge under hip

What does pitocin do prelabor?

push contractions

What does pitocin used for PP?

tx hemorrhage

What is butorphanol used for?

pain

What should be monitored with butorphanol?

respirations

What are the 3 main side effects of meperidine?

urinary retention, seizures, respiratory depression

What should meperidine not be mixed with?

MAOIs

What is promethazine used for?

tx N/V

What is nifedipine used for?

tx HTN

What should be monitored when taking nifedipine?

edema

What should not be taken with nifedipine?

grapefruit juice

When should nifedipine not be given?

when systolic BP is under 90

What does dinosporstone do?

stimulates contractions

What does methergine used for?

prevent PP hemorrhage

What are the main 2 side effects of methergine?

seizures, HTN

When should methergine not be used?

induction

What is terbutaline used for?

stop preterm labor

What are the two main side effects of terbutaline?

HTN, hyperglycemia

What is magnesium sulfate used for?

seizures

What should be monitored when taking magnesium sulfate?

DTRs

What lab value does magnesium sulfate affect?

calcium

When should magnesium sulfate be held?

hypermagnesemia, hypocalcemia

What is betamethasone used for?

fetal lung maturity

What does betamethasone secrete?

surfactant

When should betamethasone be held?

epidurals

What is warfarin used for?

prevent venous thrombosis

What does warfarin put pt at risk for?

hemorrhage

What is the main sign of magnesium toxicity?

no DTRs

What is the antidote for magnesium toxicity?

calcium gluconate

What does labetalol treat?

HTN