OB exam 2

What is a normal fontanel?

soft spot, posterior and anterior diamond shaped

Right Occipitoposterior (ROP)

baby leaning right on moms pelvis facing up

Left Occipitoposterior (LOP)

baby leaning left on moms pelvis, facing up

Right Occipitotransverse (ROT)

presentation of the fetal occiput transverse to the mothers right

Left Occipitotransverse (LOT)

presentation of fetal occiput transverse to the mothers left

Right Occipitoanterior (ROA)

baby leaning right on moms pelvis facing moms back

Left Occipitoanterior (LOA)

baby leaning left on moms pelvis facing moms back

MOST COMMON

PT teaching on fontanels

close within 18mo to yr,

Why do infants have fontanels?

help the baby get through the birth canal

Definition of true labor

cervial dilation

Signs of Labor

cervical change

backache

weight loss (1-3.5)

lightening (feeling fetus “drop” fetus descends into pelvis)

contractions

inc vaginal discharge or bloody show

energy burst

n/v and indigestion

cervix becomes soft, partially effaced, begin to dilate

rupture of membrane (cnxt start about 24hrs after)

SVE interpretation

dilated, effacement, station

Effacement

how much the cervix has thinned out

Station

how far fingers in touch baby (-5 to +5, +4 is on the floor)

1st stage of labor

onset of contractions of to full dilation

2nd stage of labor

full dilation to birth

Contractions during first stage of labor (latent)?

irregular, mild to moderate

occurs every 5-30 min

lasts 30.45 secs

First stages of labor (active)?

rapid dilation and effacement

some fetal descent

feelings of helplessness

anxiety, restlessness inc as contractions become stronger

How many cm dilated is the pt in the first stage of labor (active)?

4-7cm

3rd stage of labor

baby delivery to placenta delivery

schultze and duncan presentation

Schultze presentation

shiny fetal surface of placenta emerges first (clean)

Duncan presentation

dull maternal surface of placenta emerges second (dirty)

Contractions during the first stage of labor (active)?

more regular

every 3-5 min

lasting 40-70 sec

How many cm dilated is the pt in the first stage of labor (transition)?

8-10cm

Contractions during the first stage of labor (transition)

strong to very strong

every 2-3min

lasts 45-90sec

First stage of labor (transition)

complete dilation

tired, restless, irritable

feeling out of control, pt states “cannot continue”

n / v

urge to push

inc rectal pressure and feelings of having a bowel movement

inc blood show

most difficult part of labor

4th stage of labor

postpartum (of both baby and placenta), 2 hrs post delivery of placenta

maternal stabilization of vitals

lochia scant to moderate rubra

Which stage of labor does the spontaneous rupture of membrane happen?

transition

What happens if the ROM lasts greater than 24hrs (only water broke no baby)?

infection

5 P’s of labor

Passenger

Power

Passaway

Position

Psychologic response

Occitput Presentation

back of head

Chin presentation

mentum

Shoulder presentation

scapula

Breech presenation

sacrum or feet

Normal assessment of labor

Types of anesthesia

epidural

spinal anesthesia

local

general

pudendal nerve block

combined epidural spinal

nitrous oxide

Epidural and spinal blocks contraindications

low platelets/coagulopathies, current infection, maternal behavior

Complications of anesthesia

spinal headache from leakage of CSF

Interventions of anesthesia

bloodpatch for spinal headahce

Maternal effects of IV pain meds

Infant effects of maternal pain meds

can cause respiratory depression

What should a nurse do IMMEDIATELY after ROM happens?

assess FHS (110-160) for abrupt declaration, indicates fetal distress to rule out umbilical cord prolapse

How should the amniotic fluid look after the ROM happens?

waterly, clear, slightly yellow tinge

no foul order

700-1000 mL

How should you confirm that amniotic fluid is present and not urine?

nitrazine paper (6.5-7 pH)

Amnioinfusion

infusion of room temperature isotonic fluid into the uterine cavity to increase fluid around the cord & prevent compression during uterine contractions

Indications for an amnioinfusion

oligohydramnios

fetal cord compression

Oligohydramnios

scant amount or absence of amniotic fluid

What is oligohydramnios caused by? e

uteroplacental insufficency

PROM

postmaturity of fetus

What device is used to infuse for an amnioinfusion?

IUPC

How does an amnioinfusion help?

reduces the severity of variable decels caused by cord compression

Maternal hypotension

placenta cant perfuse oxygen

FHR variability

Early decels

onset at beginning of contraction

Late decels

happen at peak of contractions (late recovery)

Variable decels

sudden drop, rapid return

Prolonged decels

usually 7mins, low until it recovers

Assessment of fetal wellbeing during intrapartum

how does the baby react to contractions

Assessment of fetal wellbeing during antepartum

accelerations

Uteroplacental insufficiency means

baby is not getting enough oxygen

Signs of uteroplacental insufficiency

late decels

bradycardia

tachycardia

absent variability

Side effects of tocolytics

Indications for tocolytics

suppression of uterine activity

Magensium sulfate (tocolytic agent)

maternal and fetal or neonatal adverse reactions are less severe and less frequent with the beta adrenergic agonists, REDUCES NEONATAL NEUROLOGIC MORBIDITY

Indications for PTL meds

to accelerate fetal lung maturity and reduce severity of respiratory complications (tocolytic therapy)

How do we know when someone is experiencing PTL?

cervical length shortening

When to discontinue oxytocin

when decelerations occur and contractions come in too hard and too fast

Care management of prolapsed cord

immediately manually lift the presenting part off the umbilical cord with sterile gloved hand

Methods of induction/augmentation

mechanical dilation

medications

AROM

Mechanical dilation

Medications (for induction)

oxytocin - watch for tachysytole

AROM

chorioamnionitis - bacterial infection

When to use vacuum extractors/forceps?

maternal exhaustion ot fetal compromise

Indications for forcepts

maternal exhaustion

fetal distress

abnormal presentation or breech requiring delivery of head

Indications for vaccum

maternal exhaustion and ineffective pushing efforts

fetal distress in second stage

not used to assist before 34wks gestation

Complications of cesarean section?

infection

Vertex presentation

chin to chest (what we want)

Sinciput presentstion

Brown presentation

Engagement and descent

Flexion

Internal rotation

Extension

External rotation

Expulsion

Syncliticism

fetal position we want

Asyncliticism

head tilted, what we dont want

What do steroids do for PTL?

promote lung maturity

Terbutaline

(asthma med = fast hr) slows and prevents contractions of uterus

Side effects of magnesium sulfate

muscle weakness, blurred vision, n/v , headache, iv site irritation

Side effects of steroids

flushing of face, glucose in urine

Side effects of terbutaline

inc HR,