Term
| Early Postpartal Hemorrhage |
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Definition
| Occurs in the first 24 hours after child birth |
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Term
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Definition
| Occurs 24 hours to 6 weeks after birth |
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Term
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Definition
A blood loss of greater than 500mls for a vaginal delivery and 1000mls of blood loss after a cesarean delivery.
A decrease in the hematocrit of 10 points from the time of admission to the time of postbirth. |
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Term
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Definition
Decreased blood pressure, increase in pulse, decrease in urinary output does not appear until as much as 1800 to 2100 mls has been lost.
Women who are natural reheads tend to experience heavier bleeding after childbirth as stated in text.
Saturation of 1 pad/hour, HTN, tachycardia, boggy uterus. |
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Term
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Definition
| Most common cause of postpartal hemorrhage. |
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Term
| Causes of Postpartal Hemorrhage |
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Definition
Multiple Gestations
Hydraminos
Macrosomia
Full Bladder |
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Term
| Uterine Atony Lack of Muscle Tone |
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Definition
Uterus is difficult to feel, and when found it feels soft or boggy.
Fundal height may be high
Lochia is increased and may contain large clots. (Too large: size of egg or golf ball) |
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Term
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Definition
| Prolonged labor, oxytocin augmentation, grandmultiparity, anesthesia/drugs, intra-amniotic infection-chorioamnionitis, asian/hispanic heritage, cesarean section, retained placenta, placenta previa, tocolytics (terbutaline) |
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Term
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Definition
| Ideally, PPH is prevented beginning with adequate prenatal care, good nutrition, and avidance of traumatic procedures, risk assessment, and early management of comlications as they arise! |
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Term
| Most effective way to prevent Uterine Atony |
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Definition
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Term
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Definition
IV Oxytocin (Pitocin)
Methergine- 0.2mg give in the Vastus Lateralis--- DON'T give for Patients with HTN!!!!
Cytotec- 800-1000mcg given rectally
Hemabate- stimulates myometrial contractions. DON'T give to patients with a history of Asthma. |
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Term
| Treatment for Uterine Atony |
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Definition
Radiographic guided embolization of the pelvic vessels.
Ligation of the uterine vessel to slow blood loss and allow normal clotting mechanisms to occur.
Hysterectomy
Tamponade Balloon Catheter |
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Term
| Types of Lacerations of the Genital tract |
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Definition
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Term
| Causes of Lacerations of the Genital Tract |
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Definition
Nulliparity
Epidural anesthesia
Precipitous Childbirth (Less than 3 hours)
Macrosmia
Forceps/ Vacuum |
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Term
| Signs of Lacerations of the Genital Tract |
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Definition
Bleeding persists in the presence of firmly contracted uterus
Episiotomy-slow steady bleeding
Bright red blood |
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Term
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Definition
Direct Pressure
Suture may be indicated
Ice Pack |
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Term
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Definition
Result of injury to a blood vessel from birth trauma.
250-500ml of blood may develop rapidly
May be vulvar, vulvovaginal, or subperitoneal
Subperitoneal hematomas involve the uterine artery branches or vessels
Monitor size, document, apply ice pack |
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Term
| Risk Factors for Hematomas |
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Definition
| Preeclampsia, pudendal anesthesia, preciptious labor, prolonged second stage of labor, vacuum assisted delivery, macrosomia, forceps assisted delivery. |
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Term
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Definition
| Associated with perineal pain, rectal pressure if in the posterior vaginal area, difficulty urinating if in the upper part of the vagina, pelvic pain if a subpertoneal hematoma, develop shock. |
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Term
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Definition
| Ice pack, evacuation, surgery, antibiotic therapy |
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Term
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Definition
| A prolaps of the uterine fundus to or through the cervix so taht the uterus is turned inside out after birth. |
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Term
| Degrees of severity for uterine inversion |
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Definition
Incomplete Inversion- when only the fundus lies within the endometrial cavity.
Complete Inversion- Fundus passes through the opening of the cervix.
Prolapsed inversion- when the corpus extends to or through the introitus.
It may be spontaneous, it may be unavoidable, proper management of the third stage prevents most inversions) |
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Term
| Uterine Inversion Management |
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Definition
Immediately replace the uterus, may require the use of tocolytics (Terbutaline, nitroglycerine, general anesthesia), IV fluids, No Oxytocin until the uterus is correctly repositioned, abdominal vaginal surgery may be required,blood administration, broad specturm atibiotics.
POST REPLACEMENT
Hold uterus in place manually until uterine contractions occur.
Frequent VS and gentle fundal checks
Strict I/O
Uterotonic agents started (oxytocin, prostaglandins, methergine) |
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Term
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Definition
| Separation of the uterine myometrium of previous uterine scar with rupture of membranes and possible extrusion of the fetus or fetal parts into the peritoneal cavity. |
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Term
| Clinical manifestations of Uterine Rupture |
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Definition
Presents with severe abdominal pain, may occur in the abdominal cavity and be undetected until sypmtomatic for hypovolemic shock.
Primary sign is fetal distress and bradycardia.
Vaginal bleeding
Sycnope
Pallor
Hypotention
Palpation of fetus through the abdominal wall
Maternal Tachycardia |
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Term
| Uterine Rupture Treatment |
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Definition
Immediate Surgery
Replace fluid and blood as needed
Hemodynamic stabilization |
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Term
| Risk Factors for Uterine Rupture |
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Definition
Prior Uterine Surgery
Fetal malpresentaion
Grandmaltiparity
Induction of Labor
Overdistended uterus
Fetal Posistion
Prostaglandin administration |
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Term
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Definition
Should be suspected when postpartal bleeding persists without an identifiable cause.
A condition marked by great reduction in the circulating levels of platelets and coagulation factors due to the utilization of platelets in excessive blood clots throughout the body. |
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Term
| Risks for Coagulation Disorders |
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Definition
Preeclampsia
Amniotic embolism
Sepsis
Abruptio Placentae
Prolonged fetal demise
Preexisting condition |
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Term
| Management of Coagulation Disorders |
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Definition
| Assess fundus, massage fundus, IV access, Weigh pads, Administer medication as needed (Uterine Stimulants), Monitor for side effects, Assess vital signs every 10 minutes during PPH, auscultate breath sounds, foley catheter. |
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Term
| Management and Assessment of Coagulation Disorders |
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Definition
Hemodynamic monitoring, skin and mucous membrane color, maternal position, maternal fetal oxygen status, blood, blood proudcts, rhogam administration (72 hours to administer). Labwork: CBC (specifically Hgb, Hct, platelets)
Fibrinogen, PT/PTT, fibrin degredations products of fibrin split products, blood type, RH and antibdy screen. KB stain If mom is negative. |
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Term
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Definition
Associated with late postpartal hemmorrhage
Postpartum fundal height remains high
Lochia fails to progress from rubra to serosa to alba.
Result of retained placenta
Oral methergine for up to one week. |
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Term
| Abnormal Placental Implantation |
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Definition
Associated with previous C section
Elevated with Maternal Serum Alpha feto protein in the 2nd trimester
Elevated free beat human chorionic gonadotropin levels in the 2nd trimester.
Advanced maternal age |
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Term
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Definition
Occurs when there is a lack of decidua basalis, so that the placenta is attached directly to the myometrium.
A complete accreta occurs when the entire placenta is adherent.
A partial accreta occurs when one or more cotyledons adhere.
A focal accreta occurs when one piece of cotyledon adheres. |
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Term
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Definition
| Occurs when the placenta penetrates the uterine musculature and the placenta develops on organs in the vicinity of the percreta. |
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Term
| Riks factors for Placenta Previa |
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Definition
| Prior placenta previa, Prior c-section |
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Term
| Clinical Manifestations of Placenta Previa |
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Definition
| Placenta does not separate readily, vaginal bleeding |
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Term
| Management of Placenta Previa |
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Definition
| Hemodynamic monitoring and stabilization, antibiotic management, surgery, placental removal, curretage of the uterine cavaity, methotrexate |
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Term
| Retained Placental Fragment |
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Definition
| Somography may be used to diagnose placental fragments, manual removal, surgical procedure (d/C) |
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Term
| Maternal effects of alcohol use in pregnancy |
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Definition
Malnutrition- especially folic acid deficiency (1st trimester)
Bone Marrow suppression
Increased incidence of infections
Liver Disease |
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Term
| Fetal neonatal effects of alcohol use in pregnancy |
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Definition
Fetal alcohol spectrum disorders- umbrella for all prenatal exposure to ETOH. Not a clinical diagnosis.
Fetal alcohol syndrome (Clinical Diagnosis) Preventable intellecutal disability. Group of physical, behavioral, and congitive malformations. |
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Term
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Definition
| There is no known safe amount of alcohol to consume in pregnancy. Even low levels of alcohol should be avoided. |
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Term
| 1st week of life effects signs of fetal neonatal alcohol use in pregnancy |
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Definition
| sleeplessness, excessive arousal states, inconsolable crying, abnml reflexes, hyperactivity with minimal attentiveness to environment, jitteriness, abdominal distention, poor sucking, seizures, alcohol dependence, s/s withdrawal often appear 6-12 hours to 3 days of life. |
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Term
| Interventions for Baby with acohol use in pregnancy |
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Definition
| Provide decreased stimuli, swaddle tight, baby in NICU |
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Term
| Maternal effects of Cocaine/Crack use in pregnancy |
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Definition
| Siezures and hallucinations, pulmonary edema, respiratory failure, cardiac problems, spontaneous aborthsion 1st trimester, abruptio placenta, IUGR, preterm birth and stillbirth. |
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Term
| Neonatal effects of cocaine/crack use in pregnancy |
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Definition
| Decreased birth weight and head circumference, fedding difficulties, nonatal effects from breast milk: extreme irritability, vomiting and diarrhea, dilated pupils and apnea. |
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Term
| Normal Glucose Homeostatis |
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Definition
| Glucose increased blood glucose, normally there are no issues because glucose is able to join forces with a hormone to enter the muscle and liver cells where it is stored as glycogen to fuel our bodies. |
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Term
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Definition
| Balances the amount of glucose in the blood with the amunt of glucose the cells need for fuel. Produced by beta cells in the Iseltes of Langerhans in Pancreas. Engables glucose to enter cell for energy use, If insulin is insufficient or ineffective: decrease glucose cells are able to absorb leading to higher blood glucose levels or hyperglycemia. This should stimulate the pancreas to release more insulin and allow more glucose absorption. Glucose can't enter cells without insulin. |
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Term
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Definition
Endocrine and metabolic disorders require careful management to promote maternal and fetal weel being and positive energy outcome.
Diabetes Mellitus is most common endocrine disorder associated with pregnancy. |
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Term
| Pathology of Diabetes Mellitus |
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Definition
| Endocrine disorder of carbohydrate metabolism, results from inadequate production or utilization of insulin, cellular and extracellular dehydration when glucose cannot enter the cells it builds up in the blood, cells literally starve to death, see a converion of fats/proteins for energy instead of carbs to energy. |
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Term
| Classification of Diabetes |
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Definition
Type I- Beta cell destruction, defective insulin secretion, managed with insulin (No insulin production)
Type II; Insulin resistance or inadequate production, defective insulin action, managed with diet and exercise, and oral glycemic agents.
Pregestations- Type I or II existing before pregnancy.
Gestational GDM- onset during pregnancy. |
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Term
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Definition
| Usually absolute deficiency, cellular destruction, probably autoimmune process (antibodies against B cell), viral triggered, prone to ketoacidosis, genetically susceptible (teddy study), Low vertical transmission (not likely to go from parent to child), concordance in monozygotic twins <50% |
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Term
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Definition
| Abnormal production and or ineffective use of insulin, B Cell exhaustion/resistance, specific causes of Type II or unknown, most prevalent, Risk or numerous (agineg, sedentary lifestyle, obesity/ increased abdominal fat, previuos delivery of a macrosomic baby, prior gestational diabetes, genetics), strong familial occurrence, monozygotic concordance. |
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Term
| Effect of Pregnancy on Carbohydrate Metabolism Early Pregnancy |
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Definition
| Before placenta is fuly functioning 1st trimester-- Increase in estrogen, progesterone, stimulates increased maternal insulin production, increased tissue sensitivity, this leads to build up of glycogen stores in liver and other tissues storing energy, when maternal serum levels fall leading to pancreas release of glucagon leading to breakdown of liver stores of glycogen and return or glucose to the blood stream. In blood stream the glucose goes to the baby. |
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Term
| Effect of Pregnancy on Carbohydrate Metabolism |
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Definition
When placenta kicks in around 13 weeks or 2nd trimester
Normal physilogical changes lead to insulin resistance
To spare glucose for the fetus, placena produces hormaones that antagonize insulin, HUMAN PLACENTAL LACTOGEN (HPL)
These hormones lead to increased resistance to insulin.
ALL moms become insulin resistant 2nd and 3rd trimester |
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Term
| Effect of Pregnancy on Carbohydrate Metabolism Later in Pregnancy |
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Definition
Prolonged hyperglycemia and hyperinsulinemia following a meal.
Increased insulin production But placenta is decreting hormones that increase peripheral resistance to insulin (hPL) Ensures and abundant supply of glucose for the fetus.
You need 2-4X more insulin per glucose during pregnancy in order to enter the cell. |
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Term
| Glucose Levels and the Fetus |
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Definition
Fetalglucose levels transported from mom's bloodstream. Insulin does not cross placenta ITS TOO LARGE!
Baby produces it's own insulin around 10 weeks. |
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Term
| Carbohydrate Metabolism Later in Pregnancy |
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Definition
| Increased maternal resisitance to insulin also means: Woman has decreased peripheral uptake of glucose to meet her own needs. This leads to a catabolic state duing fasting periods during night or after meal absorption, glucose diverted to fetus so maternal fat is metabolized more readily than in non pregnancy women. Because of hPL that baby gets what it needs. |
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Term
| Women may have the following during pregnancy |
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Definition
| No problems adapting to increased insulin needs, pregestations diabetes (type I- insulin deficiencey, Type II- insulin insufficience/resistance---- Icrease needs of insulin), Gestational diabetes (have problems adapting to insulin needs) |
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Term
| Gestational dabetes Mellitus |
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Definition
A carbohydrate intolerance of variable severity with onset first recognized during pregnancy.
Diagnosis is essential because even mild diabetes increases the risk for fetal M&M.
Up to 50% of women will progress to Type II DM in the years to come. |
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Term
| Concerns after Diagnosis of GDM |
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Definition
| Twice the risk of developing preeclampsia, MACROSOMIA is the biggest concern, birth injuries, RDS from delayed pulmonary maturation, Neonatal hypoglycemia within 1 hour of birth, IUGR due to vascular involvement. |
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Term
| Concerns for Pregestational Diabetic |
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Definition
| Congenital Heart anomalies, Polyhydramnios, IUGR, increased risk of infection, perinatal loss, anomalies, and sudden unexplained stillbirth |
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Term
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Definition
MUST establish glycemic control before conception to minimize complications during pregnancy. ***Rigid glycemic control througout*** a good level is around 100-110 fasting
Help moms understand that changes will occur as a result of placental hormones.
HgbA1c- measures glycemic control over time. Good control 7 or less. |
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Term
| How does pregnancy Influence Diabetes |
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Definition
| As the placenta matures the production of HPL increases leadig to insulin requirements that are double to quadruple pre pregnancy requirements. This is true whether or not the woman was a diabetic before pregnancy. |
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Term
| Who is at risk for developing GDM |
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Definition
| Over 40, family history of diabetes in a first degree relative, prior macrosomic, malformed, or stillborn infants, Obesity, hypertension |
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Term
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Definition
| Screen all or high risk pregnant women 24-28 weeks, earlier if risk is hight. 50gm glucose test, random, non fasting, drink 50gm glucose drink, draw blood 1 hour, no smoking, eating, exercise for that hour, 135 or above abnormal indicates risk for DM. |
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Term
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Definition
| 3 hour GTT with 2 or 4 values elevated. Only if 1 hour test is abnormal. Overnight fasting; draw fasting sugar; drink 100gm glucose dring. Draw blood at 1,2,3 hour intervals. May have increased risk of diabetes later in life with one abnormal value. |
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Term
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Definition
All women are tested for diabetes near te end of the 2nd trimester.
Those who have a 1 hour gtt that is elevated will be recreened with a 3 hour gtt. If 2 of the 4 values are abnormal GDM.
GDM is managed with diet and exercise unless the woman is determined to need oral or injectable insulin. |
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Term
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Definition
IUGR, L/S ratio typically 2:1 indicates maturity but in a diabetic mom may need L/S ratio of 4:1 to say for sure lungs are mature.
Risk for immature lungs leads to RDS
Macrosomia- risk for birth injuries such as shoulder dystocia. |
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Term
| Nursing Management of the Diabetic Patient |
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Definition
| Diabetic diety, nutirtional counseling, may be considered high risk, check FBS and 1 or 2 hour postprandial sugars, teach nutrition, rationale, home monitoring, begin insulin if not controlled by diet, exercise after a meal to use up glucose. |
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Term
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Definition
Diet, glucose testing, exercise 15-30 walking 4-6 times a week.
Fetal surrveillance, NST, doppler flow studies, detect fetal compromise, prevent death, prevent unnecessary preterm birth. |
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Term
| Determining Date and Method of Birth |
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Definition
| No electives deliviers before term without FLM studies, Lung maturation delayed though fetus may be large, PG more predictive than L/S ratio, some recommend c/s for 4000 gms or greater. |
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Term
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Definition
| Risk for hypoglycemia, high circulating glucos levels while in utero lead to fedus produces own insulin. At the time of deliver the source of the glucose is cut off leaving neonate with high levels of circulating insulin but no excess glucose. All available gucose is moved into cells and serum levels plummet. Risk for immature lungs. Signs are Grunting, retractions, tachypnea, nasal flaring. |
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Term
| What happens in the PP period |
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Definition
| Moms need to have their glucose levels checked following delivery. If normal at 6 weeks should continue to monitor annually since many will develop type II. |
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Term
| Nursing Management in Labor |
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Definition
| Monitor Blood sugar and hydration, maintain plasma glucose levels at 80-110 during labor, use NS for IV fluid, IV glucose and insulin administration, no IV glucose loads. Continuous EFM for utero placental insufficiency, watc labo progress, anticipate problems at birth Shoulder dystocia, injury, neonatal team. |
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Term
| What happens after delivery? |
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Definition
| The placenta delivers so the hormones that were decreasing the tissues sensitivity to insulin are no longer present. Insulin needs rapidly decline in the PP period so be sure to check glucose levels before administering insulin agents. The needs will be less. Moms are encouraged to breastfeed: lactogenesis utilizes a lot of glucose so insulin needs remain lower. |
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Term
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Definition
| Insulin requirements decrease with placenta delivery. Type I insulin requirements may decrease by 1/2 of pregnancy needs. Type II or GDM/ insulin usually no longer needed. Encourage breastfeeding: Antidiabetic effect, may lower insulin needs to 1/2 prepregnancy levels, and lowers the babys risk of developing diabetes. |
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Term
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Definition
Asymptomatic women- pregnancy has no effect
Symptomatic with low CD4 count- pregnancy accelerates the disease.
Zidovudine (ZDV) therapy diminishes risk of transmission to fetus. Transmitted through breast milk. Half of all neonatal infections occurs during labor and birth. |
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Term
| HIV mother Increased Transmission Risk |
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Definition
| High Viral Load (active virus), Risk of chorioamnionitis, ROM >4hrous before birth, prematurity, breastfeeding. All women are screen at prenatal visit. |
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Term
| Treatment during pregnancy |
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Definition
| Counsel about implications of diagnosis on pregnancy, antiretroviral therapy, fetal testing, cesarean birth, breast feeding contraindicated. |
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Term
| HIV in Pregnancy: Maternal Risks |
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Definition
| Intrapartal or PPH, PP infection, poor wound healing, infections of the GU tract, compromised immune systems. |
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Term
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Definition
| Infants will often have a positive antibody titer, infected infants are usually asymptomatic but are likely to be premature, low birth weight and SGA |
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Term
| Care of Child of HIV positive MOM |
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Definition
| Standard Precautions, antiretrovirals x6 weeks, routine vaccines, NO OPV< MMR or Varicella, no family member should get OPV |
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Term
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Definition
Autosomal recessive, a recognized cause of mental retardation cause by deficiency in enzyme phenylalanine hydrolase- absence impairs bodys ability to metabloze phenylalanine, found in all protein foods.
Toxic accumulation in blood interferes with brain development and fxn, universal screening of newborns began in 1960's. |
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Term
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Definition
| Toxic accumulation of pheylalnine in blood intereferes with brain development. Teratogenic. Key to prevention of effects is identification of women with the disorder. LOW PROTEIN DIET. Microcephaly mental retardation, cardiac defects. Treatment effectiveness is strict diet before conception and throughout pregnancy. Dont Breast Feed. |
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Term
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Definition
| Used to recommedn affected children on phenylalnine restricted diet to age 6. Further treatment believed unneccesary- NOW recommended througout life. Very difficult diet to tolerate and follow. Subtle nerologic, behavioral, IQ effects found with discontinuation of diet. |
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Term
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Definition
| Long, difficult, or abnormal labor. The most common cause of c/s. Dysfunctional albor form abnormal uteirne contractions preventing normal progress of: cervical dilation, effacement(primary powers), Descent (secondary powers) |
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Term
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Definition
Abnormal UC that prevent the normal progress of dialtion or descent of fetus. Protractions disorders: slower than normal labor.
Arrest disorders: Complete cessation of UC. |
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Term
| Hypertonic Uterine Dysfunction |
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Definition
Uncoordinated Uterine Activity, UC frequenct, painful but ineffective (Prodromal labor) Latent phase.
Medical management: evaluate labor progress, evalate cause of labor dysfunction, hydrate to improve perfusions and coordination of UC. Have patient drink water and contractins may become regular and effective. |
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Term
| Hypertonic Uterine Dysfunction Nursing Actions |
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Definition
| Promote rest to break pattern- give ambien, relaxation techniques, hydrate with IV or PO fluids, assess FHR and UC, evaluate progress with SVE, inform provider of progress, educate patient and family. |
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Term
| Hypotonic Uterine Dysfunction |
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Definition
| Pressure of UC is insufficient IUPC <25mmHg, During active labor UC become weaker and less effective, risk for exhaustion and infection related to long labor, fetus at risk for intolerance of labor and asphyxia |
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Term
| Hypotonic Uterine Dysfunction |
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Definition
| Assessment Findings: Decreased frequency, strength, duration of UC, increased fear and anxiety levels, Medical management: evaluate progress, determine intervention, augment with oxytocin, perform amniotomy, perform c/s when all other options have failed. Amniotomy releases prostaglandins which stimulate contractions of the smoth muscle. |
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Term
| Hypotonic Uterine Dysfunction Nursing Actions |
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Definition
| Assess uterine activity, assess maternal and fetal status, stimulate uterine activity: ambulate/position change, hydrate (dehydration may cause dysfunction), augment with oxytocin per order. Evaluate labor with SVE, educate patient and family, provide emotional support and minimize the risk of infection. |
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Term
| Inadequate Expulsive Forces |
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Definition
| Unable to push or bear dow, ineffective pushing (little or no fetal descent), May be necessary to augment with pitocin, assist with vacuum or forceps, perfomr c/s, power form contraction and mom pushing 2nd stage. |
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Term
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Definition
| Causes: fetal size, anomalies, Cephalopelvic Disproportion (CPD), malposition, malpresentation, multifetal pregnancy. Extral limb, organs hat are supposed to be inside but are on the outside. |
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Term
| Malposition/Malpresentation |
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Definition
| Persistent occiput-posterior (OP) position, brow presentation, face presentation. |
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Term
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Definition
| Shoulder presentation (Transverse Lie), compound presentation- more than one presenting part. |
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Term
| Breech Presentation Types |
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Definition
| Frank, Single or double footling (incomplete), complete. |
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Term
| Breech Presentation Risks |
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Definition
| Head trauma, increased risk for infant mortality, neonatal complications, cord prolaps, risk of head entrapment and asphyxiation. |
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Term
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Definition
| Contractures of the pelvic diameters that reduce the capacity of the bony pelvis, inlet, midpelvis, or outlet. Soft tissu dystocia results from obstruction of the birth passage by an anatomic abnoramlity other than the bony pelvis. HPV can cause soft tissue dystocia, maternal obesity. |
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Term
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Definition
Deliberate stimulation of UC before onset of spontaneos labor. Complex intervention leading to cascade of interventions:
IV fluids, bedrest, continous EFT, increased pain med use, amniotomy, prolonged stay in hospital. |
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Term
| Factors to consider when inducing labor |
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Definition
| Parity, status of membranes, statuse of cervix (favorable or unfavorable), Hx of previous c/s births |
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Term
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Definition
| Endogenous oxytocin is produced by hypothalmus (posterior pituitary), eynthetic oxytocin is identical to endogenous, controversy over dose and rate increase intervals for induction of labor. |
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Term
| Risks associated with inductions |
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Definition
| Tachysystole, water intoxication may occur with high concentrations and large amounts of hypotonic solutions. |
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Term
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Definition
| Uterine Dysfunctions pattern one contraction after another |
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Term
| Administration fo Induction |
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Definition
| IVPB at site most proximal to venous site, always infused via pump, titration should reflect maternal/fetal respnse, decrease of DC dose whe UC are too frequent, increase when UC inadequate using lowest possible dose. Once in active labe should be DC. Indeterminate or abnormal FHR patterns: change maternal position, IV hydration, O@ by mask 10L NRB, decrease or DC oxytocin, Notify provider and request bedside evaluation of FHR tracing. |
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Term
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Definition
| Process of physical softening and opening of the cervix in prep for labor. Assessed via Bishops Score >6 favorable for induction, <6 meachanical or pharm ripening needed. |
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Term
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Definition
| Device inserted into cervix, stays in place 6-12 hours, laminaria, dilapan, balloon catheter |
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Term
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Definition
Placed in or nar cervix--- Prepidil (Dinorprostone Gel) delay oxytocin 6-12 hours, Cervidil (dinoprostone insert) Oxytoncin delayed 30-60 minutes after removal,
Misoprostil or cytotec delay oxytocin 4 hours. The is a risk for tachysystole with all of these prostaglandins. Cervidil is the only one that can be removed. Cytotec is the most commonly used. |
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Term
| Tachysystole Hyperstimulation |
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Definition
| Exessive uterine activity, 5 or more UC in 10min over 30 min period. A series of single UC lasting 2 minutes or longer. UC occurring within 1 minute of each other. Decreases O2 to the fetus, progressive fetal deterioration, may result in abruption or rupture. May see a change in variability. |
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Term
| Tachysystole Nursing Actions |
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Definition
| Reposition mom, IV bolus of at least 500mL LR, decrease Oxytocin by at least halft, D/C oxytocin if pattern persists, O2 at 10L by mask, notify provider, consider terbutaline if no response to prior interventions. |
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Term
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Definition
| suppresses uterine contactions and is a beta adrenergic may cause tachycardia, may feel like heart is beating out of the chest. Given IV 0.25mg. |
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Term
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Definition
| Digital separation of chorionic membran from wall of cervix and lower uterine segment. Release of prostaglandins, little evidence, assess FHR before and after, may have spotting after procedre. May have milde cramping. |
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Term
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Definition
| Artificial rupture of membranes (AROM) typically used to augment or shortne labor, may induce labor, most effective in multips dilated 2cm or more, done in early labor increase risk of c/s 2/2 abnml FHR, Assess FHR before and after, maternal temp q4 hours, document time, color, odor, amount. |
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Term
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Definition
| Fewer than 3 hours from onset to delivery. Fisk for pph, fetus at risk for hypoxia and CNS depression related to hypoxia from rapid brth. Assessment findings: hypertonic UC, rapid dilation and effacement. |
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Term
| Nursing Actions of precipitous Labor |
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Definition
| Remain with patient, emotional support, anticipate complications. |
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Term
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Definition
| Prolapsed umbilical cord, when cord lies below the presentig part of fetus. Contributing factors include, Long cord, malpresentation, transverse lie, unengaged presenting part. |
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Term
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Definition
| Shoulder dystocia, head is born, but anterior should cannot pass under pubic arch. Newborn is more likely to experience birth injuries. Mother's primary risk stems from excessive blood loss, lacerations, extension of episiotomy, or endometritis. Check moro reflex for broken clavicle. |
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Term
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Definition
| Dysfunctional labor, uterine rupture, perineal lacterations, pph, pueperal infection, shoulder dystocia. |
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Term
| Nursing Intervention for Shoulder Dystocia |
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Definition
| Head of bead flat down to change angle of pelvis, McRoberts Position, apply suprapubic pressure by rolling. |
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Term
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Definition
| When a piece of amniotic fluid gets into the pulmonary vessel and occuldes it. Presents as a PE. Rare but fatal, can occur during labor, delivery, or up to 24 hours pp. Causes respiratory distress and circulatroy collapse. |
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Term
| Dissemiated Intravascular Coagulation |
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Definition
| Syndrome that occurs when body is breakng down blood clots faster than it can form a new clot. Quickly depletes body of clotting factors leading to hemorrhage or maternal death. |
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Term
| Impact of Post term pregnancy: Maternal |
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Definition
| After 42 weeks, perineal damage, hemorrhage due to over distention of the uterus, increased risk of cesarean birth, anxiety, emotional fatigue, persistence of normal discormforts. |
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Term
| Impact of Post term Pegnancy: Fetal |
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Definition
| Decreased Perfusion, oligohydramnion, SGA, Macrosoma, Increased risk for meconium staining, placenta is non functioning, variable heart tones due to cord compression and low fluid. |
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Term
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Definition
| s/s Wetigh loss, decrease uterine size, meconium in AF. Treatment fetal surveillance, NST< CST< BPP Q week, kick counts, induction |
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Term
| Multiple Gestation Pregnancy Risks |
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Definition
| Spontaneous abortion, gestational diabetes, hypertension, acute fattly liver disease (not clotting), PE, maternal anemia, hydraminos, PROM, Incompetent cervix, IUGR (look pale dry not healthy) |
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Term
| Multiple Gestation Labor Risks |
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Definition
| Preterm labor, uterine dysfunction, abnormal getal presentations, instrumental or cesarean birth, pph |
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Term
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Definition
| Placenta Previa, placenta implanted in lower uterin segment near or over internal cervical os. Classifaction based on degree internal cervical os is covered by placenta. |
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Term
| Risk Factors Associated with Placenta Previa |
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Definition
| Prior uterine surgery, history of prior placenta previa, impeded endometrial vascularization, increased placental mass, parity, maternal age, number of curettages for spontaneous or induced abortions, higher altitudes, maternal smoking,male fetuses, multiple gestations |
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Term
| Classifications of Previas |
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Definition
Marginal Previa: Placenta is within 2-3cm of internal os but does not cover it.
Partial Previa: Placenta implanted near the cervix with a portion covering part of the cervical os.
Total Previa: The cervical os is completely covered. |
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Term
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Definition
| NEVER vaginal exam with vaginal bleeding. Transverse US is the best diagnosis, abdomen is soft, non tender uterus higher. |
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Term
| Clinical Manifestation with Previa |
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Definition
| The inital beeding episode is usually around 34 weeks. |
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Term
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Definition
| Conservative, hospitaliztion, decrease activity and exercise, fetal monitoring, pelvic rest, delivery c/s unless previable fetus, fetal demise or marginal previa. Bed Rest, up to bathroom, fetal monitoring, c/s |
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Term
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Definition
| Premature separation of the placenta from its implantation site, typically occrring after the 20th week of pregnancy. |
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Term
| Factors associated with abruptio placentae |
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Definition
COCAINE USE
partial abruption of current pregnancy
Prior abruption placentae
Rapid decompression of the uterus, hypertension, preterm premature rupture of membranes <34 weeks, prior c/s, blunt abdominal truama, multiparity, cigareette, smoking, extremely short length of the umbilical cord, uterine anomalies, uterine fibroids at the placental implantation ite, use of intreauterine pressure catheters during labor |
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Term
| Clinical Manifestations of abruptio placentae |
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Definition
| Abdominal pain, contractions, hyperonus, concealed hemorrhage, vs. vaginal bleeding, rapid labor progress, fetal and uterine respons: fetal tachycardia, bradycardia, loss of varioability, late decelerations, decreasing baseline, sinusoidal pattern, low amplitude high frequency contractions. |
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Term
| Management of abruptio placentae |
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Definition
| Fetal assessment, KB tes, Fluid resuscitation, blood replacement products, lactated ringers, US, emergent C/S, |
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Term
| Umbilical cord insertion complications |
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Definition
| succeturiate placenta, circumvallate placenta, battledore placenta, prolaspsed umbilical cord, velamentous insertion. |
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Term
| External Cephalic Version |
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Definition
| Changed from breech, transverse, or oblique lie to a cephalic presentation by external manipulation of the maternal abdome. Success reates are highest for transverse position. |
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Term
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Definition
| Also called internal version. Used only with the second twin during a vaginal birth. Hand is placed in the uterus, grabs the fetus's feet, and then turns the fetus from a transverse or noncephalic presentation to a breech presentation. |
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Term
| Risks associated with breech |
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Definition
| Nonreassuring fetal heart tones, dystocia, smaller head circumfrance, SGA |
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Term
| Criteria for External Version |
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Definition
| Single fetus, not engaged, appropriate amount of amniotic fluid, reactive NST, 36-37 weeks |
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Term
| Contraindications for external version |
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Definition
| IUGR (amniotic fluid may be decreased), retal anomalies, ROM, nonreassuring NST, amniotic fluid disorders, previous c-section, nuchal cord, multiple gestations, bleeding, uteroplacental insufficiency |
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Term
| External version procedure |
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Definition
| Fast for 8 hours, US to confirm fetus, amniotic fluid, maternal VS, reactive NST, blood work (CBC, Blood Type), IV, magnesium sulfate, terbultaline, supine or trendelenburg |
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Term
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Definition
| Medications- cytotec, cervadil, prepidil, balloon catheter. Prostaglandins cause thinning of the cervix and promotes smooth muscle contractions. |
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Term
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Definition
| Misoprostol is a syntheti PGE1 which softens or ripens the cervix and induce labor. Intial dose is 25mcg, should not exceed more than 3-6 hours, pitocin should not be administed less than 4 hours after dosing with cytotec. Continuous fetal monitoring. |
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Term
| Contraindications for CYTOTEC |
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Definition
| Nonreassuring FHR tracing, frequent UC with moderate intensity, prior c/s, placenta previa, undiagnosed vaginal bleeding |
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Term
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Definition
| Cervidil, prepidil, placed in teh posterior vagina and left in place, provides a slow release of 10mg of 0.3mg/hour over 12 hours |
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Term
| Advantages of Prostaglandins |
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Definition
| can be removed easily, may lower oxytocin requiements, incidence of c/s reduced |
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Term
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Definition
| Uterine hyperstimulation, pph, uterine rupture |
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Term
| Mechanical Methods of cervical ripening |
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Definition
| Balloon catheters, foley catheter placed through the cervix, weight of the balloon applies pressure on the os of the cervix and assists in ripening the cervix. |
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Term
| Management of cervical ripening |
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Definition
| Check fetal heart tones fore 30 minutes before and after administration, assess maternal vs, encourage patinet not to get out of bed, monitor risks of tachysystole and FHR problems, tachysystole occurs provide oxygen and have patient lay on the left. Terbutaline may be used. |
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Term
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Definition
| Labor induction-the stimulations of uterus contractions before the spontaneous onset of labor, with or without ruptured membranes. Labor augmentation artificial stimulation of uterin contraction when spontaneous contractions have failed to result in progressive cervical dilation or the descent of the fetus. |
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Term
| Inductions for Augmentation |
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Definition
| Hypertensive disorders, preeclampsia, chorioamnionitis, post term pregnancy, fetal compromise, mild abruptio, nonreassuring fetal heart rate, fetal demise, PROM |
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Term
| Contraindications for Inducation |
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Definition
| Fetal maturity, cervical readiness, gestational age, amniotic fluid, L/S ratio,abnormal serial US |
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Term
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Definition
Evaluate changes in cervix, effacement, consistency, presenting part, and position.
The higher the score the more favorable for labor to occur. Fetal fibronectin may be a predictor of labor. |
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Term
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Definition
| Surgical ncision of the perineal body, may prevent lacerations of the periurethra, perineum, anal sphincter, and recutm. Reduce risk to the fetus, protects the bladder, may be driven by local norms or practitioner prefernece. |
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Term
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Definition
Trauma is more apt to happen to the anal sphincter with a miline episiotomy. Women who tear natuarlly have less risk of sixual dysfunction.
Blood loss, infections, dyspareunia, flatal incontinence, may result in future 3/4 degree tears. |
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Term
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Definition
| Used when shoulder dystocia is anticipated, multiple gestation, breech, LGA, use instead of forceps or vacuum |
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Term
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Definition
| Primigravida, encourage sustained breath holding, arbitrary time limit on second stage of labor |
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Term
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Definition
| Provides more room for instrument assisted births or LGA, decreases the possibility of a traumatic extension into the rectum. Begins in the midline of the posterior fourchette and extends at a 45 degree angle downward to the right or left. |
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Term
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Definition
| Along the median raphe of the perineum from the vaginal orifice to the fibers of the anal sphincter. Less blood loss, easier to repair and less discomfort. |
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Term
| Mediolateral complications |
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Definition
| More blood loss, longer healing period, postpartal discomfort. |
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Term
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Definition
| Pain relief, Ice pack inspect every 15 minutes during the first hour, assess for redness, swellng, tenderness, and hematomas. Perineal care. |
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Term
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Definition
| Forcep assisted deliver helps rotate the fetal head to an occiput anterior position. Peper forcepts are designed to be used with a breech presentation. Orther forceps are used whtn the fetus is cephalic. |
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Term
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Definition
| Are applied when the fetla skull has reached the pelvic or and is on the perineum. |
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Term
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Definition
| Presence of any condition in which the mother or fetus is at risk and the risk will be relieved by birth. May be used to shroten the second stage of labor due to exhaustion. |
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Term
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Definition
| eccymosis, edema, caput succadeneum, caphalhematoma, low apgar scores, retinal hemorrhage, elevated bilirubin level |
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Term
| Maternal risks of forceps |
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Definition
| Lacerations, birth canal, periurethral lacerations |
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Term
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Definition
| Assists in the delivery by applying pressure to the fetal head, soft suction is placed against the occiput of the head, if applied for greater then 10 minutes may reult in calp injuty. |
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Term
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Definition
| Preferred over forceps. C/I: fetal macrosomia, high fetal station, face or breech presentation, less than 34 weeks, incompletely dilated cervix, previous fetal scalp blood sampling. |
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Term
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Definition
| Birth through an abdominal and uterine incision. Most commonly done due to dystocia or previous |
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Term
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Definition
| Complete Placenta Previa, cephalopelvic disproportion, placental abruption, active genital herpes, umbilical cord prolapse, failure to progress, nonreassuring fetal status, benign tumors that obstruct the birth canal. Breech, previous c/s, congenital anomolies, cervical cerclage, severe RH isoimmunization, maternal preference. |
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Term
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Definition
| Infection, reactions to anesthesia agents, blood clots, bleeding, twice as likely to be readmitted in 60 days, maternal morbidity. |
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Term
| Advantages of Transverse Incision |
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Definition
| Almost invisible after healing, less bleeding, better healing. Lower uterine segment is the thinnest portion of the uterus and involves less blood loss. Requires only moderate dissection of the bladder from underlying myometruium. Less likely to rupture during subsequent pregnancies. Decreased chance of adherence of bowel or ometum to the incision line. |
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Term
| Disadvantage of Transverse Incision |
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Definition
| Takes loner, is limited in size due to the presence of major blood vessel on either side of the uterus. Hase a greater tendence to extend laterally ito the uterine vessels. |
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Term
| Lower Uterine Segment Vertical Incision |
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Definition
| Preferred for multiple gestation, abnormal presentation, disadvantages: May extend down into the cervix,more extensive dissections of the bladder is needed to keep the incision in the lower uterine segment. Homeostatis and closure is more difficult if the incision extends in the upper segment of the uterus. Vertical incision carries a higher risk or rupture. |
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Term
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Definition
| Preoperative teaching, gastric antacids to balance pH of stomach, start IV (18g), Place foley catheter, shave the area, assess fetal HR |
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Term
|
Definition
| Full assessment, assess vs and lochia every 5-15 minutes, ecourage deep breathing and coughing, continue IV fluids. |
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Term
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Definition
| One previuos cesearean birth and a low transverse uterine incision, an adquate pelvise, no other uterine scars or previous uterine rupture. A physician who is able to do a cesarean eeds to be available throughout active labor. In house anesthesia personnel are available for emergency c/s if warranted. |
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Term
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Definition
| Uterine Rupture, uterine dehiscence, hyerectomy, uterine infection, maternal death, neonatal death, antepartum stillbirth, intrapartum stillbirth, transfusion, hypoxic ischemic encephalopathy. |
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