OB Chapter 22

Amniotic fluid embolism

- When amniotic fluid containing fetal and placental cells enters the maternal circulation.

Elective

- Without an obstetric or medical indication -Fear of labor ( by 39 week )

People at risk for Stillbirth

-Adolescents -Women over 35 years old -Women of African descent -Multifetal gestations -Congenital anomalies -Maternal disease.

GBS (Group B streptococcus)

-Asymptomatic for women -Badly for infants

1st sign of cord prolapse

-Change in fetal heart rate tracing, typically **Severe fetal bradycardia **Variable decelerations

Hypotonic uterine dysfunction

Contractions are to weak/uncoordinated to dilate the cervix

Pt teaching when pushing

-Deep breath at the beginning of every contraction, hold it, then tighten your abdominal muscles and push down with as much force as possible while the nurse counts to 10.

Unplanned

-Emergency - Rupture of the uterus

Indications for C-section

-Failure to progress -Nonreassuring fetal heart rate -Fetal malpresentation -Umbilical cord prolapse -Fetal macrosomia

Types of breech

-Frank -Footling -Complete

Episiotomy risk for?

-Infection, bleeding, and pain

Episiotomy

-Is a surgical incision of the posterior aspect of the vulva made during the second stage of labor. -Done on the midline or mediolateral

How long is a hypotonic uterine dysfunction

-Less than 3 of 4 every 10 min less than 50 sec long

Passageway

- The maternal bony pelvis and soft tissues.

Valsalva method

- Urge to bear down when the women is pushing

Power

- Uterine contractions and pushing efforts.

Cephalic Presentations (head first presentations)

- Vertex (Correct one) -Sinciput -Brow -Face

TOLAC/VBAC risks

****Hemorrhage -Surgical injuries -Uterine rupture -Infant death or neurological complications

Cephalopevic disproportion (CPD)

- A mismatch between the size of the fetal head (larger) and the size of the maternal pelvis.

Treatment for Uterine tachysystole

- Administration of an opioid (pain relief), warm bath.

C-section complications for mothers

- Bowel and bladder injury during surgery, hemorrhage, amniotic fluid embolism, and infection. -A major neonatal complication is respiratory distress.

Types of uterine incisions

- Classical (vertical) -Low vertical -Low transverse *****Low transverse incision is the SAFEST attempt after vaginal delivery

Uterine tachysystole

- Contractions are strong, organized, and fundal.

Passanger

- Feta Factors

Position

- Maternal position

Psyche

- Maternal state of mind

Normal fetal position

- Occipito anterior position

What doe you cover the prolapsed cord with?

- Sterile gauze wet with sterile NSS and place the woman in Trendelenburg position (Knee to chest)

Uterine Rupture symptoms

- Sudden development of a category II or category III fetal heart rate pattern (often bradycardia) -Weakening contraction, and abdominal pain -Vaginal bleeding or hematuria -Loss of fetal stations -Maternal hypotension and tachycardia.

How long does uterine tachysystole last?

-More than 5 contractions over 10 min within a 30 min window frame

5 P's

-Powers -Passageway -Passenger -Psyche -Position

Ineffective pushing

-Pushing before the cervix is fully dilated *Can lead to swelling and soft tissue dystocia

Amniotic fluid embolism symptoms

-Respiratory failure (dyspnea first) -Cardiac arrest -Frothy sputum late sign.

Planned C-section

-Scheduled -Placenta previa, an active genital herpes outbreak.

GBS infection signs (Infants):

-Sepsis -Pneumonia -Meningitis

Operative vaginal delivery risks

-Shoulder dystocia -Tissue damage to mother and fetus -Fetus hemorrhage -Cerebral Palsy ****

Prevention of perinatal loss

-Taking folic acid before and during pregnancy. -Routine syphilis screening and treatment. -Screening for and treating hypertensive disorders and maternal diabetes. -Access to emergency obstetric care

1st sign of shoulder dystocia

-Turtle sign

GBS- positive pt's are treated with what antibiotics

1st choice: Penicillin If allegeric use Cefazolin, Clindamycin, or Vancomycin (At least 4 hrs before delivery)

Precipitous labor lasts for

3 hrs or less

Screening for GBS

35-37 weeks of gestation

Hypotonic uterine dysfunction occurs in what phase

Active phase

After reviewing a patient's prenatal record, the nurse determines which of the following is a contraindication for vaginal birth after cesarean?

Answer: Previous cesarean birth with a vertical uterine incision

A nurse in the labor room is preparing to care for a client with hypertonic uterine dysfunction. The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. The priority nursing intervention would be to:

Answer: Provide pain relief measures

Dystocia

Any labor with abnormality fast or slow progression

Pelvimetry

Assessment of the maternal bony pelvis to determine its sufficiency for vaginal birth

Uterine Rupture treatment

Cesarean delivery and possible hysterectomy.

Placenta Accreta

Chorionic villi attach directly to the uterine myometrium. -Associated with maternal hemorrhage and failed placental separation after birth.

Cord prolapse

Condition where umbilical cord precedes fetal head in the birth canal.

Hypertonic uterine dysfunction

Contractions are frequent, irregular, and do not contribute to cervical effacement, dilation, or fetal descent

Internal podalic version

Conversion from a dorsoposterior transverse lie to a breech presentation

Obstetric emergency example

Cord prolapse ***Immediate C-section delivery

A patient delivered 1 hour ago and suddenly experiences cardiac arrest. What should the nurse do next? A. call for help B. open airway and assess breathing C. initiate CPR D. All the above

D. all of the above ***Possible amniotic Fluid embolism

Complete breech

Fetus is sitting with legs crossed. (Hips and knees flexed)

Operative vaginal delivery

Forceps are applied on the sides of the fetal head to allow the provider to pull with contractions when the baby is at the level of ischial spine (station 0)

True/ False - After an unsuccessful delivery using forceps, the provider will likely attempt a vacuum-assisted delivery.

False

Amniotic fluid embolism risk

Hemorrhagic shock with disseminated intravascular coagulation.

Women who are not screens before labor and delivery preterm, are provided with what antibiotics for GBS?

IV-PCN-G, Ampicillin or Cefazolin, Clindamycin, and Vancomycin if allergic to PCN

Vacuum

Is a device that applies suction to the fetal head Engagement of the presenting part, to aid in extraction -Empty bladder is IMPORTNAT!!!

Shoulder dystocia

Is obstruction by the shoulders after the birth of the head

Where does hypertonic uterine dysfunction occur?

Latent phase

Nursing interventions for shoulder dystocia

McRoberts maneuver- woman's legs flexed apart, knees on her abdomen. Preferred method when woman is having epidural anesthesia. (Woods screw maneuver) Suprapubic pressure can then be applied to the anterior shoulder in an attempt to push shoulder under symphysis pubis.

Placenta increta

Myometrium is invaded

Placenta percreta

Myometrium is penetrated High incidence of abdominal hysterectomy

Amniotic fluid embolism treatment

NO TREATMENT -Focus on care for hypotension and hypoxemia

What drug do you avoid during TOLAC procedures?

OXYTOCIN (Pitocin) -May increase uterine rupture

Most common fetal malpresentation

Occiput posterior positon (OP)

Hypotonic Uterine Dysfunction treatment

Rest an amniotomy (Opening the sac by the worker), or oxytocin administration.

Retention of the placenta for more than 30 min can cause

Risk for postpartum hemorrhage and endometritis

Vacuum risks and complications

Risks -Shoulder dystocia -Tissue damage to the mother and fetus Complications -Mom perineal swelling and bruising.

Uterine Rupture

Tear in the wall of the uterus

External Cephalic Version (ECV)

The obstetric provider rotates the fetus by external pressure to a cephalic lie. (attempted after 36 wks)

TOLAC (VBAC)

Trial of labor after cesarean

Uterine rupture is most common in what type of women?

Women who are attempting TOLAC

Maternal pelvis

can be smaller than normal or contracted can lead to dystocia.

Frank breech

hips flexed, knees extended (Most common)

Normal time for placenta removal

less than 30 min, usually between 20-30 min

Footling breech

one or both feet are present first at the cervix