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L&D 8

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juniperk's version from 2017-11-19 05:34

Section

Question Answer
What is an external cephalic version?Manipulation of the fetus through the abdominal wall from a breech or shoulder to a vertex presentation.
What do you need to do an external cephalic version?1. IV started 2. Good fetal pattern 3. Uterine not contracting. ( give tocolytic to prevent contractions in a mom who is NOT contracting. Contractions can rupture uterus) 4. If mom is full term, give pitocin once baby is verted
What is the preferred skin cut in a csection? Plannenstiel - bikini cut
What are the 3 uterine incisions in a csection? how are they cut?Low transverse (L to R bikini line) Low vertical (Low up and down) classic (high up and down) DO NOT LET VERTICAL OR CLASSIC LABOR!
What are the 2 maneuvers for shoulder dystocia?McRoberts and Suprapubic pressure
What are the 3 signs in Virchow's triad?Hypercoagulability. Hemodynamic changes (stasis, turbulence) Endothelial injury/dysfunction
What are 5 maternal reasons to induce or augment the mom?Diabetes, 2. Preeclampsia 3. Slowed progress of labor 4. History of precipitate labor 5. Chorioamnionitis
What are 4 fetal reasons to induce or augment the mom?Prolonged ROM 2. Postmaturity 3. Rh sensitization 4. Fetal death
What are 5 maternal reasons to NOT induce or augment the mom?Previous classic uterine incision 2. Placenta previa 3. Grandmultipara 4. Overdistended uterus 5. Active genital herpes
What are 4 fetal reasons NOT to induce or augment the mom?1. Cephalopelvic disproportion. 2. Severe fetal distress 3. Fetal malposition 4. Fetal immaturity
What are prostaglandins used for?To ripen the cervix
What is cervidil (dinoprostone)? What is needed prior to insertion?Ripens the cervix to improve the bishop score. Placed transversely into the posterior vaginal fornix and stays for 12 hours. Prior to insertion: reassuring fetal monitor strip for 30 minutes prior to insertion.
What are the 4 nursing considerations when the mom has dinoprostone?Continuous fetal and uterine monitoring. 2. Lateral recumbent position for 1-2 hours after insertion. 3. Maternal VS q 2 hs. 4 Remove for a minimum of 20 min before amniotomy and 30 before pitocin.
What are the 3 side effects for dinoprostone?NV 2. Fever 3. Hypertonus
What are 3 things Cytotec (misoprostol) is used for? What is needed prior to insertion?GI use but for OB: Ripen the cervix 2. Induce labor 3. Postpartum hemorrhage. 25 mcg pill placed in the posterior vaginal fornix every 4 hours. Prior to insertion: reassuring fetal monitor strip for 30 minutes prior to insertion.
What are 2 nursing considerations for misoprostol and a side effect?Continuous fetal and uterine monitoring. 2. Can start oxytocin 4 hours after last dose. SE: uterine hyperstimulation.
Which mechanical method of cervical ripening is used for fetal demises?Laminara- inserted into cervical canal where it absorbs cervical fluids and swells.
If the mom is using the foley bulb for ripening, how much dilated will she be when the bulb falls out?3 cm
What is the goal for oxytocin?to mimic natural labor
How is oxytocin given? What are the 2 nursing considerations? 3 Side effects?Y'd into the closest port using an IV pump. Nursing c: VS with each increase. 2. Continuous fetal and uterine monitoring. SE: Tetanic contractions 2. Maternal hypotension 3. Antidiuretic effects
What is the half life of oxytocin?7-15 minutes Takes 3-5 half lives to reach steady state concentrations
How often do you increase pitocin?every 30 to 60 minutes
What are the 2 goals for MVU?5 contractions in 10 minutes with cervical change and 180-250 MVU
What are the 3 things that define uterine hyperstimulation?1. > 5 contractions in 10 minutes. 2. Contractions lasting 2 minutes or more 3. Contractions of normal duration occurring less than 1 minute of each other
What is polystole?contractions that occur in sets of 2 or more
What is tachystole?same as hyperstimulation
What is hypertonus?Uterine resting is elevated above normal (>30 mmHg)
What is tetanic contractions?Long and strong but not necessarily close together. >90mmHg and >90 seconds
What is a protracted active dilation phase?Nulli < 1.2 cm/h Multip <1.5 cm
What is protracted descent?<2cm/hr
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