OB Test 2
Terms in this set (93)
Ductus anteriosus closes
no longer shunts blood away from lungs
after birth becomes Ligamentum artriosum
Foramen ovale closes
blood no longer moves from right atrium to left atrium
becomes the Fossa Ovalis
Ductus venosus closes
no longer bypasses liver
after birth becomes Ligamentum Venosum/teres
Umbilicial arteries and vein close
oxygenated blood no longer come from placenta
stay open for about 10 hours after birth
carry deoxygenated blood
oxygenated blood from the placenta enters the fetus through the...
First breath after birth
increase alveolar O2 pressure causes vasodilation in the pulmonary vessels
What initates respirations at delivery?
pressure changes, temperature, light, chest squeeze, clamping of the cord
Fetus heart circulation
right atrium is greater than the left encouraging blood flow through the foreman ovale.
opposite after birth
surface tension-reducing lipoprotein found in the newborn's lungs that prevents alveolar collapse at the end of expiration and loss of lung volume.
What removes the amniotic fluid from the fetus' lungs as the baby is born?
the pulmonary capillaries and the lymphatics
sucking on hand, looking around(quiet alert)
Why is feeding frequently a good thing?
helps promote stool production
yellowing of skin
result of increased bilirubin blood levels
prevent by early and frequent feedings
3-5 days of life
serum bili 10 mg/dl and then decline rapidly over the first week
occurs in 80% of premmies
caused by short life span of RBC, delayed passage of meconium
delayed passage of meconium
hemolytic breakdown of red blood cells
serum bili > 5 mg/dL/day
more than 17 mg/dl
impaired metabolism, excretion reabsorption
polycythemia, blood incompatibilities, acidosis
first 24 hours of life
treatment for pathologic jaundice
risk factors of the development of jaundice
fetal-maternal blood incompatibility, premmie, breastfreeding, male, cephalhematoma, cutaneous bruising, infections, Asians or native americans.
a yellow to orange bile pigment produced by breakdown of red blood cells.
toxic to tissue
leads to kernicterus
NB produce 6-8 mg/kg/day
due to ineffective breast feeding
decreased volume feedings
delayed passage of meconium
Maternal Rh- blood type
Rh+ passed to fetus causing RBC destuctive
Maternal O blood type
anti-A or Anti-B antibodies passed to newborn causing hemolysis
baby stool in the womb
composed of amniotic fluid, shed mucosal cells, intestinal secretions, and blood
can happen during stress.
first period of reactivity
begins at birth
can last from 30 minutes to 2 hours
alert, moving, appears hungry
spontaneous moro, sucking, chewing, rooting, and fine tremors
RR and HR are elevated
period of decreased responsiveness
30 minutes to 2 hours of age
RR and HR decrease
more relaxed an responsiveness declines
difficult to arouse
can be used for mother and baby to remain close but rest
second period of reactivity
begins when baby awakens and show interest in stimuli
lasts 2-8 hours
Heart and Respiratory rate increase
peristalsis also increases
not uncommon to pass meconium or void
increase in muscle activity
interaction b/w mother and baby
found on nape of the neck, eyelids, and between the eyes and upper lip.
superficial vascular areas, this will fade.
most visible when newborn is crying
unopened sebecaous glands found on newborn's nose, chin, forehead. will disappear 2-4 weeks
60% of newborns
concentrated of pigmented cells
lower back and buttocks
mostly black, Asian, and indian babies
benign, transient, idiopathic
small papules or pustules on skin resembles flea bites
immature immune system
70% of newborns
port wine stain
commonly appears on face or other body parts
capillary angioma located directly below the dermis
nevus vasculosus or strawberry hemangioma
benign capillary hemangioma
dermal and subdermal
raised, rough, dark red and sharply demarcated
often resolve by age 3
dilation of blood vessels on only one side of the body, giving the newborn the appearance of wearing a clown suit
localized edema on the scalp from the pressure of the birth process
swelling that crosses suture lines
localized effusion of blood beneath the periosteum of the skull.
due to disruption of vessels during birth
does not cross suture line
can be due to forceps or vacuum
blue hands and feet
fine, downy hair
pain controlled with acetaminophen, sucrose, EMLA cream, dorsal penile block
lower risk of HIV
lower risk of penile cancer
lower risk of cervical cancer in female partners
risks are rare and treatable
clean with warm water
apply ointment to prevent sticking
notify if no void 6-8 hours post op
monitor bleeding, redness, edema, purulent, drainage
yellow exudate is normal
do not forcibly retract foreskin
change diaper frequently and wash hands with mild soap and water
when able to retract easily, retract and wash glands
apgar scoring is done at 1 and 5 minutes. if the 5 minute score is less than 7 another score is done at 10.
Fetal heart rate
Category 1: normal
baseline rate (110-160 bpm)
baseline variability moderate
present or absent accelerations
present or absent early decelerations
no late or variable decelerations
Fetal heart rate
Category 2: indeterminate
not predictive of abnormal fetal acid base status
fetal tachycardia (>160 bpm)
fetal bradycardia (<110 bpm) not accompanied by absent baseline variability
absent baseline variability not accompanied by recurrent decelerations
minimal or marked variability
recurrent late decelerations with moderate baseline variability
recurrent variable decelerations accompanied by minimal or moderate baseline variability; overshoots or shoulders
prolonged decelerations >2 mins but <10 mins
Fetal heart rate
Category 3: abnormal
predictive of abnormal fetus acid base status
fetal bradycardia (<110 bpm)
recurrent late decelerations
recurrent late decelerations
all with decreased variability
rare, smooth, undulating basline
severe fetal anemia
impending fetal death
Why do a speculum exam when determining if membranes have been ruptured?
We do speculum exams when determining ruptured membranes because the lube from vaginal exams can mess with the ph of the results.
Nitrazine swabs and Fern tests
False Nitrazine swabs can occur. False positives also show a yellow to olive green color. A true rupture would be more of a blue-green. A fern test should be done to determine if membranes have actually ruptured.
Postpartum Assessment - BUBBLE-EEE
Breast, Uterus, Bladder, Bowel, Lochia, Episiotomy, Epidural, Extremities, Emotion
size, shape, color, symmetry, engorgement, erythema, bleeding, bruising.
nipples for cracks or discharge
assess fundus. *make sure bladder is empty if possible
massage fundus if boggy or relaxed until firm
considerable diuerisis (3000 ml) w/in 12 hrs of birth. don't sense the need to void even if their bladder is full. Their bladder can become distended.
may not occur for 2-3 days after birth this is normal
amount, color, odor, change w/ activity
position woman on her side. look for irritation, ecchymosis, tenderness, or hematomas. can assess perineum and hemorrhoids too.
visual inspection/side effects of epidural
LOC and sensation
determine degree of sensory/motor function return
observe how she interacts with her family independence, energy, eye contact with new born, posture, comfort, sleep
Blood thinners & breastfeeding
generally considered safe
depends on the medication
Postpartum hemorrhage PPH
leading cause of maternal death
majority occur 4 hours after birth
defined as greater than 500 ml after vaginal birth
or greater than 1000 ml after C/S
abnormally adherent placenta
Placenta accreta: The placenta attaches strongly to the myometrium, but does not penetrate it.
Placenta increta: Occurs when the placenta penetrates the myometrium.
Placenta percreta: The worst form of the condition is when the placenta penetrates the entire myometrium to the uterine serosa (invades through entire uterine wall).
within 24hours after birth
uterine atony, retained placenta, coagulation, lacerations, hematomas
Between 24 hours and 6 weeks
infection, retained placenta
3rd stage management
supporting the uterus while gently applying traction to guide the placenta out
failure of the uterus to contract and retract after birth.
a boggy or relaxed fundus is a sign of uterine atony
a prolapse of the uterine fundus to or through the cervix so that the uterus is turned inside out after birth.
incomplete involution of the uterus or failure to return to its normal size and condition after birth.
breast redness, tenderness, hot to touch
flu like symptoms - often first symptom
cracks or fissures of the nipples
statsis of milk
causes of mastitis
weaning or missed feeding, poor fitting bra, engorgement
prevention of mastitis
empty breast frequently
proper fitting bra
position of the baby
treatment of mastitis
keep milk flowing
Can you continue to breast feed if you have mastitis?
Yes this infection wont harm the baby.
score >7 is successful
<7 requires interventions: observations and pt teachings
repeating <7 requires interventions and consultant with lactation specialist
<6 cervical ripening techniques need to be applied
contraindications for induction
active genital herpes
pelvic structure abnormality
abnormally long cord
had a previous C/S or uterine surgery.
Indications for induction for diabetic mothers
macrosomia(baby is too big)
most likely to have injury
decrease fetal movement
non-reassuring signs on fetal monitor
low BPP score
grade 3 placenta
decreased amniotic fluid
Cervical ripening techniques
Prostaglandins cervidil or semen
balloon (foley catheter)
osmotic (laminaria- seaweed)
stripping the membranes
amniotomy-rupture of membranes
What conditions must be present before membranes can be ruptured?
mature fetal lungs
cervical 2cm dilation
vertex presentation has to be down
expectation of delivery within 24 hours
What interventions would help relieve back pain?
lean on bed
rock her hips
dilatation of 1 cm/hour
regular contractions every 3 minutes
mod. to strong intensity (240 MVU)
soft resting tone
Reassuring fetal heart tracing
Montevideo Units MVU
peak pressure of contractions
minus resting tone
added up over 10 minute period
intrauterine pressure catheter
What interventions can help for variable decelerations due to cord compression?
iv fluid bolus giving baby more oxygen and fluid
give oxygen 10/liters face mask
perform sterile vaginal exam because cord could be prolapsed
notify provider should be there
inserting intrauterine pressure catheter to add enough fluid to give the cord some cushion
Nursing considerations for patients receiving an epidural
Informed consent: witness make sure they understand
reassuring fetal heart rate
maternal pulse ox
assist with positioning
monitor with complications
What is a complication that can arise with an epidural
drop in BP.
they get 2 liters of fluid very rapidly.
Tachycardia, sweaty, clamy, late decelerations
Maneuvers for dystocia
McRoberts, put head of bed down knees to ears
Suprapubic pressure, pop the shoulder out with down pressure
Gaskin Maneuver, all fours
Zavanelli, push baby back in and go do a C/S