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Final exam maternal health

Terms in this set (61)

Amniotic Fluid Index
Sum of pocket in each quadrant
Results normal if AFI >5cm and NST is reactive
cervical cerclage
suture is placed around the cervix beneath the mucosa to constrict hte internal os of the cervix
prophylactic: usually happens at 12-14 weeks gestation
therapeutic: 14-23 weeks
rescue: 16-23 weeks
Contraction stress test (CST)
Nipple-stimulation or Oxytocin-stimulated
Achieve 3 or more contractions in a 10 minute window
Provides a warning of fetal compromise earlier than NST
Negative CST
No late or significant variable decelerations
Positive CST
Late decelerations following > 50% of contractions
Equivocal-suspicious
Intermittent late decelerations or significant variable decelerations
Equivocal- hyperstimulatory
Decelerations in the presence of UCs > q 2 minutes or loner than 90 seconds
Unsatisfactory
< 3 UCs in 10 minutes or tracing not interpretable
reactive non-stress test
Two accelerations in a 20-minute period, each lasting at least 15 seconds and peaking at least 15 beats/min above the baseline. (Before 32 weeks of gestation, an acceleration is defined as a rise of at least 10 beats/min lasting at least 10 seconds from onset to offset)
nonreactive non-stress test
A test that does not demonstrate at least two qualifying accelerations within a 20-minute window
pregestational diabetes complications
Macrosomia
Hydramnios
Ketoacidosis
Hyperglycemia
Hypoglycemia
1 hour glucose test (OGTT)
negative <130-140 mg/dL
3 hour glucose (OGTT)
positive - have 2 or more:
fasting: >95
1 hour: >180
2 hour: >155
3 hour: >140
Gestational hypertension
Systolic >140 or Diastolic >90
2 occasions 4-6 hours apart, within 1 week
late postpartum eclampsia
>48 hours post-delivery (up to 4 weeks)
about 15% of cases of eclampsia
headache, blurred vision, SOB, edema, upper gastric pain
Reduced Cervical Competence (Recurrent Premature Dilation of the Cervix)
Conservative management
bed rest (perhaps), pelvic rest, progesterone, anti-inflammatory drugs, and antibiotics
Cervical cerclage
methotrexate
given for ectopic pregnancy
destroys rapidly dividing cells
chemo drug
-need to double flush
salpingectomy
surgical procedure for ruptured ectopic pregnancy - remove fallopian tube
salpingotomy
surgical procedure to remove just the ovum (fallopian tube spared)
placenta previa
placenta implanted in lower uterine segment near or over internal cervical oss
-marginal
-partial
-total
bright red bleeding and painless
expectant management (previa)
observation
bed rest
active management (previa)
cesarean
abruptio placentae
premature separation of placenta
-pain
-dark bleeding (if present)
-increase in fundal height
-high uterine baseline tone (no relaxation)
-hard, board like abdomen
-systemic signs of early hemorrhage
-persistent late decelerations
velamentous cord insertion
vessels can tear easily because no wharton's jelly protecting it
Associated with placenta previa and multiple gestation
Cord vessels branch at membranes and course onto placenta
Rupture of membranes or traction on cord may tear one or more fetal vessels
Fetus may rapidly bleed to death as a result
Preterm labor
cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy
Fetal fibronectin
glycoprotein present before 22 weeks and after 35 weeks
If absent, patient thought to not be in preterm labor
vaginal swab
preventing preterm labor
-progesterone (start at 20 weeks)
-activity restriction
-restrict sexual activity
tocolytics
afford opportunity to begin administering antenatal glucocorticoids
-mag sulfate (for fetal neuro protection)
-terbutaline (subQ, PO; asthma medication; relaxes uterine muscle)
-indomethacin 24-32 weeks, given for 72 hours
- nifedipine (32-34 weeks)
antenatal glucocorticoids
Single course of:
Betamethasone 12mg IM X 2, 24 hours apart
Dexamethasone 6mg IM X 4, 12 hours apart
-max benefit to baby 24 hours after injection
-only given once or twice
Inevitable preterm birth
labor has progressed to cervical dilation of 3-4 cm
-mag sulfate given
-malpresentation is common
-neonatal resuscitation
Premature rupture of membranes (PROM)
-rupture at least 1 hour before onset of labor at any gestational age
-infection is greatest risk
-labor will likely be induced (if term)
preterm premature rupture of membranes (PPROM)
Membranes rupture before completion of week 37, not in labor
Approximately 10% of all preterm births
Infection is a major risk factor
Pathologic weakening of the amniotic membranes
-Inflammation
-Stress from uterine contractions
Managed conservatively
-NST, BPP, Kick Counts, Monitor for Infection
-Usually hospitalized
Chorioamnionitis
Bacterial infection of the amniotic cavity
Ascending infection
Major cause of complications
1% to 5% of term births, 25% of preterm births
Clinical findings:
-Maternal fever
-Fetal tachycardia
-Uterine tenderness
-Foul odor of amniotic fluid
Treatment
-IV antibiotics: Ampicillin/PCN/Gentamycin
Hypertonic or primary dysfunctional labor
strong contractions but no labor progress
during latent phase
Hypotonic or secondary uterine inertia
during active phase
protracted active phase dilation
not dilating but in active labor
protracted descent
fetus is not descending into the pelvis
precipitous labor
labor lasts less than 3 hours
complications:
-placental abruption
-uterine tachysystole
--recent cocaine or amphetamine use
laminaria
dried seaweed sticks inserted into cervix that absorb water and dilate the cervix
to ripen cervix
balloon catheter
balloon is inserted past cervical os inflated to thin cervix from inside to outside
to ripen cervix
bishop score
dilation, effacement, fetal station, cervical consistency, cervical position
indicates whether to induce
montevideo units (MVUs)
how to calculate if contractions are strong enough
spontaneous labor usually begins when MVUs are between 80-120
need internal monitor
forceps-assisted birth
-indicated for prolonged 2nd stage of labor
-abnormal FHR
-abnormal presentations
-arrest of rotation
vacuum-assisted birth
Attachment of vacuum cup to fetal head, using negative pressure to assist birth of head
Prerequisites
Completely dilated cervix
Engaged head
Vertex presentation
Ruptured membranes
No suspicion of CPD
McRoberts maneuver
-for shoulder dystocia
-woman flexes thighs against abdomen
-flattens pelvic curve
suprapubic pressure
-for shoulder dystocia
-pushes the fetal anterior should downward to displace it from above the mother's symphysis pubis
Gaskin Maneuver
for shoulder dystocia
"All Fours"
Turn from supine to hands-and knees to relieve all weight-bearing on the sacrum Deliver the posterior shoulder and arm first following the curve of the pelvis axis
Zavanelli Maneuver
for shoulder dystocia
The fetal head is rotated to direct OA and flexed.
• Firm pressure is applied to the vertex as it is replaced into the vagina as far as possible.
• Tocolytic medication may be given and the delivery is accomplished by a Cesarean birth.
umbilical cord prolapse
Cord slips down after the membranes rupture and becomes compressed between the fetus and pelvis.
Key interventions
-Relieve pressure on the cord without compression of the blood vessels
-Expedite delivery
-give terbutaline
Risk Factors
-Ruptured membranes and fetal presenting part at high station
-Fetus that poorly fits pelvic inlet because of small size or abnormal presentation
-Excessive volume of amniotic fluid (hydramnios)
Erb-Duchenne paralysis (Erb palsy)
Brachial plexus injury d/t stretching or pulling (shoulder-head)
Paralysis of extremity, arm limp
Tx - passive ROM, positioning of affected arm, avoid stress on muscles
3 - 6 months to resolve
Hypoxic-Ischemic Brain Injury
Seizures, hypotonia, poor suck/swallow, apneic episodes
Treat symptoms, supportive care
signs of sepsis in baby
-temp instability
-feeding intolerance
-jaundice
-I/T ratio is important
I/T ratio (immature to total neutraphil ratio)
-if the IT ratio is greater than .2, there are more immature than mature neutrophils in the blood stream
-normal values can rule out sepsis
Indicrect Coomb's test
-for early jaundice in babies when mom is O+; screening test for Rh compatibility; if maternal titer for Rh antibodies is greater than 1:8, doppler study for determination of bilirubin in amniotic fluid is indicated to establish severity of fetal hemolytic anemia
Late Preterm Infants
Born between 34 0/7 and 36 6/7 weeks
Respiratory problems
Thermoregulation problems
Hypoglycemia
Hyperbilirubinemia
Feeding problems
Acidosis
Sepsis
Postterm Infant
Gestation that extends beyond 42 weeks
3.5% to 15% of pregnancies
Cause of delayed labor is unknown
Placental dysfunction
Significant increase in fetal and neonatal mortality
Current fetal distress
Increased risk for birth injuries - clavicle fracture, Erb's palsey
Appear thin with loose skin folds
Cracked, peeling skin
Meconium staining
Respiratory difficulties at birth
Hypoglycemia
Inadequate temperature regulation
Preterm Infant
Infants born before 37 weeks gestation
Immaturity of most organ systems
Actual cause unknown
Distinct characteristics
Small, scrawny
Large head
Translucent skin
Lanugo
Respiratory distress syndrome
Hyaline membrane disease
Surfactant
Absence of the alveolar stability
Prolonged hypoxemia
(chorionic villus sampling) CVS
10-13 weeks gestation
for genetic studies
(percutaneous umbilical blood sampling) PUBS
done of CVS is inconclusive or to ID a specific mutation
access to fetal blood
MSAFP (maternal serum alpha fetoprotein)
for id of neural tube defect
done between 15 and 20 weeks gestation
part of triple-marker screen and quad screen
Triple screen
-MSAFP
-unconjugated estriol
-hCG
tests for fetal chromosomal abnormalities (trisomy 18 and 21)
16-18 weeks gestation
Quad screen
-same as triple screen plus inhibin A
-better for women under 35 for detecting chromosomal abnormalities
-16-18 weeks
cell-free DNA (cfDNA)
-sample of maternal blood
-noninvasive prenatal testing
-fetal Rh status
-gender
-single gene disorders
-trisomies 18 and 21
-optimally done 10-12 weeks
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