OB Exam #4: Childbirth at Risk I

what is known as painless dilation of the cervix WITHOUT UCs due to a structural/functional defect of the cervix?
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what procedure sow's the fat structure of the cervix shut and goes in like a purse string, the length of the cervix is what is being sown (at the neck)?cerclage procedureIn a cerclage procedure, what are the three things that are examined for and if these result it is considered an emergency and may result in a 5-7 day hospitalization or longer?- SROM - Infection - UCsthe sutures for a cerclage procedure are cut at how many weeks GA (or onset of labor) for vaginal brith since there is no a longer a need to keep the baby in utero and keep the pregnancy going?37 weekswhat is known as the occurrence of regular UCs with cervical dilation and effacement between before 37 weeks and statistics should that it is highest for black infants (around 11-13% of preterm labor for the population)?preterm labor (PTL)what is estimated to be $30 billion per year and compared to the medical cost of healthy babies which is $4,389, medical costs for these babies are $54,194 and contraction frequency alone is not a diagnosis for this?Preterm labor (PTL)the diagnosis of what include at least 1 cm dilated/80% effaced with regular UCs which are 4 UCs Q 20 minutes or 8/hour and <2.5 cm cervical length (by TVUS) greater risk of delivery <35 weeks?preterm labor (PTL)what does TVUS stand for?transVaginal UltraSoundwhat is considered as regular UCs?4 UCs Q 20 min OR 8 Q1 hrhow many % effaced should the cervix be to be considered PTL? how many cm should the cervix be dilated for PTL?- 80% effaced - 1 cm dilatedone day in utero is worth how many days in the NICU?3 daysless than how many cm cervical change (by TVUS) is there a greater risk of delivery <35 weeks?<2.5 cmthe three risk factors for what condition is having a history of this in the past, you are pregnant with multiples (twins, triplets, etc. - biggest concern is not making it full term), and issues with the cervix/uterus - incompetent cervix or cervical insufficiency - non-contracting problem but can turn into preterm labor - funky anatomy?preterm labor (PTL)although the exact cause is unknown, what are the three big risk factors of preterm labor?1. history of PTL 2. pregnant with multiples 3. issues with cervix or uterusprompt diagnosis is difficult as symptoms are common in normal pregnancy but they include abdominal pain/contractions, 'menstrual cramps', low, dull backache, pelvic pain/pressure, vaginal bleeding/discharge, urinary frequency (UTI - irritable ecosystem - inflammation and infection - tweaked environment - contractions begin), N/V and diarrhea?preterm labor (PTL)complications of what condition is a delivery and systemic maturational deficiencies in the neonate?preterm labor (PTL)what must the patient do if she is less than 37 weeks GA and she experiences one of the 6 symptoms of preterm labor which are: abdominal pain, dull backache, pelvic pain/pressure, vaginal discharge/bleeding, UTI (urine frequency), and N/V/D?contact the doctorfor PTL, what type of prevention includes screening for h/o PTLor S/S through cervical length and fetal fibronectin (fFN)?primary preventionfor PTL, what type of prevention includes diagnosis and treatment of infections, presence of cervical cerclage, and progesterone injections in the second semester which promotes uterine relaxation?primary preventionwhat is given to a patient for primary prevention of PTL to promote uterine relaxation?progesterone injectionswhat type of prevention includes looking out for people who are at risk for PTL, risk or history, any signs and symptoms, testing for fetobribronectin, testing of vaginal secretions?primary preventionif what is present in your body (in the vaginal secretions) it is a possible indication that you will deliver early and if negative then we are reassured that delivery will not happen in the next 2 weeks?fibrobnectinwhat type of prevention for PTL is a tocolytic drug therapy (medications to inhibit UCs), and BMZ steroids?secondary preventionthe goal of what in PTL clinical therapy secondary prevention is to delay birth by 48 hours to maximize benefits of steroids - any longer would be ideal- or transport to a facility with a NICU?tocolysiswhat medication therapy stops/inhibits UCs?tocolyticskwhat medications therapy for secondary prevention of PTL is given at 24-34 weeks for patients at risk and given a total of 2 doses Q24 hours, 12 mg IM to take effects since it needs 24 hours to be effective since it decreases likelihood of prematurity associated with RDS (accelerates the maturity of the baby's lungs, less complications occur when they are out) and transport to a facility with a NICU afterwards?betamethasone (BMZ)at how many weeks GA (range) is BMZ given for a secondary prevention for PTL?24-34 weekswhat does MINT medication management stand for?- Magnesium - Indocin - Nifedipine - terbutalinewhat type of MINT medical management which is used for PTL prevention is a beta-adrenergic agonist (stimulates the sympathetic nervous system), smooth muscle relaxer, IV, IM, SQ, PO (most frequent is SQ)?Trebutaline (Brethine)what type of MINT medical management which is used for PTL prevention can cause maternal hypotension, tachycardia, palpitations, and hyperglycemia?terbutaline (Brethine)what type of MINT medical management which is used for PTL prevention displaces intracellular Ca++, thus inhibits ICs, and is infused via IV?magnesium sulfatewhat type of MINT medical management which is used for PTL prevention has side effects of flushing, feeling warm, headache, nausea, dry mouth, dizziness, and lethargy?magnesium sulfatewhat type of MINT medical management which is used for PTL prevention is used in preeclampsia for central nervous depression and seizure prevention, and smooth muscle relating for uterine relaxation and used in tocolysis, and it stops the calcium from filling up muscular cells - will not contract as strong as it usually would?magnesium sulfatewhat type of MINT medical management which is used for PTL prevention can actually help prevent cerebral palsy in babies - neuroprotective for the baby should you deliver early and calms the uterus (tocolytic for PTL)?magnesium sulfatewhat type of MINT medical management which is used for PTL prevention is a calcium channel blocker and decreases Ca++ into the myometrium to inhibit UCs and is PO?Nifedipine (Procardia)what type of MINT medical management which is used for PTL prevention includes the side effects of arterial dilation, facial flushing, hypotension, tachycardia, and Headache (HA)?Nifedipine (Procardia)what type of MINT medical management which is used for PTL prevention is a prostaglandin synthetase inhibitor (blocks prostaglandins which increases contractility making tissues more twitchy) and is an NSAID which is taken PO?Indocin (Indomethacin)what type of MINT medical management which is used for PTL prevention do fetal effects include oligohydramnios (decreases fetal urination) (caution with this if patient already has oligo issue and check AFI before use!!), premature closure of ductus arterioles with prolonged use (prostaglandins keep it open but inhibited with this drug) (risks may be too high and benefits may start to decrease)?indocin (Indomethacin)Indocin (Indomethacin) is not recommended after how many weeks GA or for longer than how many hours since it is a blocker of prostaglandins?- 34 weeks - 48 hoursfor what type of MINT medical management which is used for PTL prevention do we have to check the AFI for before we administer it?indocin (Indomethacin)for what condition does health promotion education include S/S of infection and this condition, and UC self evaluation (put hands on belly and notice tightening) and making sure they call provider if they have UCs or loss of fluid?preterm labor (PTL)for what condition does hospital care include promoting rest, VS, FHR with UC, decrease anxiety, arrange consults if requested, A LOT of information is given about the NICU, and finally the outcomes, so if this information overload causes a lot of anxiety instead of relieving it then consults should be avoided?preterm labor (PTL)what is known as the spontaneous rupture before labor onset any time after 37 completed weeks; before contractions start, full term and broken bag of water before going into labor (contractions)?premature rupture of membranes (PROM)what is known as a rupture of membranes for longer than 24 hours before brith (onset of contractions/cervical change)?prolonged ROMwhat is known as the spontaneous rupture of membranes before 37 weeks (making sure we keep a patient pregnant for as long as possible if ruptured and not yet in term)?preterm premature rupture of membranes (PPROM)for what condition do causes/risk factors go hand in hand and include bleeding/abruption (clot and weak spot), infection (can weaken membrane and rupture), tiny abruption (can be very slow and insidious), prior PPROM, incompetent cervix (funneling of membrane into the wedge), and smokingpremature rupture of membranes (PROM)the complications for what include infection (chorioamnionitis and endometritis) and abruption placenta (more frequent with this - infection may cause this premature separation or bleeding episodes can contribute to weakening of membranes) in the birthing person?Preterm premature rupture of membranes (PPROM)the complications for what include premature delivery, neonatal infection (sepsis), and oligohydramnios (which can cause fetal pulmonary hypoplasia, fetal growth restriction and limb position defects) for the fetus?preterm premature rupture of membranes (PPROM)what does PPROM stand for?preterm premature rupture of membraneswhat complications of PPROM is described as less water for the fetus, worried for lung development (fluid helps with movement of the baby but also helps with maturing the lungs, swallowing it helps lubricate the lungs), and also worried about fetal growth restriction and limb position defects?oligohydramniosthe assessment for what includes TACO and duration, gestational age (how we can manage them and keep them pregnant a bit longer but infection indicates when to stop and how long we go with this) and signs of infection?rupture of membraneswhat clinical therapy of ROM tests for pooling of amniotic fluid, is done by the nurse and assesses for ROM, includes nitrazine testing of the fluid (pH paper used when swabbing fluid and checks the pH - the presence of amniotic fluid would turn the paper blue or darker indicating alkali pH) and microscopic examination - ferning (looking for snowflakes after taking a swab and looking at it under the microscope)?sterile speculum examsterile speculum exam, amnisure and fetal well-being (EFM) are tests done to confirm what?rupture of membranesfor what condition does management include monitoring for S/S of labor onset and infection, if no evidence of infection then conservative management and home care if stable and if evidence of infection the antibiotics and delivery is indicated?preterm premature ROMfor PPROM management, if there is no evidence of what then conservative management and home care if stable (keeping patient pregnant - can go several weeks while ruptured) is indicated?infectionfor PPROM management, if there is evidence of what and contractions then antibiotics and delivery are indicated?infectionwhat are generally not indicated for PPROM if there are contractions and an infection?tocolyticswhat management is given at 24-34 weeks if there is PPROM and needs 48 hours for the full effect?corticosteroids: Betamethasone or dexamethasonefor a patient who is at a high risk condition of preterm labor, what plan of care do you recommend? (select all that apply) A. TACO Assessment B. Cervical cerclage C. Betamethasone 12 mg IM, Q 24 hours x 2 doses D. sterile speculum exam E. nitrazine testing F. RhoGAM PRN G. Plan for C/S H. Type and cross x2 units J. Indocin (Indomethacin) K. Nifedipine (Procardia)C, J, & Kfor a patient who is C/O cramping and backache for 5 hours, and urinary frequency, no bleeding is notes and BOWI, + Fetal Movement (FM) at 1200, and she is a G3 P0111 (delivery experience prior to 20 weeks), EDC = date/month, EGA 28 4/7 weeks, no significant medical or surgical history, and FHR is 155 with moderate variability, UCs are Q 5-8 minutes, SVE 2/2/-2, and UA appears cloudy and positive leukocyte esterase, what high risk condition is this patient experiencing? A. PTL B. PPROM C. Cervical Insufficiency D. Placenta AccretaAwhat term is used for two ova (fraternal) in the uterus?dizygoticwhat term is used for one ovum (identical twins)?monozygoticwhat terms are used for monozygotes having two separate outer bags, separate placentas and separate inner bags?dichorionic/diamnioticwhat terms are used for monozygotes using one placenta but having two different bags?monochorionic/diamnioticwhat terms are used for mono zygotes using one placenta and one bag (both babies in one)?monochorionic/monoamnioticthese make up 33.7/1000 live births and some implications for what are overstretched uterus (PTL, dysfunctional labor, PPH) (double the placenta and volume and hormones), gestational diabetes, Hypertension (more volume), maternal anemia, and preterm PROM (may break due to pressure)?multiple gestation (twins)what is the number one thing we want to prevent in multiple gestation and early and frequent prenatal care will be important to prevent this and US will be crucial to care?preterm labor/birthwhat baby is closest to the exit or lower presenting part? A. Baby A B. Baby Bbaby Afor multiple gestation, if baby A and B are vertex/vertex or vertex/breech then possible for what type of delivery? what is preferred since it is easier to guide the baby down? why?- vaginal delivery - vertex/breech - more work for mom in a vertex/vertex positionin what position do both babies have to be in a multiple gestation for a C/S?breech/breechwhat positions of the babies in a multiple position is less common and is at 20% instead of 40%? what two scenarios of the babies are more common?- baby A in breech position and baby B in vertex position - vertex/vertex or vertex/breechthe hospital care for what includes IV, anesthesia consult highly recommended, type and cross (increased risk for PPH), EFM (label them well), birth method: vaginal and C/S (includes possible maternal complications, and fetal position), pediatric teams for delivery, and placentas being examined?multiple gestationpainless bleeding is involved in what? A. placenta previa B. placental abruption C. bothAbright red bleeding is involved in what? A. placenta previa B. placental abruption C. bothAprior uterine scar risk factor is involved in what? A. placenta previa B. placental abruption C. bothAsoft relaxed uterus is involved in what? A. placenta previa B. placental abruption C. bothARhoGAM PRN is involved in what? A. placenta previa B. placental abruption C. bothCC/S likely is involved in what? A. placenta previa B. placental abruption C. bothCtype and cross match is involved in what? A. placenta previa B. placental abruption C. bothCdark red bleeding is involved in what? A. placenta previa B. placental abruption C. bothBpainful bleeding is involved in what? A. placenta previa B. placental abruption C. bothBmaternal HTN risk factor is involved in what? A. placenta previa B. placental abruption C. bothBfrequent UCs/rigid uterus is involved in what? A. placenta previa B. placental abruption C. bothBwhat condition involves the placenta being improperly implanted in the lower uterine segment, placental villi torn from uterine wall with UCs?placenta previawhat condition involves the patient presenting with painless, bright red vaginal bleeding, always visible, then more perfuse, fetal heart rate usually in normal range and fetal presentation may be breech or transverse lie; engagement is absent?placenta previathe risk factors for what condition include previous incidence of this condition, multiparty, prior C/S or uterine surgery, recent spontaneous/induced abortion, and large placenta?placenta previafor what conditions are there four types of incidence which include low-lying, marginal, partial and complete?placenta previawhat condition includes insidious fresh blood escaping from the uterus, no pain occurring, no contractions for bleeding to get started, less than ideal places for implantation of placenta, prior scars prevent embryo from bedding down into more ideal area (all areas are used up), and large placenta may increase risk?placenta previaclinical therapy for what condition includes assessing the amount of bleeding, history (different bleeding episodes throughout the pregnancy), and cause of bleeding (No SVE - can make it worse so assess safely; US possible)?placenta previafor placenta previa, expectant management if less than how many weeks GA and bleeding stable for what condition includes (observation and make sure they resolve) bed rest with bathroom privileges, VS and IV/labs/type and cross-match (possible blood products), if expecting delivery then BMZ if <34 weeks, RhoGAM if Rh negative?37 weeksfor placenta previa, if more than how many weeks then clinical therapy includes monitoring bleeding, delivery when indicated (do not wait to prolong pregnancy) and C/S PRN r/t placenta placement?37 weeksless than how many weeks is the mother when BMZ is given as clinical therapy for placenta previa?<34 weekswhat condition is the premature separation go the placenta from the uterine wall after 20 weeks, prior to birth (before the baby is out and still in utero), caused by (#1 cause and ideology) decreased blood flow/degenerative changes in placental vessels -> retroplacental clots or possible vessel rupture -> separation?abruption placentaethe risk factors for what condition are maternal HTN, trauma (MVC or blood force), uterine over-distention, PPROM, cocaine abuse, chorioamnionitis, and presents with severely painful (often contractions happen at the same time) and dark red bleeding (higher location and there are clots)?abruption placentaethe classifications of what condition includes partial or complete (we may or may not see some bleeding depending on the site of detachment) (if the center of the placenta is detached then bleeding and clots are trapped, but if separation occurs on the edges then the blood will escape), concealed or apparent, and grade 1-3 depending on the severity (depends on how much tissue is detached and how much bleeding is involved)?abruption placentaethe three complications of what condition include the birthing persona and depending on the severity of the bleed and time between separation and birth it includes dissemnated intravascular coagulation (DIC), shock resulting from moderate to severe hemorrhage, and possible hysterectomy?abruption placentaewhat complication of abruptio placentae is described as large amounts of clotting factors are used up at the placental site?dissemnated intravascular coagulation (DIC)for what condition do complications include complications from prematurity, anemia and hypoxia (chronic) for the fetus and possible mortality with greater placental separation?abruptio placentaewhat condition has a sudden onset, can be concealed or visible, dark blood, content uterine tenderness and palpation, firm to rigid tone, fetal distress or absent, and no relationship of fetal presentation?abruptio placentaecoagulation tests in what complication of abruption placentae include fibrinogen and platelets being decreased and PT/PTT being prolonged?Disseminated Intravascular Coagulation (DIC)what condition happens in a chronic or a emergency sense, can happen in a small setting, tiny clots will occur and still be considered this disorder (there is a range of how severe this condition is) and clinical therapy includes maintaining CV status of birthing person with hemodynamic monitoring (VS, and volume management), monitor urine output, labs, IV (16G or 18G) x2, and type cross (whole blood, cry, FFP) (blood products PRN) and EFM for uterine pattern (no break in between UCs)?abruptio placentaebirthing method for what condition depends on the maternal/fetal condition and involves fluid replacement, Rh-neg, RhoGAM PRN, NSVD, and emergency C/S?abruptio placentaefor what condition are the uterine patterns continuous with no breaks in between, needing to figure out what separation is caused by, why it is so painful, often moves towards delivery and is often a C/S, if complete separation then vaginal is possible but C/S is still more common?abruptio placentaewhat placental problem occurs more than 30 minutes after brith (did not spontaneously deliver), and involves increased risk with a succenturiate placenta (one or more accessory lobes), normal amount of placenta but extra lobe hanging out int he uterus, PPH risk, and manual extraction or curettage is indicated?retained placentawhat placental problem is an issue that involves the chorionic villi attaching directly to the myometrium of the uterus instead of attaching to the endometrial lining of the uterus, and the risk for this is previous C/S or myomectomy, and finally theres is possible PPH (due to amount of bleeding during detachment) and failure of placental separation which may require a hysterectomy?placenta accretewhat placental problem is when the placenta grows into the muscle of the uterus (myometrium) and is not just attached to it?placenta incretawhat placental problem is when the placenta grows through the muscle and can attach to other organs in the body but mainly the abdominal cavity; will need surgery?placenta percreta