OB Exam #4: Childbirth at Risk II

what is defined as >2000 mL amniotic fluid or an AFI over 25, occurs in 2% of all pregnancies, and is associated with fetal anomalies?
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what is defined as >2000 mL amniotic fluid or an AFI over 25, occurs in 2% of all pregnancies, and is associated with fetal anomalies?
polyhydramnios
what is the highest risk of polyhydramnios?
prolapsed cord
what condition can end up in preterm birth/dysfunction labor, is due to issues with the baby kidneys and baby cannot swallow and regulate so there are CNS issues involved also and may be associated with diabetes since women who have hyperglycemia give the excess sugar to the baby and therefore the baby has polyuria due to the sugar?
polyhydramnios
nursing assessments for what condition includes disproportionate fundal height increases, difficulty palpating fetus/auscultating FHR (depending on the volume and what the contents are), and Assist with AFI?
polyhydramnios
what may the result of polyhydramnios be due to overstitching of the uterus, and prolapsed cord since amniotic sac may break and umbilical cord comes down first before the baby's head?
preterm delivery
nursing management for what condition includes maternal dyspnea and pain (harder to breath since volume takes up all this space and this is expected), and no AROM with amnihook, consider alternative methods (can cause uncontrollable gush and head descent so cord prolapse risk and would want to use a tinier hook or even use the FSE to make a small tear or even an amniocentesis to remove some fluid)?
polyhydramnios
what medication causes decreased fetal fluid and therefore will not be given long term because of the risk of oligohydramnios?
Inducin
what condition of the pregnant mother is described as less than 500 mL of amniotic fluid or AFI less than 5, 5-8% of all pregnancies, associated with prevention of urine production or collection in amniotic sac and may be caused by post term GA (towards 42 weeks the placenta gets calcified and is not as efficient anymore), IUGR/placental insufficiency kidney issue of the baby), or fetal renal malformations?
oligohydramnios
what is more common or frequent than the other?
A. polyhydramnios
B. oligohydramnios
oligohydramnios
the result of what condition includes fetal adhesions/impaired movement (less fluid to protect the baby so restricted movement and due to prolonged entrapped position), cord vulnerability (may be compressed due to no cushion), and pulmonary hypoplasia (lungs are not being cleaned out and lubricated - underdeveloped lungs at the time of delivery)?
oligohydramnios
the nursing assessment of what condition includes fundal height being less than expected for GA (at 20 weeks it should be at the umbilicus for reference and so that is 20 cm - for normal healthy functional pregnant woman), NST/BPP/continuous EFM, observe for signs of cord compression (variable decels), and assist with AFI?oligohydramniosthe nursing management for what condition includes amnioinfusion possible in labor (not a long term thing but only to provide extra fluid only during late stages of labor for extra cushion), intrauterine resuscitation PRN (reposition, IV fluid bolus, and O2), and possible induction for IOL (this condition is one of the reasons we would induce labor)?oligohydramnioswhat is known as abnormal or difficult labor and consists of problems with powers?dystociawhat is the term used for a slower than normal rate of dilation and descent during labor and is a problem with the powers of the uterus?protracted laborwhat is the term used for a stopped labor and no progression in dilation or descent is happening and is a problem with the powers of the uterus?arrest laborwhat two types of uterine dysfunctions are under the problems of powers of protracted vs. arrest?hypertonic and hypotonic uterine dysfunctionwhat is the term used for a very quick labor and is a problem with the powers of the uterus?precipitate labordystocia problems with the what include OP malposition, face/brow and breech presentation, shoulder dystocia, multifetal pregnancy, and cephalopelvic disproportion (CPD)?problems with the passengerdystocia problems with the passageway includes what?cephalopelvic disproportion (CPD)what is much like the heart and is like a contracting conductor and tells the uterus to contract as one giant unit and maximizes efficiency of the effort and makes the muscle work as a team and this is why toco is on the fundus and how we track the production of UCs throughout the muscle and radiates the entire uterus and works together and relaxes together?uterine pacemakerwhat type of uterine dysfunction involves the presentation/cause being the uterus failing to relax between UCs >1 uterine pacemaker, and clinical manifestations are uncoordinated, ineffectual, and painful UCs?hypertonic Uterine dysfunctionwhat type of uterine dysfunction involves the presentation/cause being weak UCs that become milder due to an overstretched uterus and clinical manifestations are UCs with weak intensity, unable to dilate/efface cervix?hypotonic uterine dysfunctionwhat type of uterine dysfunction has an occurrence of labor of prolonged latent phase and the nursing management therapeutic rest with pain management?hypertonic uterine dysfuncitonwhat type of uterine dysfunction has an occurrence of labor of prolonged active phase and the nursing management is to assess CPD cause and if not then proceed with augmentation with AROM/Pitocin?hypotonic uterine dysfunctionwhat type of uterine dysfunction has complications of increased fatigue/stress to the mother and baby and increased risk for PPH, and atony?both hypertonic and hypotonic uterine dysfunctionwhat type of uterine dysfunction has the uterus not being able to relax due to multiple pace makers and so even though you have a conductor contracting one area, you have another conductor telling the uterus to contract in another area?hypertonic uterine disruptionwhat type of uterine dysfunction has the uterus weakly contract and never gets strong enough for cervical change and may be due to overstretched uterus, large baby or polyhydramnios, or twins or a number of reasons that lead to a bad labor, and may make initial changes in the uterus but will not get strong enough o get through the active phase?hypotonic uterine disruptionwhat phase of labor is prolonged in hypertonic uterine disruption?latent phasewhat phase of labor is prolonged in hypotonic uterine disruption?active phasewhat term describes the entire labor and birth within 3 hours - happens too fast, everything happens super quick, can be even quicker than 3 hours?precipitate labor and birththe causes for what includes very soft tissue or low muscle tone (low resistance of soft tissue), abnormally strong uterine contractions, used to have a baby in the past or even recently?precipitate labor and birthhow many cm/hour does a primigravida complete for a precipitate labor and birth?5 cm+how many cm/hour does a multigravida possibly complete for a precipitate labor and birth?10 cm (all the stages within this time frame)what has no danger to it and no complications associated but can be scary to go through due to no control of body (no slow or controlled pushing) and can be intense and very fast and may involve some stress not he baby but nothing to concerning?precipitate labor and birthmaternal risks for what include very few if patient has adequate passageway and anxiety/fear; perineal laceration risk; uterine rupture possible; hemorrhage risk and fetal-nonatal risk of non-reassuring FHR d/t intense UCs (some stress), and head trauma?precipitate labor and birthclinical therapy for what includes obtaining history prenatally; possible IOL, stay calm, stay with patient, call out for help (don't leave her), support the perineum, and dry off baby, stimulate?precipitate labor and birthclinical therapy for what includes does not happen for first time moms, if this is already happening when you first encounter the patient then do your best to stay calm, talk through things carefully, stay in control, call out for assistance (nice to know there is more help coming), do not leave the patient, offer induction in a controlled sense if they are a candidate for quick delivery?precipitate labor and birthclinical therapy for what includes supporting the perineum to avoid the tearing, taking the baby and keeping them warm and crying, letting them snuggle with the mom, don't worry about cutting the cord, as the baby starts to come out, ease the baby as much as possible, support the perineum and reinforce it so tissue can stretch and accommodate, downward motion and upward motion, dry off baby and place on chest, if placenta delivers then tie off the cord but usually don't worry?precipitate labor and birthwhat are the two priorities in a precipitate labor and birth?keeping mom calm and making sure baby is crying and dry/warmwhat is an obstetric emergency and occurs when the head comes out but the shoulders are stuck in the vagina and is the most stressful spot for the baby - compression from everywhere so cord compression risk (problem is with passenger and passageway)?shoulder dystociathe two complications of what are brachial plexus injury and fractured clavicle?shoulder dystociathe clinical therapy for what is identifying macrosomia before labor onset or if the birthing person has a small passageway (identifying who is at risk for this)?shoulder dystociawhich one of the maneuvers for shoulder dystocia is described as laying the patient flat on there back and bringing their legs back as far onto the abdomen as they can so that the pelvic outlet is opened up just a bit more to have extra wiggle space to come out?McRoberts maneuverwhich one fo the maneuvers for shoulder dystocia is described as trying to push and reduce the shoulder, basically punching the patient in the stomach (not really), point is to condense the shoulder to get them through the pubic been and get them out; THIS IS NOT FUNDAL PRESSURE; pushing on the funds would push the baby farther into the bone which is bad and makes it worse?suprapubic pressurewhich one fo the maneuvers for shoulder dystocia is described as the provider at the perineum and hooking their finger under the baby's armpit twisting them like a cork screw out of the perineum and is usually a combination of all three maneuver's to get the baby out?Rubin's/Wood's screw maneuverwhat does the nurse begin to do when head dystocia is apparent and is done to get a sense of how long this baby is in this bad position for (to monitor how long the baby is not getting O2 - clock ticks and all maneuvers are done)?calling out 30 second incrementsclinical therapy for what includes hands/knees position, episiotomy (emergent case and if the baby is truly stuck then this will make extra room and may be helpful for getting the baby out), elective clavicular fracture (clavicle may break sometimes, take a look at baby closely when they come out make sure there is no crepitus and no feeling of fracture with the clavicle and if there is then only cast them with safety pin so they do not move the arm around), and zanvenelli maneuver (pushing baby back in for C/S)?shoulder dystociawhat complication of shoulder dystocia includes possible nerve damage and is shown when the baby is moving but not moving one arm quiet as much and we worry about this?brachial plexus injurynursing care for what includes observing for dysfunctional labor pattern or pushing issues ("turtling"), and prepare for extra staff/neonatal team to be at delivery?shoulder dystociawhat is the term used when the mother gives a good push and the head stays in one place and head keeps going out then back in to where it was before - mismatch of something and something is wrong - need extra bodies so the NICU team (possibly a difficult delivery)?turtlingwhich one fo the maneuvers for shoulder dystocia is described as pushing the head back in to perform a C/S instead of a vaginal delivery?Zanvenelli maneuvernursing care for what includes NB assessment for clavicle fracture or signs of brachial plexus injury, and fundal checks and assessment for signs of PPH (lots of manipulation on the uterus so must check for all of this)?shoulder dystociaa patient is in the second stage of labor for 3 hours, the patient is pushing with good effort but the head retracts between pushes, the patient is a G1 P0000, EDC = date/month, EGA is 41 1/7 weeks, type 2 DM, EFW 4300 gm, and FHR is 130, minimal variability, early decels noted, Pitocin infusing at 12 mu/min and pt is in good spirits but fatigues, what high risk condition is the patient at risk experiencing? A. oligohydramnios B. precipitate labor C. shoulder dystocia D. uterine ruptureCfor shoulder dystocia, what plan of care fo you recommend? A. Flex the thighs back and lower the patient's head B. Sterile speculum exam C. SVE to maintain upward pressure on the fetal head D. RhoGAM PRN E. Pediatrics team for neonatal rescuscitation F. Assessment for loss of fetal station G. Perform suprafundal pressure H. assess baby for clavicular/brachial plexus injury I. assist with emergency C/SA, E, H, & Iwhat is the term used for pregnancy that extends beyond 42 completed weeks?post-term pregnancymaternal risk for what include IOL, FAVD/VAVD, perineal damage, hemorrhage, and C/S, and for fetal-neonatal risks it includes decreased uteroplacental circulation, oligohydramnios, macrosomia, and meconium-stained fluid?post-term pregnancyclinical therapy for post-term pregnancy includes an NST/BPP and an IOL in which week GA because after delivery starts to become more difficult?41st weekfor what would we have to induce labor for and the concern is the size of the baby, placenta not being as fresh anymore and not as vascular for the baby anymore (some clots may form and no good perfusion), oligohydramnios (placenta coming out), meconium (baby is mature and ready to be outside - body functioning normally)?post-term pregnancywhat is known as the narrowing in any part of the passageway (bony pelvis or sift tissue) (due to inlet and outlet contractors) and also may be due to excessive fetal size for pelvis?Cephalopelvic Disproportion (CPD)The implications (results) for what are prolonged labor and uterine rupture and is when the passenger and passage way does not work together (mismatch), and it is important to try and measure ahead of time (measure conjugates and different angles since we will have idea of how big the outlet and size is and how big the parameters are)?Cephalopelvic Disproportion (CPD)the nursing management for what includes fetopelvic relationships (pelvimetry and estimated weight of the fetus), borderline diameters (trial of labor vs. decision for C/S), EFM for signs of fetal distress, and repositioning during labor to change pelvic angles (making as much room as we possibly can and look for malpositions)?Cephalopelvic Disproportion (CPD)what is the term that describes the umbilical cord preceding the fetal presenting part; presenting part not firmly against the cervix and cord is trapped between presenting part and the maternal pelvic?umbilical cord prolapsewhat complication can occur due to umbilical cord prolapse which results in persistent variable decelerations progressing to prolonged/terminal deceleration?cord compressionthe risk is higher for what when the presenting part does not fill the pelvic outlet completely and example of this would be a breech or premature baby (too small) - more room for the cord to come out and more worried for these patients since it is easier for the cord to come out before the babies?umbilical cord prolapsewhat is known as a true emergency and results with an ultimate cord compression, cannot push it back once it comes out, only option is to have an emergency C/S, may see mini variables but then relived but ultimately will result in prolonged decelerations?umbilical cord prolapseonce you find what then you want to keep the head and body off of the cord and the nurses job would be to make sure you keep the head pushed up and off the cord to give enough time for perfusion to the baby so we can go to an emergency C/S, your hand will remain in the patient the entire time until the delivery through C/S is initiated by the surgeon and he relieves you - this will allow perfusion for the baby?umbilical cord prolapsethe prevention for what is that the presenting part is well engaged - minimal risk and after AROM, FHR, bedrest is possible (EFM: variable to prolonged decelerations)?umbilical cord prolapseafter what occurs it is considered an emergency and it is important to remain calm, explain the situation to the patient (case where it is okay to not explain everything in the moment and wait until afterwards), SVE maintained upward pressure on presenting part, off of the cord, emergency C/S will be done and notify anesthesia and NICU team immediately and woman should be on her side knees to chest?umbilical cord prolapseto prevent what condition you should know the risks which include breech or small baby, making sure the presenting part is well engaged and settled into the pelvis and fills up that pelvic outlet before assisted rupture, and it is possible to get SROM if presenting part is not well engaged but not a likely occurrence?umbilical cord prolapsethe patient is C/O increasing contraction pain, despite laboring with epidural and bleeding is noted on the crux pad, and the patient is G2 P0101, EDC = date/month, EGA is 40 0/7 weeks, prior classical C/S at 25 weeks GA, and FHR is 140, minimal variability, late decelerations noted and SVE at 0900 6/80/0, and SVE at 1300 6/90/-3. what high risk condition is the patient at risk of experiencing? A. oligohydramnios B. shoulder dystocia C. uterine rupture D. cord prolapseC. uterine rupturefor uterine rupture, what plan of care do you recommend? (select all that apply) A. Flex the thighs back and lower the patient's head B. Sterile speculum exam C. SVE to maintain upward pressure on the fetal head D. RhoGAM PRN E. Pediatrics team for neonatal rescuscitation F. Assessment for loss of fetal station G. Perform suprafundal pressure H. assess baby for clavicular/brachial plexus injury I. assist with emergency C/SE, F, & Iwhat is known as the nonsurgical disruption of the uterine cavity and women are at risk if they had incisional pain with prior C/S?uterine rupturewhat type of uterine rupture involves the endometrium, myometrium, and serosa separated?completewhat type of uterine rupture involves only some of the layers of the uterus and hangs on by a window of uterine layers?incompletethe risk factors for what condition of the mother includes previous uterine incision (C/S, or a myomectomy), classical C/S scar, abdominal trauma, and operative vaginal delivery (extra manipulating with forceps and vacuum)/uterine manipulation?uterine ruptureif the patient has an epidural and they are completely fine and pain free but then all of a sudden they get breakthrough pain, what does this indicate a risk for?uterine rupturecomplications fo what condition include maternal hemorrhage or pain/uterine tenderness and fetal-neontal Anemia/hypoxia or fetal demise?uterine ruptureclinical therapy of women with what condition includes non-reassuring FHR notes, loss of fetal station, and only diagnosed via surgical incision?uterine rupturewhat is described as loss of fetal station due to baby thinking they have found another exit but there is no other way that baby can go backwards in station and the only way is they try and find another exit to come out of which is not really an exit and lodges self in pelvis therefore the head will be higher than it was before?uterine ruptureclinical therapy for what condition includes vaginal bleeding can occur so monitor pad count/weight loss (weight of the pad) and preparations for emergency C/S birth is needed so the pediatrics team for neonatal resuscitation will be needed (nurse assist in this) and we will hopefully be able to intervene fast enough to get them out quickly?uterine rupture