1. What is the first intervension for someone who has UC dysfunction?
    • Hydrate. 
    • Could be cramping due to dehydration. 
    • Can also ambulate, distract, rest, etc.
    • Rx is last resort. 
  2. What are some causes of maternal dystocia?
    • Platypelloid/android pelvis
    • FUPA
    • HPV/Genital warts
    • Any other fleshy obstruction to the vaginal canal. 
  3. What are some causes of fetal dystocia?
    • size
    • anomalies
    • CPD
    • Multiple feti (twins, trips, God forbid quads)
    • Malposition
    • Malpresentation
  4. What is always the biggest risk for malpositioned/breeched presentations?
    • Prolapsed cord.
    • Admin O2.
    • Get baby out quickly! May mean shoving head back in and running to OR.
  5. What do you do about shoulder dystocia?
    • Drop bed to Trundelburg's
    • place Mom in McBob's postion: knees bent and shoved way up towards chest. Hopefully this will roll pelvis bone over shoulder.
    • Can also apply suprapubic pressure to rotate shoulder medially to tuck it under the pupic bone.
    • May also break collar bone to deliver. Will reset very quickly after birth but will leave a lump in the bone. 
  6. What is the major symptom of placenta previa?
    • Painless vaginal bleeding, usually ~34ks.
    • may also present with contractions. 
    • NEVER do a SVE on pt with previa and/or vaginal bleeding!!!
  7. Which tocolytic do you want to administer before attempting a version?
    IV Nitroglycerine
  8. What is an amniotomy and why would you consider doing one?
    • Artificial rupture of fetal membrane (SOW)
    • To induce labor
    • augment labor
    • apply an internal FSE
    • IUPC
    • Obtain a fetal scalp blood sample
  9. Why would you consider an amnioinfusion?
    • Prevent variable decels
    • Treat variable deels
    • *Will not be effective if goal is to dilute meconium stained amniotic fluid. 
  10. What are some maternal and fetal indications for foreceps delivery?
    • Maternal:
    • Hear disease
    • Acute pulomanary edema
    • intrapartial infection
    • prolonged 2nd stage
    • Exhaustion (mom simply is incapable of more pushing.
    • Fetal:
    • premature placental separation (abruptio placentae!)
    • Non-reassuring fetal status)
  11. What are the primary considerations when caring for a patient post c/s?
    • Airway
    • tachycardia
    • hypotension
  12. Famotadine
    • Famotadine: H2 receptor antagonist. Inhibits gastric secretions. Used prophylactically to prevent stomach content aspiration during c/s.
    • Regalan: Dopamine antagonist. Antiemetic used during c/s and prophylactically for postop. 
    • Bicitra: Reduces stomach pH. 
  13. What are the indications for a VBAC?
    • One previous c/s birht and low transverse uterine incision
    • adequate pelvis
    • no other uterine scars or pervious uterine rupture
    • avaliable dr who can do c/s
    • in-house anesthesia personnel. 
  14. What are some factors leading to uterine atony?
    • prolonge dlabor
    • macrosomia
    • oxytocin augmentation
    • grandmultiparity
    • anesthesia/drugs
    • intra-amniotic infection
    • chroiamnionitis
    • asian/hispanic 
    • c/s
    • retained placenta
    • placenta previa
    • multiple gestation
    • hydramnios
    • tocolytics
  15. Oxytocin
    • 1st line pph.
    • Must dilute in 1000mL LR
    • Prolonged admin-->antidiuretic and water toxicity
  16. Methergine
    • Ergot derivitive
    • Vasoconstrictor
    • CX for HTN
    • Do not admin IV to v risk of sudden HTN
  17. Hemabate
    • Cx for cardiac, renal, or pulmonary dysfnxn.
    • Do not admin IV
    • 2000mcg max
  18. Misoprostil
    • Prostoglandin
    • Few side effects
    • Most commonly admin'd PR (rectal)
  19. Dinoprostone
    • Prostoglandin
    • Either vaginal or rectal admin
  20. What are some indications for locations of pp hematoma?
    • Typically present with peri pain
    • Rectal pressure if in posterior vaginal area
    • Diff urinating if in upper part of vagina
    • Pelvic pain if subperitoneal hematoma
    • All may-->shock if unidentified
  21. What are some causes of uterine rupture?
    • Pervious incision
    • Tachysystole or hypertonus
    • Trauma
  22. What are the SnSs of uterine rupture?
    • Severe abd pain
    • Changing uterine tone
    • fetal bradycardia
    • fetal station may suddenly change
    • Maternal n/v
    • maternal syncope
    • vaginal bleeding
    • Referred pain (possibly to shoulder)
    • maternal tachycardia and hypotension
    • palpation of fetus through  abd wall. 
  23. What are the biggest risk factors for developing abnormal placental adherence?
    • placenta previa 
    • c/s
  24. What are the two main causes of late pph
    • Subinvolution
    • --fundus remains high
    • --lochia fails to progress from rubra to serosa to alba
    • --usually because of retained placenta
    • --Tx with Methergine ~1wk.
    • Retained placental fragment
    • --D & C (debridement and curatage). 
  25. What are some early signs of alcohal withdrawl in the neonate?
    • Sleeplessness/jitteriness
    • Poor suck
    • Inconsolable crying
    • Hyperactive w/ little interest in environment
    • abd dinstension
    • seizures
  26. What are some maternal risks for crack/cocaine use during pregnancy?
    • seizures/hallucinations
    • pulmonary edema
    • resp failure
    • cardica problems
    • spontaneous abortion, abruptio placentae (biggest) IUGR, pretuern birth, stillbirth
  27. What are some fetal risks for maternal crack/cocaine use during pregnancy?
    • v birth weight and head circumference
    • diff feeding
    • if in breast milk
    • --extreme irritability
    • --v/d
    • --dilated pupils
    • --apnea
  28. What is the biggest concern with pregenstational type I DM?
    Diabetic ketoacidocis
  29. What is the effect of HPL on maternal insuline needs during pregnancy?
    HPL-->v insulin sensitivity in mom, so-->^ demand of insulin supply to x2-x4 pregrenancy needs. 
  30. What is the screening method for determining GDM?
    • screen at 24-28 weeks, earlier if high risk
    • 50gm glucose test
    • --random
    • --non-fasting
    • --draw blood in 1hr during which no eating, exercise, or smoking
    • >135-->risk for GDM
  31. What is the diagnostic test for diagnosing GDM?
    • 3 hr GTT with 2/4 results elevated
    • Done via overnight fast followed by 100gm glucose drink.
    • Draw blood at 0,1, 2, and 3 hr.
  32. What are the risks associated with GDM?
    • Macrosomia
    • x2 risk preeclempsia
    • RDS from delayed pulmonary maturation
    • hypoglycemai within 1hr birth
    • IUGR
  33. What are additional concerns if pregestational diabetes?
    • congenital heart anomolies
    • polyhydramnios
    • IUGR
    • ^nfxn
    • pernatal loss, anomalies, and sudden unexplained stillbirth
  34. What are some good pregestational DM teaching points?
    • establish good control before attempting conception because...
    • --x5 risk of heart and CNS anomolies
    • Help mom anticipate normal elevated insulin demands during pregnancy
    • HgbA1c is good indication of control
    • ADA diet
    • Nutrition, rational, and home monitoring
    • Suppliment with insulin if not entirely diet controlled
    • Monitor fetus with NST and ultrasound
    • PG more reliable than L:S ratio for determining fetal lung maturity
  35. Why is breastfeeding encouraged after delivery of the diabetic mother?
    • has an antidiabetic effect
    • lowers insulin needs to 1/2 of prepregnancy levels
    • v baby's risk of becoming diabetic
  36. What is criteria for diagnosing chronic HTN in pregnant mom?
    • >140/90
    • Present before pregnancy or up to 20 weeks gestation
    • ^risk of developing pre/eclampsia
  37. Risks of chronic HTN during pregnancy
    • abruptio placentae
    • pulmonary edema after delivery
    • renal failure
    • hypertensive encephalopathy
  38. What should women with chronic HTN take if they want to breastfeed?
  39. T/F women with HIV can breastfeed without risk to neonate.
    • F
    • Virus passes in breastmilk
  40. What increases risk of passing HIV to birthing child?
    • ^ viral load
    • chorioamnionitis
    • ROM>4hrs prebirth
    • Prematurity
    • breastfeeding
    • **always test neonate at least 6mo after birth. Will always test positive before 6mo. 
  41. What are some maternal risks associated with HIV?
    • hemorrhage
    • pp nfxn
    • v wound healing
    • nfxn of genitourinary tract
  42. Neonate risks associated with HIV?
    • premature
    • SGA
    • v birth weight
  43. what can you do for the neonate of an HIV pos mom?
    • standard precautions
    • antiretrovirals first 6wks
    • routine vaccines, but no OPV, MMR, or Varicella because they are live viruses.
    • No family members should get these either. 
  44. What are complications of PKU?
    • Toxic build up of phenylalanine
    • teratogenic-->microcephaly, mental retardation, cardiac defects
    • Mom must be on strick diet BEFORE and THROUGHOUT conception. Not much use to start diet afterward.
    • Subtle neuro, behavioral, and IQ effects if diet discontinued after age 6. 
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