What is the first intervension for someone who has UC dysfunction?
- Could be cramping due to dehydration.
- Can also ambulate, distract, rest, etc.
- Rx is last resort.
What are some causes of maternal dystocia?
- Platypelloid/android pelvis
- HPV/Genital warts
- Any other fleshy obstruction to the vaginal canal.
What are some causes of fetal dystocia?
- Multiple feti (twins, trips, God forbid quads)
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.
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.
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!!!
Which tocolytic do you want to administer before attempting a version?
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
- Obtain a fetal scalp blood sample
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.
What are some maternal and fetal indications for foreceps delivery?
- Hear disease
- Acute pulomanary edema
- intrapartial infection
- prolonged 2nd stage
- Exhaustion (mom simply is incapable of more pushing.
- premature placental separation (abruptio placentae!)
- Non-reassuring fetal status)
What are the primary considerations when caring for a patient post c/s?
- 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.
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.
What are some factors leading to uterine atony?
- prolonge dlabor
- oxytocin augmentation
- intra-amniotic infection
- retained placenta
- placenta previa
- multiple gestation
- 1st line pph.
- Must dilute in 1000mL LR
- Prolonged admin-->antidiuretic and water toxicity
- Ergot derivitive
- CX for HTN
- Do not admin IV to v risk of sudden HTN
- Cx for cardiac, renal, or pulmonary dysfnxn.
- Do not admin IV
- 2000mcg max
- Few side effects
- Most commonly admin'd PR (rectal)
- Either vaginal or rectal admin
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
What are some causes of uterine rupture?
- Pervious incision
- Tachysystole or hypertonus
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.
What are the biggest risk factors for developing abnormal placental adherence?
What are the two main causes of late pph
- --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).
What are some early signs of alcohal withdrawl in the neonate?
- Poor suck
- Inconsolable crying
- Hyperactive w/ little interest in environment
- abd dinstension
What are some maternal risks for crack/cocaine use during pregnancy?
- pulmonary edema
- resp failure
- cardica problems
- spontaneous abortion, abruptio placentae (biggest) IUGR, pretuern birth, stillbirth
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
- --dilated pupils
What is the biggest concern with pregenstational type I DM?
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.
What is the screening method for determining GDM?
- screen at 24-28 weeks, earlier if high risk
- 50gm glucose test
- --draw blood in 1hr during which no eating, exercise, or smoking
- >135-->risk for GDM
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.
What are the risks associated with GDM?
- Macrosomiax2 risk preeclempsia
- RDS from delayed pulmonary maturation
- hypoglycemai within 1hr birth
What are additional concerns if pregestational diabetes?
- congenital heart anomolies
- pernatal loss, anomalies, and sudden unexplained stillbirth
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
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
What is criteria for diagnosing chronic HTN in pregnant mom?
- Present before pregnancy or up to 20 weeks gestation
- ^risk of developing pre/eclampsia
Risks of chronic HTN during pregnancy
- abruptio placentae
- pulmonary edema after delivery
- renal failure
- hypertensive encephalopathy
What should women with chronic HTN take if they want to breastfeed?
T/F women with HIV can breastfeed without risk to neonate.
- Virus passes in breastmilk
What increases risk of passing HIV to birthing child?
- ^ viral load
- ROM>4hrs prebirth
- **always test neonate at least 6mo after birth. Will always test positive before 6mo.
What are some maternal risks associated with HIV?
- pp nfxn
- v wound healing
- nfxn of genitourinary tract
Neonate risks associated with HIV?
- v birth weight
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.
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.