ch. 10 notes

  1. hypertonic uterine contractions
    • -painful
    • -most often occur in first time mothers
    • -contractions are ineffectual, erratic, uncoordinated, and of poor quality that involve only a portion of the uterus
    • -increase in frequency of contractions, but intensity is decreased, do not bring about dilation and effacement of the cervix

    -prolonged latent phase, stays at 2-3 cm
  2. trebutiline
    used to reduce high uterine tone
  3. hypotonic uterine contractions
    • -overstretching of the uterus, large baby, multiple babies, polyhydramnios, multiple parity
    • -bowel or bladder distention preventing descent
    • -excessive use of analgesia

    -prolonged active phase, little or no cervical change
  4. amniotomy
    the artificial rupture of the amniotic sac with a tool called the amniohook or amnicot

    • advantages of doing this before pitocin:
    • -contractions are more similar to those of spontaneous labor
    • -usually no risk of rupture of the uterus
    • -does not require as close surveillance

    • disadvantages
    • -delivery must occur, increase danger of prolapse of umbilical cord, infection, fetal decelerations
  5. cervical ripening
    devices inserted through the vagina and into the cervix to dilate the cervix

    • -prostaglandin E2 medications
    • -prepidil gel
    • -cervidil

    • -prostaglandin E1 medications
    • -cytotec
  6. stripping of the membranes
    digital separation of the chorionic membrane from the wall of the cervix and lower uterine segment during a vaginal exam done by primary care provider to stimulate labor.
  7. augmentation
    ineffective contractions that need to become more effective
  8. pitocin
    • assess to make sure CPD is not present
    • -give 10 units/1000cc fluid and hang as secondary infusion, never as primary
  9. inadequate expulsive forces
    occurs in the second stage of labor when the woman is not able to push or bear down

    • -fetal asphyxia (no o2)
    • -maternal exhaustion
    • -possible c/section
  10. precipitous labor
    • labor that lasts less than 3 hours from the onset of labor to birth
    • -high risk of hemorrhage
    • -rapid and intense labor
    • -fetus at risk for CNS depression (hypoxia)
  11. fetal dystocia-pelvic dystocia
    • -problems of passenger/passageway
    • -large fetal size (macrosomia)
    • -malpresentation
    • -position
    • -multiples
    • -fetal anomalies
    • -size and shape of maternal pelvis
    • -quality of contractions
  12. cephalopelvic disproportion (CPD)
    large baby or small pelvis, usually diagnosed when there is an arrest in descent, station remains the same doesnt progress
  13. external version procedure
    • -lots of risks
    • -moving baby around
    • -fetus can not be engaged
    • -a reactive NST
    • -36 plus weeks of gestation
    • -administer terbutaline prior
    • -administer rhogam is mother is rh neg.
  14. forceps-assisted delivery
    risks: facial edema or lacerations, caput succedaneum (molding) or cephalohematoma (bleeding)

    maternal: lacerations of birth canal, perineal bleeding, bruising, edema, bladder trauma

  15. vacuum extraction
    advantages: easier application, no anesthesia, less maternal tissue damage, fewer fetal injuries

    disadvantages: cephalohematoma or caput succedaneum

  16. VBAC
    vaginal birth after cesarean
  17. post term pregnancy
    greater than 42 weeks
  18. obstetrical emergencies-shoulder dystocia
    • mcroberts maneuver
    • -problems delivering the shoulders after the head
    • -turtle sign
  19. prolapse of the umbilical cord
    when the cord lies below the presenting part of the fetus
  20. occult prolapse
    when the cord is palpated through the membranes but does not drop into the vagina
  21. rupture of the uterus
    partial or complete tear in the uterine muscle
  22. disseminated intravascular coagulation (DIC)
    syndrome that occurs when the body is breaking down blood clots faster than it can form a clot, thus the body quickly depletes itself of clotting factors leading to hemorrhage
  23. amniotic fluid embolism
    • rate, fetal complication
    • can occur during pregnancy, L&D, PP
    • amniotic fluid enters the maternal vascular system and initiates a cascading process which lease to cardio respiratory collapse and DIC
  24. retained placenta
    • retention of placenta beyond 30 mins
    • bleeding may be excessive
    • manual removal
  25. lacerations
    • 1: perineal skin and vaginal mucosa (skid mark)
    • 2: through fascia (little deeper than paper cut)
    • 3: through the muscle
    • 4: extends through the rectum
Card Set
ch. 10 notes