Download Obstetric Emergencies: Cord Prolapse, VBAC, and Fetal Heart Rate Decels and more Cheat Sheet Nursing in PDF only on Docsity!
OB Final Exam Review
Prolapsed Cord- (OB EMERGENCY) - the fetus is not affixed to the cervix, the fetus is
still ballotable (bounce the baby), the mother should be put into hands and knee position/knees to chest, call for help, take mom to OR for emergency c/s, and the mother will be placed on her back, with the nurse under the drapes to keep the presenting part off of the cord. The cord presents ahead of the fetus. If there is an epidural placed, the mom cannot get onto her hands and knees, so Trendelenburg would be used.
Placenta Previa- OB EMERGENCY!! The placenta implants into the lower uterine segment
and either partially covers the cervix or completely covers the cervix. As the cervix opens, the placenta begins to rip, no dilation for this mother. No vaginal exams! Hemorrhage is the biggest concern regarding, there is also risk for death due to preterm birth. Anesthesia complications may arise, IUGR due to poor placental exchange, fetal anomalies, and abnormal placental attachment. 3 types: accreta, increta, perceta (worst one). Causes ; c/s, advanced maternal age >35, history of multiparity, smoking, and history of prior suction curettage. This is more common with women carrying male fetuses (larger placentas). Total (Complete)- cover the entire cervical opening, do not want pushing. c/s needed. Partial- partially covering the cervix, c/s needed. Marginal- slightly covering the cervical opening. S/S: painless, bright red vaginal bleeding after 20 weeks of gestation, non-tender, soft, relaxed uterus, FHR is normal unless placenta is detaching, and VS of mom are normal unless underlying issue. A transabdominal ultrasound is performed followed by a transvaginal scan. This is normally taken care of with an emergency c/s. Treatment: <36 weeks = bedrest, observation, IV, type/screen, always considered a high risk pregnancy. <34 weeks will need betamethasone for lung maturity. Should deliver at a level 3 NICU and emotional support will be needed for the mother.
Placental abruption- OB EMERGENCY!! When the placenta prematurely separates from
the uterus. Can be partial, complete, or concealed. “Baby drowns in the blood” May see tachysystole. Worry for hemorrhage and hypovolemic shock. Worries for babies are IUGR, preterm birth, survival rate, and risk for SIDS (Smoking increases the risk for SIDS).. 50% fetal mortality rate. Causes; maternal hypertension, cocaine, smoking, history of other abruptions, blunt trauma, car accident, or from domestic violence. This also can occur in twin gestations.
Concealed = External = emergency c/s. S/S: dark red vaginal bleeding, rigid abdomen, abdominal pain (severe pain), uterine tenderness, contractions, board like abdomen, and pain mild-severe. Could have maternal hypovolemia (shock, oliguria, anuria) coagulopathy. Mild-severe uterine hypotonicity = board like abdomen.
Shoulder Dystocia- (OB Emergency!) shoulder of the baby is caught behind the pubic
bone of the mother. Turtle sign is a dead give away! McRoberts maneuver is the
preferred position for moms. Nurses should apply supra pubic pressure, NEVER apply
fundal pressure. The baby should be delivered vaginally as soon as the anterior shoulder
is released.
Uterine Rupture- (OB Emergency) Life-threatening OB injury. This is a disruption of
all the layers of the uterus NOT caused by surgery. IUPC is used to monitor this.
Always known as a high risk pregnancy. More than 50% of the time the baby dies if
there is a uterine rupture.
● Causes; TOL for VBAC, uterine scar (not on the skin), several c/s,
induced/augmented labor, multifetal gestation, and macrosomia. If the uterine
scar is up and down, the mother will never be able to deliver vaginally. Bikini
cut is A-okay.
● S/S: abnormal FHR tracing (could be absent FHR), loss of fetal station, constant
abdominal pain, uterine tenderness, change in uterine shape, cessation of
contractions, hypovolemic shock from hemorrhage , and fetal parts may be
palpable through the abdomen.
● Treatment; prevention is the best treatment, c/s, no labor, no pitocin, no
vaginal birth. Observe for tachysystole. Postpartum = observe for excessive
bleeding, especially if the fundus is firm but hemorrhagic shock is present.
C-Section- could be done for anything, even by mothers request. There are anesthesia
and surgical risks present.
● Complications; harm to other adjacent organs, infection, and surgery. Wet lungs
may cause the baby to have RDS.
Accelerations- abrupt (onset to peak less than 30 seconds) increase in FHR above the
baseline rate. The peak is at least 15 beats/min above baseline and the acceleration lasts 15 seconds or more, with the return to baseline less than 2 minutes from the start of the acceleration.
Serosa- pinkish-brown, 4-10 days , contents include; blood, wound exudate, RBC’s, WBC’s, trophoblastic tissue debris, cervical mucus, and microorganisms. Alba- whitish-yellow, 10-14 days and can last 3-6 weeks, contents include; WBC’s and trophoblastic tissue debris. B- Breasts U- Uterus B- Bladder B- Bowel L- Lochia E- Episiotomy H- Holman’s Sign E- Emotions
Postpartum Hemorrhage- (OB EMERGENCY) from leftover placental fragments or the
mother is tired from pitocin making the uterine contract (causes boggy fundus). Massage the fundus!!! Can go into DIC. Leading cause of maternal morbidity and mortality, this normally has little warning. Diagnosis is based on observations. Primary cause is uterine atony!!! Meds include; pitocin, methergine, hemabate, and cytotec. May need a D&C. Vaginal birth = 500 mL C/S = 1000 mL
DIC- (disseminated intravascular coagulation) pathologic form of clotting which is diffuse
and consumes large amounts of clotting factors. NEVER a primary diagnosis. Results from an event that triggers overactivation of the clotting cascade. Also triggered by large amounts of thromboplastin, abruption (most common cause), severe preeclampsia, HELLP syndrome, or a dead fetus. DIC results in; clotting, bleeding, and ischemia & is an OB EMERGENCY!!!! S/S; spontaneous bleeding from gums/nose, oozing from venipuncture sites, petechiae, signs of bruising, hematuria, GI bleeding, tachycardia, and diaphoresis. Treatment; observe s/s of bleeding, monitor urinary output since RF can occur, foley catheter, and frequent vital sign checks. Will normally stay in L&D for close monitoring and care. Platelets = decreased Fibrinogen = decreased Factor V and V111 = decreased
PT = prolonged PTT = prolonged FDP = increased D-dimer = increased
HELLP Syndrome- This stands for H- hemolysis, EL- elevated liver enzymes, and LP-
low platelets. This occurs in 0.5-0.9% of all pregnancies and 10-20% of women with preeclampsia and severe features develop this. Clinical manifestations tend to be non-specific.
Uterine Atony - can lead to pp hemorrhage, if the uterus is deviated to the right or left
encourage the patient to void. Massage the uterus to firm, peppermint oil in the bed pan, pouring water over the perineum. Straight cath the patient and check the fundus for firmness.
Hyperbilirubinemia- An increase in the total serum bilirubin levels of the blood. This can
cause jaundice, which is a yellow discoloration of the skin, mucous membranes, sclera, and various organs.
Physiologic Jaundice- o ccurs in over 60% of infants and is more common in preterm infants.
Appears on the 2nd-3rd^ day of life. This usually reaches its peak of 10-12mg by the 5th^ or 6th^ day of life and then slowly levels begin to decline. This can cause an immature liver and a slower metabolic process.
Pathologic Jaundice- WORSE!! causes Rh and ABO incompatibilities, maternal infections,
and maternal diabetes. This can lead to acute bilirubin encephalopathy or kernicterus. This is rare but does occur and deserves further testing/investigation. The serum bilirubin will be >5 in the cord blood. This can occur within the first 24 hours of life.
Phototherapy- purpose is to reduce the level of circulating unconjugated bilirubin or keep it
from increasing. This breakdown increases gastric motility. The nurse should closely monitor urinary output as an indication of hydration, and monitoring stools is also important. Stools that are loose can cause skin breakdown. Close the infant's eye before applying a mask for phototherapy. When feeding the mask should be taken off and the baby should be taken out of the isolette. Phototherapy lights are also known as blue lights and bili blankets can also be used.
Rh Incompatibility- the Indirect Coombs test is done on the mother during pregnancy and
after birth. If the test is negative this indicates that sensitization has not occurred, so during pregnancy the woman is given Rhogam (twice in total). The Coombs test is also done on the cord blood of the baby. (RH- baby with RH+ mom =okay , Mom- Baby +is a big risk ) blood test would be done during pregnany and mom will be given RhoGam
NICU Babies- lights, noise, talking outside of their isolette is very stressful for the
newborn. This causes the baby to burn calories which can prolong improvement. Every
caution is made to protect the baby from environmental stressors. Do not slam port holes,
decibels from 90-120 can cause hearing damage or loss.
PDA (patent ductus arterious) - left to right shunt, that is diagnosed and corrected during infancy. Complications include a VSD, endocarditis, and pulmonary emboli. treatment is surgery. ASD (artrial septal defect) - abnormal opening (hole) between the atria, left to right shunt, and one of the most common congenital defects during pregnancy. The 3 issues include; an incompetent foramen-ovale (most common), improper development of the septum primum, and left to right shunting occurs. VSD - ventricular septal defect. VSD is an abnormal opening between the right and left ventricles, causing a left-to-right shunt. This is usually diagnosed and corrected early in life. This may occur as a single lesion or a combination with other cardiac anomalies, such as Tetralogy of Fallot. Women with large VSDs may be at a higher risk for; arrhythmias, heart failure, and pulmonary hypertension. ROP (retinopathy of prematurity) - multicausal disorder that affects the developing retinal vessels of preterm infants. Maturity of these vessels do not occur until 42-43 weeks. The cause is too high of O2 and prematurity. This can lead to blindness. Surgical interventions, cryotherapy, and photocoagulation.
Breastfeeding- latch, colostrum, timing on each breast, how do you know the baby is
getting enough? 5 mins on each breast and then rotate. A baby does not need a whole lot,
feeds every 2-3 hours or feeds on demand. Lips are flanged, open for the correct latch.
No clicking sound, only swallowing. Maybe uncomfortable, the baby pulls to get the
milk.
- Complications; sore nipples. Use cabbage leaves, self-expression, feed the
infant more, and ice. Breast shields can be used.
Neonatal Hypoglycemia Causes Interventions Surfactant Magnesium sulfate: Preeclampsia Eclampsia Risks for PPD Hx. of PPD Hx. Of major depressive episode Life Stress Lack of social support
Unmarried Intimate Partner Violence Causes & Symptoms Biologic, psychologic, situational or multifactorial Estrogen fluctuations Pervasive sadness and mood swings Newborn Complications Apical pulse rate Care immediately after delivery Apgar scoring Medications given after birth Medications given if narcotics given to mother Complications of newborns Cyanosis Newborn Cephalahematoma-what is it, what is it caused from, what are the risks? Charting Caput Succeedum –charting, what is this, what caused from, what are the risks? PDA-Patent Ductus Arteriosus Describe Treatment ROP-Retinopathy of Prematurity Describe Causes-O Hypertensive Disorders
