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Comprehensive information on three obstetrics emergencies: prolapsed cord, vaginal birth after cesarean section (vbac), and fetal heart rate decelerations. It covers causes, symptoms, treatment, and potential complications for each emergency. The document also discusses the importance of prevention and close monitoring in managing these situations.
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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.
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.
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.
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
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
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
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.
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.
cause jaundice, which is a yellow discoloration of the skin, mucous membranes, sclera, and various organs.
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.
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.
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.
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
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.
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