OB procedures (unit 3)

Question 1

external cephalic version (ECV)

Answer 1

• manually change fetal position using abdominal manipulation
• 37-39 wks
• used to prevent C/S d/t breech

Question 2

contraindications for ECV

Answer 2

• previous C/S
• placenta previa (can’t deliver vag anyway)
• twins
• oligohydramnios
• uterine anomalies
• abruption/UPI

Question 3

risks r/t ECV

Answer 3

• umbilical tangle
• fetal hypoxia
• placental abruption
• Rh iso-immunization
• SROM

Question 4

labor induction

Answer 4

• artificial stimulation of labor when pt is not in labor

* medical OR elective

Question 5

labor augmentation

Answer 5

•artificial stimulation of labor when pt is IN labor, but not progressing appropriately

Question 6

indications for induction

Answer 6

•pre-eclampsia/PIH
•SROM at term
•maternal medical problems
•chorioamnionitis
•IUGR, post term, incompatibility
•IUFD
*NOT convenience

Question 7

elective induction for convenience

Answer 7

•not recommended, but done
•should be considered if 
-hx of rapid labor & far from hospital
-specialized neonatal care needed
-41 wks PG

Question 8

39 week rule

Answer 8

•no elective inductions prior to 39 wks GA b/c too many risks

Question 9

risks r/t induction

Answer 9

• hypertonic ctx
• placental abruption
• uterine rupture
• postpartum hemorrhage
• C/S

Question 10

natural induction

Answer 10

• breast/nipple stimulation
• sex
• acupuncture/pressure

Question 11

mechanical induction (cervical ripening)

Answer 11

• balloon cath
• laminaria tent
• osmotic dilators
• membrane stripping
• amniotomy (AROM)

Question 12

chemical induction

Answer 12

•nonhormonal
-herbs/oils
-enemas
•hormonal
-oxy
-prostaglandins
-misoprostol, mifepristone if goal is to soften cervix first

Question 13

pitocin

Answer 13

• synthetic form of oxytocin
• causes uterine ctx
• short t1/2
• lower dose needed in augmentation

Question 14

pitocin admin

Answer 14

•always mix IVPB
•always use pump
•attach as close to insertion site as possible
•start low and slow
-titrate until desired result

Question 15

tachysystole

Answer 15

•hyper stimulation of uterus
•ctx > 90 sec
• > 5 U ctx in 10 min
*causes late decel, abnormal FHR, loss of variability

Question 16

intrauterine resuscitation for tachystytole

Answer 16

• pt on side
• stop pit
• open main fld. line
• O2 @ 10L
• vag exam (r/o prolapse)
• have Brethine 0.25 mg SQ ready

Question 17

Brethine (Terbutaline)

Answer 17

• muscle relaxer

* relaxes uterus

Question 18

hemorrhage r/t Pitocin

Answer 18

•PP risk
•all receptors saturated so uterus can’t clamp down anymore
*uterine atony from Pit

Question 19

Bishop score

Answer 19

• estimates how successfully woman’s labor can be induced by determining if her cervix is favorable
• based on dilation, effacement, station, consistency, & postion

Question 20

readiness for induction

Answer 20

• Bishop score of 9+ for nullips

* 5+ for multip

Question 21

cervical ripening

Answer 21

•chemically/mechanically softened day before labor
•thins, allowing for successful induction
*do before inducing if have low Bishop score

Question 22

mechanical cervical ripening

Answer 22

• hydrophobic insertion
• attracts liquid, swelling and dilating cervix
• Laminaria/Lamicel
• takes 8-12 hrs

Question 23

chemical cervical ripening

Answer 23

• Cervidil (Dinoprostone)

* Cytotec

Question 24

amniotomy

Answer 24

•AROM
•induce/augment labor
•done only if fetal station low and cephalic fetus
*labor w/in 12-24 hr
*WONT shorten labor

Question 25

RN role amniotomy

Answer 25

•FHR •assess amniotic fld. (color, odor, amnt) •bedpan if have to urinate *excessive fld indicates poly and high station

Question 26

risks r/t amniotomy

Answer 26

* cord prolapse * infection (fetal tachy) * abruptio placenta

Question 27

DONT let woman ambulate if...

Answer 27

•ROM and high fetal station | *should not perform amniotomy if head not well-applied to cervix

Question 28

forceps/vacuum extraction

Answer 28

•operative vaginal delivery that provides traction and aids in descent/rotation of fetus in 2nd stage *can't use for preterm

Question 29

indications for operative vaginal delivery

Answer 29

* maternal exhaustion * inadequate pushing * cardiac/pulmonary dz * fetal HRN abnormality if can't do C/S fast enough * breech (get head out)

Question 30

maternal risks r/t operative vaginal delivery

Answer 30

* bladder injury * cervical laceration * vaginal laceration/hematoma

Question 31

fetal risks r/t operative vaginal delivery

Answer 31

* facial/scalp abrasion/asymm * nerve injury * cephalohematoma * intracranial hemorrhage * scalp edema (caput) * shoulder dystocia

Question 32

RN role episiotomy

Answer 32

* ice * monitor infection * NEVER give enema/suppository * PO stool softeners

Question 33

indications for C/S

Answer 33

* placental abnormality * PIH * dysfxnl labor * herpes/HIV * IDDM * previous C/S * cord prolapse * fetal distress * breech presentation * multip

Question 34

C/S contraindications

Answer 34

*if risk to mom > than baby •IUFD •clotting dz •fetal dz incompatible w/ life

Question 35

maternal risks r/t C/S

Answer 35

* infection * hemorrhage * bladder/organ damage * DVT * paralytic ileus * psychological

Question 36

fetal risks r/t C/S

Answer 36

* TTN r/t retaining lung fld. * injury * respiratory distress

Question 37

C/S incision types

Answer 37

* low transverse (preferred) * low vertical * classical (high vertical)

Question 38

when is classical C/S incision employed

Answer 38

``` •very premature •placenta previa •emergency birth •morbid obesity *shouldn't labor in subsequent PG ```

Question 39

vaginal birth after C/S

Answer 39

* only if was LTCS * only if 1 prior C/S * induce w/ Pit * have anesthesia and MD ready