Abnormal implantation causes bleeding in the third trimester of pregnancy as the cervix begins to dilate/efface. What is the COCA assessment for lochia? What is placental abruption? When does preeclampsia become HELLP syndrome? What can placenta previa cause?

What can placenta previa cause?

Refrain from performing vaginal exams/inserting anything into the vagina; may exacerbate bleeding. What are contraindicated interventions for placenta previa? What are common complaints by patients experiencing placental abruption? What are delivery options in UCP? What is tissue in PPH? How can we treat it?

What are contraindicated interventions for placenta previa?

HTN with the presence of proteinuria What are the two classifications used to move from gestational HTN to preeclampsia? What is thrombin in PPH? How can we treat it? What should be done if there is a positive one hour GTT? What is tissue in PPH? How can we treat it?

What are the two classifications used to move from gestational HTN to preeclampsia?

Transition occurs when there is hepatic dysfunction & hematologic effects caused by the preeclampsia. What are delivery options in UCP? What therapeutic communication can we provide for mom diagnosed with GDM? When does preeclampsia become HELLP syndrome? What is lochia rubra?

When does preeclampsia become HELLP syndrome?

Hemolysis (anemia/jaundice) Elevated liver enzymes (ALT/AST, RUQ pain, & N/V) Low platelets (thrombocytopenia) resulting in abnormal bleeding/clotting. What should be done if there is a positive one hour GTT? What are mechanisms to promote uterine involution? What is HELLP syndrome broken down? What should we tell mothers about exercise in pregnancy?

What is HELLP syndrome broken down?

Labs; CBC, ALT, C-reactive protein What are risk factors for PP endometritis, mastitis, & infections? How is HELLP syndrome diagnosed? Why would we use an IUPC? What should be done if there is a positive one hour GTT?

How is HELLP syndrome diagnosed?

Labetalol, Hydralazine, Nifedipine, & Methyldopa. AVOID ACEI's & ARBS. What is mastitis? How can it be treated? What medications can we use to treat HTN in preeclampsia? What is lochia alba? What are interventions for shoulder dystocia?

What medications can we use to treat HTN in preeclampsia?

OB EXAM TWO

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Medicine - Obstetrics

user_kumartyv Created by 9 mon ago

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Placenta is covering the cervical os instead of attaching to the fundus.

Abnormal implantation causes bleeding in the third trimester of pregnancy as the cervix begins to dilate/efface.

Refrain from performing vaginal exams/inserting anything into the vagina; may exacerbate bleeding.

HHHBSR; Headache, heartburn, hyperreflexia, blurred vision, sudden weight gain (fluid retention), & RUQ pain (liver)

HTN with the presence of proteinuria

Transition occurs when there is hepatic dysfunction & hematologic effects caused by the preeclampsia.

Hemolysis (anemia/jaundice) Elevated liver enzymes (ALT/AST, RUQ pain, & N/V) Low platelets (thrombocytopenia) resulting in abnormal bleeding/clotting.

Labs; CBC, ALT, C-reactive protein

Dipstick urine testing (>0.4) & 24hr urine collection for proteinuria & Cr clearance. Assessments for fetal well-being.

Labetalol, Hydralazine, Nifedipine, & Methyldopa. AVOID ACEI's & ARBS.

CNS depressant used to avoid seizures; give 4-6 grams over 20 mins. HAVE CALCIUM GLUCONATE ON HAND.

LOC, respirations, BP, reflexes, & I/Os.

Seizure precautions, maintain airway, & give mag sulfate.

One hour GTT should be less than 130-140.

2 or more values should be met/exceeded; Fasting (95mg/dl) 1hr (180mg/dl) 2hr (155mg/dl) 3hr (140mg/dl)

Check 3 hour GTT & HgbA1C.

Discussing feelings, how this could affect her & baby, support network, etc.

Healthy diet, exercise, medications, follow diabetic diet/carb counting, self-administration of insulin, checking own blood sugars, & continuous appointments for A1C, etc.

When the placenta detaches from the uterus before the baby has been delivered.

Hypovolemic shock (pale skin, dizziness, LOC, low BP, weak pulse) & uterus firm/contracted before delivery. - DIC, increased H/H, & fetal distress.

Hard/board-like abdomen, tenderness, & painful dark red bleeding.

Betamethasone; used to enhance fetal lung maturity & surfactant production in fetuses.

Uterine contractions (may last for 1hr or longer), menstrual cramping, low backache, urinary frequency, changes in vaginal discharge, PROM, & changes in cervical dilation.

The cord is lying below the presenting part of the fetus, this results in cord compression & compromised fetal circulation.

Rupture of membranes, malpresentation, transverse lie, SGA, long umbilical cord, multifetal pregnancy, negative station, or hydramnios.

Cervical check for cord placement (may visualize cord hanging out), FHR may show variable/prolonged deceleration, & fetal activity may cease.

Insert two fingers and apply pressure to either side of the cord on the fetal presenting part to elevate off the cord; hold until delivery.

Place client into knee to chest or Trendelenburg position. Sterile-saline soaked towel over cord, administer oxygen, & IV fluid bolus.

Rush to c-section.

McRobert's maneuver; knees pulled back almost touching face - Opens up the hips

Head is born but anterior shoulder cannot pass under pubic arch.

obesity, diabetes, macrosomia, & hx of prior shoulder dystocia

Prostaglandin/Cytotec (Misoprostol) & Cervidil - Gel/suppositories used to soften the cervix to make it more receptive to labor induction methods.

Oxytocin/Pitocin - Used to stimulate contractions

Determines maternal readiness for labor

Operative delivery, retained placenta, traumatic injury, hematomas, PP hemorrhage, improper aseptic technique, bad peri care, & amnioinfusion.

Fever, increased HR, foul smelling lochia, pain/tenderness, warmth, swelling, pus drainage, chills, backache, & HA.

Bleeding from delivery through Day 4; - Bright red, heavy flow blood, w/ small to medium blood clots.

Day 4-10; - Pinkish brown, less blood, more discharge, & fewer clots.

Up to 6 weeks; - Yellow/white, little blood, some discharge, & no clots.

Fundal height should decrease by 1cm every 24 hours; - Fundus should be right above the umbilicus post-delivery & at the pubic bone by day 7.

Assessing for redness, edema, ecchymosis, discharge, & approximation (edges).

Ice packs, peri-bottles, pain medication, sitz bath, witch hazel pads, & tub soaks. - Ice for first 24hrs and then heat.

PP oxytocin & breastfeeding

Strict bed rest, elevate the extremities, apply heat, give analgesics, anticoagulants, antibiotics, & TED stockings.

Weight blood-soaked items (peri pad) on scale; subtract dry weight of item from wet weight for total blood loss. Check fluid at bucket under bed before placenta is delivered and then after. - 1ml blood = 1g blood

Loss of more than 500ml in vaginal birth or 1000ml in c-section; - Decrease in HCT 10% or more from baseline, changes in maternal HR/BP/O2 saturation.

Assess/massage the fundus!! Stop bleeding, give IV fluids & blood products.

Uterine atony (boggy uterus/soft); - Fundal massage, medications & empty bladder.

Damages to the genital structure during birth; - Apply pressure & stitch lacerations.

Retainment of placental fragments; - Ensure placenta comes out completely intact & remove tissue ASAP

Blood clotting condition; causes DIC which increases bleeding risk by stopping the clotting process of blood. - Give blood products.

Place mom in lateral position, increase IVF, elevate moms legs, & supply oxygen 8-10L via mask.

Assess maternal temperature & attempt to control. Give mom medications to lower fetal HR.

Color, odor, consistency, & amount

Pitocin, methergine, Hem abate, & Cytotec.

Inflammation of the tissue around the milk ducts; can be nursed through and treated with antibiotics.

Movements/positioning, medications, distractions, heat, & therapeutic touch.

Encourage her to push, follow provider directions, labor coaching.

No more than 5 contractions every 10 minutes.

To assess strength of contractions.

You can still workout but stay safe! May need modifications.

Have the client empty the bladder or perform emptying. Fundus may be off midline and unable to contract normally due to full bladder.

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OB EXAM TWO

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