High Risk Intra and Postpartum
- 1. High Risk Intrapartum and Postpartum
- 2. Malposition / Malpresentation Labor may not progress Occiput posterior most common malposition Assist with position change Counterpressure
- 3. Breech Complete Frank Footling External version Trial of labor (TOL)
- 4. Shoulder Dystocia Mc Roberts Maneuver Rubin technique
- 5. Dysfunctional labor Labor that does not proceed as expected Dystocia Eustocia
- 6. Hypertonic Contractions Frequent, intense, painful No fetal descent Latent phase Fetus R/F poor profusion Treatment with intact membranes Rest, hydration, sedatives Tocoylotics
- 7. Hypotonic Contractions Failure to progress Fewer than 2 contractions in a 10 minute span Active phase Treatment Augument labor : Pitocin Amniotomy Cervidil
- 8. Bishops Scale Determines inducibility Cervical dilation Cervical effacement Cervical consistency Fetal station Fetal position
- 9. Operative Vaginal births Forceps Instruments used to apply traction or rotation to a fetal head
- 10. Vacuum Assisted Birth Suction to deliver the head
- 11. Preterm Labor Labor that occurs before completion of the 37 th week of gestation PROM PPROM
- 12. Risk factors for Preterm Birth Multiple gestation Bacterial vaginosis Urinary tract infection Previous history Poor weight gain
- 13. Management Depends on the gestational age Terbutaline Magnesium Sulfate Celestone
- 14. Cord Prolapse Cord as the Presenting part Hidden Complete
- 15. Post term Pregnancy Greater than 42 weeks Associated with fetal morbidity and mortality Fetal risks Maternal risks
- 16. Cesarean section Classic – vertical incision Pfannensteil – horizontal incision Vertical uterine scar can lead to uterine rupture
- 20. Uterine Inversion The turning inside out of the uterus Complete inversion Incomplete inversion
- 21. Amniotic Fluid Embolism Amniotic fluid in the maternal circulation 80% maternal mortality rate Risk factors Signs and symptoms: respiratory distress, cyanosis, C-V collapse DIC
- 22. Precipitous Delivery Rapid or sudden delivery less than 3 hours Maternal risks: uterine rupture, lacerations, pp hemorrhage, AFE Fetal risks: hypoxia, intracranial hemorrhage
- 23. Placenta Accreta - superficial Placenta Increta – invasive Placenta Precreta – through the myometrium
- 25. Postpartum Hemorrhage Most common complication Early – first 24 hours Late – after 24 hours Uterine Atony
- 26. Risk factors for uterine atony Overdistention of the uterus Rapid or prolonged delivery Pitocin Retained placental tissue Distended bladder Uterine anamoly
- 27. Uterine Atony
- 28. Pathophysiology of hemorrhage Decrease venous return Decrease cardiac output Vasoconstriction Shock Acidosis Anoxia Death
- 29. Tissue Uterine contraction and relaxation will expel the placenta Placenta needs to be inspected to confirm intactness
- 30. Uterine Subinvolution Failure of the uterus to return to its nonpregnant state Large noncontracted uterus Backache Lochia ruba
- 31. Hematomas / Thrompophlebitis Injury to blood vessel Vagina and vulva Pressure discoloration visible Inflammation of vein Superficial Femoral Pelvic Can lead to pulmonary embolism
- 33. Puerperal Infection 100.4 Taken twice 6 hours apart on any two of the first 10 pp days excluding the first 24 hours GBS E Coli Chlamydia Staph
- 34. Urinary Tract Infection E Coli Lower – cystitis Upper – pyelonephritis Gantrisin
- 35. Mastitis Breast feeding moms Usually unilateral Staph aureus Axillary adenopathy
- 37. Postpartum Affective Disorders Blues Depression Psychosis
- 38. Fetal Death Demise Spaldings sign Grieving process
- 39. Knot in cord
- 40. Maceration