Term
| 3. Identify the risk of uterine rupture for a woman with one previous low-transverse incision attempting a VBAC |
|
Definition
|
|
Term
| 4. Identify the short and long term benefits and harms to the mother of attempted VBAC versus elective repeat cesarean delivery. |
|
Definition
a. Avoiding major abdominal surgery
b. lower rate of hemorrhage
c. infection
d. shorter recovery period
e. If considering more children, could avoid multiple c/s and those complications such as hysterectomy, bowel or bladder injury, transfusion, infection, abnormal placentation such as placenta previa or placenta accreta.
f. Lower rate of severe morbidity and mortality (per BBC)
g. lower rate of moderate mortality
h. lower rate of amniotic fluid embolism |
|
|
Term
| 5. Identify the short and long term benefits and harms to the baby of attempted VBAC versus elective repeat cesarean delivery. |
|
Definition
| a. Decreased respiratory morbidity, transient tachypnea, and hyperbilirubinemia |
|
|
Term
| 6. Know the ACOG recommendations for use of oxytocin and prostaglandins in women with a history of cesarean section. |
|
Definition
| prostaglandins are contraindicated; foley balloon and oxytocin ok to use |
|
|
Term
| define a complete uterine rupture |
|
Definition
● All layers of uterine wall are separated
● Mortality/morbidity greater with this rupture |
|
|
Term
| define an incomplete uterine rupture |
|
Definition
● Uterine muscle is separated but visceral peritoneum is intact
● Also referred to as uterine dehiscence |
|
|
Term
| 2. Recognize risk factors for uterine rupture. |
|
Definition
● Previous C/S, most common cause is separation of a previous C/S scar
● Trauma
● Preexisting injury or anomaly
● Previous curettage, perforation or myomectomy
● Excessive or inappropriate uterine stimulation with oxytocin (uncommon)
● High parity
● Difficult birth; forceps usage
● Malpresentation
● Fetal anomaly
● Induction of labor (suspected association)
● History of placenta increta, percreta
● Previous invasive molar pregnancy
● Obstructed labor
● Previous rupture
● Internal version
● External version
● Uterine overdistension (hydramnios, multifetal pregnancy)
● Breech birth
● Difficult removal of placenta
● Intra-amnionic installation
● Perforation by IUPC
● Vigorous uterine pressure during delivery |
|
|
Term
| 3. Discuss maternal and fetal signs and symptoms of uterine rupture. |
|
Definition
● Maternal hypovolemia
● Maternal chest pain (from diaphragmatic irritation)
● Bradycardia
● Fetal distress
● Abnormal fetal heart tracing
● Failure to progress
● Pain (however can be little appreciable pain or tenderness)
● Vaginal bleeding
● MOST COMMON: NRFHT WITH VARIABLE HEART RATE DECELERATIONS THAT MAY EVOLVE INTO LATE DECELS, BRADYCARDIA OR DEATH |
|
|
Term
| 4. Describe emergency management of uterine rupture. |
|
Definition
● Presenting signs often nonspecific
● Urgent delivery indicated (usually means a C/S)
● Uterine rupture diagnosed during surgery and surgical correction initiated
● Adequate IV access
● Arrange for blood transfusion
● Notify NICU team for newborn
● Prognosis dismal if rupture and expulsion of fetus into peritoneal cavity
● Fetal condition depends on degree of rupture
● Maternal death uncommon
● Hysterectomy may be needed to control hemorrhage |
|
|
Term
| 1. Define uterine inversion. |
|
Definition
| ● Expulsion of uterus through the vagina |
|
|
Term
| what risk are associated with uterine inversion? |
|
Definition
| ● Risk for PPH and DIC is high |
|
|
Term
| 2. Identify causes of uterine inversion. |
|
Definition
strong traction on umbilical cord attached to placenta implanted in fundus
-can also be caused by accreta |
|
|
Term
| 3. Discuss signs and symptoms of uterine inversion. |
|
Definition
● Maternal shock; most common symptom -- occurs quickly!!!
● Hemorrhage |
|
|
Term
| 4. Describe emergency management of uterine inversion. |
|
Definition
● Inform nurse of diagnosis
● Explain to woman what is going on
● Request emergency OB and anesthesiology consults
● Attempt to reposition uterus, if unsuccessful -- surgical intervention
● Do not remove placenta if still attached
● Woman into Trendelenburg
● IV access
● Discontinue uterotonics
● Evaluate for signs of shock
● Type and cross, initial PPH protocol if needed |
|
|
Term
| 1. Define postpartum hemorrhage. |
|
Definition
| ● more than a 10-point drop in hct compared to prenatal value |
|
|
Term
| 2. Recognize the risk factors for postpartum hemorrhage. |
|
Definition
| issues with uterine tone, retained tissue, trauma, and thrombin |
|
|
Term
| what is 3rd Stage Hemorrhage |
|
Definition
| ○ Excessive bleeding during the third stage of labor, prior to placental expulsion |
|
|
Term
| what is the cause of 3rd Stage Hemorrhage |
|
Definition
| PARTIAL SEPARATION OF THE PLACENTA |
|
|
Term
| what is the leading risk factor for 3rd stage of labor hemorrhage? |
|
Definition
| almost always due to mismanagement, but other reasons include include AP infection, intrauterine infection, previous cesarean birth, disease processes of fetal membranes |
|
|
Term
| define Immediate 4th stage Hemorrhage: |
|
Definition
| ○ Excessive bleeding during the fourth stage of labor, following placental expulsion [AKA immediate postpartum hemorrhage (PPH)] |
|
|
Term
| what is the cause of Immediate 4th stage Hemorrhage: |
|
Definition
| ○ Cause: UTERINE ATONY (approximately 80% of immediate PPH) • Retained placental fragments or cotyledon(s) • Cervical, vaginal, perineal lacerations • Rare: uterine rupture, lower uterine segment laceration |
|
|
Term
| 4. Describe management steps for retained placenta. |
|
Definition
● Natural Interventions: upright position, baby to breast, nipple stimulation, empty bladder
-manual evacuation |
|
|
Term
| 5. Describe management steps for third stage hemorrhage. |
|
Definition
● Thoroughly massage the uterus (Remember that this is the ONLY time you ever do this with a placenta undelivered!)
● Controlled cord traction with a contracted uterus and with guarding to facilitate expulsion of placenta as separation occurs (watch for signs!)
-manual removal of placenta |
|
|
Term
| 2. Recognize risk factors for placental abruption. |
|
Definition
| a. AMA, smoking during pregnancy, chorio, HTN, PROM, FGR, hx of abruption, polyhydraminios, trauma, cocaine or illicit drug use, and EVC |
|
|
Term
|
Definition
| ● Placental villi are attached to the myometrium |
|
|
Term
|
Definition
| ● Villi invade into the myometrium |
|
|
Term
|
Definition
| ● Villi penetrate through the myometrium and uterine serosa and into adjacent tissue, often bladder |
|
|
Term
| 2. Recognize risk factors for an abnormally adherent placenta. |
|
Definition
● Related to C/S
● Previous curettage
● Gravida >6
● Placenta previa
● Linked to down syndrome pregnancy
● Maternal age >35
● Leading cause of intractable PPH requiring emergency peripartum hysterectomy
● Risk of maternal death from hemorrhage |
|
|
Term
|
Definition
| Placenta implants over inner cervical os |
|
|
Term
| what are the four types of placenta previa? |
|
Definition
| complete, marginal, partial, and low-lying |
|
|
Term
|
Definition
| entire inner os is covered |
|
|
Term
|
Definition
| inner os partially covered |
|
|
Term
|
Definition
| edge of placenta is at margin of os |
|
|
Term
| define low-lying placenta |
|
Definition
| placental edge is close to inner os |
|
|
Term
| 2. Recognize risk factors for placenta previa: |
|
Definition
● Advanced maternal age
● Multiparity
● Multifetal gestations
● Prior c/section (risk increases with each c/section also)
● Prior c/section and a previa increases risk of needing cesarean hysterectomy (due to accreta, increta, percreta),
● Cigarette smoking
● Unexplained elevated MSAFP |
|
|
Term
| describe latent period in regards to PROM. How does it differ in term versus preterm |
|
Definition
| the period between ROM and onset of labor. term gestation will tyipically begin labor in 24hrs....preterm latent phase can last a lot longer, even weeks |
|
|
Term
| 2. Describe accurate diagnosis of chorioamnionitis |
|
Definition
| Commonly diagnosed based on clinical symptoms: i.e. fever over 100.4 without other recognized causes (such as UTI). Other symptoms: maternal tachycardia (= or > 100-120), fetal tachycardia (=/>160), uterine tenderness, purulent or foul-smelling amniotic fluid and maternal leukocytosis (>15,00o-18,000). |
|
|
Term
| 1. Identify predisposing factors for cord prolapse. |
|
Definition
| Prematurity, multiple gestation, multiparity, polyhydramnios, fetal malpresentation, ROM |
|
|
Term
|
Definition
300 mg of proteinuria in a 24hr urine or protein creatinine ratio greater than or equal to 0.3 or persistent 1+ protein on a dipstick OR
GHTN with platlets that are less than 100, creatinine greater than 1.1 or doubling baseline, serum transaminase levels twice the normal range, or GHTN with HA, visual disturbances |
|
|
Term
| • Severe preeclampsia If one or more of the following criteria are present: |
|
Definition
1. Blood pressure of 160 mm Hg systolic or higher or 110 mm Hg diastolic or
higher on two occasions at least 6 hours apart while the patient is on bed
rest
2. Oliguria of less than 500 ml in 24 hours
3. Cerebral or visual disturbances
4. Pulmonary edema or cyanosis
5. Epigastric or right upper-quadrant pain
6. Impaired liver function as indicated by abnormally elevated blood
concentrations of liver enzymes (to twice normal concentration), severe
persistent right upper quadrant or epigastric pain unresponsive to
medication and not accounted for by alternative diagnoses, or both
7. Thrombocytopenia
8. Renal insufficiency
• Hemolysis Elevated Liver enzymes Low Platelets: subset of sever pre-e |
|
|
Term
| which pts are most at risk for developing superimposed pre-eclampsia? |
|
Definition
Patients with underlying renal or
vascular disease have a high risk of developing superimposed preeclampsia, as do those
with essential hypertension. |
|
|
Term
| 8. Discuss the use of blood pressure lowering medications in labor for women with severe hypertension. |
|
Definition
Antihypertensive therapy is reserved for women with systolic blood pressure greater
than 160 mm Hg or diastolic blood pressure greater than 105-110 mm Hg.
Increasingly, risk of stroke is felt to be correlated with maximum systolic blood
pressure |
|
|
Term
| discuss the onset and maximum effect of labetalol |
|
Definition
| onset is 2-5 minutes with its max effect occuring after 5mins of administration |
|
|
Term
| discuss the onset and maximum effect of hydralazine |
|
Definition
| onset is 5-20 mins with max effects seen by 30mins |
|
|
Term
| hydralazine should be administered over |
|
Definition
|
|
Term
| 1. Recognize conditions that may precipitate DIC. |
|
Definition
| Placental abruption, obstetrical hemorrhage, preeclampsia, Hellp syndrome, acute fatty liver, sepsis, and amnionic fluid embolism |
|
|
Term
| Describe the signs and symptoms of amniotic fluid embolism. |
|
Definition
○ Hypotension
○ Hypoxia
○ Gasping for air
○ Cyanosis
○ Seizure
○ Cardiorespiratory arrest
○ Consumptive coagulopathy
○ Massive hemorrhage
○ Death |
|
|
Term
| 6. Risk factors for GBS infection in the newborn. |
|
Definition
● Maternal colonization of the gastrointestinal tract
● Prolonged rupture of membranes
● Chorioamnionitis
● Vaginal birth |
|
|
Term
| Know potential neonatal complications of operative vaginal delivery. |
|
Definition
○ cephalohematoma(vacuum has higher risk)
○ subgaleal hemorrhage
○ retinal hemorrhage
○ juandice secondary to hemorrage
○ shoulder dystocia
○ clavicular fracture
○ sclap laceration
○ death
○ facial nerve injury (forceps has higher risk)
○ brachial plexus injury
○ depressed skull fracture
○ corneal abrasion |
|
|
Term
| Know potential maternal complications of operative vaginal delivery. |
|
Definition
○ higher rates of 3rd and 4th degree lacerations
○ vaginal wall and cervical wall lacerations
○ episotomy extensions (3rd and 4th degree)
○ urinary retention and bladder dysfx r/t forceps, vacuum, epidural use
○ anal incontinence
○ pelvic organ prolapse |
|
|
Term
| what combo of medications are contraindicated when inducing a women for a TOLAC? |
|
Definition
| prostiglandins followed by oxytocin administration |
|
|
Term
| what combo of induction is safe for TOLAC? |
|
Definition
| foley catheter followed by oxytocin; does not increase the risk of rupture |
|
|
Term
| _____responsible for the majority of adverse maternal and neonatal outcomes associated with attempted VBAC |
|
Definition
|
|
Term
Planned Repeat Cesarean Birth:
Good for whom? |
|
Definition
• Women who have a classical or T-shaped cesarean incision
• Women who have had trans-fundal surgery
• Women with a contracted pelvis
• Women with a previous uterine rupture
• Medical or Obstetrical complications that preclude vaginal birth |
|
|
Term
Planned TOLAC:
Good for Whom? |
|
Definition
• Women for whom the risks are as low as possible and the chance of success is as high as possible
• Women for whom those risks are acceptable to both the woman and her healthcare provider
• Women planning future pregnancies
• Most women with one prior cesarean section and a low transverse incision should be offered TOLAC.
• Most women who present to labor and delivery in advanced labor. |
|
|
Term
| Major surgery has significant long-term risks to the woman. What are some of those risk? |
|
Definition
• Adhesions
• Chronic pelvic pain
• Decreased fertility
• Stillbirth
• Abnormal placentation |
|
|
Term
| which women have the highest risk of death with an ERCD? |
|
Definition
| • The highest risk of maternal death is to women with comorbidities. |
|
|
Term
| what are the benefits of VBAC? |
|
Definition
• Lack of major surgery
• Lower hemorrhage and infection rates
• Shorter recovery period
• Avoidance of future consequences of
multiple cesarean deliveries |
|
|
Term
______group has the highest respiratory
morbidity |
|
Definition
|
|
Term
|
Definition
from birth to 24 hours PP (AKA Primary PPH)
• More common
• Greater blood loss
• Greater morbidity |
|
|
Term
| what are the management steps for 3rd stage hemorrhage? |
|
Definition
Controlled cord traction with a contracted uterus and with
guarding to facilitate expulsion of placenta as separation
occurs (watch for signs!)
• Concurrently: IV, type and cross-match, treat s/sx of shock as
needed
Third Stage Hemorrhage Management (3)
If these measures are unsuccessful:
• You will need to manually remove the placenta
• But wait—what might we not have done yet? What do we
know as an intervention from active management of third
stage? What else can you try?
– **When will you try this?
Manual Removal of the Placenta
• Procedure is well described in Varney’s Midwifery, pages
1061-1062.
• Is this a difficult procedure?
• Is this a painful procedure?
Risk Factors for Fourth Stage Hemorrhage
• Risk Factors
–Overdistended uterus
–Oxytocin induction or augmentation
–Rapid or precipitous labor and birth
–Prolonged labor
–Grand multiparity
–Hx of uterine atony/PPH with previous
birth(s)
–Uterine relaxing agents (e.g., magnesium sulfate,
terbutaline)
Causes of Fourth Stage Hemorrhage
• Uterine atony (approximately 80% of immediate PPH)
• Retained placental fragments or cotyledon(s)
• Cervical, vaginal, perineal lacerations
• Rare: uterine rupture, lower uterine segment laceration
Fourth Stage Hemorrhage Management
Varney’s Old vs. New
• Rationale for sequence of steps:
• Most 4th stage hemorrhages are caused by UTERINE
ATONY
• It is very uncommon that genital tract trauma is the cause
•Therefore, treat uterine atony!
Fourth Stage Hemorrhage Management (2)
Always, but especially with risk factors, anticipate a PPH; in
other words, BE PREPARED!
Management Steps:
• Check for uterine tone (remember the likely cause of this
bleeding!)
• If atonic, massage fundus to contract the uterus (that might
resolve it!)
With continued bleeding…
Fourth Stage Hemorrhage Management (3)
• Let’s back up just a bit: You MUST think about how you
managed third stage of labor
• Active Management vs. Expectant Management of Third
Stage
**WHY?
Fourth Stage Hemorrhage Management (4)
• Administer oxytocin (IM if no IV) if not already given
• Ensure an empty bladder**
• Bimanual compression
• You’ll see some midwives using meds and not doing
bimanual compression initially.
**What do you think? How will you ‘ decide?
Fourth Stage Hemorrhage Management (5)
• Ensure patent IV with oxytocin added to IV solution
• With continued bleeding…
• Ask that consulting physician be called
• Continue bimanual compression
• Concurrently: type and cross-match
sent, monitor for s/sx shock
Fourth Stage Hemorrhage Management (6)
• When will you do the following?
–Administer another medication
–Examine placenta for completeness; intrauterine
exploration if needed (rarely needed)
–Stop bimanual compression
–Check for lacerations, tie bleeders, repair
Fourth Stage Hemorrhage Management (7)
• Monitor for s/sx hypovolemic shock: hypotension;
tachycardia; rapid, shallow breathing; and cool, clammy skin.
–If present: Trendelenburg, warm blankets, O2, order blood
(rarely needed)
- Very rarely needed (EXTREME):
aortic compression (pressing the
aorta against the spine)
Medications for Fourth Stage Hemorrhage
Evidence-Based Medications
• Pitocin 10 units IM or in 500ml IV fluid
• Synthetic oxytocin
• First line medication for uterine atony
• Causes intermittent uterine contractions
• Methergine 0.2mg IM
• Synthetic ergot
• Contraindicated with HTN, can cause HTN, do not
• use IV—can result in hypertensive crisis/stroke
• Causes a sustained uterine contraction
Medications for Fourth Stage Hemorrhage (2)
Another Evidence-Based Medication
• Hemabate 250mcg IM
• Synthetic prostaglandin
• Contraindicated with asthma (relative); also with renal,
cardiac, pulmonary, or hepatic disease
• Side effects: nausea, vomiting, diarrhea; also, elevated
temp, HTN, bronchoconstriction
• ALSO GIVE LOMOTIL and an anti-emetic
• Used when Pitocin and Methergine are not
effective
• Causes intermittent contractions
Medications for Fourth Stage Hemorrhage (3)
A Final Medication
• Cytotec (misoprostol)
• Synthetic prostaglandin
• Sometimes used as first or second-line therapy for PPH
•Side effects: nausea, vomiting, diarrhea, HTN (less
frequent and intense than Hemabate)
•Less expensive than Hemabate
Medications for Fourth Stage Hemorrhage (4)
Cytotec (misoprostol) (continued)
• “…misoprostol does not work as well as oxytocin infusion,
and it has more side effects.” (Mousa, Blum, Abou El
Senoun, Shakur, & Alfirevic, 2014)
• What are the concerns?
•Cytotec no more effective than Pitocin, possibly less
effective
•Side effect profile of Cytotec is significant: shivering, fever
(Mousa, et al., 2014; Gibbins, Albright, & Rouse, 2013)
Medications for Fourth Stage Hemorrhage (5)
• Caveat about misoprostol:
• In settings where oxytocin administration is not possible,
misoprostol should be used
–No access to refrigeration, needles, syringes, IV solutions,
economic resources
A Related Topic
Retained Placenta
• Definition: A placenta that has not separated in a timely
manner and when there is no obvious hemorrhage
• Up to 30 minutes typically considered normal
• Natural Interventions: upright position, baby to breast, nipple
stimulation, empty bladder
**Would you administer oxytocin? Why?
Why not? When?
More Retained Placenta
• If placenta still retained at 30 minutes…
• Consultation—when?
• Manual removal of the placenta is indicated—who?
• What needs to occur for optimal outcome—what conditions?
More Retained
Placenta (2)
• Considerations:
• Is this an emergency?
• Who is most skilled?
• What are possible causes of a retained placenta?
• OR, anesthesia—invasive, painful, difficult, risky
**How to achieve best possible outcome?
More Retained
Placenta (3)
• Questions to Ponder:
• Would you consider giving Pitocin IM or IV in solution prior
to 30 minutes?
• When would you call the physician?
• When do you think YOU should do the procedure—
emergency, non-emergency? With or without physician
presence?
•CONSIDER: Who is most experienced and safest to
perform this invasive procedure?
Source Materials
Anderson, J.M., & Etches, D. (2007). Prevention and
management of postpartum hemorrhage. American Family
Physician, 75(6), 875-882.
Cunningham, F., Leveno, K., Bloom, S., Hauth, J. Rouse, D. &
Spong, C. (2010). Williams Obstetrics (23rd edition). McGraw
Hill: New York.
Mousa, H., Blum, J., Abou El Senoun, G., Shakur, H., &
Alfirevic, Z. Treatment for primary postpartum haemorrhage.
Cochrane Database of Systematic Reviews 2014, Issue 2.
Art. No.: CD003249.
Source Materials (2)
Gibbins, K.J., Albright, C.M., & Rouse, D.J. (2013). Postpartum
hemorrhage in the developed world: Whither misoprostol?
American Journal of Obstetrics and Gynecology, 208(3),
181-183.
King, T., Brucker, M., Kriebs, J., Fahey, J., Gegor, C. &
Varney, H. (2015). Varney's Midwifery (5th ed). Burlington,
MA: Jones & Bartlett Publishers.
Varney, H., Kriebs, J., & Gegor, C. (2004). Varney’s midwifery
(4th ed.). Sudbury, MA: Jones & Bartlett Publishers.
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304/7/14
3
Hemorrhage in Childbirth:
Third and Fourth Stage Bleeding
Nora Webster
NM622
Definitions
Third Stage Hemorrhage: Excessive bleeding during the third
stage of labor, prior to placental expulsion
Fourth Stage Hemorrhage: Excessive bleeding during the
fourth stage of labor, following placental expulsion [AKA
immediate postpartum
hemorrhage (PPH)]
More Definitions
“Excessive bleeding” (AKA hemorrhage):
• Too much blood loss
• Not as simple as it sounds:
• Subjective estimation-we’re notorious
• Widely accepted definition ≥ 500ml
• Normal blood loss with birth ≥ 500ml
Still More Definitions
• Early PPH: from birth to 24 hours PP (AKA Primary PPH)
• More common
• Greater blood loss
• Greater morbidity
• Late PPH: from 24 hrs PP to 6wks PP
• Incidence of PPH: up to 18% with ~3%
• of vaginal births resulting in severe PPH
(Anderson & Etches, 2007)
Third Stage Hemorrhage
• Caused by PARTIAL SEPARATION OF THE PLACENTA
• Almost always a result of mismanagement of third stage (i.e.,
its occurrence is within your control most of the time)
• RARE if third stage is properly managed
• Other causes include AP infection, intrauterine infection,
previous cesarean birth, disease processes of fetal
membranes)
Review of Normal Third Stage
• Some blood loss in third stage is normal
• When placenta spontaneously separates, a temporary partial
separation may occur
• Signs of separation: small gush or trickle of blood,
lengthening of cord,
change in shape/position of
uterus
Third Stage Hemorrhage Management
• Ask that consulting physician be called
• Thoroughly massage the uterus (Remember that this is the
ONLY time you ever do this with a placenta undelivered!)
–2015 Varney’s does not state this, but the 2004 Varney’s
states this as does the 2010 Williams’ Obstetrics
–This is the least invasive of the initial intervention options
(consistent with midwifery philosophy)
*** Why does this intervention make sense?
Third Stage Hemorrhage Management (2)
• Controlled cord traction with a contracted uterus and with
guarding to facilitate expulsion of placenta as separation
occurs (watch for signs!)
• Concurrently: IV, type and cross-match, treat s/sx of shock as
needed |
|
|
Term
| why is the tx for 4th stage hemorrhage, tx of uterine atony? |
|
Definition
Most 4th stage hemorrhages are caused by UTERINE
ATONY
• It is very uncommon that genital tract trauma is the cause
•Therefore, treat uterine atony! |
|
|
Term
| Review management steps of 4th stage hemorrhage |
|
Definition
Administer oxytocin (IM if no IV) if not already given
• Ensure an empty bladder**
• Bimanual compression |
|
|
Term
| what medications are used for 4th stage PPH? |
|
Definition
Pitocin 10 units IM or in 500ml IV fluid
• Methergine 0.2mg IM; sustained uterine ctx
Hemabate 250mcg IM; give lomotil and antiemetic
Cytotec |
|
|
Term
| what are the side effects of cytotec? |
|
Definition
| shivering, fever, nausea, vomiting, diarrhea, HTN |
|
|
Term
| what are the side effects of methergine? |
|
Definition
can cause HTN, do not
• use IV—can result in hypertensive crisis/stroke
• Causes a sustained uterine contraction |
|
|
Term
| what are the side effects of hemabate? |
|
Definition
nausea, vomiting, diarrhea; also, elevated
temp, HTN, bronchoconstriction , intermittent ctx |
|
|
Term
| what is the greatest risk of PPROM? |
|
Definition
Primary risk is preterm birth
Perinatal morbidity and mortality from prematurity |
|
|
Term
| what is the primary concern for PROM? |
|
Definition
|
|
Term
| CNMs should offer women the option of expectant management under the following conditions: |
|
Definition
Term, uncomplicated, singleton, vertex pregnancy, clear amniotic fluid
No fever
No evidence of significant risk of fetal acidemia
No identified infection including GBS, Hepatitis B & C, HIV
Minimized vaginal exams including avoidance of baseline vaginal exam |
|
|
Term
| review Factors other than duration of rupture that impact infection risk |
|
Definition
vaginal exams
duration of labor
internal monitors
positive GBS status |
|
|
Term
| Amnioinfusion is recommended for |
|
Definition
| repetitive variable decelerations |
|
|
Term
| what are the benefits of an amnioinfusion for recurrent variable decelerations? |
|
Definition
| reduction in variable decelerations, fewer cesarean sections and improved neonatal outcomes. |
|
|
Term
| Describe the primary sign of DIC. |
|
Definition
| Excessive bleeding at sites of moderate trauma |
|
|
Term
| what are the screening recommendations for GBS? |
|
Definition
| GBS culture completed between 35 - 37 weeks gestation. |
|
|
Term
| __________is the leading infectious cause of neonatal mortality and morbidity in the US |
|
Definition
|
|
Term
| review Recommendations for treatment of GBS |
|
Definition
Penicillin 1st line
Ampicillin
Cefazolin
Clindamycin (for those allergic to penicillin)
Erythromycin
Vancomycin |
|
|
Term
| Prevention of GBS with ruptured membranes Prophylaxis treatment should be given for ROM with duration of |
|
Definition
| >18hrs and temperature of 100.4 or greater |
|
|
Term
| Risk factors for GBS infection in the newborn. |
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Definition
Maternal colonization of the gastrointestinal tract
Prolonged rupture of membranes
Chorioamnionitis
Vaginal birth |
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