PROM/PPROM
2 risk factors for PROM.
What is: cervical insufficiency, Hx: PROM, drug use, invasive procedures (amniocentesis/chorionic villi sampling), lower genital infections, low socioeconomic status, multiple gestation, nutritional deficiency, tobacco use, polyhydramniosis, vaginal bleeding, underweight?
The components are measured in a SVE.
What is dilation/effacement/station?
Contraindication to vaginal birth if fetus is in brow or face presentation.
What is: if chin is posterior oriented (against maternal pubic bone)?
The stages of labor, in order from beginning to end.
What is: latent, active, transition, second, third?
Patients with PPROM are at 15-25% risk of this type of infection.
What is intra-amniotic infection, or chorioamnionitis?
Plan of treatment for PPROM between 24-33 weeks.
What is watchful waiting and administration of tokolytics to prevent labor, corticosteroids to develop fetal lungs, and mag sulfate to increase efficacy of steroid tx?
The anatomical landmark(s) that fetal station is determined with.
What is the ischial spines of the pelvis?
Birthing position with shoulder as presenting part where vaginal birth is contraindicated due to his of limb entrapment.
What is transverse position?
Patient is 4 cm dilated--determine stage of labor.
What is active stage?
In labor pain management, a downside to giving morphine/opiate medications early in labor course.
What is diminishing efficacy with every dose, as pain increases during course of labor.
Symptoms to report to physician in a PROM patient?
What is: development of maternal fever, tachycardia, and fetal tachycardia?
The stage of labor when the patient's SVE measurements are: 3/70/-2
What is early/latent stage?
Two symptoms of amniotic fluid embolism (AFE).
What is maternal collapse, cardiac arrest, abnormal coagulation, convulsions, hypotension, hemorrhage, shortness of breath, premonitions of doom?
Patient is experiencing contractions every 2-3 minutes, lasting about 60 seconds in duration. Determine the phase of labor.
What is transition phase?
A pre-ecclamptic patient presents to the ED after experiencing a seizure. The pharmaceutical agent used to stop further seizure activity.
What is magnesium sulfate?
Name two tokolytics, and the maximum time they can be used to delay labor during PPROM.
What is indomethacin (5 days), nifedipine (5 days), magnesium sulfate (5 days), and terbutaline (48 hours)?
What is a contraindication for nifedipine use to delay labor in PPROM?
The stage of labor when SVE measurements are: 6/80/+2.
What is active phase of labor?
Name the three pharmacologic agents in A-OK protocol for AFE
What is:
A-Atropine 1 mg IVP every 3-5 min
O-Ondansetron 8 mg IV every 4 hrs
K-Ketorolac 30 mg IV every 6 hrs
The stage initiated by a gush of blood and the lengthening of the umbilical cord.
What is stage three?
What is the target time to birth after presentation of the fetal head?
What is 10 minutes? To avoid ischemic injury
The reason magnesium sulfate is given in PPROM for fetal health.
What is prevention of cerebral palsy?
The patient has an anterior positioned cervix that is medium in consistency. The SVE measurements are: 3/60/+1. Find the Bishop score for this patient.
What is Bishop score of 10?
What does this score indicate about the patient?
Demonstrate McRobert's position.
What is: spread it baby?
The patient is experiencing contractions every 3-5 minutes and suddenly feels the uncontrollable urge to bear down. Identify the proper nursing intervention for the patient at this phase in labor.
What is: breathing exercises to avoid pressure/bearing down--the patient is likely in active stage labor, and the cervix is not dilated enough to push at this time.
Name the steps of management after cord prolapse.
What is: call for help, two fingers lifting preventing part off of cord (avoid compression), steep Trendelenburg or knee chest position, insertion of foley and fill bladder with 500-750 mL water, ensure continuous fetal heart monitoring, O2 via face mask, and immediate transport to surgery (or vaginal birth if imminent)?