2020/2021 latest NURSING 306wk6 OB practice Qs.pdf

● Risks: ○ Prolonged PPROM r/t ↑ risk of chorioamnionitis, placental abruption & cord prolapse ● Predisposing fx: ○ ↑parity (had a lot of babies), adv. maternal age(35 y.o), ○ short umbilical cord (baby starts to come down birth canal and tug on cord) → can cause an abruption ■ Short umbilical & late decels → (lot of fetal distress) ■ Dr. could poss cut the cord around the neck or do a c-section ○ chronic HTN, PIH, direct trauma (HTN, preeclampsia, seizure), ○ vasoconstriction (cocaine or cigarette use) ● Fetal distress on monitor. Can progress to DIC. ○ Draw labs to see if this is occurring ● Get mom ready c-section ○ (18 gauge IV- to give her fluid & blood) ● Management: ○ Emergency c-section ○ Large 18 gauge IV ○ O2 via mask, fetal monitoring, maternal VS, lateral positioning, labs, blood trans ■ Type & crossmatch → (don't do often) expensive, only good for 3 days ● (2 units) ● Do when they have placenta abruption or placenta previa ○ Mom can hemorrhage & bleed a lot ■ For c-section → type & screen (looking at antibodies) ○ LABS: ■ CBC (H&H), platelet count, PT/PTT, fibrinogen levels, fibrin degradation productions (sx of DIC) → to RULE OUT DIC ● Teaching: c-section: ○ Signed consent ● Placentaa previa: ○ Types: low-lying, marginal (spotting blood), partial, complete ○ A condition where the placenta attaches to the lower uterine segment of the uterus Low implantation of placenta (no pain receptors in the placenta) ■ abrupt, painless, bright red bleeding ○ Associated with ↑parity, adv. maternal age, previous c-section or uterine curettage, multiple gestation ○ Dx: ■ ultrasound. May resolve as pregnancy progresses. ○ Bleeding common around 30/32 wks: (can have ep. Of bleeding: 400-500cc’s) ● Then it may stop, but we won’t send her home ■ Bedrest, VS, IV fluids, type & crossmatch, observe for bleeding ○ Emergency: ■ assess bleeding, hx, uc’s/labor ○ NEVER do vaginal exam !!! → if mom has significant bleedingLatest 2020/2021NURSING 306wk6 OB