Podcast
Questions and Answers
Match the following types of umbilical cord prolapse with their descriptions:
Match the following types of umbilical cord prolapse with their descriptions:
Complete prolapse = Cord slips completely out of the uterus Partial prolapse = Cord slips down alongside the fetus Occult prolapse = Cord is hidden and cannot be seen during examination Prolapse with rupture = Cord prolapse occurs with membrane rupture
Match the causes of fetal hypoxia with their respective descriptions:
Match the causes of fetal hypoxia with their respective descriptions:
Maternal hypertension = Decreased blood flow to the placenta Umbilical cord accidents = Obstruction of blood flow through the cord Placental abruption = Separation of the placenta from the uterine wall Prolonged labor = Increased pressure on the fetus reducing oxygen supply
Match the signs of disseminated intravascular coagulation (DIC) with their definitions:
Match the signs of disseminated intravascular coagulation (DIC) with their definitions:
Petechiae = Small red or purple spots on the body Hematemesis = Vomiting of blood Ecchymosis = Larger areas of bleeding under the skin Oliguria = Decreased urine output
Match the nursing roles during a cesarean birth with their responsibilities:
Match the nursing roles during a cesarean birth with their responsibilities:
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Match the risk factors for fetal complications with their corresponding descriptions:
Match the risk factors for fetal complications with their corresponding descriptions:
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Match the types of umbilical cord prolapse with their definitions:
Match the types of umbilical cord prolapse with their definitions:
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Match the causes of fetal hypoxia with their descriptions:
Match the causes of fetal hypoxia with their descriptions:
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Match the aspects of disseminated intravascular coagulation (DIC) with their effects:
Match the aspects of disseminated intravascular coagulation (DIC) with their effects:
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Match the following types of umbilical cord prolapse with their descriptions:
Match the following types of umbilical cord prolapse with their descriptions:
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Match the nursing roles during a cesarean birth with their responsibilities:
Match the nursing roles during a cesarean birth with their responsibilities:
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Match the following causes of fetal hypoxia with their characteristics:
Match the following causes of fetal hypoxia with their characteristics:
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Match the risk factors for fetal complications with their descriptions:
Match the risk factors for fetal complications with their descriptions:
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Match the following conditions associated with disseminated intravascular coagulation (DIC) with their effects:
Match the following conditions associated with disseminated intravascular coagulation (DIC) with their effects:
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Match the nursing role in unscheduled cesarean birth with the corresponding action:
Match the nursing role in unscheduled cesarean birth with the corresponding action:
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Match the fetal risks association with shoulder dystocia:
Match the fetal risks association with shoulder dystocia:
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Match maternal complications related to severe perineal lacerations:
Match maternal complications related to severe perineal lacerations:
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Match the following risk factors for fetal complications with their descriptions:
Match the following risk factors for fetal complications with their descriptions:
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Match the following components of nursing actions during cesarean birth with what they address:
Match the following components of nursing actions during cesarean birth with what they address:
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Match umbilical cord prolapse risks related to the fetus:
Match umbilical cord prolapse risks related to the fetus:
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Match the following descriptions of placental abruption with their characteristics:
Match the following descriptions of placental abruption with their characteristics:
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Match the following types of amniotic fluid embolism with their specific traits:
Match the following types of amniotic fluid embolism with their specific traits:
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Study Notes
Severe Perineal Lacerations (4th Degree)
- Associated with maternal symphyseal separation and peripheral neuropathy.
- Can result in sphincter injuries, infection, bladder injury, and postpartum hemorrhage.
- McRoberts maneuver is an intervention: flexing the patient's thighs tightly towards the abdomen while shifting the hips away from the body and applying suprapubic pressure.
Fetal Risks Associated with Shoulder Dystocia
- Compression of the fetal neck by the maternal pelvis impairs fetal circulation, increasing intracranial pressure (ICP), leading to anoxia, asphyxia, and neurological injury.
- The "turtle sign" (retraction of the fetal head against the maternal perineum after delivery of the head) is an early indicator.
Umbilical Cord Prolapse
- Total or partial occlusion of the umbilical cord, rapidly deteriorating fetal perfusion and oxygenation, causing fetal hypoxia.
- Can lead to fetal heart rate (FHR) decelerations, including severe sudden decelerations, often with prolonged bradycardia or recurrent moderate-to-severe variable decelerations.
- Occult prolapse: the cord passes through the cervix alongside the presenting part, not visible or palpable.
- Overt prolapse: cord is visible or palpable in the vagina or beyond the labia.
- Fetal risk factors include malpresentation (breech), fetal anomalies, intrauterine growth restriction (IUGR), and small for gestational age (SGA) infants with an unengaged presenting part.
- Pregnancy risk factors include artificial rupture of membranes (AROM).
Disseminated Intravascular Coagulation (DIC)
- The body breaks down blood clots faster than it can form them, depleting clotting factors, leading to hemorrhage and potentially maternal death.
- Always secondary to another pathological process: placental abruption, amniotic fluid embolism (amniotic fluid or fetal material entering maternal circulation through uterine veins), sepsis syndrome, acute fatty liver of pregnancy, severe preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count), and massive obstetric hemorrhage.
Role of the Nurse in Unscheduled Cesarean Birth
- Stabilize the patient and fetus, aiming for a 30-minute "decision to incision" time.
- Nursing actions include: completing admission assessments, obtaining necessary labs (CBC, platelets, blood type and screen/crossmatch), starting an IV and fluid preload, inserting a Foley catheter (usually post-anesthesia), preparing the surgical site, administering pre-op medications, preparing the partner/support person, completing the surgical checklist, notifying relevant personnel, initiating continuous electronic FHR monitoring, administering oxygen as needed, assessing vital signs, and providing emotional support.
Intraoperative Complications Associated with Cesarean Birth
- Hemorrhage, bladder, ureter, and bowel trauma.
Fetal Heart Rate (FHR) Patterns
- Moderate FHR variability (6-25 bpm): most reassuring.
- Marked tachycardia (>25 bpm): concerning.
Acceleration Measurement
- Visually apparent abrupt increase in FHR above the baseline.
- ≥15 bpm for ≥15 seconds, but <2 minutes (longer durations may indicate baseline change).
- In preterm infants, ≥30 seconds to reach nadir.
Periodic Decelerations
- Mirrors contractions (nadir at peak of contraction).
- Caused by head compression; generally reassuring.
Variable Decelerations
- Abrupt decrease in FHR below the baseline.
- Not always associated with contractions.
- Caused by umbilical cord compression.
Labor Stages and Induction/Augmentation
- First stage arrest: <6 cm dilation with membrane rupture and 4+ hours of adequate contractions/6+ hours if inadequate contractions.
- Second stage arrest: Failure of fetal head descent after 2 hours of pushing (or 3 hours of pushing if multiparous).
- Vaginal birth: Spontaneous delivery without instrumental assistance.
- Induced labor: Initiating labor before spontaneous onset with >6 cm dilation and membrane rupture, or > 5cm without rupture and 4+ hours of adequate contractions/6+ hours if inadequate.
Fetal Presentations Leading to Dystocia
- Information not provided in source.
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