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Questions and Answers

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:

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:

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:

<p>Scrub nurse = Maintains sterile field and instruments Circulating nurse = Coordinates care and provides support Recovery nurse = Monitors the mother's recovery post-surgery Anesthesia nurse = Administers anesthesia and monitors effects</p> Signup and view all the answers

Match the risk factors for fetal complications with their corresponding descriptions:

<p>Advanced maternal age = Increased risk of chromosomal abnormalities Multiple gestation = Higher chance of preterm labor and delivery Chronic maternal diseases = Conditions like diabetes affecting fetal health Substance abuse = Increased risk of developmental issues in the fetus</p> Signup and view all the answers

Match the types of umbilical cord prolapse with their definitions:

<p>Occult prolapse = Neither visible nor palpable, occurs when the cord passes through the cervix alongside the presenting part of the fetus Overt prolapse = The cord presents before the fetus and is visible or palpable within the vagina Total occlusion = Complete blockage of the umbilical cord leading to fetal distress Partial occlusion = Blocked segment of the cord causing limited blood flow to the fetus</p> Signup and view all the answers

Match the causes of fetal hypoxia with their descriptions:

<p>Compression of the fetal neck = Caused by the maternal pelvis during delivery Rapid deterioration in fetal perfusion = Resulting from umbilical cord prolapse Iatrogenic causes = Artificial rupture of membranes that may lead to fetal complications Malpresentation = Fetus positioned incorrectly, increasing risks of complications</p> Signup and view all the answers

Match the aspects of disseminated intravascular coagulation (DIC) with their effects:

<p>Thrombocytopenia = Low platelet count leading to increased bleeding risk Prolonged coagulation time = Delayed clotting response during hemostasis Microvascular thrombosis = Formation of small clots that restrict blood flow to organs Fibrinolysis = Breakdown of blood clots contributing to bleeding complications</p> Signup and view all the answers

Match the following types of umbilical cord prolapse with their descriptions:

<p>Single Umbilical Cord Prolapse = Cord slips past the presenting part of the fetus Multiple Umbilical Cord Prolapse = More than one cord is involved in the prolapse Cord Prolapse with Ruptured Membranes = Cord descends with the amniotic fluid leaking Cord Prolapse with Intact Membranes = Cord descends while the membranes are still intact</p> Signup and view all the answers

Match the nursing roles during a cesarean birth with their responsibilities:

<p>Prepare the surgical area = Ensure all necessary instruments are sterile and ready Monitor fetal heart rate = Continuously assess the fetal condition prior to incision Assist with anesthesia = Help the anesthesiologist in positioning and monitoring patient Provide emotional support = Address patient concerns and anxiety pre-surgery</p> Signup and view all the answers

Match the following causes of fetal hypoxia with their characteristics:

<p>Maternal Hypotension = Decreased blood flow to the placenta Umbilical Cord Compression = Reduction of oxygen supply due to cord pressure Placental Abruption = Separation of the placenta from the uterine wall Severe Preeclampsia = Impaired blood flow leading to fetal distress</p> Signup and view all the answers

Match the risk factors for fetal complications with their descriptions:

<p>Unengaged presenting part = Increased chances of cord prolapse during labor Intrauterine growth restriction = Fetus smaller than expected for gestational age, leading to complications Breech presentation = Position of the fetus that increases risk of cord issues during delivery Artificial rupture of membranes = Induced procedure that can inadvertently cause cord complications</p> Signup and view all the answers

Match the following conditions associated with disseminated intravascular coagulation (DIC) with their effects:

<p>Hemolysis = Destruction of red blood cells leading to anemia Elevated Liver Enzymes = Indicates liver stress or damage Low Platelet Count Syndrome = Increased risk of bleeding due to low platelet levels Massive Obstetric Hemorrhage = Significant bleeding that can lead to shock</p> Signup and view all the answers

Match the nursing role in unscheduled cesarean birth with the corresponding action:

<p>Stabilize Patient and Fetus = Address emergency situation quickly Complete Preoperative Assessment = Ensure all necessary vital signs are recorded Initiate Continuous FHR Monitoring = Monitor fetal heart rate in real-time Prepare Support Person = Provide appropriate surgical attire for OR entry</p> Signup and view all the answers

Match the fetal risks association with shoulder dystocia:

<p>Increased intracranial pressure = Can occur due to compression of the baby's neck Anoxia = Lack of oxygen that can lead to severe neurological damage Asphyxia = Insufficient oxygen reaching the fetus during delivery Retraction of the fetal head = Known as the 'turtle sign' indicating potential complications</p> Signup and view all the answers

Match maternal complications related to severe perineal lacerations:

<p>Symphyseal separation = Separation of the pubic bones, can cause pain and mobility issues Sphincter injuries = Damage to pelvic floor muscles affecting bowel control Postpartum hemorrhage = Excessive bleeding after delivery, requiring urgent care Bladder injury = Potential damage during complicated deliveries affecting urination</p> Signup and view all the answers

Match the following risk factors for fetal complications with their descriptions:

<p>Maternal Diabetes = Can lead to fetal hyperglycemia and macrosomia Advanced Maternal Age = Increased risk of genetic abnormalities Obesity = Higher chance of pregnancy-related complications Intrauterine Infections = Can cause severe fetal illness or effects</p> Signup and view all the answers

Match the following components of nursing actions during cesarean birth with what they address:

<p>Administer Preop Meds = Prepare patient for surgery Start IV Line = Ensure hydration and medication access Assess Patient's Vital Signs = Monitor stability before surgery Complete Surgery Checklist = Ensure all necessary preparations are made</p> Signup and view all the answers

Match umbilical cord prolapse risks related to the fetus:

<p>Fetal anomalies = Congenital conditions that may lead to abnormal positioning Small for gestational age = Increases the chance of non-engaged presentations during labor Breech presentation = Position of the fetus that complicates delivery processes Intrauterine growth restriction = May contribute to cord prolapse due to lower fetal weight</p> Signup and view all the answers

Match the following descriptions of placental abruption with their characteristics:

<p>Partial Abruption = Only a portion of the placenta separates Complete Abruption = Total separation from the uterine wall Preterm Abruption = Occurs before labor begins Late Abruption = Occurs during labor and delivery</p> Signup and view all the answers

Match the following types of amniotic fluid embolism with their specific traits:

<p>Classic Amniotic Fluid Embolism = Introduction of amniotic fluid to the maternal circulation Meconium Aspiration = Fetus inhales meconium-stained fluid during labor Fetal Cell Embolism = Entry of fetal cells into maternal circulation Septic Amniotic Fluid Embolism = Infection-related passage of material into maternal circulation</p> Signup and view all the answers

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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