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Exam One-Maternity
Terbutaline (Brethine)
Mechanism of Action
Beta-2 Agonists
Indications
Asthma
Tocolytic
Side Effects
Hypotension
Tremor
Tachycardia
Pulmonary Edema
Hyperglycemia
2 mins
Pregnant Diabetic Patient Interventions
First Trimester
Increase Insulin then Decrease
Metformin
Nutrition
Exercise
Second Trimester
Increase Insulin
More Likely to Develop Hypoglycemia than Hyperglycemia
Third Trimester
Double or Quadruple Insulin
Early Delivery
Postpartum
Drastically Decrease Insulin
Monitor Neonate for Hypoglycemia
3 mins
Insulin
Rapid Acting
Insulin Lispro (Humalog)
Insulin Aspart (Novolog)
Insulin Glulisine (Apidra)
Short Acting
Regular Insulin (Humulin R)
Intermediate Acting
Isophane NPH (Humulin N)
Long Acting
Detemir (Levemir)
Glargine (Lantus)
2 mins
Magnesium Sulfate
Mechanism
Muscle Relaxant
Indications
Preterm Labor Contractions
Preeclampsia
Side Effects
Warm Feeling
Hypotension
Decreased Deep Tendon Reflexes (DTRS)
Decreased Respiratory Rate
Decreased Urine Output
Paralytic Ileus
Antidote
Calcium Gluconate
2 mins
Incompetent Cervix
Mechanism
Premature Cervical Dilation
Assessment
Recurring Miscarriage
Short Cervix
Considerations
Cervical Cerclage
Rest
Labor
1 min
Dinoprostone and Misoprostol
Mechanism
Prostaglandins
Indications
Promote Cervical Ripening
Prevent GI Ulcers
Medical Abortion
Side Effects
Fetal Distress
Hyperstimulation of Uterus
Considerations
Vaginal Insertion
Give Before Induction of Labor
2 mins
Ectopic Pregnancy
Signs and Symptoms
Lower Abdominal Pain
Delayed Menses
Abnormal Vaginal Bleeding
Shock
Referred Shoulder Pain
Cullen Sign
Considerations
Methotrexate
Surgery
RhoGAM
2 mins
Hyperemesis Gravidarum
Signs and Symptoms
Excessive Vomiting
Significant Weight Loss
Dehydration
Hypotension
Electrolyte Imbalance
Interventions
Antiemetics
Frequent Small Meals
IV Therapy
2 mins
Severe Preeclampsia
Mechanism of Action
Vasospasm and Decreased Organ Perfusion
Intravascular Coagulation
Increased Permeability and Capillary Leakage
Signs and Symptoms
Hypertension
Proteinuria or End-Organ Dysfunction
HELLP Syndrome
Hepatic Dysfunction and Hemolysis
Elevated Liver Enzymes
Low Platelet Counts
3 mins
Preeclampsia Assessment
After 20 Weeks of Pregnancy
Mild
Hypertension > 140/90
Proteinuria or End-Organ Dysfunction
Severe
Hypertension > 160/110
Progressive Renal Insufficiency
Vision Changes
HELLP Syndrome
Pulmonary Edema
2 mins
Preeclampsia Interventions
Side Lying Position and Bedrest
Antihypertensives
Magnesium Sulfate
Labor Induction
1 min
Eclampsia
Mechanism of Action
Increased Central Nervous System Irritability
Signs and Symptoms
Hyperreflexia
Positive Ankle Clonus
Headaches
Visual Disturbances
Epigastric or RUQ Pain
Seizures
Coma
Considerations
Don't Leave Bedside
Magnesium Sulfate
2 mins
Abruptio Placentae
Mechanism
Premature Separation of Placenta
Assessment
Tearing Pain
Bleeding (Often Concealed)
Rigid Uterus
Contractions
Interventions
Corticosteroids as Needed
Emergent Delivery
Considerations
Increased Risks for Neonate
Rh (Rhesus) Incompatibilities
Increased Risk for Shock
Monitor Fetal Heart Rate
3 mins
Placenta Previa
Mechanism
Placenta Covers Cervical Os
Assessment
Painless
Bright Red Vaginal Bleeding
Interventions
Stable Fetus
Bed Rest
Observation
Unstable Fetus
C-section Delivery
Considerations
Risk for Shock
Magnesium Sulfate
Tocolysis
3 mins
Placental Implantation Abnormalities
Mechanism
Placenta Adheres Directly to Myometrium
Placenta Accreta
Placenta Increta
Placenta Percreta
Caused by Scar Tissue
Hemorrhage
Diagnosis
Ultrasound is First-line, then MRI
Treatment
C-section Delivery
Artery Ligation or Embolization
2 mins
Variable Decelerations
Mechanism
Umbilical Cord Compression
Occurs During
Abnormal Cord Position
Considerations
Transition Phase
Interventions
Oxygen with Non-Rebreather (8-10 L/min)
Change Maternal Position
Discontinue Oxytocin
2 mins
Late Decelerations
Cause
Uteroplacental Insufficiency
Occurs During
Disruption of Oxygen Transfer to Fetus
Considerations
Abnormal Pattern
Interventions
Discontinue Oxytocin
Oxygen with Non-Rebreather (8-10 L/min)
Side-lying Position
Elevate Legs
Increase Rate of IV Solution
2 mins
Decelerations (and Accelerations) Overview
VEAL CHOP
Variable Deceleration
Cord Compression
Early Deceleration
Head Compression
Acceleration
Okay
Late Deceleration
Placental Insufficiency
2 mins
Probable Signs of Pregnancy
Goodell Sign
Chadwick Sign
Hegar Sign
Positive Serum and Urine Sample
Braxton Hicks Contractions
Ballottement
2 mins
Positive Signs of Pregnancy
Fetus on Ultrasound
Fetal Heart Rate by Doppler or Fetoscope
Fetal X-ray
Fetal Movements
1 min
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