Full Course Description
OB Emergencies: Current Trends, Treatments & Issues
Copyright :
05/03/2024
High Risk Postpartum Patients: Conquer the Mother-Baby Warning Signs
Program Information
Objectives
- Explain the two phase process that results in pre-eclampsia.
- Compare the two blood pressure parameters that require treatment and how those treatments differ.
- List criteria for the diagnosis of preterm labor and the pharmacologic management options.
- Determine the two most important factors to assess appropriateness for elective induction.
- Explain the most effective way to change medical staff practices.
- Evaluate the possible causes of a post-partum hemorrhage and appropriate management of each.
- Analyze strategies for collaborative care with the ICU and Emergency Department
- Explain why a d-dimer is no longer recommended as part of the evaluation for pulmonary embolism in pregnancy.
- Evaluate the latest ACOG recommendations for preventing blood loss during delivery.
- Explain why neurological outcomes with AFE are so poor and the rapid interventions that could make a difference.
Outline
Preeclampsia Eclampsia and HELLP
- Tips for timely intervention: Know when you MUST intervene
- Why have we gotten so aggressive?
- Latest available medical treatments & nursing interventions
- Morbidly and mortality associated with diagnosis
Preterm Labor: Rapid Diagnosis and Intervention Can Make All the Difference
- Who Is at the highest risk and strategies to lower the risk
- Preterm labor or just contractions? Make your diagnosis!
- Beta-mimetics, Mag, Calcium Channel Blockers, NSAIDS, progesterone, Antibiotics: Who get what?
The Perils of Shoulder Dystocia
- Can we predict shoulder dystocia?
- The latest legal outcomes for patients with shoulder dystocia
- When a shoulder dystocia occurs: The essentials of management
Post Partum Hemorrhage
- Patients at risk for postpartum hemorrhage
- New tips for assessing blood loss accurately
- Most recent clinical practice guidelines
- New medications and old meds with new protocols
High Risk Induction
- Trends in elective and medical inductions
- The newest options for inductions
- Risks and benefits for induction patients
- How to change your hospital policies
- Examples of informed consent
VTE in Pregnancy and Postpartum
- #1 cause of Maternal death in the US (...and why the ICU nurse is running from me)
- New recommendations for evaluation and prevention
- Treatment in pregnancy
- Timing delivery
Catastrophic Events
- AFE
- Cardiac and respiratory arrest
- Loss of fetal heart tones
- Recognition
- What really goes wrong - and how?
- Be prepared for aggressive resuscitation!
Copyright :
05/02/2024
Sepsis in Pregnancy
Pregnancy-related sepsis is a life-threatening medical emergency infection that can take place during pregnancy, childbirth, post-abortion, miscarriage, or the postpartum period. It is the second leading cause of pregnancy-related deaths in the US. Fast recognition and treatment of sepsis is key, which means you need to know the signs and symptoms of sepsis in pregnancy, as well as how to screen for sepsis early and initiate treatment. You will learn the unique physiology during and following pregnancy and the challenges healthcare providers face when identifying and managing pregnancy-related sepsis.
Program Information
Objectives
- Evaluate the national and global issue of mortality and morbidity surrounding sepsis in pregnancy.
- Determine the risk factors for sepsis in pregnancy.
- Integrate understanding of physiologic changes during pregnancy as they relate to sepsis.
- Analyze key challenges related to identification and treatment of sepsis in pregnancy.
- Apply screening and management guidelines for sepsis in pregnancy into practice.
Outline
National and global issue of mortality and morbidity surrounding sepsis in pregnancy
- Leading cause of maternal morbidity and mortality
Risk factors for sepsis in pregnancy
- Common sources of infection
- Preterm labor and preterm delivery
- Fetal infection
Physiologic changes during pregnancy as they relate to sepsis
- Immunological adaptations of pregnancy
- Cardiovascular adaptations of pregnancy
- Impact on the maternal response to infection
Key challenges related to identification and treatment of sepsis in pregnancy
- Antibiotic resistance patterns
AVOG and SMFM guidelines
- Screening
- Management guidelines for sepsis in pregnancy
Target Audience
- Nurses
- Nurse Practitioners
- Physicians
- Physician Assistants
- Midwives
- Doulas
Copyright :
03/10/2023
Obstetric ACLS: Strategies to Enhance Maternal Resuscitation Outcomes
Cardiac-pulmonary arrest is a preventable clinical problem if detected in time by using early warning score (EWS) and treated promptly without delay. EWS provides a way to quickly and efficiently respond to emergencies in hospitals, allowing medical personnel to quickly assess the situation and act. The resuscitation in obstetric patients is particularly challenging, as it involves the lives of both mother and fetus. Being knowledgeable of possible causes and required therapies is a vital component in successful resuscitation. As physiological and anatomical changes occur during pregnancy, special considerations are required during cardiopulmonary resuscitation.
Program Information
Objectives
- Determine factors that are responsible for cardiac arrest during pregnancy.
- Demonstrate the key components of obstetric ACLS.
- Choose when obstetric ACLS should be initiated.
- Plan to incorporate the best practice interventions into obstetric ACLS.
Outline
Factors Responsible for Cardiac Arrest During Pregnancy
- Cardiac risk factors
- Non-cardiac risk factors
When Should Obstetric ACLS be Initiated
- Obstetric Early Warning Score
- Rapid response involvement
Key Components of Obstetric ACLS
- BLS
- Chest compressions
- Airway management
- Breathing
- ACLS
- Chest compressions
- Airway management
- Breathing
- Defibrillation
- IV access
ACLS Interventions of Obstetric Patient
- Drugs
- Tools useful during resuscitation
- Extracorporeal cardiopulmonary resuscitation (ECPR)
Treat the Arrest Cause
Potential Complications & Risk of Obstetric ACLS
Target Audience
- Nurses
- Nurse Practitioners
- Doulas
- Clinical Nurse Specialists
- Physician Assistants
- Physicians
Copyright :
02/28/2024
Maternal Healthcare’s Future: The Patient, The Provider & The Promise
The field of obstetrics is high adrenaline, high pace, and full of highs and lows. We have made large strides in the advancement of perinatal care, but we still have a long road ahead. In this session, we will briefly touch on maternal care’s past as we look toward maternal care’s future. As we anticipate improvements in obstetrical care outcomes in the future, let’s put this in the perspective of the Patient, The Provider, and the Promise.
Program Information
Objectives
- Determine the rationale and motive for discontinuing the traditional Friedman Curve in labor.
- Evaluate the data on oral intake during labor.
- Analyze the challenges with progesterone use for preterm birth prevention and new tools for PTB on the horizon.
- Choose team-based maternity care for better patient outcomes.
Outline
The Patient
- New data analyses on the course of “modern labor”
- Postpartum hemorrhage and evidence based prophylactic medication
- The future of preterm birth prediction: Cervical shear wave-elastography
- NPO status recommendations
The Provider
- The field of obstetrics is high adrenaline, high pace, and full of highs and lows
- Traumatic events, such as complicated deliveries, postpartum hemorrhage, eclamptic cases, and neonatal death take a toll
- Nurses must keep a vigilant watch over their patients, help their colleagues in emergencies, and defend their clinical insight to doctors
- As healthcare providers we must recognize and support the reality that healthcare is a team sport
- Hospital debriefing protocols can help being the healing process
The Promise
- We promised that we would not allow burnout to affect us
- We promised ourselves to have work-life balance
- We promised never to lose our passion for our profession
- Renew your dedication, your passion, your striving for better work-life balance and self-care
Target Audience
- Nurses
- Nurse Practitioners
- Physicians
- Physician Assistants
- Midwives
- Doulas
Copyright :
03/10/2023
Minimize OB Legal Risks with Empathy, Communication & Trust
Litigation continues to rise involving obstetric patients and revolves around allegations of negligence and medical malpractice during pregnancy, childbirth, or the immediate postpartum period. OB health care practitioners are at risk of being sued while coping with significant ethical dilemmas in practice. Lois A. Fenner McBride, RN, MS, JD, Attorney at Law, will deliver information about the current legal and ethical issues impacting OB patient care from failure to rescue, inadequate pregnancy management, labor stimulation methods, fetal distress and more! A “mere” mistake should not end your career. Learn how to protect yourself personally and professionally through communication, trust, documentation, and compassion.
Program Information
Objectives
- Evaluate how demonstrations of care and effective communication contribute to a reduction in obstetric mortality.
- Determine the importance of implementing safeguards (assessments, in service education, debriefing, validation of competencies, orientation and cross training) to minimize liability risks.
- Analyze the elements of litigation, defenses, and various outcomes.
- Plan to meet legal and regulatory standards through efficient and accurate documentation to protect the patient and health care practitioner in cases of disputes and litigation.
Outline
OB Litigation: Current Legal and Ethical Issues in Practice
- Chain of command/documentation/respondeat superior
- Verbal orders/telephone triage
- Failure to rescue
- Failure to follow procedures, protocols, and policies
- Inadequate pregnancy management/failure to refer/failure to assess and treat
- Wrongful birth
- Mom’s refusal of treatment
- Labor stimulation methods and risks
- When to resuscitate and how long to resuscitate
- Home births/birth centers
- Access to care
- Delay in treatment/fetal distress
- High risk procedures
- Mandatory reporting
- Minors/Informed consent
- Abortion: What is happening now
- Safe Haven
- Advanced directives/DNR
Strategies to Lower the Liability Risks
- Risk management/error prevention/emergency drills/simulations
- Maternal assessments
- Postpartum assessments
- Neonatal assessments
- Sentinel events/debriefing/learning from mistakes/improvement/ not denial and cover up
- CEU and learning are forever
- Inservice education: Mandated and beyond the minimum
- Orientation/evaluations/chart audits/competency validation/re-education prn
- Updating procedures, policies, and protocols
- Emotional support for staff: active listening, appropriate feedback, intervention, and support
Target Audience
- Nurses
- Nurse Practitioners
- Doulas
- Clinical Nurse Specialists
- Physician Assistants
- Physicians
Copyright :
02/26/2024
Electronic Fetal Monitoring: A Standardized Approach
Obstetric clinicians with their knowledge and skills, remain one of most important elements in high-quality intrapartum care. Unfortunately, after several decades of clinical use, many uncertainties continue to surround intrapartum monitoring including interpretation, management, and other related decision-making processes. When clinicians are not current in fetal monitoring or do have a firm grasp of basic concepts, there is a risk for adverse maternal and neonatal outcomes. This can have a significant negative impact on families and the healthcare system. Therefore maternal-fetal safety is of the utmost importance. Thus, continuous learning that includes contemporary research is fundamental for patient safety and for optimizing perinatal outcomes. An overview of fetal monitoring principles as well as updated research will be presented in this 2-hour recorded session.
Program Information
Objectives
- Define FHR characteristics using NICHD standardized terminology.
- Distinguish between the 3 elements of EFM standardization.
- Evaluate an organized, systematic ABCD approach to FHR management.
- Critique research related to Category II FHR management.
Outline
ABCD approach
- Assess the oxygen pathway a. Lungs, heart, vasculature, uterus, placenta, umbilical cord
- Begin corrective measures as previously outlined
- Clear obstacles to delivery
- Facility
- Staff
- Patient
- Fetus
- Labor
- Determine decision to delivery time
- Facility response time
- Staff
- Surgical, medical and obstetric considerations
- Other considerations (e.g., EFW, presentation)
Terminology
- What is it called
- Consensus statement by NICHD
- Adopted by AWHONN, ACOG, and ACNM
- Interpretation
- What does it mean
- What information does the FHR tracing provide regarding oxygen transfer
- Head compression, cord compression, uteroplacental dysfunction
- All decelerations have the exact same triggers
- Interruption of oxygen transfer from the environment to the fetus at one or more points along the oxygen pathway
- moderate variability and/or accelerations exclude ongoing hypoxic injury
- Management
- What do we do about it
- Corrective measures
- IV fluid bolus
- Lateral positioning
- Correct hypotension
- Decrease uterine activity
- Amnioinfusion
- Tocolytic administration
- Alter pushing technique
- Oxygen administration for maternal pulse ox <96%
- Introduction to ABCD approach to management
ABCD approach
- Assess the oxygen pathway
- Lungs, heart, vasculature, uterus, placenta, umbilical cord
- Begin corrective measures as previously outlined
- Clear obstacles to delivery
- Facility
- Staff
- Patient
- Fetus
- Labor
- Determine decision to delivery time
- Facility response time
- Staff
- Surgical, medical and obstetric considerations
- Other considerations (e.g., EFW, presentation)
“Intrapartum management of Category II FHR tracings towards standardization of care” 2013 article
- Algorithm
- Expert Opinions a. Not evidence based
- Definition of Significant Decelerations
- Key components of algorithm that are missing
- Precise cervical dilation
- When to notify primary clinician
- “A standardized approach for Category II fetal heart rate with significant decelerations: Maternal and neonatal outcomes”. 2018 article
- Prospective interventional trial: 29 hospitals
- Comparison between 2013 expert opinion and this trial algorithm
- Published results related to maternal and neonatal outcomes
- Only research conducted with a research protocol
Target Audience
- Nurses
- Nurse Practitioners
- Physicians
- Physician Assistants
- Midwives
- Doulas
Copyright :
01/03/2023
Traumatic Birth Experiences: Best Practices to Minimize Impact to Mom and Baby
Over 20% of women report a traumatic birth experience. An obstetrical emergency is just one factor that contributes to this experience for women. The experience can have far reaching effects – on the maternal-infant relationship and breastfeeding, as well as subsequent births. It may cause not only psychological stress, but also physical pain. Symptoms range from irritability to flashbacks. Women describe their experiences as degrading and inhumane. We need to acknowledge birth trauma and its effect on women and their families.
Program Information
Objectives
- Anticipate interventions to decrease the effects traumatic birth.
- Analyze risk factors for traumatic birth.
- Evaluate negative effects on the mother-infant dyad after a traumatic birth.
- Develop a discharge plan for the women who experienced a traumatic birth.
Outline
Long- and Short-Term Effects
- Effect on the patient
- Effect on the mother-infant dyad
- Effect on the family
The Patient’s Perspective
The Nurse’s Role
- Assessment
- Recognition
- Intervention
The Sexually Abused Patient Target Audience
- Nurses
- Nurse Practitioners
- Physicians
- Physician Assistants
- Midwives
- Doulas
Copyright :
03/09/2023