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OB/PEDS: Midterm > INTRAPARTUM COMPLICATIONS: > Flashcards

INTRAPARTUM COMPLICATIONS: Flashcards

1
Q

Dystocia
Cause:?

A

Difficult Labor/ birth
- Caused by: dysfunctional or uncoordinated contractions.
— Irregular in strength, timing or both.

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2
Q

Shoulder Dystocia:

A
  • Urgent-umbilical cord can be compressed
  • Turtle sign- Head retracts into perineum after delivery-*may prevent respirations
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3
Q

McRobert’s maneuver:

A

Used to treat Shoulder dystocia

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4
Q

Hypertonic Labor:

A
  • More frequent but less intense and ineffective.
  • Painful- related to no resting phase; (causes tissue ischemia)
  • Delays dilation and effacement
  • Prolonged latent stage
  • Prolonged pressure on the fetal head
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5
Q

Precipitous Labor & Birth:
- contributing factors:

A

Labor that lasts less than 3 hours
Contributing factors:
- Multiparity
- Placental abruption
- Infection (causes uterine cramping and contractions)
- Large pelvis
- Previous precipitous labor
- Small fetus in favorable position

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6
Q

Precipitous Labor & Birth: Priority
Interventions: ?

A

promote fetal oxygenation and maternal comfort
Interventions:???
- Side-Lying
- Administer O2
- Stop Pitocin
- Administer tocolytic
- Breathing techniques

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7
Q

Risks to the Mother of precipitous Labor:

A
  • Loss of coping abilities
  • Lacerations
  • Postpartum hemorrhage
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8
Q

Risks to the Baby of precipitous Labor:

A
  • Hypoxia due to uteroplacental insufficiency related to intense contractions
  • Cerebral trauma
  • Brachial plexus injury
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9
Q

PROM Premature Rupture of Membranes Earlier than 37 weeks gestation
Causes:

A
  • Chorioamnionitis
  • Infections
  • Weak Amniotic sac
  • Fetal abnormalities or malpresentation
  • Incompetent cervix
  • Overextension of uterus
  • Hormonal changes or nutritional deficiencies
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10
Q

PROM Premature Rupture of Membranes Earlier than 37 weeks gestation:
Complications

A
  • Infection to mother and fetus
  • Preterm labor
  • Oligohydramnios: a disorder of amniotic fluid resulting in decreased amniotic fluid volume for gestational age
  • *Umbilical cord prolapse
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11
Q

PROM Management:

A
  • Labor is induced if term
  • prevent further loss of fluid.
  • avoid intercourse or orgasm and nipple stimulation.
  • *If Preterm: administer Betamethasone to accelerate fetal lung maturity
  • Administer antibiotics
  • Activity restricted and possible bed rest
  • Monitor fetus for signs of distress
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12
Q

Preterm Labor

A
  • After 20th week and before end of 37th week
  • Affects 1 of 8 babies in US
  • No scheduled C-sections prior to 39 weeks gestation.
  • Newborn mortality doubles each week before completing 39 weeks gestation
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13
Q

Preterm Labor Signs & Symptoms:

A

same/similar to normal labor
- Uterine contractions
- Sensation of the baby “balling up”
- Cramps
- Low backache
- Pelvic pressure
- Increase in spotting or vaginal discharge
- Abdominal cramps with or without diarrhea
- A sense of “not feeling well”

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14
Q

Preterm Labor Treatment

A
  • Hydration
  • Tocolytics: to inhibit contractions
    — Magnesium Sulfate
    — Calcium antagonists
    — prostaglandin synthesis inhibitors
    — beta adrenergics
  • Steroid (Betamethasone) for the fetus
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15
Q

Magnesium Sulfate
Route:
- Indication:

A

May be administered IV or PO to stop labor
- preterm labor
- seizures
- women with preeclampsia

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16
Q

Magnesium Sulfate

Reflex documentation

A

0= no reflex
+1= hypotonic
+2 reflex
+3-4= hypertonic

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17
Q

Magnesium Sulfate

Non-therapeutic: reflexes

A

hypotonic & hypertonic

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18
Q

Magnesium Sulfate: hypotonic & hypertonic
Theraputicness

A
  • If hypotonic=too much.= d/c mag sulfate/ antidote
  • If hypertonic=not enough
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19
Q

Magnesium Sulfate toxicity s/s
Antidote:

A

Blurred vision, headache
lethargy, weakness
nausea/Vomiting, constipation
- Calcium Gluconate (for hypotonic)

20
Q

Calcium Channel Blockers for Preterm Labor Treatment

A

Nifidipine

21
Q

Nifidipine
Theraputics:
Route:
Nursing implication
S/S

A

prevents muscle contractions, type of tocolytic
- Administered PO
- Assess BP
S/S:
- hypotension due to vasodilation
- flushing of skin
- headache
- transient tachycardia

22
Q

Prostaglandin Synthesis Inhibitor
For Preterm Labor Treatment

A

Indomethacin

23
Q

Indomethacin
Route:
Therapeutics:
Nursing implications:

A
  • PO type of NSAID
  • Limit use before 32 weeks gestation
  • Use only for 48-72 hrs. to decrease chance of closing ductus arteriosis.
  • Decreases amount of amniotic fluid
  • Assess for GI bleed
24
Q

Beta Adrenergic
For Preterm Labor Treatment

A

Terbutiline

25
Q

Terbutiline:
Route:
Nursing implications:
S/S:

A
  • IV or SubCut
  • *black box warning.
  • Not recommended anymore except in extreme cases.
  • *Causes tachycardia and dysrhythmias (mom needs to be on a tele monitor)
  • Only use for 48-72 hrs
26
Q

Corticosteroid
For Preterm Labor Treatment

A

Betamethasone- for the fetus

27
Q

Bethamethasone
Route:
Therapeutics:

A
  • IM injection
  • Used to accelerate fetal lung maturity (between 24- 34 weeks)
  • Reduces RDS (respiratory distress syndrome), Intraventricular hemorrhage, and death
28
Q

Postterm pregnancy

A

Longer than 42 weeks

29
Q

Postterm pregnancy:
Maternal Risks:

A
  • LGA
  • Increased incidence of assisted delivery (forceps, vacuum or C-section)
  • Increased psychological stress
30
Q

Postterm pregnancy:
Fetal Risk:

A
  • Decreased placental perfusion & Less amniotic fluid
  • Oligohydraminos
  • Meconium aspiration
31
Q

Macrosomia:

A

large baby for term

32
Q

Risks of Macrosomia:
Mother

A
  • CPD- cephalopelvic disproportion
  • Dysfunctional and prolonged labor
  • Lacerations
  • Postpartum hemorrhage
33
Q

Risks of Macrosomia:
Infant

A
  • *Hypoglycemia: not getting enough glucose when born
  • *Polycythemia: if they are hypoxic, the bones produce more RBC’s
  • *Hyperbilirubinemia: when the RBCs break down= increased bilirubin
  • Meconium aspiration
  • Asphyxia
  • Shoulder Dystocia
  • Brachial plexus injury or fractured clavicle
34
Q

Prolapse of Umbilical Cord:
Cause

A

Occurs when umbilical cord comes out before the fetal presenting part
Causes:
- *Major cause: Breech presentation
- Fetus in high station
- Small fetus
- Transverse lie
- Polyhydramnios

35
Q

Occult (hidden) prolapse:

A

The cord is compressed between the fetal, presenting part and pelvis, but cannot be seen or felt during vaginal examination

36
Q

Cord prolapsed in front of the fetal head:

A

The cord cannot be seen, but can probably be felt as a pulsating mass during vaginal examination

37
Q

Complete cord prolapse:

A

The cord has been seen protruding from the vagina

38
Q

Management of Prolapsed Cord

A
  • Knee chest position or trendelenburg
    — Knee-chest uses gravity to shift the fetus out of the pelvis. The woman’s thighs should be at right angles to the bed and her chest flat on the bed
    — The woman’s hips are elevated with 2 pillows; this is often combined with the trendelenburg (head down) position
  • Firm pressure on head to relieve cord compression
  • *Administer O2
39
Q

Uterine Rupture/Dihiscence
Causes:

A
  • previous uterine surgery or C- Section
  • intense labor
  • High parity
40
Q

Uterine Rupture/Dihiscence:
S/S:

A
  • Abdominal pain and tenderness
  • Chest pain between scapulae or on inspiration
  • Hemorrhage
  • Hypovolemic shock
  • Cessation of contractions
  • Fetal distress on monitor (you would see late decelerations)
41
Q

Uterine Rupture/Dihiscence:
Treatment:

A
  • Stabilize mother and fetus
  • Delivery may be imminent
  • Replace blood & fluid loss
  • Repair if rupture is small
42
Q

Uterine Inversion
Degrees:

A

Uterus completely or partly turns inside out, during the third stage of labor
- 1st degree: inverted fundus up to cervix
- 2nd degree: body of uterus protrudes through cervix into vagina
- prolapse of inverted uterus outside vulva

43
Q

Uterine Inversion:
Causes:

A
  • fundal pressure
  • Pulling of umbilical cord
  • Increased intraabdominal pressure
  • Abnormally attached placenta
  • weak uterine wall
44
Q

Uterine Inversion:
S/S

A
  • uterus may protrude into the uterus??
  • Hemorrhage
  • Shock
  • Severe pelvic pain
45
Q

Uterine Inversion:
Treatments

A
  • stabilize mother and fetus
  • Replace blood
  • Replace uterus
  • Possible hysterectomy
46
Q

Anaphylactoid Syndrome/Amniotic Fluid Embolism

A
  • Amniotic fluid is drawn into the maternal circulation and carried to woman’s lungs.
  • Contains Fetal cells and matter (skin, vernix, hair, meconium); can obstruct pulmonary vessels
  • *DIC (Disseminated intravascular coagulation) occurs due to thromboplastin in amniotic fluid
47
Q

Treatment of Anaphylactoid Syndrome

A
  • CPR
  • Oxygen and mechanical ventilation
  • Correction of hypotension
  • Blood therapy to correct coagulation defects
  • Immediate C-section

OB/PEDS: Midterm (21 decks)

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