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OB > Prelabor Complications and High Risk L&D (1) > Flashcards

Prelabor Complications and High Risk L&D (1) Flashcards

1
Q

what are prelabor complications

A
  • incompetent cervix
  • PROM
  • preterm
  • placental probs
  • multiple gestation
  • amniotic fluid probs
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2
Q

what is dilation of the cervix without pain or contraction

A

cervical insufficiency (incompetent cervix)

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3
Q

what is incompetent cervix d/t?

A

congenital (structural), acquired (trauma), hormonal

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4
Q

what is a stitch placed in the cervix to help cervical incompetency?

A

cerclage

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5
Q

what is the goal of a cerclage?

A

to maintain pregnancy

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6
Q

what is the risk of a cerclage?

A

if membrane bulges, a needle could rupture

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7
Q

what should you watch for in a pateint with cerclage?

A

s/sx of labor (cramp/infection)

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8
Q

rupture of membranes prior to the onset of labor (after 38 wk)

A

premature ROM

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9
Q

rupture of membranes prior to onset of labor (before 37 wk)

A

preterm premature ROM

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10
Q

ROM for more than 24 hours prior to delivery

A

prolonged rupture of membranes

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11
Q

what causes a greater risk for PROM?

A
  • lower econ status
  • infection
  • incomp cervix
  • multiple gestation
  • prior PPROM
  • prior preterm
  • smoking/substance
  • fetal anomaly
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12
Q

maternal risks of PROM

A
  • infection
  • choioamnionitis (infection of pregnancy)
  • endometritis
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13
Q

fetal risks of PROM

A
  • preterm delivery
  • infection
  • cord prolapse
  • oligohydramnios
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14
Q

what to do if ROM is suspected?

A

nitrozene test for amniotic fluid

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15
Q

management of PROM/PPROM

A
  • monitor infection
  • monitor contractions
  • bedrest
  • fetal assessment
  • corticosteroids
  • possible antibiotics
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16
Q

time to be considered preterm

A

after 20 wk, before 38 wk

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17
Q

what are causes of preterm labor?

A
  • trauma
  • poor PN care
  • substances
  • anemia/infection
  • bleeding/cervix
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18
Q

how is preterm labor disgnosed?

A
  • patient symptoms
  • contractions
  • cervical exam
  • fetal fibronectin
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19
Q

what is a vaginal swab that tests for presence of fetal fibronectin?

A

fetal fibronectin (FFN)

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20
Q

what does -FFN and +FFN indicate

A
  • -FFN= likely will not deliver within 14 days
  • +FFN= doesn’t tell much, if theres vaginal manipulation it’ll be positive
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21
Q

what are maternal risks of preterm labor

A
  • the underlying cause (bleeding, infection, etc)
  • DVT (bedrest)
  • emotional concerns
  • s/e from meds used to treat PTL
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22
Q

what are fetal risks of preterm labor

A
  • mortality
  • immature body systems and lungs
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23
Q

what kind of meds are used to stop labor?

A

tocolysis

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24
Q

what are examples of drugs to stop labor?

A
  • ritodrine (yutopar)
  • mag sulfate
  • calcium channel blockers
  • prostaglandin synthetase inhibitors
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25
Q

what preterm labor med reduces calcium entering smooth muscle cells

A

calcium channel blockers

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26
Q

what preterm labor med prevents the action of prostaglandins> prevent calcium from entering the smooth muscle cells

A

prostaglandin inhibitors

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27
Q

management of preterm labor

A
  • bedrest
  • VS
  • fetal monitoring
  • contraction monitoring
  • administration of tocolytics
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28
Q

what is the separation of the placenta from the uterine wall

A

placental abruption

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29
Q

what are some cuases of placental abruption

A
  • substance use
  • PROM
  • infection
  • HTN
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30
Q

how does placental abruption affect fetus

A

not enough blood, o2, and nutrients

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31
Q

how does placental abruption affect mother

A

blood/hemorrhage

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32
Q

what kind of placental abruption is when blood passes between fetal membrane and uterine wall, escapes vaginally (vaginal bleeding)

A

marginal

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33
Q

which placental abruption is where the placenta separates centrally, not on the edges, bleeding intract with no vaginal bleeding

A

central

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34
Q

which placental abruption is massive vaginal bleeding, almost total separation, lots of distress,a nd no o2

A

complete abruption

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35
Q

what is when the palcenta improperly implants over the lower portion of the uterus and may cover the cervix, not @ fundus

A

placenta previa

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36
Q

what is the mother at risk for with placental previa?

A

hemorrhage/fetal distress

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37
Q

what does the presence of placenta previa indicate?

A

c/s delivery

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38
Q

what are some considerations of palcenta previa?

A

no vag exam if bleeding, labs, pad count

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39
Q

which placental prob is painful

A

abruption

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40
Q

which placental prob results in more bleeding?

A

they both bleed, but previa is more

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41
Q

which thing makes a greater risk for GDM, HTN, HELLP, hydramnios, PROM, pulmonary edema, LBW??

A

multiple gestation

42
Q

is there a coorelation of multiple gestation with preterm birth?

A

yes!! 50% chance with twins and increases with more multiples

43
Q

less than the normal amount of amniotic fluid

A

oligohydramnios

44
Q

what does oligohydramnios put the fetus at risk for?

A

lung compliance issues, decelerations (variable)

45
Q

great amount of amniotic fluid?

A

hydramnios (polyhydramnios)

46
Q

what does (poly)hydramnios put the pregnancy at risk for?

A

malpresentation (breech), ROM -> possible cord prolapse, lack of o2

47
Q

abnormal labor pattern related to contractions, expulsion, fetal size, position, presentation, or the pelvis

A

dystocia

48
Q

what are characteristics of hypotonic contractions?

A
  • irregular contractions
  • lack intensity
  • less than 1cm/hr
49
Q

interventions for hypotonic labor patterns

A
  • pitocin augmentation
  • amniotomy
  • active management of labor
50
Q

what does active management of labor include?

A
  • 1:1 nurse:patient
  • amniotomy
  • cervical exams
  • pitocin
51
Q

management of tachysystole labor patterns

A
  • fetal assessment
  • pain amangement
  • pitocin (break cycle)
  • amniotomy (promote labor)
52
Q

what is it called when the entire labor and birthing process occurs within 3 hours

A

precipitous labor and delivery

53
Q

what are causes of precipitous L&D

A
  • low resitance of maternal soft tissues
  • abnormally strong contractions
54
Q

what are maternal risks of precipitous l&d?

A
  • fear
  • lacerations
  • bleeding
55
Q

what are fetal risks of precipitous L&D

A
  • hypoxia
  • meconium (in fluid)
  • injuries
  • low APGAR
56
Q

what is the classification for post dates pregnancy

A

pregnancy that lasts longer than 42 completed weeks, so the start of week 43

57
Q

what are risks of post dates pregnancy

A
  • induction
  • LGA or macrosomic
  • c/s
  • oligohydramnios
  • dysmaturity (IUGR)
58
Q

what is the normal position of baby

A

occiput anterior

59
Q

what can cause a baby tobe occiput posterior?

A

maternal pelvis

60
Q

management of occiput posterior presentation

A
  • position change, hands and knees
61
Q

risks of occiput posterior

A
  • c/s
  • longer labir (1st and 2nd stages)
  • pitocin augmentation
  • laceration/episiotimy
  • instrumental delivery
  • manual rotation
  • bleed/infection/pain
62
Q

fetal weight of more than 4000gm (8.82 lbs)

A

macrosomia

63
Q

risk factors of having a macrosomia baby

A
  • maternal obesity
  • diabetes
  • post term
  • multiparity
64
Q

what are maternal/fetal risks of macrosomia

A
  • dysfunctional labor
  • laceration/episiotomy
  • instrumental delivery
  • bleed/infection
  • shoulder dystocia (McRoberts)!!!
65
Q

how to help McRoberts (shoulder delivery)

A

flex thighs to abdomen

66
Q

what defines nonreassuring fetal status

A

inadequate fetal oxygenation leading to distress and acidosis

67
Q

what are causes on nonreassuring fetal status

A

-uteroplacental insufficiency
-cord compressions

68
Q

what are nonreassuring signs

A
  • decelerations, absent variability
  • meconium stained fluid
  • acidosis (7.2pH or less)
69
Q

what are the interventions for nonreassuring fetal status?

A

5Ps
* turn pitocin off, turn on left side, turn fluids on, turn on o2, turn call light on

70
Q

what is when the unbilical cord falls into the vagina prior to delivery and becomes trapped between the pelvis and presenting part, interfering with blood flow

A

cord prolapse

71
Q

what is the cause of prolapse?

A

when the presenting part is not well applied

72
Q

what are risks associated with cord prolapse

A
  • limit bloodflow
  • hypoxemia
  • bradycardia
73
Q

what are emergent interventions for cord prolapse

A
  • relieve cord compression
  • knee/chest position
  • prepare for c/s
74
Q

what is a retained palcenta

A

placenta is not delivered 30 mins or more after delivery, manual removal or D&C

75
Q

what is wehn placental chorionic villi attach to the myometrium

A

placenta accreta

76
Q

what is when the placenta invades the myometrium

A

placenta increta

77
Q

what is when the palcenta penetrates the myometrium

A

placenta percreta

78
Q

what is the amternal risk of placenta problems?

A

bleeding!!

79
Q

what is the manual movement of the fetus from breech or transverse to cephalic presentation

A

external version

80
Q

when is an external version done

A

after 36 weeks

81
Q

what must be present for an external version to be performed?

A

adequate amniotic fluid, reassuring FHR, no high risk situations

82
Q

softening and effacing the cervix prior to induction of labor

A

cervical ripening

83
Q

meds for cervical ripening?

A
  • cytotec (inserted into vag/oral)
  • cervidil/prepidil (vaginally)
84
Q

what are mechanical methods of ripening the cervix

A

pressure from balloon

85
Q

stimulation of contractions prior to spontaneous labor

A

labor induction

86
Q

stimulation of contractions in addition to spontaneously occuring contractions

A

labor augmentation

87
Q

what are common indications of induction or augmentation?

A

DM, HTN, PROM, infection, fetal demise, nonreassuring FHR, IUGR, oligohydramnios

88
Q

describe bishop score

A

augmentation/induction scale
score of 9 is favorable
less than 9 is associated with long labor and higher c/s rates

89
Q

manual separation of maniotic membranes. thought to release prostaglandins and initiate labor

A

membrane stripping

90
Q

what is the goal of oxytocin/pitocin infusion

A

stimualte adequate contractions that lead to dialtion (slowly, small amnts)

91
Q

what needs to be well applied for an amniotomy (AROM)

A

head of baby

92
Q

nursing assessment following AROM

A

FHR pattern
amount
color of fluid

93
Q

administration of warmed sterile fluid into uterus through an intrauterine pressure catheter

A

amnioinfusion

94
Q

what is the goal of an amnioinfusion

A

increase fluid volume to decrease umbilical cord compression or dilute meconium

95
Q

instrumental delivery to assist in delivery once head is on pelvic floor, used when fetus/mother is threatened

A

foreceps

96
Q

risks of foreceps

A

trauma to mom/fetus

97
Q

suction applied to head to aid in delivery, risk of trauma to mom/fetus

A

vacuum extraction

98
Q

when is vacuum used for extraction

A

prolonged secind stage of labor or non reassuring FHR

99
Q

viable and safe alternative for subsequent delivery if prior indication is not recurring

A

VBAC (vaginal birth after c/s)

100
Q

what is the success rate of VBAC, and what are risks

A

60-80%
uterine rupture

101
Q

contraindications of VBAC

A

previous classical incision or uterine rupture

OB (19 decks)

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