3 Labor & Birth Complications With Additional Lbaor Topics

Question 1

Preterm birth

Answer 1

Any birth occuring between 20-36/6

Question 2

RF to put you into preterm labor

Infections (5)
5 more

Answer 2

UTI, yeast infection
HIV, HSV, chorioamnionitis
Hx of PTL
Multifetal gestation
Smoking/substace abuse
Violence/domestic abuse
Lack of prenatal care

Question 3

Things to help us predict PTL/birth

2 things that combined is best way to determine risk for PLT

Answer 3

Endocervical length

Fetal fibronectin (fFN) test

Question 4

How we check endocervical length

What we use
When does the shortening occur
What length is indicating of low risk

Answer 4

Use transvaginal US

Cervical shortens before uterine contractions

30mm+ indicated low risk

Question 5

Fetal fibronectin (fFN) test

What is done (when)
What is expected early and late pregnancy
What does fFN during this time tell us

Answer 5

Vaginal swab (22-34wks)

Expected to find fFN in early and late pregnancy

During 22-34 wks it can indicate inflammation (⬆️ risk of PLT)

Question 6

Teaching S/S for PTL

Answer 6

Change in vaginal discharge

Pelvic/low abdominal pressure/cramping (may have diarrhea)

Low back ache

Uterine tightening

Question 7

Interventions for PTL

Answer 7

Teach s/s
FHR/contraction moniotred
Activity restriction
Hydration
Treat infection
Tocolytics
Glucocorticoids (lung maturity)

Question 8

Activity restrictions for PTL

Answer 8

Modified bedrest with BRP

Rest in left lateral position

Avoid sexual intercourse

Question 9

Why is hydration important when it comes to PTL

Answer 9

Dehydration can cause uterine contractions

Question 10

Tocolytic meds
Nifedipine

What it does
Route

Answer 10

Suppresses contractions by inhibiting Ca entering smooth muscles

Route: PO

Question 11

Nifedipine

SE
Do what to prevent one of them

Answer 11

HA
Flushing
Dizziness
HOTN

Stay hydrated to combat HOTN

Question 12

Nifedipine

Do not adminiter with what

Answer 12

Mg sulfate
Terbutaline

(TOCOLYTICS)

Question 13

Tocolytic meds
Mg sulfate

Does
Contraindication (6)

Answer 13

Inhibit uterine contractions

CI:
-Active vag bleeding
-cervix 6cm+
-34wk gestation
-chorioamnionitis
-acute fetal distress
-if you have taken nifedipine

Question 14

Mg sulfate

adverse effects/toxicity
(7)
(2) NST and FHR resultes
Toxicity relearn from 1st exam
Tx

Answer 14

Flushed/sweating
Muscle weakness
Flu-like symptoms
N/V
Pulmonary edema
Chest pain
HOTN

Nonreasctice NST
Reduced FHR variability

Tx: Ca gluconate

Question 15

Tocolytic meds
Terbutaline

What it does
Route

Answer 15

Inhibit uterine activity
Route (SQ q4h for up to 24hrs)

Question 16

Terbutaline

CI (4)

Answer 16

Cardiac disease

DM

Preeclampsia

Pregnancy induced HTN

Question 17

Terbutaline

Adverse effects
cardiac(5)
Neuro (3)
Labs (2)

Answer 17

Cardiac:
Chest discomfort
Palpitations
Dysrhythmias
Tachycardia
HOTN

Neuro:
N/V, tremors, nervousness

LABS:
Hypokalemia
Hyperglycemia

Question 18

Terbutaline

When to notify provider

Answer 18

Nortify provider if :

HR >130
BP <90/60
CP
Cardiac dysrhthmias

Question 19

Tocolytic meds
Indomethacin(NSAID)

When would this med be chosen
Does
Route

Answer 19

Blocks prostaglandins suppressing uterine contractions

Route: PO: no longer than 48hrs

Question 20

Indomethacin

Can cause what sever thing

Administer only if baby is what age

Answer 20

Can narrow or prematurely close ductus arteriosus

Adminiter only if <32wks gestation

Question 21

Indomethacin

adverse effects
1st one (4)
2nds one

Answer 21

Pulmonary edema:
CP,SOA,wheezing/crackles, productive cough

Postpartum hemorrahe d/t reduced plt aggregation

Question 22

Indomethacin puts pressure on what by narrowing the ductus arteriosus

Answer 22

The foramen ovale, leading to increased pressures.
Causing pulmonary edema

Question 23

What meds promote lung maturity and what are they

Answer 23

Antenatal glucocorticoids

Betamethasone or Dexamethason

Question 24

Antenatal glucocorticoids (betamethason/dexamethasone)

Given between what weeks when at risk of what
Stimulates what
Reduces what 3 things

Answer 24

Given 24-34 wks if at risk or threatening PTL/birth

Stimulates production of surfactant

Reduces:
Intraventricular hemorrhage (IVH)
Necrotizing enterocolitis
Death in neonates

Question 25

Betamethasone or dexamethasone Route and how many injections (how far apart) Monitor what Need to be given when to be effective

Answer 25

Route: IM 2 injections 24hr apart Monitor blood sugars if Diabetic Need given at least 24hrs before delivery

Question 26

PPROM What is it

Answer 26

Preterm prelabor ROM spontaneous rupture between 20-36/6 wks

Question 27

(3)PPROM RF

Answer 27

Infection of urogential tract Hx of PTL or PPROM Shortening of cervix

Question 28

PPROM Do what (8) things if ROM

Answer 28

monitor FHR and uterine contractions GBS cultures/vag cultures for chlamydia and gonorrhea Limit vaginal exams (prevent infection) Daily (NST, BPP, kick counts) Glucocorticoids if <34wks Recommended 7-day course of broad Abx Maintain hydration Bedrest with BRP

Question 29

PPROM/PROM pt education (6)

Answer 29

Bedrest with BRP Record daily kick counts/self-assess uterine contractions Pelvic rest Avoid tub baths Monitor for foul smell (infection) Temp q4hrs (notify if 100.4+)

Question 30

Theraeutic procedures: labor and delivery External cephalic version (ECV) What is it Use what to help during procedure Performed what wks What two things are done before procedure Med given

Answer 30

Attempt to turn fetus form breech/shoulder to vertex US scanning during procedure Performed 37-38wk inpatient setting NST and informed consent done before procedure Terbutaline SQ to relax uterus

Question 31

External cephalic version CI (6)

Answer 31

Previous C/S Multifetal gestation Cephalopevic disproportion Plecenta previa Uteroplacental insufficiency Nuchal card

Question 32

Cephalic version Preparing the pt for procedure (5)

Answer 32

Infromed consent Perform US prior to procedure NST (fetal well being) Rhogam administered at 28wks if mother Rh- IVF and tocolytics given

Question 33

Cephalic version monitoring(5) and interventions (1)

Answer 33

Monitor: FHR during and after Uterine contractions ROM Bleeding Moms VS Interventions: Rhogam post procedure for Rh- mom

Question 34

Induction of labor How we do it Its elective and not recommended before when UNLESS

Answer 34

Chemical (drugs) or mechanical intitiation of uterine contractions Not recommended before 39wks unless: -HTN/preeclampsia -IUGR -diabetes -chorioamnionitis -post-term

Question 35

Induction of labor CI (5)

Answer 35

Fetal distress Transverse lie Shoulder/breech presentation Placental previa Previous classical (vertical) uterine incision

Question 36

induction of labor Bishop score Cervical ripening meds we use

Answer 36

Bishop score: tells us how well her cervix will be for labor and delivery -8+ means its good Cervical ripening meds: Dinoprostone Misoprostol

Question 37

Augmentation of labor What is it Meds/intervention to do this (2) Risks of the interventions (3)

Answer 37

Stimulation of contractions once labor has begun but progress is inadequate Meds: Oxytocin Amniotomy (AROM) Risks: Compressed cord Prolapsed cord Infection

Question 38

Oxytocin Route Does: begin at/increase rate every Assess what and how often Contractions should be what freq/duration/intensity Assess relaxation of what Interventions if tachysystole

Answer 38

Route: IV Begin at 1miliunit/min Increase rate 1-2/min every 30-60 mins Asses fetus and contraxctions q15mins Contraction: q2-3mins/80-90secs/strong palpation Assess relaxation of uterus Uterine tachysystole: -⬇️ or D/c oxytocin -give tocolytic -oxygen

Question 39

Operative vag birth (forceps, vaccume assisted delivery) Indication

Answer 39

Maternal exhaustion Ineffective pushing Fetal compromise in 2nd stage

Question 40

Operative vag birth (forceps, vaccume assisted delivery) Have to have what: (4)

Answer 40

Skilled clinician Vertex presentation/full cervical dilation Fetal head engaged or lower Empty bladder

Question 41

Episiotomy What is it 2 types

Answer 41

Incision in perineum to enlarge vaginal opening to facilitate birth Median (midline) episiotomy Mediolateral episiotomy

Question 42

Cesarean birth 2 types

Answer 42

Scheduled c-section Unplanned c-section

Question 43

Scheduled c-section Why you may have (5)

Answer 43

Repeat Malpresentation Placental previa Active genital herpes HIV+ w/ high viral load

Question 44

Unplanned c-section Why you may have (3)

Answer 44

Non-reassuring fetal status Cervicopelvic disproportion (dont fit in pelvis) Placental abruption

Question 45

TOLAC and VBAC VBAC contraindications (3)

Answer 45

TOLAC (trial of labor after cesarean) VBAC (vaginal birth after cesarean) CI: Previous classical c-section incision Uterine surgeries Previous uterine rupture