At Risk Labor & Birth

Question 1

Nursing Responsibilities

Answer 1

• Nurse & OB team must use knowledge & skills in a concerted effort to provide care in event of complication
• Uderstand normal borth processes
• Prevent & detect deviations from normal labor & birth
• Implement nursing measure if complication arise

Question 2

Preterm Labor & Birth

Answer 2

• Preterm Labor
  > cervical changes & uterine contractions occuring btwn 20 & before end of 37 wks
• Preterm Birth
  > birth tht occurs before the completion of 37 wks

Question 3

PROM

Answer 3

Spontaneous rupture of membranes is the spontaneous rupture of amniotic membranes 1 hour or more before the onset of true labor

Question 4

PPROM

Answer 4

Preterm, premature rupture of membranes is a premature, spontaneous rupture of membranes after 20wks of gestations and prioir to end of 37wks

Question 5

How to Confirm Rupture of Membranes

Answer 5

Positive nitrazine paper test: blue, pH 6.5-7.5
Positive ferning test

Question 6

Spontaneous Preterm Birth

Answer 6

• Birth w/out being induced
• An early initiation of labor process
• 75% of preterm births happen on their own

Question 7

Indicated Preterm Birth

Answer 7

• A means to resolve maternal or fetal risk
  > induced labor due to maternal/fetal risk
• Preeclampsia, HTN, seizures, abnormal FHR

Question 8

Causes of Preterm Birth

Answer 8

• Immune
  > infections: GBS, UTI
• Bleeding at site of placental attachment
  > placenta previa
  > placenta abruption
• Psychosocial
  > stress
  > trauma
• Endocrine
  > dcr in progesterone; will be started on progesterone to hopefully wait until term

Question 9

Preterm Labor & Birth Risk Factors

premies

Answer 9

• Preeclampsia
• Race (AA)/Record of hx
• Elevated BP
• Maternal age incrd
• Infection of urinary tract
• Excess/little amniotic fluid
• Second tri bleeding/Second baby (multifetal getation)
• low weight like anorexia

Question 10

Preterm Labor & Birth - Prevention

Answer 10

• Infections
  > hlth promotion & disease prevention
  > prenatal care
• Prior Hx of SPB
  > preconception counseling
• Pharma for SPB
  > Indomethacin: blocks prostaglandins
  > Nifidepine: stop contractions/inhibit Ca
  > Magnesium Sulfate: slow down preterm labor

Question 11

S/S of Preterm Labor

Answer 11

• More than 4-6 contractions in an hour or longer
  > every 10-15mins w/in the hr
  > it is full term you would not tell her to come in but preterm she must come in
• Discomfort
  > dull, intermittent lower back pain
  > menstrual-like cramps
  > pelvic pressure/heaviness
• Vaginal Discharge
  > rupture of membranes
  > change in discharge

Question 12

What Meds will Help Mature Fetal Lungs

Answer 12

Steroids
betamethasone and dexamethasone

Question 13

Ruptured Membranes Risks

Answer 13

• After rupture immediately assess FHR
  > take temp regualry; if mom’s temp incrs baby’s HR incrs
• Biggest Risk:
  > prolapsed cord: med emergency, cord cannot be delivered before baby, big variable decels, cannot take fingers off cord once found - prep for c-section
  > chorioamnionitis: an ascending infection, originating in the lower genitourinary tract and migrating to the amniotic cavity.

Question 14

Ruptured Membranes Documentation

Answer 14

• Time
• Amount
• Color
• Odor (bleachy)

Question 15

Chorioamnionitis

Answer 15

• Infection tht occurs when bacteria invades membranes, placenta, amniotic fluid, or surrounding tissue of fetus
• Mom’s VS:
  > tachy
  > fever
• Physical Assessment Findings
  > uterine tenderness
  > purulent amniotic fluid
  > odor
• FHR Pattern
  > tachy

Question 16

External Cephalic Version

Answer 16

Ultrasound guided procedure to externally turn fetus from breech into cephalic lie

Question 17

Induction/Augmentation of Labor

Answer 17

• Oxytocin/Pitocin
  > assess every 30-60 minutes
  > adequate contraction 2-3 min in frequency, 60-90 sec in duration

Question 18

Cervical Ripening Prostaglandins

Answer 18

• Cervidil
• Misoprostol

Question 19

Oxytocin/Pitcon IV Delivery

Answer 19

Needs to be administered as its own separate infusion, not as a piggyback

Question 20

Focused Assessment Post Administration of Prostaglandinds

gi/gu

Answer 20

• GI/GU
  > urinary retention
  > rupture of membranes
  > uterine tenderness/pain
  > contractions
  > bleeding
  > fetal distress
• Interventions
  > sidelying position
  > monitor for hyperstim of uterus/fetal distress

Question 21

Forcep-Assissted Birth

Answer 21

• Indication
  > providers fingers are too large to grip fetal head
  > provider needs skill
• Forceps placed on zygomatic bones of fetus
• Traction applied
• Maternal/Fetal Risk
  > laceration to perineum
  > facial nerve palsy/bruising neonate

Question 22

Vacuum-Assisted Birth

Answer 22

• Indication
  > pts tht are tired/poor pushing efforts
  > more often used than forceps
  > have to see baby’s head
  > vacuum removed before delivery
• Vacuum positioned on fetal head
• Traction applied
• Maternal/Fetal Risk
  > laceration to perineum
  > facial nerve palsy/bruising neonate
• Nurses role is just documentation & placing vacuum

Question 23

Cesarean Birth - Complications/Risks

Answer 23

• Aspiration
• Clots
• Infection
• Bladder injury

Question 24

Cesarean Birth - Pre-Op Care

Answer 24

• NPO at midnight
• Foley
• Antibiotic
• meds for her stomach
• IV fluids

Question 25

Cesarean Birth - Post-Op Care

Answer 25

- **Bleeding/Infection precautions** - **Uterine activity** > fundal massage - **I&Os** - **Post-op respiratory care**

Question 26

Cesarean Birth - Recovery Time

Answer 26

**Can take up to a year**

Question 27

Cesarean Birth - Indications

Answer 27

- **Placenta complications** > placenta previa - **Malpresentation** > breeched - **Active infection** - **Cord prolapse** - **Fetal compromise**

Question 28

Cesarean Birth - Horizontally Incision

Answer 28

**Heals easy, goes w/ mom's fibers**

Question 29

Cesarean Birth - Vertical Incision

Answer 29

- **Will always have to have c-section** - **Does not heal a good**

Question 30

Baby's that go through stress of labor then transitioned to c-section tend to handle external uterine life better

Answer 30

**True** They are able to remove fluid during the labor process compared to infants that have scheduled c-sections

Question 31

Meconium-Stained Amniotic Fluid

Answer 31

- **Medical emergency** - **Fetus has passed 1st stool before birth** - **Fluid is thick** - **Risk for** > meconium aspiration syndrome/pneumonia

Question 32

Shoulder Dystocia

Answer 32

- **Medical emergency** - **Head is born, but anterior shoulder cannot pass under pubic arch** - **Risk for** (infant) > brachial plexus injury - **Maternal Complications** > hemorrhage > rectal injury - **Interventions** > hyperflex hips > Mc Roberts maneuver

Question 33

What sign indicated that the infant is experiencing shoulder dystocia

Answer 33

**Turtle sign** Retraction of fetal head toward perineum

Question 34

Prolapsed Umbilical Cord

Answer 34

- **When cord lies over presenting part of fetus** - **DO NOT move hand!** > Call for help > 100% O2 > Prep for c-section - Other nurses will position mother in trendelenburg or knee to chest

Question 35

Amniotic Fluid Embolism

Answer 35

- **Amniotic fluid enters maternal blood stream** - **S/S** > acute onset of hypotension > hypoxia > CV collapse > coagulopathy (bleeding) - Maternal mortality 61%+ - Neonatal outcome is poor

Question 36

Uterine Rupture

Answer 36

- **Abnormal FHR tracing** > late decels, bradycardia - **Physical Exam** > abdominal rigid/pain > shock: due to massive blood loss, hypovolemix shock - **Vaginal Exam** > blood > loss of fetal station: "destationing"; during contraction baby is trying to deliver into rupture - **Causes** > miss management of oxytocin