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Flashcards in BirthComplications Deck (31)
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1
Q

What is the nurse’s role in promoting labor progress?

A

Evaluate regularly: contractions, FHR, descent. Cervical dilation, 1cm/hr for active labor. I/O
Provide support: relaxation and stress reduction
Promote empowerment: allow expression of fears and concerns. Provide encouragement.

2
Q

Abnormal or difficult labor wherein the progression of labor deviates from normal. Characterized by slow progression of labor.

A

Dystocia.
Primary reason for C/S. becomes apparent during the “active phase of labor” (4cm). Termed “failure to progress” of dilation or descent of the head.

3
Q

Contractions start too early

Contractions won’t start

A

Preterm labor

Prolonged pregnancy

4
Q

Prior to the end of the 37th week of gestation. Regular contractions with dilation and effacement. Symptoms?

A
Preterm labor (PTL)
Uterine contractions, cramping or low back pain. Pelvic pressure or "fullness." Increase in vaginal discharge over normal. N/v, diarrhea. Unusual leaking fluid from the vagina.
5
Q

Preterm labor risk factors?

A

Maternal age, black ethnicity, low socioeconomic status. ETOH, drugs, smoking. History of preterm labor or birth. Diabetes and/or chronic HTN. Pregnancy with multiples. PROM and late or no prenatal care.

6
Q

How does one know if it’s really preterm labor?

A

How do the contractions feel?

Do these things help to stop or decrease contractions: resting on side, emptying bladder, increasing fluids.

7
Q

Management of PTL?

A

Tocolytic therapy, corticosteroids, home monitoring, diagnostic testing (fetal fibronectin)

8
Q

What does magnesium sulfate (MgSO4) do for PTL and preeclampsia?

A

PTL: Relaxes the uterine muscle to stop and prevent contractions
Preeclampsia: Decreases cerebral excitability and thus the risk of seizures in women with preeclampsia

9
Q

Administration and care with magnesium sulfate?

A

Loading doses then 1-4gm/hr. Continuous monitoring of fetal heart tones. Monitor and report hypotension, depressed DTRs, LOC, blurred vision, headache, u/o less than 30mL/hr, RR <12.
Calcium gluconate at the bedside for reversal of MgSO4

10
Q

This med promotes fetal lung maturity by increasing surfactant. Repeat in 7 days until lungs are mature or delivery.

A

betamethasone (Celestone)

2 doses IM 24 hours apart. Improvement in lung maturity can be seen after 24 hrs. Monitor mother for infection

11
Q

Risks of being “post term”?

A

Past the end of the 42nd week. Placental insufficiency, fetal macrosomia, shoulder dystocia, brachial plexus injuries, cephalopelvic disproportion

12
Q

Prolong pregnancy management?

A

Non-stress tests (NST) twice a week, daily fetal movement counts (at least 10 per day), biophysical profile, possible cervical ripening and induction of labor

13
Q

Indications for induction of labor?

A

Being post term, uncontrolled or worsening gestational HTN, gestational diabetes, PROM or PPROM, uterine infection, maternal or fetal medical conditions, placental insufficiency, non-reassuring non-stress tests

14
Q

Induction of labor?

A

Cervical ripening based on Bishop score, possible amniotomy, oxytocin (pitocin). Monitor contraction and fetal HR monitoring

15
Q

This med ripens the cervix to begin contractions. Inserted into the cervix every 6 hours.

A

misoprostol (Cytotec)
Monitor FHR and contraction pattern closely. May cause hypertonicity of uterus or FHR changes. Induction cannot be done for 4 hours after the last dose

16
Q

Uterotonic agent used for induction or augmentation of labor.

A

oxytocin (Pitocin)
IV, on med pump per protocol. Baseline/ongoing vital signs and FHR assessments. Contraction pattern may become hypersonic causing decreased FHR variability. Rapid dilation may occur leading to precipitous delivery, cervical laceration, or rupture of uterus.

17
Q

Oxytocin (pitocin) for induction of labor

A

10 units in 1000mL lactated ringers. Infusion pump piggybacked into main line IV. Start at 1-2 mU/hr. Assess contraction and FHR patterns every 15 min in first stage and every 5 min second. Monitor I/O, voiding, vitals, pain. Emotional support.

18
Q

What problems can present with the passenger?

A

Position, presentation, number, and size

19
Q

What does the McRoberts maneuver do?

A

Tilts the pelvis by lifting the knees up, orienting the symphysis more horizontally to facilitate shoulder delivery.

20
Q

What problems may occur with the psyche?

A

Psychiatric illness. Increased stress related hormones reduce uterine contractility and reduce utero-placental perfusion.

21
Q

What are examples of obstetric emergencies?

A

Prolapsed umbilical cord, uterine rupture, placental abruption, amniotic fluid embolism

22
Q

Cord protrudes along or ahead of the presenting part of the fetus. Risks?

A

Prolapsed umbilical cord. Total or partial occlusion of the cord. Rapid deterioration of fetal perfusion. Risks include malpresentation, growth restriction, prematurity, ruptured membranes at high station, hydramnios, grandmultiparity, multifetal gestation

23
Q

What is to be done when a prolapsed cord presents?

A

Verify station prior to the artificial rupture of membranes. Check fetal heart tones during artificial rupture and after.
Gloved hand on the presenting part to keep it of the cord. Position changes on bed rest. Monitor fetal heart tones and apply oxygen if needed/ordered. Prepare for emergency c/s.

24
Q

Premature separation from a normally implanted placenta after 20 weeks. Caused by forcing blood into the under layer of the placenta causing detachment.

A

Abruptio placentae.
Focus is on the cardio status of the mother and on the delivery of the fetus quickly by c/s if alive. Will deliver vaginally if the fetus is not alive.

25
Q

Risk factors for abruptio placentae?

A

Any HTN problems, seizures, uterine rupture. Trauma, previous history of abruption, placental pathology. Coagulation defects, smoking, cocaine use.

26
Q

Tearing of the uterus at the sire of a previous c/s scar.

A

Uterine rupture. First and most reliable sign is sudden fetal distress. Acute, continuous ab pain w/ or w/o epidural. Irregular ab contour. Loss of the station of the presenting part of the fetus. Hypovolemic shock of the fetus or mother.

27
Q

Break in the barrier between maternal circulation and amniotic fluid. From a placental abruption or uterine trauma.

A

Significant maternal and newborn morbidity and mortality. Rare and often fatal. Sudden onset hypotension, hypoxia, and coagulopathy. Suspect in any woman with sudden dyspnea.

28
Q

Warm, sterile normal saline or lactated ringer’s infused into uterus through intrauterine pressure catheter after membranes are ruptured.

A

Amnioinfusion.
250mL to 500mL by infusion pump over 20-30 minutes. Watch for hypertonic uterus. Observe for pad under mother for leaking infused liquid.

29
Q

Indications for amnioinfusion? Contraindications?

A

Oligohydramnios. Thick meconium stained fluid. Severe or longed variable decelerations.
Amnionitis, hydramnios, uterine hypertonia, known uterine anomaly, placental abruption or placenta previa.

30
Q

Assisted delivery devices?

A

Forceps.
Vacuum extraction. Provider performed, not nursing. Woman pushes while provider pulls suction attached to scalp. Can be done a certain number of times if suction cap come off. Once maximum has been reached, most use alternate device or c/s. Nurse’s responsibility to track number of unsuccessful tries.

31
Q

Vaginal birth after c/s?

A

VBAC. Risks for laboring after previous c/s. Uterine rupture, hemorrhage.
Contraindications include previous classical uterine incision and myomectomy.