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Flashcards in Complications in Labor(HD) Deck (78):
1

High Risk Pregnancy Factors:
(Biophysical)

-Genetics
-Nutritional Status
-Medical/Obstetrical history

2

High Risk Pregnancy Factors:
(Psychosocial)

-Smoking
-Caffeine
-Alcohol
-Drugs
-Psychological status

3

High Risk Pregnancy Factors:
(Sociodemographic)

-Low income
-no prenatal care
-age
-parity
-marital status
-residence
-ethnicity

4

High Risk Pregnancy Factors:
(Environmental)

-Exposure to teratogens

5

Fetal Status Tests(Ultrasound)

-visualizes fetal and maternal structures
-can be done transvaginaly

6

Fetal Status Tests(Amniocentesis)

-done 12-20 weeks
-genetic diseases
-quadruple screening
-fetal lung maturity

7

Fetal Status Tests(Non-stress test)

-external fetal monitoring
-reactive vs. non-reactive

8

Maternal Testing

-Maternal HGC for 02
-indirect coombs, test for RH
-triple screen(16weeks):
AFB=alpha fetal protein=neural tube defects=spina bifida
HCG=increase rapidly in beginning=hormone=rise in losing pregnancy
Estriol=High=down syndrome
-Glucose Screening
-Vaginal Culture

9

Hyperemesis Gravidarum(Etiology)

-a lot of vomiting during pregnancy
-excessive and difficult to alleviate N&V
-can happen to anyone young,old,obese,smoker
-morning sickness=no electrolyte imbalance
-hyperemesis=electrolyte imbalance
-antiemetics use cautiously; not in the beginning

10

Hyperemesis Gravidarum(s/s)

-weight loss
-dehydration
-electrolyte imbalance
-ketonuria
-acetonuria

11

Hyperemesis Gravidarum(tx)

-Rest
-IV fluids
-Antiemetics use cautiously
-severe cases-hospitalization-PPN or TPN

12

Hyperemesis Gravidarum(Nursing Care)

-I&Os
-smalls meals
-FHR
-VS
-Rest
-Assess for s/s of dehydration=poor skin turgor, dry mm, excessive thirst, dark concentrated urine

13

Incompetent cervix(Etiology)

-Painless, premature dilation of cervix
-Spontaneous abortions in obstetrical History
-under 14weeks: not able
-above 26weeks: age of viability

14

Incompetent cervix(Tx)

-Cervical Cerclage(closing opening surgically) if cervix is dilated more than 3cm and membranes intact
-Done between 14-26 weeks
-non-weight bearing recommended

15

Incompetent cervix(Nursing Care)

-Pt Education: explaining to mom why she should stay on bedrest
-emotional support

16

Bleeding Disorders

Early Pregnancy(before 24weeks)
-spontaneous abortions
-ectopic pregnancy
-hyditaform mole

Late Pregnancy(towards end of pregnancy)
-Placenta Previa
-Placenta Abruptio

17

Spontaneous Abortions(etiology)

loss of pregnancy before 20 weeks
-ruptured membrane 24-36hrs for fetal survival
-remaining tissue parts can lead to hemorrhage/infection/death
D & C=dilate cervix and move excessive tissue

18

Spontaneous Abortions(Threatened)

-vaginal bleeding, closed cervix, mild cramps

19

Spontaneous Abortions(Inevitable)

-cervical dilation, ruptured membranes, vaginal bleeding

20

Spontaneous Abortions(Complete)

-products of conception expelled
-uterine contractions
-bleeding

21

Spontaneous Abortions(Incomplete)

-profuse bleeding, retained tissue parts
-need D&C surgery to remove tissue parts

22

Spontaneous Abortions(Missed)

-fetus dies but retained, amenorrhea, foul smelling discharge or bleeding

23

Spontaneous Abortions(Septic)

-infection of uterus

24

Spontaneous Abortions(Habitual)

-3 or more consecutive loss of pregnancies

25

Spontaneous Abortions(Tx)

-Threatened-bedrest
-other-IV oxytocin(cause contraction)
-D&C
-Vacuum evacuation

26

Spontaneous Abortions(Nursing Care)

-vs
-I&O
-risk for hemorrhage
-Rhogam if Rh negative
-Emotional Support

27

Ectopic Pregnancies

-fertilization not in uterus
-not occupying uterine cavity
-increase w/ std's
-ruptured appendix
-endometrosis

28

Ectopic Pregnancies(S/s)

-abd tenderness
-spotting
-bleeding
-decrease H&H
-increase WBC
-shoulder pain

29

Ectopic Pregnancies(Dx and Treatment)

-Trans Vaginal ultrasound
-methotrexate(antineoplastic; attack growth of cell)
-Salpingectomy(salpingectomy=salpinge aka removal of fallopian tube)

30

Ectopic Pregnancies(Nursing care)

-monitor s/s shock
-pre & post op care
-grief counseling
-pregnancy counseling
-monitor HCG levels

31

Hydatiform Mole(molar pregnancy)(Etiology)

-Abnormal trophoblastic tissue-avascular vesicles
-complete or incomplete

32

Hydatiform Mole(S/s)

-abnormal uterine growth
-PIH(pregnancy induced hypertension)
-HCG level
-excessive N/V
-vaginal bleeding
-no heartbeat

33

Hydatiform Mole(Dx and Tx)

-Transvaginal ultrasound
-D&C=dilation and curclage=scraping of wall of uterus
-rhogam

34

Hydatiform Mole(Nursing Care)

-assess for infection and hemorrhage
-patient education
-emotional support

35

Placenta Previa(Etiology)

-abnormal placement of placenta
Types:
-marginal=on side
-partial=covering part of internal os
-total=everything upside down, entire os is covered

36

Placenta Previa(S/s)

PAINLESS bleeding in 3rd trimester**
-goal for pt to reach 34 weeks=lung development

37

Placenta Previa(Tx)

-bedrest=no pressure of fetus on placenta
-C-section=possible vaginal delivery with marginal=requires C-section except possibly a marginal

38

Placenta Previa(Nursing Care)

-monitor FHR
-assess for hemorrhage
-assess fundus(bleeding behind fetus)
-emotional support for family

39

Abruptio Placentae(etiology)

-premature separation of placenta
-caused by physical/emotional trauma/car accident/fall down stairs/
-PIH(pregnancy induced hypertension)
-h/o abruption
-smoking/cocaine
-PROM(premature rupture of membrane)

40

Abruptio Placentae(s/s)

-PAIN**
-vaginal bleeding
-fetal distress
-hard uterus
-maternal shock

potential for:
-maternal shock/death
-fetal brain damage
-fetal demise

41

Abruptio Placentae(Tx)

-CBR-complete bed rest
-FHR
-Moms VS
-C/section

42

Pregnancy Induced Hypertension(Toxemia)

-PIH=after 20weeks
-no proteinuria
-B/P= increase 140/90
-increase of 30mm systolic
-increase of 15mm Diastolic

TX:
-monitor closely
-rest
-low salt diet

-high bp after 20weeks of pregnancy
-any mother w/Bp 140/90=PIH
-if increase of 30mm systolic=PIH
-increase 15mm diastolic=PIH

43

Pre-Eclampsia

-mild, severe
-HTN after 20weeks
-s/s=proteinuris edema of hands and face
-headache, blurry visiom
-damage to epithelium lining of vessels due to decrease in blood supply
-can lead to HELLP syndrome
HEMOLYSIS
ELEVATED LIVER ENZYMES
LOW PLATELETS
-elevated liver enzymes=increase in ammonia, not enough o2 to fetus

44

Pre-eclampsia(mild)(TX)

-limit activity
-possible complete bed rest lying on back or side lying
-anti-hypertensive
-pt education-often pt feels fine
-

45

Pre-eclampsia(Severe)(TX)

-hospitalization
-antihypertensive(concerned with hypotension)
-MagSO4=classic drug for eclampsia, decrese smooth muscle of body
-calcium gluconate=antidote for MagSO4
-Lasix=makes urine frequent, given because risk of fluid overload
-Amniocentesis=done in late pregnancy to see lung development
-decrease incidence of seizures as a preventative, prophalatic

46

Eclampsia(Etiology)

-s/s pre-eclampsia w/ SEIZURES
-p/f abruption
-fetal compromise, fetal death, maternal death

47

Eclampsia(S/S)

-seizures
-HTN, proteinuria(Large and excessive)
-decrease urine output, increase BUN and creatine(toxic)
-decrease platelets(lead to bleeding)
-visual problems(temp. blind)
-pulmonary edema(fluid in lungs)
-put on dialysis/ventilator

48

Eclampsia(Tx)

-multiple antihypertensive
-MagSO4=drug of choice for pre-eclampsia=can cause loss of deep tendon reflex
-excreted by kidneys must have good urine output and renal function
-give calcium gluconate if loss of deep tendon reflex
-foley in if less that 60cc/hr
-below 30cc/hr=stop magnesium sulfate

49

Eclampsia(Nursing care)

-quiet room
-VS
-I&O
-FHR
-increase protein diet
-monitor deep tendon reflexes
-side position
-seizure precaution(padded bedside, suction machine)
-suction at bedside
-emotional support
-mom Is at risk up to 48hrs after delivery

50

Blood incompatibility(ABO incompatibility)

-ABO incompatibility
-Mom=O(contains anti-A and Anti-B Antibodies)
-Fetus= A or B
-cause jaundice or hepatosplenomegaly

51

Blood incompatibility(Rh incompatibility)

-Mom=Rh-
-Fetus=Rh+
-leakage of antigens can occur during delivery
-first pregnancy no difficulty
-subsequent pregnancy antibodies attack

52

Blood incompatibility(Treatment)

-Rhogam(immunoglobulin) 72hrs after delivery
-may be given at 28weeks gestation
-pathological jaundice
-Rh (-) mother Rh (+) baby= problem
-rh- mom given rhogam
-given @28weeks and again 72hrs after birth

53

Gestational Diabetes(Etiology)

-abnormal metoblism caused be need for more insulin and increase in hormone(HPL)

54

Gestational Diabetes(s/s)

-rapid weight gain
-increase surgar in urine
-increase sugar in blood
-potential for DKA

55

Gestational Diabetes(effect on fetus)

-macrosomia
-neonate hypoglycemia

56

Gestational Diabetes(Tx)

-insulin
-daily bs
-frequent monitoring
-possible c-section

57

Gestational Diabetes(nursing care)

-pt education/nutrition
-usually resolves after delivery

58

Sickle cell

-avoid crisis
-potential for MI
-CVA
-PE during labor
-needs 02

59

Anemia

-monitor H/H
-iron supplement
-incerase iron diet

60

Cardiac

-maintain B/P
-limit activity during labor
-usual c-section

61

Infection

-cultures
-c/section to avoid transmission during delivery

62

Dystocia

-prolonged labor
-freidman curve:
used to graph dilation n descent
-potential problems:
infection
postpartum hemorrhage
exhaustion of mother
-can be related:
power-contraction
postiton of fetus
presentation of fetus
size of fetus

63

Dystocia related to contractions
(Hypotonic)

-weak ineffective contractions in active phase
-failure to progress contractions
treatment:
-amniotomy
-iv Pitocin(oxytocin)=increase uterine contractions
-possible c/section

64

Dystocia related to contractions
(Hypertonic)

-frequent strong contractions=uncoordinated in latent phase
treatment:
-sedative or medication to relax uterus
-brethine-relax smoothe musle of lung
-Procardia-regulate contraction of uterus
-MgSo4=drug of choice for eclampsia causes deep muscle tendon relax
-calcium carbonate is the antidote

65

Dystocia related to position,size,presentation:
Abnormal position

-posterior
-severe back pain
-may need forceps
-can rotate to normal position

66

Dystocia related to position,size,presentation::
cephalopelvic disproportion

-head too large or pelvis too small
-trial labor
-monitor bladder
-possible c/section

67

Dystocia(Macrosomia)

-large baby over 10lbs
-frequently with diabetic mother
-episiotomy, possible c/section

68

Dystocia(Abnormal Presentation/Breech):

-will try external version
-potential prolapsed cord and aspiration
-possible c/section
-(face)interferes with normal mechanism

69

Precipitous Labor

-completed within 3 hours
-strongs, frequent contractions
-potential fetal distress, perineal lacerations and hematomas
-precipitous delivery= multipara, do not leave alone

70

Induction of Labor

-stimulating labor before it naturally starts
-augmentation(adding)-accelerates or helps labor after it has started
-prostaglandins-cervival gel
-Laminaria-dried seaweed
-nipple stimulation, oxytocin from posterior pituitary
-walking-stimulates descent

71

Induction of Labor

-given in microdrops
-oxytocin: 10units/1000cc ringers
-stimulates uterine contractions

72

Induction of Labor(s/s of overstimulation)

-contractions closer than q2mins
-longer than 90sec=fetal distress
-rest less than 60sec=fetal distress
-possible fetal distress
-rupture of uterus

73

Induction of Labor(Contraindications)

-placenta abnormalities(placenta abrupt(premature rupture of placenta),placenta previa(misplaced placenta)
-abnormal presentations
-prolapsed cord
-fetal distress
-prior c/section with classic or low vertical incision

74

Amniotomy

-artifical rupture of membranes to stimulate or augment labor
-potential complications
umbilical cord prolapse
infection
abruption
Nursing Care:
-FHR
-monitor moms VS
-check amniotic fluid

75

Premature rupture of membranes

-before labor starts naturally and after 38weeks
-guidelines for premature rupture of membrane(72hrs or signs of infection fever 101F or higher)
-possibly caused by infection(chorioamnionitits or group B strep)
-Nursing Care:
-check pH of vagina using Nitrazine paper
-monitor VS
-Bedrest
-monitor Fetal status

76

Pre-Term Labor(Etiology)

-cervical changes after 20 weeks and before the end of 37 weeks
-low socioeconomic status
-young mother
-incompetent cervix
-poor nutrition, stress
-decrease blood supply to uterus
-abdominal trauma
-polyhydramnios(excess amniotic fluid in amniotic sc)

77

Pre-Term Labor(Nursing Care)

-Bedrest
-IV hydration
-tocolytics: to relax uterus and stop contractions
-betamethasone: to hasten fetal maturity and increase surfactant production in fetus
-care of infant-NICU-given surfactant to keep alveoli open to prevent RDS

78

Post term pregnancy

-pregnancy last longer than 42 weeks
-decrease placental perfusion risk of decrease 02 to the fetus
-may pass meconium
-decrease in amniotic fluid
-fetus keeps gaining weight
Nursing care and treatment:
-induction of labor
-c.section