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Women's Health > Complications of Labor > Flashcards

Complications of Labor Flashcards

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1
Q

cervical change and uterine contractions occurring at 20-37 wks of pregnancy (costly and deadly)

A

preterm labor (PTL)

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2
Q

birth that occurs before the completion of 37 wks

A

preterm birth

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3
Q

length of gestation regardless of birth wt
more dangerous than birth wt alone because less time in uterus means immature body systems and decreased surfactant levels

A

preterm birth or prematurity

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4
Q

what is low birth wt

A

less than or equal to 2500 g at birth

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5
Q

what is the cause and effect of low birth wt

A

cause is preterm or IUGR

effect is low amount of brown fat which in turn causes respiratory distress, hypoglycemia, and cold stress

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6
Q

describe spontaneous preterm births

A

responsible for 75% of preterm births

cause:infection, placental causes

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7
Q

describe indicated preterm births

A

responsible for 25% pf preterm births

typically a C section d/t known complications like DM and HTN

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8
Q

how to predict spontaneous preterm labor/birth

A

risk factors
cervical length (if length is greater than 30 mm unlikely to be premature birth)
Fetal Fribronectin test (fFN test)

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9
Q

describe fFN test

A

glycoprotein “glue” found in plasma and produced during fetal life

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10
Q

______ can cause premature contractions

A

dehydration

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11
Q

PTL (preterm labor) management

A

pt teaching (loss of mucus plug, hydrate, rest)
prevention and early recognition and diagnosis
activity restriction (sexual)
**Tocolytic medication
promotion of getal lung maturity

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12
Q

describe Tocolytic meds

A

used for suppression of uterine activity

CANNOT give if HR is >130

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13
Q

spontaneous rupture of amniotic sac and leakage of fluid prior to onset of labor at ANY gestational age (no contractions)

A

Premature Rupture of Membranes (PROM)

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14
Q

membranes rupture before 37 wks gestation
responsible for 10% of preterm births
proceeded by infection
<32 wks is managed expectantly and conservatively

A

PPROM

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15
Q

what does infection d/t amniotic fluid often lead to

A

choriomnionitis

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16
Q

PROM and PPROM management

A

watch for infection
fetal assessment
antenatal glucocorticoids can raise blood sugar

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17
Q

describe why magnesium sulfate would be given before 32 wks

A

**contraindicated in myastheria gravis

reduces severity and risk of cerebral palsy in birth before 32 wks

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18
Q

what does ACOG recommend for pregnant women between 24 and 34 wks at risk of delivery in 7 days

A

single course of corticosteroids (takes 2 days for injectionto reach baby)

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19
Q

how do we know if woman is at risk of delivery soon

A

positive fFN test

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20
Q

antibiotics not used for _____ membranes

A

INTACT

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21
Q

what is usually the cause of chorioamnioitis and what is the treatment

A

gonorrhea and chlamydia

antibiotics and glucocorticoids

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22
Q

bacterial infection of amniotic cavity
major cause of complications
maternal fever, maternal and fetal tachy, uterine tenderness, foul odor of amniotic fluid

A

chorioamnionitis

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23
Q

what is term versus full term

A

term 37 wks

full term 40 wks

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24
Q

describe post term pregnancy

A

pregnancy > 42 wks gestation

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25
maternal risks with post term pregnancy
dysfunctional labor and birth canal trauma, labor interventions, maternal fatigue and psychological reactions
26
fetal risk with post term pregnancy
macrosomia, prolonged labor, shoulder dystocia (stuck), trauma, aging placenta, postmaturity syndrome
27
describe postmaturity syndrome complications
become apoxic relaxed anal sphincter can cause aspiration of meconium high risk for resp distress
28
five factors affecting labor
powers, passage, passenger, maternal position, psychological response
29
describe hypertonic uterine dysfunction
greater than 4 contractions in 10 min too many contractions do not change cervix, decreases oxygen to baby give Tocolytic to relax and recommend rest
30
suppresses contractions/premature labor
Tocolytic
31
describe hypotonic uterine dysfunction
``` initially normally progresses, then first contractions become week and inefficient, then stop completely give Oxytocin (pitocin) to increase contractions ```
32
what are secondary powers
problems with bearring down effects
33
what tells you how often labor should take place (depending on gravida/parity)
Friedman's curve
34
lasts < 3 hrs from onset of contractions to birth high risk for lacerations and tearing slow involutions, risk of hemorrhage
precipitus labor (intense)
35
contractions of pelvic diameters that reduce capacity of bony pelvis, inlet or outlet
pelvic dystocia
36
obstruction in birth passage | can be adipose tissue d/t obesity
soft tissue dystocia
37
what is recommended for pelvic or soft tissue dystocia
c section
38
mother needs to be in ____ to help prevent dystocia
upright position
39
fetal causes of dystocia
abnormalities, malposition, malpresentation cephalopelvic disproportion (CPD AKA FPD) multifetal pregnancy
40
maternal _____ can also cause dystocia
psychological stress
41
describe obesity parameters
obestity: BMI > 30 kg | extreme obesity: BMI >40 kg
42
pregnancy complications d/t obesity
venous thromboembolism and c sections
43
describe external cephalic version (ECV)
- attempt to turn fetus from breech or shoulder presentation into a vertex presentation - ultrasound screening to verify and check placenta - NST and informed consent before procedure - easy if small baby or multifetal
44
what is ECV contraindicated in
anyone with a scarred uterus
45
describe internal version
rarely used, safety questionable | used in twin gestation to deliver second fetus
46
chemical or mechanical initiation of uterine contractions | electively or for indicated reasons
induction of labor
47
labor induction without medical indication | risks: increased risk of c section, neonate morbidity, cost
elective induction
48
elective induction should not be initiated until woman is ____ wks
39
49
how do you know if good candidate for induction
>9 on Bishop's scale
50
cervical ripening methods
prostaglandins, Foley bulb to traction
51
what is an amniotomy
break waters
52
what med is used to induce labor
pitocin- synthetic oxytocin used when labor is progressing slowly or induction is necessary
53
normally produced by posterior pituitary gland | stimulates uterine contractions and aids in milk let down
oxytocin
54
help contractions get longer | stimulation of uterine contractions AFTER labor has started spontaneously or progresses slowly
augmentation of labor | methods: oxytocin infusion or amniotomy
55
transabdominal incision of uterus | birth rate over 32% in US
c section
56
what is VBAC and TOLAC
VBAC: vaginal birth after c section (only can be done if horizontal uterine incision) TOLAC: trial of labor after c section
57
risks of c section
bleeding, infection, anesthesia complications
58
what are the obstetric emergencies
``` meconium stained amniotic fluid shoulder dystocia prolapsed umbilical cord rupture of uterus amniotic fluid embolus ```
59
fetus passed stool prior to birth (dark black/green) | causes: breech , hypoxia, umbilical compression
meconium stained amniotic fluid
60
if baby aspirates meconium...
can cause resp distress
61
head born, shoulder cannot pass newborn experience birth injury maternal risk: excessive blood loss, lacerations, extension of episotomy, enbdometrisis
shoulder dystocia
62
interventions of shoulder dystocia
McRobert's position (knees to ears) | suprapubic pressure
63
cord comes out before baby | d/t: long cord (>100 cm), malpresentation (breech), transverse lie, unengaged head in cervix
prolapsed umbilical cord
64
interventions for prolapsed umbilical cord
``` elevate presenting part (insert 2 fingers into cervix and press up) Trendelenburg position (feet up and head down) OR knee chest position ```
65
this is a rare but serious emergency | d/t scarring of C section, uterine trauma, congential uterine anomaly
rupture of uterus
66
MAJOR emergency amniotic fluid containing particles or debris enters maternal circulation typically occurs during 3rd stage of labor
amniotic fluid embolus (AFE)
67
what does AFE cause
``` major anaphylaxis (resp distress) CODE- start bagging with amboo bag ```

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