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Flashcards in Intrapartal Complications Deck (49)
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1

Premature ROM

-defined as SROM 1 hour or more before labor starts

2

PPROM

occuring before 37 weeks either as a slow leak of fluid or gush

3

Risk factors for PROM

-infections
-hx of PROM
-hydraminos
-multiple pregnancy
-cervical insufficiency
-anything that adds stress to amniotic structures

4

Chorioamnionitis

inflammation and infection in fetal membranes and amniotic fluid

5

endometritis

infection of the uterine endometritum

6

PPROM Fetal Risks

-RDS
-Sepsis
-umbilical cord compression or prolapse
-other complications r/t preterm birth

7

Diagnosis of PROM

-speculum exam - pooling

-nitrazine test

-fern test

8

fern test

refers to detection of a characteristic 'fern like' pattern of cervical mucus when a specimen of cervical mucus is allowed to dry on a glass slide and is viewed under a low power microscope.

9

Management of PROM

-fetal age and presence/absence of infection determine management plan

-if infection is present, start antibiotics on mother and deliver

-assess neonate and start antibiotics

10

Medical Management of PPROM

-hospitalize
-assess for infection
-labs: CBC, CRP, UA, C/S and cultures
-determine gestational age
-assess fetal well being
-betmethazone
-by 24 wks, assess fetal lung maturity
-patient and family support and teaching

11

Nursing Management of PPROM

-hx: ROM time, quantity, quality of fluid, signifiant OB gyn problems

-PE: continously assess for signs of infection and assess hydration status

-assess knowledge base, coping ability and educate

-monitor for infection

-montior well being of mom and baby

-maintain optimal comfort

-prepare/support for C/S, neonatal care or demise

12

Preterm Labor

-labor occurring between 20-36 weeks with documented CTX and cervical changes

-disproportionate # of women are socio-economically underprivileged

-ACOG defines PTL as prior to 37 weeks

13

Preterm birth and prematurity

describes length of gestation regardless of birth weight

14

Low birth weight

-only considers a birth weight of less than 2500 gm

15

Preterm births account for...

about 10 percent of all births

-US and state of florida gets a "C" grade for pre-term birth rates

16

Risk factors for PTL

-age
-infections esp UTI and vaginal
-cervical incompetence
-bleeding
-substance abuse
-multiple gestation
-polyhydraminios
-anatomic abnormalities
-stress
-sex

17

Shorter Cervical Length

-Average CL at 24 weeks is 3.5

-20 percent probability of PTL is CL less than 2.2

-when CL less than 1.5 risk of PTL reaches 50 percent

18

Fetal Fibronectin

negative predictive value of approx 96 percent for not delivering within next 2 wks

-positive test has approx 20 percent predictive value for preterm delivery (bet. 24-34 wks)

-so, a positive test means preterm delivery is: ????

-negative test means: ????

19

Classic symptoms of preterm labor

-UTI
-cramping
-CTX
-pelvic pressure
-backache
-vaginal d/c or ROM
-bleeding
-diarrhea

20

Prevention and Tx of PTL

-primary and secondary prevention suggests looking at high risk pts

-approx 50 percent of preterm births occur in women considered low risk

-current research reflects the use to tocolytics to be overrated and BR may not be as effective as was once believed

21

BMS

Betamethasone

-halting labor progression for 48 hours can buy time to give mother 2 injections 24 hours apart to promote fetal lung maturity

22

Tocolytics

drugs that attempt to stop labor

-potentially serious side effects necessitate close monitoring

23

Magnesium Sulfate

-CNS depression

-ADR: resp depression, pulmonary edema, hypotension, cardiac arrest

24

Beta-agent: Terbutaline

-B-adrenergic agonist

-ADR: hypotension arrhythmias, pulmonary edema, MI, hyperglycemia, and hypokalemia

25

CA+ Channel blockers: Nifedipine

-smooth muscle relax, vasodilation

-ADR: profound hypotension and decrease in placental perfusion

26

Lifestyle modifications to decrease PTL

-sex
-riding long distanes in car/bus
-carrying heavy loads
-standing more than 50 percent of time
-heavy housework or climbing stairs
-hard physical work
-being unable to stop and rest when tired

27

Teaching self care for PTL

-empty bladder
-lie down tilted toward left side
-drink 24-32 oz of fluid
-soak in warm tub with uterus submerged
-rest 30 minutes after symptoms stop
-if symptoms persist contact practitioner

28

Management of inevitable preterm birth

-labor progressed to cervical dilation of 4 cm likely leads to inevitable preterm birth

-perterm births in tertiary care centers lead to better mother/baby outcomes

-women at risk should be transferred quickly to ensure best outcome

-first dose of antenatal glucocorticoids should be given before transfer

29

Progesterone to prevent preterm birth in high risk women

-tx based on whomen who are considered high risk due to short cervix or hx of preterm birth

-approved in 2011

-given vaginal or IM until 36 wks gestation

-Side effects include vaginal irritation, sleepiness, HA, and breast tenderness

30

Umbilical Cord Prolapse

Umbilical cord passes through the cervix at the same time or in advance of the fetal presenting part

-cord can become compressed, leading to fetal hypoxia