Intrapartal Complications Flashcards
(49 cards)
1
Q
Premature ROM
A
-defined as SROM 1 hour or more before labor starts
2
Q
PPROM
A
occuring before 37 weeks either as a slow leak of fluid or gush
3
Q
Risk factors for PROM
A
- infections
- hx of PROM
- hydraminos
- multiple pregnancy
- cervical insufficiency
- anything that adds stress to amniotic structures
4
Q
Chorioamnionitis
A
inflammation and infection in fetal membranes and amniotic fluid
5
Q
endometritis
A
infection of the uterine endometritum
6
Q
PPROM Fetal Risks
A
- RDS
- Sepsis
- umbilical cord compression or prolapse
- other complications r/t preterm birth
7
Q
Diagnosis of PROM
A
- speculum exam - pooling
- nitrazine test
- fern test
8
Q
fern test
A
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
Q
Management of PROM
A
- 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
Q
Medical Management of PPROM
A
- 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
Q
Nursing Management of PPROM
A
- 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
Q
Preterm Labor
A
- 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
Q
Preterm birth and prematurity
A
describes length of gestation regardless of birth weight
14
Q
Low birth weight
A
-only considers a birth weight of less than 2500 gm
15
Q
Preterm births account for…
A
about 10 percent of all births
-US and state of florida gets a “C” grade for pre-term birth rates
16
Q
Risk factors for PTL
A
- age
- infections esp UTI and vaginal
- cervical incompetence
- bleeding
- substance abuse
- multiple gestation
- polyhydraminios
- anatomic abnormalities
- stress
- sex
17
Q
Shorter Cervical Length
A
- 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
Q
Fetal Fibronectin
A
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
Q
Classic symptoms of preterm labor
A
- UTI
- cramping
- CTX
- pelvic pressure
- backache
- vaginal d/c or ROM
- bleeding
- diarrhea
20
Q
Prevention and Tx of PTL
A
- 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
Q
BMS
A
Betamethasone
-halting labor progression for 48 hours can buy time to give mother 2 injections 24 hours apart to promote fetal lung maturity
22
Q
Tocolytics
A
drugs that attempt to stop labor
-potentially serious side effects necessitate close monitoring
23
Q
Magnesium Sulfate
A
- CNS depression
- ADR: resp depression, pulmonary edema, hypotension, cardiac arrest
24
Q
Beta-agent: Terbutaline
A
- 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
31
Risk factors for prolapsed cord
- breech or transverse position
- long cord
- low lying placenta
- hydraminos multi-gestation
- small fetus
32
What to do for prolapsed cord
- position knee-chest or Sim's and give O2
- if head is pressing on cord, apply gentle pressure to head
- consider tocolytic until help arrives
- vago's method: bladder filling
- fetal and maternal monitoring
- emergency C/S if rapid vaginal delivery not realistic
- emotional support
33
Placenta Previa
- implantation of placenta is lower than normal in the uterus
- may cover cervical os
34
Symptoms of placenta previa
- no pain, quiet onset
- small to heavy external bleeding
- BRB
- normal uterine tone
- abnormal fetal position
- fundal ht unchanged
- occasional shock
35
Risk factors of placenta previa
- multi-parity
- increased age
- prior C/S
- large placenta
- recent abortion
- smoking
- defective blood vessels in decidua
-exact cause unknown
36
Management Plan for Placenta Previa
- BR with BRP only if woman not bleeding
- No vaginal exams
- Monitor for blood loss, pain, contractions -Maternal and fetal VS monitoring
- H&H, Rh, UA, chemistries
- IV LR on pump
- Type & Cross 2 units. -Betamethasone if needed
- Assess need for C/S
37
Placenta Abruptio
premature separation of the placenta from the uterine wall
-variable prognosis depending upon degree
38
Greatest risk factor for abruptio placenta
HTN (chronic or gestational)
followed by advanced age, high parity, race, cocaine/tobacco, trauma, internal monitoring, and short cord
39
Complete abruptio
usually results in certain fetal demise and maternal outcomes are often poor
40
prognosis of abruptio
more than 50% placenta abruption ends in certain fetal demise
41
Severe cases of abruptio requires...
hysterectomy and predispose mother to DIC
42
Marginal
-blood passes between fetal membranes and uterine wall escaping through vagina with separation occurring at the edges
43
Central
blood is trapped between placenta and uterine wall
44
Complete
massive vaginal bleeding seen in presence of almost total separation
45
DIC
Disseminated Intravascular Coagulation
- a true obstetric emergency
- DIC results in hemorrhage, anemia, and ischemia
- obstetric causation r/t abruptio placenta, retained dead fetus, amniotic fluid embolus, severe preeclampsia, HELLP syndrome, or gram negative sepsis
46
DIC Lab Findings
- increased PT and PTT
- thrombocytopenia
- presence of fibrin split products will confirm diagnosis
47
Uterine Rupture
- rare and life threatening event
- seen with tearing of a uterine scar, the result of abdominal trauma or when a congenital defect in the uterus is present
48
Risk factors for uterine rupture
- multips
- multi-gestation pregnancies
- hyper-stimulation of uterus
- mal-position of fetus
- difficult deliveries
49
Management of Rupture
- asses mother for syncope, shock, N/V, abdominal pain, FTP, and hypotonic CTX
- assess fetus for late decels, decreased variability and changes in HR
Obstetric emergency: C/S
