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NUR 332 > Intrapartum Complications > Flashcards

Intrapartum Complications Flashcards

1
Q

PROM

A

premature rupture of membranes
- before onset of labor

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2
Q

PPROM

A

preterm premature rupture of membranes
- before 37 weeks

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3
Q

fetal new born risks with PROM

A
  • resp distress syndrome (need fluid for lung development)
  • fetal sepsis
  • malpresentation (need fluid for rotation)
  • prolapse of cord
  • non reassuring FHR pattern
  • compression of umbilical cord (inc variables bc dec cushion)
  • premature birth
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4
Q

betamethasone

A

corticosteroid that enhances fetal lung maturity

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5
Q

preterm labor or premature onset of labor

A

labor that occurs between 20-36 weeks

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6
Q

s/s of preterm labor

A
  • uterine contractions at least 4 in 20 mins or 8 in 1 hr
  • cervical changes (dilation)
  • cramps felt in low abdomen
  • constant or intermittent feelings of pelvic pressure
  • ruptured membranes
  • low, dull backache
  • inc vaginal discharge
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7
Q

strongest predictors of preterm birth

A
  • fetal fibronectin: +
  • cervical length: shortening or thinning (less than 25 mm before birth)
  • hx of preterm
  • infection
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8
Q

what is fibronectin

A

what keeps everything like the amniotic sac in the uterus

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9
Q

what are tocolytics

A

meds that stop contractions

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10
Q

what meds are tocolytics

A

nifedipine
mag sulfate
terbutaline
progesterone therapy

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11
Q

nifdipine

A

helps relax uterine muscles
- dont give if SBP under 90
- monitor BP closely

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12
Q

mag sulfate

A

smooth muscle relaxer
- monitor alertness, RR, BP, reflexes, I&Os
s/s might be lower but should still be present

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13
Q

terbutaline

A

relaxes muscle contractions
- can cause tachycardia so do not give if over 120

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14
Q

progesterone therapy

A

helps sustain therapy
- given at night time
- delays birth

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15
Q

what is cervical insufficiency

A

painless dilation of cervix without contractions cervical defect
- less than 25 mm
- previous miscarriages without contractions

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16
Q

treating cervical insufficiency

A
  • ultrasound to assess
  • bed rest
  • progesterone
  • abx if cerclage (dont need whole pregnancy)
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17
Q

what is cerclage

A

surgical closure of cervix using sutures
- prophylactic if twins +
- monitor for bleeding
- cut before delivery

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18
Q

diagnosis cervical insufficiency

A

transvaginal ultrasound 16-24 weeks

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19
Q

warning signs of impending birth

A
  • back pain
  • pelvic pressure
  • changes in vaginal discharge
  • bleeding
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20
Q

placenta previa

A

placenta implantation in the lower uterine segment

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21
Q

problems with placenta previa during birth

A

lower uterine segment contracts and dilates
placental villi are torn from uterine wall
bright red, painless bleeding occurs

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22
Q

types of placenta previa

A

complete
partial
marginal
low lying

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23
Q

nursing care for placenta previa

A

no vaginal exams
assess for bleeding
VS, fetal status
anticipate unengaged fetal presenting parts
transverse lie is common
consent for c/s

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24
Q

drugs used for placenta previa

A

mag sulfate
nifedepine
terbutaline

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25
Q

abruption placentae

A

premature separation of a normally implanted placenta from the uterine wall

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26
Q

types of abruption plancentae

A

marginal: separates at edges
central: separates centrally
complete: total separation, BLEEDING

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27
Q

grades of abruption placentae

A

grade 1: mild, slight vaginal bleeding
grade 2: partial, moderate bleeding
grade 3: moderate to severe bleeding

28
Q

main differences between placenta previa and abruption placentae

A

abruption: severe and steady plain, tenderness, firm and stony hard, likely enlarges and changes shape

29
Q

care for abruption placentae

A
  • external fetal monitoring
  • monitor for pain
  • monitor abdominal growth
  • monitor for DIC (coags)
  • maintain stable cardio status
  • c/s is safest
30
Q

multiple gestation discomforts

A
  • shortness of breath
  • backache
  • heart burn
  • round ligament pain
  • pedal edema
31
Q

comfort measures for multiple gestation

A
  • frequent rest period
  • side lying with lower legs and feet elevated
  • relief of back discomfort: pelvic rocking, good posture, good body mechanics
32
Q

multiple gestation nursing care

A
  • frequent prenatal visits
  • prenatal vitamins
  • 1 mg folic acid
  • 24 wt gain my 24 wks (40-45 lbs gain)
  • serial ultrasounds
  • c/s likely
33
Q

normal amniotic fluid

A

600-1000 ml

34
Q

hydramnios (poly)

A

more than 2000 ml
- amniocentesis

35
Q

oligohydramnios

A

less than 500 ml
- renal and urinary malformations
- skin and skeletal abnormalities
- pulm hypoplasia (underdeveloped lungs)
- cord compression

36
Q

amniotic fluid embolism
- anaphylactoid syndrome

A

amniotic fluid leaks into maternal circulation through a small tear in amniotic sac
- happens during placental separation or contracting
- embolism blocks vessels in the lungs
- rare but 80-90% mortality

37
Q

amniotic fluid embolism sx

A

chest pain
dyspnea
cyanosis
frothy sputum
tachycardia
hypotension
massive hemorrhage

38
Q

amniotic fluid embolism care

A

stabilize cardio and resp system
CPR –> displace uterus if 20 wk + bc will prevent good blood flow
blood infusion
CVC
maybe immediate birth

39
Q

dysfunctional labor patterns

A

hypotonic and hypertonic contractions

40
Q

hypertonic contractions

A

more than 5 contractions in 10 mins

41
Q

hypotonic contractions

A

2-3 contractions in 10 mins
- low intensity

42
Q

hypertonic contraction care

A
  • change positions
  • turn off oxy
  • terbutaline
  • sedation, pain meds
43
Q

hypotonic contraction care

A
  • consider CPD
  • rule out malpresentation
  • adequate hydration
  • s/s of infection
  • give oxy
44
Q

post term pregnancy

A

beyond estimated date of birth
post term: beyond 42 wks

45
Q

maternal risk of post term pregnancy

A

perineal damage
hemorrhage
inc risk of c/s
anxiety
emotional fatigue
persistance of normal discomforts

46
Q

fetal risks of post term pregnancy

A

dec perfusion
oligohydramnios
small for gest age
macrosomia
inc risk for meconium stained fluid which inc risk for aspiration

47
Q

malposition

A

persistent occiput posterior position
- mother rotates from side to side
- knee to chest position
- hands and knees position
- HCP may manually rotate fetal head

48
Q

malpresentation

A
  • shoulder presentation
  • brow presentation
  • face presentation
  • breech (frank, complete, footling)
49
Q

version

A

turning of the fetus in utero
- external cephalic version: external manipulation of maternal abdomen to change fetus from breech to cephalic
- podalic version: internal, used in delivery of 2nd twin, less common

50
Q

care during ECV

A
  • consent
  • ultrasound
  • IV access
  • terbutaline
  • fasting 8 hrs
  • fetal monitoring
  • rhogam if in -
51
Q

non reassuring fetal status

A
  • brady or tachy
  • dec fetal movement
  • meconium stained amniotic fluid
  • persistent late variables
52
Q

umbilical cord prolapse

A

umbilical cord precedes presenting fetal part and gets compressed against pelvis
- prevention is key

53
Q

umbilical cord prolapse nursing care

A
  • keep gloved fingers in vagina to relive pressure
  • position for gravity to help relieve pressure
  • position in knee to chest or trendelenburg
  • oxygen
  • prepare for c/s
54
Q

cephalopelvic disproportion

A

head is too big to pass through pelvis
- c/s

55
Q

macrosomia

A

large fetus (4000+ g)
- risks: dysfunctional labor, uterine rupture, perineal laceration, postpartum hemorrhage, shoulder dystocia

56
Q

if vaginal delivery for macrosomia baby

A
  • lack of fetal descent should be indicator
  • unexpected shoulder dystocia
  • McRoberts maneuver or apply suprapubic pressure
  • application of fundal pressure contraindicated
57
Q

shoulder dystocia

A

shoulder entrapped behind suprapubic bone

58
Q

dangers of shoulder dystocia

A

brain damage from hypoxia
brachia plexus damage
umbilical cord compression

59
Q

interventions for shoulder dystocia

A
  • lower HOB
  • McRobert’s maneuver
  • suprapubic pressure
  • document intervention and length of time
60
Q

third and fourth stage of labor complication

A

retained placenta
lacerations
placental adherence (accreta, increta, percreta)

61
Q

retained placenta

A

retention of placenta beyond 30 mins after birth
- bleeding can be excessive
- may require manual removal
- possible blood transfusion

62
Q

lacerations

A

spontaneous tearing of the perineal area
- bright red vaginal bleeding that persists despite well contracted uterus
- observe bleeding and approximation during postpartum

63
Q

accreta

A

chorionic villi attach directly to the uterine myometrium

64
Q

increta

A

chorionic villi invade myometrium

65
Q

percreta

A

chorionic villi penetrate myometrium, sometimes attaching to nearby organs

66
Q

placenta adherence

A

abnormal adherence of placenta to uterine wall
- associated with hemorrhage and failed separation at birth
- high incidence of abdominal hysterectomy

67
Q

care for placenta adherence

A

monitor for bleeding
deliver before 38 wks
type and cross
hysterectomy to prevent maternal hemorrhage
general surgeon may be need to repair

NUR 332 (3 decks)

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