- Urgent-umbilical cord can be compressed - Turtle sign- Head retracts into perineum after delivery- may prevent respirations

- More frequent but less intense and ineffective. - Painful- related to no resting phase; (causes tissue ischemia) - Delays dilation and effacement - Prolonged latent stage - Prolonged pressure on the fetal head

- Labor is induced if term - prevent further loss of fluid. - avoid intercourse or orgasm and nipple stimulation. - If Preterm: administer Betamethasone to accelerate fetal lung maturity - Administer antibiotics - Activity restricted and possible bed rest - Monitor fetus for signs of distress

- After 20th week and before end of 37th week - Affects 1 of 8 babies in US - No scheduled C-sections prior to 39 weeks gestation. - Newborn mortality doubles each week before completing 39 weeks gestation

INTRAPARTUM COMPLICATIONS: Flashcards by Mikeal Lang

Dystocia
Cause:?

Difficult Labor/ birth
- Caused by: dysfunctional or uncoordinated contractions.
— Irregular in strength, timing or both.

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Shoulder Dystocia:

Urgent-umbilical cord can be compressed
Turtle sign- Head retracts into perineum after delivery-*may prevent respirations

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McRobert’s maneuver:

Used to treat Shoulder dystocia

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Hypertonic Labor:

More frequent but less intense and ineffective.
Painful- related to no resting phase; (causes tissue ischemia)
Delays dilation and effacement
Prolonged latent stage
Prolonged pressure on the fetal head

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Precipitous Labor & Birth:
- contributing factors:

Labor that lasts less than 3 hours
Contributing factors:
- Multiparity
- Placental abruption
- Infection (causes uterine cramping and contractions)
- Large pelvis
- Previous precipitous labor
- Small fetus in favorable position

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Precipitous Labor & Birth: Priority
Interventions: ?

promote fetal oxygenation and maternal comfort
Interventions:???
- Side-Lying
- Administer O2
- Stop Pitocin
- Administer tocolytic
- Breathing techniques

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Risks to the Mother of precipitous Labor:

Loss of coping abilities
Lacerations
Postpartum hemorrhage

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Risks to the Baby of precipitous Labor:

Hypoxia due to uteroplacental insufficiency related to intense contractions
Cerebral trauma
Brachial plexus injury

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PROM Premature Rupture of Membranes Earlier than 37 weeks gestation
Causes:

Chorioamnionitis
Infections
Weak Amniotic sac
Fetal abnormalities or malpresentation
Incompetent cervix
Overextension of uterus
Hormonal changes or nutritional deficiencies

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PROM Premature Rupture of Membranes Earlier than 37 weeks gestation:
Complications

Infection to mother and fetus
Preterm labor
Oligohydramnios: a disorder of amniotic fluid resulting in decreased amniotic fluid volume for gestational age
*Umbilical cord prolapse

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PROM Management:

Labor is induced if term
prevent further loss of fluid.
avoid intercourse or orgasm and nipple stimulation.
*If Preterm: administer Betamethasone to accelerate fetal lung maturity
Administer antibiotics
Activity restricted and possible bed rest
Monitor fetus for signs of distress

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Preterm Labor

After 20th week and before end of 37th week
Affects 1 of 8 babies in US
No scheduled C-sections prior to 39 weeks gestation.
Newborn mortality doubles each week before completing 39 weeks gestation

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Preterm Labor Signs & Symptoms:

same/similar to normal labor
- Uterine contractions
- Sensation of the baby “balling up”
- Cramps
- Low backache
- Pelvic pressure
- Increase in spotting or vaginal discharge
- Abdominal cramps with or without diarrhea
- A sense of “not feeling well”

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Preterm Labor Treatment

Hydration
Tocolytics: to inhibit contractions
— Magnesium Sulfate
— Calcium antagonists
— prostaglandin synthesis inhibitors
— beta adrenergics
Steroid (Betamethasone) for the fetus

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Magnesium Sulfate
Route:
- Indication:

May be administered IV or PO to stop labor
- preterm labor
- seizures
- women with preeclampsia

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Magnesium Sulfate

Reflex documentation

0= no reflex
+1= hypotonic
+2 reflex
+3-4= hypertonic

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Magnesium Sulfate

Non-therapeutic: reflexes

hypotonic & hypertonic

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Magnesium Sulfate: hypotonic & hypertonic
Theraputicness

If hypotonic=too much.= d/c mag sulfate/ antidote
If hypertonic=not enough

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Magnesium Sulfate toxicity s/s
Antidote:

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Blurred vision, headache
lethargy, weakness
nausea/Vomiting, constipation
- Calcium Gluconate (for hypotonic)

Calcium Channel Blockers for Preterm Labor Treatment

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Nifidipine

Nifidipine
Theraputics:
Route:
Nursing implication
S/S

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prevents muscle contractions, type of tocolytic
- Administered PO
- Assess BP
S/S:
- hypotension due to vasodilation
- flushing of skin
- headache
- transient tachycardia

Prostaglandin Synthesis Inhibitor
For Preterm Labor Treatment

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Indomethacin

Indomethacin
Route:
Therapeutics:
Nursing implications:

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PO type of NSAID
Limit use before 32 weeks gestation
Use only for 48-72 hrs. to decrease chance of closing ductus arteriosis.
Decreases amount of amniotic fluid
Assess for GI bleed

Beta Adrenergic
For Preterm Labor Treatment

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Terbutiline

Terbutiline: Route: Nursing implications: S/S:

- IV or SubCut - *black box warning. - Not recommended anymore except in extreme cases. - *Causes tachycardia and dysrhythmias (mom needs to be on a tele monitor) - Only use for 48-72 hrs

Corticosteroid For Preterm Labor Treatment

Betamethasone- for the fetus

Bethamethasone Route: Therapeutics:

- IM injection - Used to accelerate fetal lung maturity (between 24- 34 weeks) - Reduces RDS (respiratory distress syndrome), Intraventricular hemorrhage, and death

Postterm pregnancy

Longer than 42 weeks

Postterm pregnancy: Maternal Risks:

- LGA - Increased incidence of assisted delivery (forceps, vacuum or C-section) - Increased psychological stress

Postterm pregnancy: Fetal Risk:

- Decreased placental perfusion & Less amniotic fluid - Oligohydraminos - Meconium aspiration

Macrosomia:

large baby for term

Risks of Macrosomia: Mother

- CPD- cephalopelvic disproportion - Dysfunctional and prolonged labor - Lacerations - Postpartum hemorrhage

Risks of Macrosomia: Infant

- *Hypoglycemia: not getting enough glucose when born - *Polycythemia: if they are hypoxic, the bones produce more RBC’s - *Hyperbilirubinemia: when the RBCs break down= increased bilirubin - Meconium aspiration - Asphyxia - Shoulder Dystocia - Brachial plexus injury or fractured clavicle

Prolapse of Umbilical Cord: Cause

Occurs when umbilical cord comes out before the fetal presenting part Causes: - *Major cause: Breech presentation - Fetus in high station - Small fetus - Transverse lie - Polyhydramnios

Occult (hidden) prolapse:

The cord is compressed between the fetal, presenting part and pelvis, but cannot be seen or felt during vaginal examination

Cord prolapsed in front of the fetal head:

The cord cannot be seen, but can probably be felt as a pulsating mass during vaginal examination

Complete cord prolapse:

The cord has been seen protruding from the vagina

Management of Prolapsed Cord

- Knee chest position or trendelenburg — Knee-chest uses gravity to shift the fetus out of the pelvis. The woman’s thighs should be at right angles to the bed and her chest flat on the bed — The woman’s hips are elevated with 2 pillows; this is often combined with the trendelenburg (head down) position - Firm pressure on head to relieve cord compression - *Administer O2

Uterine Rupture/Dihiscence Causes:

- previous uterine surgery or C- Section - intense labor - High parity

Uterine Rupture/Dihiscence: S/S:

- Abdominal pain and tenderness - Chest pain between scapulae or on inspiration - Hemorrhage - Hypovolemic shock - Cessation of contractions - Fetal distress on monitor (you would see late decelerations)

Uterine Rupture/Dihiscence: Treatment:

- Stabilize mother and fetus - Delivery may be imminent - Replace blood & fluid loss - Repair if rupture is small

Uterine Inversion Degrees:

Uterus completely or partly turns inside out, during the third stage of labor - 1st degree: inverted fundus up to cervix - 2nd degree: body of uterus protrudes through cervix into vagina - prolapse of inverted uterus outside vulva

Uterine Inversion: Causes:

- fundal pressure - Pulling of umbilical cord - Increased intraabdominal pressure - Abnormally attached placenta - weak uterine wall

Uterine Inversion: S/S

- uterus may protrude into the uterus?? - Hemorrhage - Shock - Severe pelvic pain

Uterine Inversion: Treatments

- stabilize mother and fetus - Replace blood - Replace uterus - Possible hysterectomy

Anaphylactoid Syndrome/Amniotic Fluid Embolism

- Amniotic fluid is drawn into the maternal circulation and carried to woman’s lungs. - Contains Fetal cells and matter (skin, vernix, hair, meconium); can obstruct pulmonary vessels - *DIC (Disseminated intravascular coagulation) occurs due to thromboplastin in amniotic fluid

Treatment of Anaphylactoid Syndrome

- CPR - Oxygen and mechanical ventilation - Correction of hypotension - Blood therapy to correct coagulation defects - Immediate C-section

INTRAPARTUM COMPLICATIONS: Flashcards

(47 cards)