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NUR 359: OB > Intrapartum Complications > Flashcards

Flashcards in Intrapartum Complications Deck (61):
1

def Pre-term labor/birth

cervical changes and uterine cxns bx 20-37 wks gest
-any birth before completion of 37 weeks

2

what is considered low birth wt

<2500 g

3

what do biochemical markers do

predict whether or not a mom is going into pre-term labor

4

name the biochemical markers

fetal fibronectins
salivary estriol

5

what is the endocervical length

cervical length and fibronectins together

6

what criteria makes mom a high risk for pre-term labor

less than 30 mm
test positive for fibronectins

7

how do you collect fibronectins

cervical swab and send off to lab

8

causes of pre-term labor and birth

infecs
preg complications
sociodemo factors

9

sociodemographic factors that cause pre-term labor

poverty
low edu level
lack of social support
smoking
little/no prenatal care
dv
stress

10

prevention of pre term labor

address risk factors
edu pts abt s/s

11

dx of pre-term labor

gest age bx 20-37 wks
cxns (uterine activity)
progressive cervical changes
effacement 80%
dilation 2 cm or >

12

activities that could result in preterm labor

sex
long car rides
carrying heavy loads
standing more than 50% of the time
heavy housework
climbing stairs
hard physical work
not being able to stop and rest when tired

13

what may be prescribed by MD to prevent pre term labor

bed rest

14

describe home care of high risk preg pt

- modify env for conveniences
-home uterine monitoring system
-home nurse may come to check monitor
-pt may be taught to put it on, take it off, or check monitor

15

what med may be given to suppress uterine activity

tocolytics

16

tocolytics allows ...

-opportunity to begin admin antenatal glucocorticoids
-accel fetal lung maturity
-reduce severity of sequelae in preterm births

17

name a tocolytic

terbutaline

18

what med promotes fetal lung maturity

- antenatal glucocorticoids

19

when can you not give antenatal glucocorticoids?

- cord prolapse
-chorioamniotitis
-abruptio placenta

20

name an antenatal glucocorticoid

betamethasone

21

what criteria makes a pre term birth inevitable

dilation of 4 cm or more

22

how many doses of antenatal glucocorticoids can mom receive

up to 2

23

def Premature ROM

rupture of amnio sac and leakage of amnio fluid beginning at least 1 hr before onset of labor at any gest age

24

def Preterm Premature ROM

membranes rupture before 37 weeks gest

25

PPROM is often preceded by

infec

26

when is a PPROM dx'd

after woman c/o sudden gush or slow leak of vaginal fluid

27

def dystocia

long, difficult, or abnormal labor

28

dystocia can prevent the normal progression of

- cxns
-dilation
-effacement
-descent

29

what factors incr risk for uterine dystocia

-body build
- uterine abnormalities
-malpresentation and position of fetus
-cephalopelvic disproportion
-overstim of oxytocin
-maternal fatigue
-dehydration
-electrolyte imbalance
-fear
-inappropriate timing of analgesics
-dysfx uterine cxns

30

what is cephalopelvic disproportion

when the babys head is bigger than opening to the pelvis

31

name the classification of dysfx uterine cxns

- hypertonic (primary dysfx labor)
-hypotonic (secondary uterine inertia)

32

name 2 alterations in pelvic structure

- pelvic dystocia
-soft tissue dystocia

33

def pelvic dystocia

contractures of pelvic diameters that reduce capacity of bony pelvis, inlet, midpelvis, or outlet

34

def soft tissue dystocia

obstruction of birth passage by an anatomic abnormality other than the bony pelvis

35

fetal causes of dystocia

anomalies
CPD- cephalopelvic disproportion
malposition
malpresentation
multifetal preg

36

what else can cause dystocia

hormones and NT's

37

def precipitous labor

labor lasting less than 3 hrs from onset of cxns to birth

38

medical mgmt of dystocia

external version
internal version
trial of labor
induction/augmentation w/ oxy
cervical ripening
amniotomy

39

what is oxytocin

a hormone that stim uterine cxns

40

where is oxy produced

posterior pituitary

41

what is oxy used for

induce or augment labor due to inadequate uterine cxns

42

what situations do we use oxy cautiously?

multifetal position
breech presentation
presenting part above pelvic inlet
abnormal FHR
polyhydramnios
grand multiparity
maternal cardiac disease

43

def augmentation of labor

stim of uterine cxns after labor has started but progress is unsatisfactory

44

indications for augmentation of labor

hypotonic uterine dysfx

45

common augmentation methods

oxy infusion
amniotomy
nipple stim

46

what is the McRoberts maneuvre?

moms legs up
press on pelvis and apply pressure to get baby out

47

what is zavanelli's maneuvre

push baby back in for c sec

48

what is the mortality rate for zavanelli's maneuvre

50%

49

post term maternal risks

-risks related to excessively large infant
-dysfx labor
-birth canal trauma
-fatigue
-psych rxns

50

post term fetal risks

prolonged labor
shoulder dystocia
birth trauma
asphyxia from macrosomia
aging placenta

51

when should a post-term mom be induced?

41-42 weeks
some allow up to 43 weeks

52

when would a HCP allow the mom to continue preg for up to 3 weeks

- assesment tests of fetal well being normal

53

def shoulder dystocia

head is born nut shoulder cannot pass under pubic arch

54

a newborn is likely to experience birth injuries from _______

shoulder dystocia

55

what are the mothers risks if shoulder dystocia occurs

-excessive blood loss
-lacerations
-extension fo episiotomy
-endometritis

56

if prolapsed cord is discovered, what should we have mom do?

put mom facing down with hips high
- modified sims position

57

what factors contribute to cord prolapse

-long cord
-malpresentation (breech)
-transverse lie
-unengaged presenting part

58

most frequent causes of rupture of uterus

- separation of scar of previous c sec
-uterine trauma: accidents, surgery
-congenital uterine anomaly

59

other causes of rupture of uterus

- intense spontaneous cxns
-labor stim- oxy, prostaglandins
- overdistended uterus: multifetal gest
- malpresentation
-internal or external version
- difficult forceps assisted birth

60

rupture of the uterus is more common in which women

multigravida

61

s/s of amnio embolism

- acute dyspnea
- severe hypotension