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OB > labor and birth complications (unit 3) > Flashcards

labor and birth complications (unit 3) Flashcards

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1
Q

pre-term labor (PTL)

A
  • gestation b/t 20-37 wks
  • AND uterine ctx
  • AND cervical change
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2
Q

PTL risk factors

A
  • hx of PTB (greatest predictor)
  • low SES
  • non-white
  • maternal age extremes
  • low pre-pref rate
  • substance abuse
  • inc. uterine volume
  • uterine abnormalities
  • infection
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3
Q

subjective s/sx PTL

A
  • cramping
  • low back pain/pressure
  • abd. tightening
  • vag. bleeding/discharge
  • urinary freq.
  • malaise
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4
Q

objective s/sx PTL

A
  • > 6 ctx/hr
  • vag. bleeding/discharge
  • cervical dilation/effacement
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5
Q

labs for PTL

A
  • UA/culture
  • NST
  • BPP
  • U/S (cervical length)
  • fetal fibronectin (FFN)
  • swab for infection
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6
Q

PTL tx

A
  • prevention/early recognition
  • tocolysis drug
  • steroids for fetal lungs
  • bedrest/pelvic rest
  • hydration
  • abx for infection
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7
Q

tocolysis

A
  • tx used to stop uterine activity

* goal is to but time for steroid admin

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8
Q

tocolytic

A
  • med to stop uterine activity
  • off label
  • MgSO4
  • terbutaline
  • Nifedipine
  • indomethacin
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9
Q

MgSO4

A
  • CNS depressant to prevent seizure
  • Relaxes smooth muscle (↓ vasoconstriction)
  • SE is that BP is lowered
  • Next to Pit, most common drug used in labor and delivery
  • Given IVPB via pump
  • Effect is immediate
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10
Q

terbutaline

A
  • tocolytic
  • SQ q20min for 3 doses
  • then PO q 4-6 hr
  • monitor VS, lung sounds, I/O
  • DONT give if HR > 120
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11
Q

Nifedipine/Indomethacin

A
  • tocolytics
  • PO (not as fast as others)
  • Indomethacin not used after 32 wks or longer than 48 hrs (last choice med)
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12
Q

steroids

A
  • best PTL intervention
  • most common is Celestone
  • speeds FLM, by stimulating surfactant production
  • given b/t 24-34 wks gestation
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13
Q

low birth weight (LBW)

A
  • any baby born < 2500g REGARDLESS of gestation

* usually caused by IUGR

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14
Q

greatest preterm survival prognosis

A

•27+ wks have 90% chance of survival

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15
Q

oligohydramnios

A
  • not enough amniotic fluid
  • AFI < 5
  • usually caused by renal issue, PROM, post dates, or UPI
  • tx: FHR monitoring; amnio-infusion
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16
Q

risks r/t oligohydramnios

A
  • cord accident
  • fetal malformation
  • hypoplastic lungs
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17
Q

polyhydramnios

A
  • too much amniotic fluid
  • AFI > 20
  • caused by CNS/GI track malformations and mat. diabetes
  • tx: FHR
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18
Q

risks r/t polyhydramnios

A
  • unsuccessful labor
  • cord prolapse
  • PROM
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19
Q

PROM

A
  • premature rupture of membranes

* water breaks 1+ hr before onset of labor

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20
Q

PPROM

A

•preterm premature rupture of membranes
•water breaks 1+ hr before onset of labor AND gestation < 37 wk
•hospitalized for rest of PG
*goal to get to 34 wks

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21
Q

PROM/PPROM risk factors

A
  • infection
  • incomp. cervix
  • fetal abnormalities
  • nutritional deficiencies
  • polyhydramnios
  • recent OB procedure
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22
Q

risks r/t PROM

A
  • INFECTION

* cord prolapse (olighydramnios)

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23
Q

risks r/t PPROM

A
  • INFECTION
  • cord prolapse (olighydramnios)
  • fetal abnormalities (musculoskeletal and lung)
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24
Q

how is ROM diagnosed

A

•Fern Test

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25
chorioamnionitis
•infection of chorion and amnion •higher risk if membranes ruptured long •s/sx: fetal tachy, maternal fever, foul fld. *notify MD
26
dystocia
* long, difficult, or abnormal labor r/t 5 Ps (power, passageway, passenger, position, psyche) * can lead to infection, C/S, and PPH
27
dystocia risk factors
* short * overweight * > 40 y/o * uterine abnormalities * pelvic soft tissue issues * CPD * fetal macrosomia
28
precipitate labor
* < 3 hrs form labor onset to delivery | * can cause trauma, FHR disturbance, abruption, PPH
29
precipitate labor risk factors
* hypertonic labor * induced labor * hx of precipitate labor
30
power
* fxn of uterine ct. and maternal pushing * hypotonic/hypertonic labor * ineffective pushing (fear, exhaustion, epidural, etc)
31
hypotonic labor
``` •slowing or arrest of cervical change •weak ctx (corrdinated) •no fetal distress •need augmentation **occurs during ACTIVE phase ```
32
augmentation
* IV Oxy***, AROM or nipple stim | * increased risk of fetal distress and C/S
33
intrauterine resuscitation (IUR)
* turn pt on side (correct hypoten) * turn off pit (rlx uterus) * open main IV (correct hypovol.) * O2 mask * vag. exam (r/o prolapse)
34
hypertonic labor
``` •ctx uncorrdinated •inc. resting tone •painful, but ineffective •false labor b/c NO cervical change **occurs during LATENT phase ```
35
risks r/t hypertonic labor
* fetal distress (UPI) * fetal head trauma * maternal exhaustion
36
RN care hypertonic labor
* MONITOR FHT * IUR if necessary * may give ambien or narcotics * if FHTs reactive, false labor and can DC
37
problems r/t passageway
* maternal pelvic structure abnormalities | * soft tissue obstruction
38
pelvic abnormalities
•small or abnormal shape •genetics, rickets, young age, trauma *gynecoid preferred shape (oval)
39
causes of soft tissue obstruction
•full bladder (#1) •cervical edema •HPV *empty bladder and don't push until complete dilation
40
problems r/t passenger
* macrosomia * malposition * multifetal PG * fetal anomalies
41
macrosomia
* > 4,000 g | * r/t GDM, obesity, multiparity
42
macrosomia risks to neonate
* head trauma * shoulder dystocia * brachial plexus injury * fractured clavicle * asphyxia * underdevelopment * hypoglycemia
43
turtle sign
•head retracts agains perineum and external rotation doesn't occur •r/t shoulder dystocia *can lead to nerve injury or asphyxia
44
shoulder dystocia interventions
``` •call MD •McRobert's maneuver •suprapubic pressure •Gaskin maneuver •Zavanelli maneuver (last resort) ***NEVER apply fundal pressure ```
45
McRobert's maneuver
•hyperflex mom's legs tightly to abd.
46
Gaskin maneuver
•all fours
47
Zavanelli maneuver
•push fetal head back in and do C/S
48
problems r/t postions
``` •interfere w/ dilation/descent •long dysfunctional labor •poor pain control (back) •inability to push *freq. position changes crucial ```
49
breech
* feet or butt first * requires C/S * associated w/ fibroid, hydrocephalus, fetal tumor, ONTD
50
complications of breech delivery
•prolapsed cord •cord compression •head entrapment *only do vag. if no time for C/S
51
multiples
* only vag. delivery if both vert | * r/o dysfunctional labor and PPH
52
problems r/t psyche
* previous experience/knowledge * culture * lack of support * loss of control * fear/stress
53
complication of post date PG
* > 42 wks * placental failure * UPI * oligo * r/o fetal distress, IUGR, IUFD
54
intrapartum emergencies
* prolapsed cord * uterine rupture * amniotic fld. embolism
55
risks for cord prolapse
* polyhydramnios * malpresentation * multiples * high station * small fetus
56
signs of cord prolapse
•sudden severe variable FHR •sudden fetal bradycard •see/feel cord *ALWAYS vag. exam if suspected
57
uterine rupture
* complete rupture of uterine scar * rare * r/t C/S, myomectomy, over-distended uterus, trauma
58
s/sx uterine rupture
* sudden loss of ct. * loss of fetal station * sudden fetal distress * shock * back/shoulder pain * vag. bleeding
59
uterine rupture intervention
* call MD * start IUR * prepare for C/S * anticipate infant resuscitation * have lots of blood products
60
uterine dehiscence
* incomplete rupture of uterine scar * usually little pain * does NOT involve fetal distress * labor slows/stops * if no tx, will complete rupture
61
amniotic fluid embolism (AFE)
* embolism of amniotic fld. enters maternal circulation * r/t hypertonic ctx, precipitous birth, uterine rupture, placenta abruption * rare, but high mortality rate
62
s/sx AFE
* Abrupt onset of respiratory distress, chest pain, cyanosis * Hypotension and shock * Frothy sputum * HF/arrest * Coma * Fetal Bradycardia * DIC * Massive hemorrhage
63
AFE intervention
* CPR * large bore IV * foley * MD chooses if delivery or save mom
64
placenta accreta
* slight abnormal growth of placenta into uterine muscle tissue (myometrium) * high risk of AFE, hemorrhage, hysterectomy, and death
65
placenta increta
•deep placental growth into myometrium
66
placenta percreta
•placenta grows completely thru myometrium and may adhere to structures of surrounding uterus
67
uterine inversion
* involution of uterus during delivery of placenta * results in massive hemorrhage * tx: replace blood and hysterectomy
68
retained placenta
* failure of entire or parts of placenta to deliver after 30 min * may require surgical removal * fragments can go unnoticed and lead to PPH

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