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Maternity & OB > Labor & Birth Complications > Flashcards

Labor & Birth Complications Flashcards

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1
Q

what is preterm labor?

A

spontaneous or induced labor from 20-37 wks gestation

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2
Q

How many weeks is the following:
- extremely preterm
- very
- mod
- late

A
  • extremely: < 28
  • very: 28 - 31
  • mod: 32 - 33
  • late: 34 - 36
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3
Q

How many grams birth weight for the following:
- extremely low
- very low
- low

A
  • extremely low: < 1000g (2lbs 3oz)
  • very low: < 1500g (3 lbs 4oz)
  • low: < 2500 g (5lbs 8oz)
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4
Q

what are the 4 possible causes of preterm labor

A
  1. abnormal uterine distention: multiple gestation, polyhydramnios
  2. decidual activation: prior PTB, shortened cervix, hemorrhage
  3. premature activation of maternal-fetal hypothalamic-pituitary adrenal axis (HPA): cortisol stimulates prostaglandins
  4. infection: UTI leading to prostaglandins
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5
Q

what are the 3 most common risk factors for preterm labor

A
  1. prior PTB
  2. multiple gestation
  3. uterine/cervical abnormalities, shortened cervical length
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6
Q

rate and length of contractions for preterm labor

A

contractions q4-6 times per hour that are < 10-15mins apart + cervical changes

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7
Q

s/s of preterm labor

A
  • increased vaginal discharge
  • pelvic or lower abdominal pressure
  • constant low, dull backache
  • V/D
  • possible ruptured membranes
  • feeling “flu-ish”
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8
Q

what are the criterions for diagnosing preterm labor

A

At least 2 contractions within 20 mins lasting 20 seconds AND:
- cervical dilation of > 4 cm
- cervical effacement of > 80%
- bloody show
- rupture of membranes

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9
Q

what are the key components of assessing preterm labor

A

Amniotic fluid analysis
- Lecithin to sphingomyelin (L/S) ratio
- phosphatidylglycerol

cervicovaginal secretion swab
- fetal fibronection (fFN) test

Maternal & Fetal monitoring

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10
Q

what does lecithin to sphingomyelin (L/S) ratio tell you from amniotic fluid analysis

A

if ratio is >= 2: low risk of resp distress syndrome in nondiabetic pregnancies

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11
Q

what does the presence of phosphatidylglycerol tell you from amniotic fluid analysis

A

if present -> fetal lung maturity & low risk for resp distress syndrome

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12
Q

what does fetal fibronectin (fFN) test tell you from cervicovaginal swab

A

protein that helps the amniotic sac attached to the fetus
- positive: preterm labor likely
- negative: unlikely

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13
Q

what are the managements for preterm labor

A
  • tocolytics
  • betamethasone for fetal lung maturation
  • progesterone
  • cerclage placement
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14
Q

List 4 tocolytics commonly used

A
  • CCB: nifedipine
  • NSAID: indomethacin
  • Beta-adrenergic agonists: terbutaline
  • MgSO4 for neuroprotection (prevent hemorrhage) as well
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15
Q

PROM vs. PPROM

A

PROM
- rupture >= 37 wks
- spontaneous prolonged rupture of fluids > 24hrs

PPROM
- rupture preterm < 37 wks
- higher risk for infection
- weakening of amniotic membranes

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16
Q

risk factors for PROM

A
  • previous hx
  • short cervical length
  • multiple gestation
  • STIs
  • low BMI
  • smoking/drug use
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17
Q

what can PROM lead to for the mother

A
  • infection: chorioamnionitis, endometritis
  • abruptio placenta, retained placenta
  • c-section
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18
Q

what can PROM lead to in the fetus

A
  • sepsis
  • resp distress, hypoxia
  • neuro: hemorrhage, impairment
  • fetal deformities if < 26 wks
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19
Q

assessments for PROM

A
  • no digital exams but sterile speculum okay
  • FHR, UCs
  • BPP, nonstress test
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20
Q

treatment for PROM

A
  • based on gestational age: wait or induce?
  • corticosteroids, tocolytics controversial
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21
Q

what is dystocia

A

abnormal or difficult labor

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22
Q

risk factors with dystocia

A

Power
- overstimulation with oxytocin
- maternal fatigue, dehydration, fear, electrolyte imbalances
- inappropriate use of analgesia/anesthesia

Passenger
- malpresentation, fetal position: OP, transverse lie
- cephalopelvic disproportion

Passage
- small or abnormal pelvis
- uterine issues: fibroids, tumor

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23
Q

what is hypertonic uterine dysfunction

A

uncoordinated uterine activity: contractions are frequent and painful but ineffective for cervical dilation/effacement

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24
Q

Management for hypertonic uterine dysfunction

A
  • hydration: improve uterine perfusion
  • pain management: allow uterine rest
  • promote rest: quiet environment & naps
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25
what is hypotonic uterine dysfunction
weak or ineffective contractions that doesn't promote cervical dilation/effacement
26
risk factors for hypotonic uterine dysfunction
- multiparity - extreme fear leads to release of catecholamines, which interfere with UCs
27
interventions for hypotonic uterine dysfunction
stimulate uterine activity by: - ambulate and change positions - hydrate - oxytocin empty bladder
28
what is fetal dystocia
difficult labor d/t fetal (passenger) issues in dystocia
29
causes for fetal dystocia
- macrosomnia > 4,000 - 4,500g - malpresentation, cephalopelvic disproportion - hydrocephalus, tumors - multiples - twins triplets
30
complications from fetal dystocia
- fetal asphyxia - fetal injuries - maternal lacerations
31
what is precipitous labor
extremely rapid labor and birth lasting < 3 hrs from onset | 2nd stage labor issue
32
management of precipitous labor
- augment with oxytocin - assist with vacuum or forceps delivery - c-section
33
induction vs. augmentation
induction - before labor to initiate contractions augmentation - during labor to strengthen or regulate contractions
34
what are risks of using oxytocin to induce labor
- tachysystole: >5 contractinons/10 mins - FHR decelerations - failure to induct after 24 hrs - water intoxication: oxytocin is also an antidiuretic
35
what is the goal of augmentation of labor
- make contractions stronger, more regular, and more effective to shorten the length of labor
36
what are reasons for augmentation of labor
- stalled labor/slow: < 3 contractions/10 mins - no UCs when ruptured
37
what are contraindications for augmentation of labor
- placenta previa - umbilical cord prolapse - prior classical uterine incision - active herpes - pelvic structural anomalies - invasive cervical cancer
38
what are risks with augmentation of labor
tachysystole
39
what is cervical ripening
- softening, thinning, and dilation of cervix
40
Using the Bishops score, how do you know if induction will be successful or not
- 6 +: successful induction of labor - < 6: cervical ripening agents may be used
41
what is the mechanical way of cervical ripening
- balloon catheter to insert through the vagina into the cervix
42
what are the 2 medications used for cervical ripening
prostaglandins - dinoprostone (Cervidil) - misoprostol (Cytotec)
43
contraindications for cervical ripening
- active herpes - fetal malpresentation - umbilical cord prolapse - previous classical c-section or myomectomy - complete placenta previa
44
what are the procedures for operative vaginal delivery
vaccuum extraction forceps
45
when should operative vaginal delivery
Shortening of the second stage of labor required d/t: - maternal exhaustion - inability to push effectively - maternal cardiac dx - arrest of descent - rotation of fetal head - abnormal FHR patterns
46
what are the risks of operative vaginal delivery for the mother and fetus
- mother: tearing - fetus: scalp or brain bleed, head bruise or lacerations
47
nursing actions for operative vaginal delivery
- empty bladder - vacuum pressure should be released between contractions - document type of delivery
48
what are the conditions for elective c-section
scheduled - previous c-section - maternal or fetal risk via vaginal birth - malpresentation - on maternal request
49
what are the conditions for emergent c-section
- prolapse of umbilical cord - rupture of uterus - abnormal FHR
50
what are the conditions for urgent c-section
- malpresentation diagnosed after onset of labor - placenta previa with mild bleeding
51
what conditions for nonurgent c-section
- failure to progress: cervix doesn't fully dilate - failure to descend
52
what are risks after c-section
- placenta accreta, increta, or percreta
53
what is shoulder dystocia
- head is out, but the anterior shoulder can't pass under the pubic symphysis
54
what is the first sign of shoulder dystocia
turtle sign: retraction of the fetal head after delivery of the head
55
what fetal injuries can result from shoulder dystocia
- brachial plexus injury: shoulder, arm, and hand - fx of clavicle and humerus - compression of fetal neck: impaired circulation leading to increased ICP, asphyxia, neuro injury
56
what is the McRoberts maneuver
2 people sharply bend thighs toward belly to tilt the pelvis back for more room
57
what is the woods corkscrew maneuver
rotation of posterior shoulder 180 degrees to disimpact the anterior shoulder
58
what is the Gaskin all-fours maneuver
mother moves to hands and knees to allow gravity and positional changes to free the shoulder
59
what is the Zavanelli maneuver
provider pushes the baby's head back into the uterus and an emergency c-section is done
60
what is the order of maneuvers to be done for shoulder dystocia
- evaluate for episiotomy - insert straight catheter to empty bladder - McRoberts maneuver - Woods corkscrew maneuver - Gaskin all-four maneuver - Zavanelli maneuver
61
what is prolapse of the umbilical cord
cord slips through the cervix and into the vagina and lies below the presenting part of the fetus
62
what are fetal risk factors for prolapse of the umbilical cord
- malpresentation - IUGR - small for gestational age - unengaged presenting part
63
what are maternal risk factors for prolapse of the umbilical cord
- long cord > 100 cm - AROM - polyhydramios - multiple gestation - PROM
64
what happens to FHR d/t prolapse of umbilical cord
- prolonged bradycardia - recurrent variable decelerations
65
what is the first priority for prolapse of the umbilical cord
- relieve pressure: sterile gloved hand to push the fetal presenting part upward until delivery
66
what interventions should be done for prolapse of the umbilical cord
- relieve pressure with hand - reposition to knee chest position or trendelenburg - O2 10L - large bore IV access for fluids and blood transfusion - d/c oxytocin and use tocolytics
67
what is rupture of the uterus
separation of the uterine myometrium or tearing of previous c-section scar leading to the amniotic sac, baby, or body part to enter the abd cavity
68
what are the causes of rupture of the uterus
- scarred uterus from previous c-section - uterine sx - trauma - tachysystole
69
what are the maternal s/s of rupture of uterus
- tachysystole - sudden severe abd pain - tearing sensating, burning or stabbing pain - vaginal bleed - cessation of UCs
70
what are the fetal s/s of rupture of uterus
- sudden bradycardia, prolonged late/variable decelerations, absent fetal heart tones - palpable fetus outside of the uterus - loss of fetal station
71
management of rupture of uterus
- hemodynamic stabilization large-bore IV access - O2 10L - mom in lateral position - prep for emergency c-section - insert foley catheter - if defect can't be repaired: hysterectomy

Maternity & OB (7 decks)

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