Labor & Birth Complications -- Week 4

Question 1

Preterm Labor (PTL)

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Answer 1

Regular contractions with a change in cervical effacement or dilation or both or presentation with regular uterine contractions & cervical dilation of at least 2 cm

Question 2

Preterm Birth

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Answer 2

A birth that occurs between weeks 20 & 36 6/7 weeks of gestation; more dangerous than low birth weight

• Very Preterm: < 32 weeks
• Moderately Preterm: 32 - 34 weeks
• Late Preterm: 34 - 36 6/7 weeks

75% of all births in the US are preterm

Question 3

What is considered preterm birth?

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Answer 3

Birth between 20 weeks & 36 6/7 weeks

Question 4

Define Very Preterm, Moderately Preterm, & Late Preterm Births

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Answer 4

• Very Preterm: < 32 weeks
• Moderately Preterm: 32-34 weeks
• Late Preterm: 34 - 36 6/7 weeks

Question 5

What percentage of all births in the US are preterm?

Answer 5

75%

Question 6

Low Birth Weight

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Answer 6

< 2500 grams (5.5 lbs); intrauterine growth restriction (IUGR)

Question 7

What is Intrauterine Growth Restriction (IUGR)?

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Answer 7

limited nutrients from the placenta to the baby

• can result in low birth weight – < 2500 grams (5.5 lbs)

Question 8

Spontaneous Preterm Birth

Answer 8

Spontaneous preterm births occur following an early initiation of the labor process absent of fetal or maternal illness

• 75% of preterm births

Causes: pathogens, infection, abnormalities, allergic reaction

Risk Factors: socioeconomic status

Question 9

Indicated Preterm Birth

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Answer 9

Occurs as a means to resolve maternal or fetal risk that is often related to the continuation of the current pregnancy

• diabetes, HTN, preeclampsia, etc.

Question 10

Fetal Fibronectin Test (fFN)

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Answer 10

used to predict who will NOT go into preterm labor (< 1%)

• glycoprotein “glue” found in plasma & produces during fetal life

Question 11

Signs of Preterm Labor

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Answer 11

• Vaginal discharge change / increase
• Pelvic pressure
• Mild abdominal cramps
• Constant dull back pain
• Regular contractions / ruptured membrane

Question 12

What medications are used for fetal lung maturity?

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Answer 12

antenatal glucocorticoids (ACT)

Question 13

Premature Rupture of Membranes (PROM)

Answer 13

Spontaneous rupture of the amniotic sac & loss of amniotic fluid before labor begins

Question 14

Preterm Premature Rupture of Membranes (PPROM)

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Answer 14

Ruptured membranes in preterm pregnancy (before 37 weeks)

• preceeded by infection (chorioamniotitis)

Question 15

Chorioamnionitis

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Answer 15

Bacterial infection of the amniotic cavity (major complication for mothers)

S/S: fever, tachycardia, uterine tenderness, foul odor amniotic fluid

Tx: IV antibiotics & birth of the fetus / GBS (group beta strep) test

Question 16

S/S of Chorioamnionitis

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Answer 16

• Fever
• Tachycardia
• Uterine tenderness
• Foul odor amniotic fluid

Question 17

Postterm Pregnancy

Answer 17

birth at > 42 weeks (0.5% of mothers)

• increases maternal morbidity, dysfunctional labor, abnormal growth, shoulder dystocia, meconium stained fluid

Question 18

Dystocia (dysfunctional labor)

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Answer 18

Difficult labor for any reason

abnormal contractions; hypertonic uterine dysfunction; latent / active; protraction (slower); arrest (cease); anesthesia; precipitous labor (< 3 hours); intrauterine pressure catheter (IUPC); tachysystole; pelvic structure; cervical edema; fetal causes (anomalies, CPD, malposition, multifetal); psychological (anxiety)

the 5 Ps = challenges

Question 19

Obesity

Answer 19

**At an increased risk for certain complications: **spontaneous abortions, stillbirth, HTN, gestational diabetes, C/S, VTE

Difficulties in Care: difficult fetal monitoring, routine procedures taking more time, mobility issues, wound infections

Question 20

External Cephalic Version (ECV)

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Answer 20

External rotation of the fetus into the proper delivery position (usually performed by 2 doctors)

Contraindications: anomalies, 3rd trimester bleeding, placental insufficiency

Question 21

Induction of Labor

Answer 21

• chemical or mechanical
• initiation of uterine contractions before they’re spontaneous
• onset to bring about birth
• > 39 weeks, increased risk for C-section

Station is not -3 or higher
* must be free of HSV

Question 22

Amniotomy

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Answer 22

Artificial rupture of membranes

Question 23

Bishops Score

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Answer 23

A rating system used to evaluate inducibility or cervical ripeness

• Determines likeliness of havign a vaginal delivery

Question 24

Augmentation of Labor

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Answer 24

Stimulation of ineffective uterine contractions after labor has started spontaneously but is not progressing satisfactorily

Ex:
* IV pitocin
* oxytocin
* amniotomy

Question 25

**Active Management of Labor**

Answer 25

Aggressive use of oxytocin so that the woman gives birth within 12 hours of admission to the labor unit

Question 26

**Operative Vaginal Birth** | **KNOW THIS!!!!!**

Answer 26

**Vacuum or forceps used during vaginal birth** * maternal exhaustion **Must be:** fully dilated, empty bladder, vertex position, ruptured membrane, fetal head circumference * **After birth, check for hematoma, lacerations, & bruises**

Question 27

**VBAC** | **KNOW THIS!!!!!**

Answer 27

**Vaginal Birth After Cesarean Section**

Question 28

**TOLAC** | **KNOW THIS!!!!!**

Answer 28

**Trial of Labor After Cesarean Section** ## Footnote Allowing labor to progress naturally for women who want to have a VBAC

Question 29

**Elective Cesarean Section**

Answer 29

Maternal request

Question 30

**Risks associated with Cesarean Section**

Answer 30

* Intubation complications * aspiration * pneumonia * hemorrhage * bowel / bladder injury * amniotic fluid embolism * VTE * wound infection * UTI

Question 31

**Meconium Stained Fluid** | **KNOW THIS!!!!!**

Answer 31

**Fetus has passed stool prior to birth** * Obstetric Emergency!!!!!! * Could indicate breech, hypoxia peristalsis, cord compression

Question 32

**Shoulder Dystocia** | **KNOW THIS!!!!!**

Answer 32

**Head is born, but anterior shoulder cannot pass under pubic arch** * Injuries related to asphyxia, brachial damage, & facture * maternal blood loss, episiotomy, PP hemorrhage **Tx:** * **McRoberts maneuver & suprapubic pressure** * Gaskin maneuver

Question 33

**Prolapsed Umbilical Cord** | **KNOW THIS!!!!!**

Answer 33

**When the umbilical cord presents first & is squeezed between the vaginal wall & the baby's head** * can insert fingers to relieve pressure off the cord, knees to chest position

Question 34

**Uterine Rupture** | **KNOW THIS!!!!!**

Answer 34

**Tear in the wall of the uterus** ## Footnote * **prevention** is the best tx

Question 35

**Amniotic Fluid Embolism (AFE)** | **KNOW THIS!!!!!**

Answer 35

Anaphylactoid syndrome *Sudden, acute onset of* **hypotension, hypoxia, & hemorrhage** * **Cause:** coagulopathy * Mortality Rate: 20 - 60% * Amniotic fluid can contain vernix, hair, cells, skin, meconium **Risk Factors:** maternal age, post-term, induction, eclampsia, c/s, forceps / vacuum

Question 36

**Postpartum Hemorrhage** | **KNOW THIS!!!!!**

Answer 36

**Cumulative blood loss > 1,000 mL or s/s of hypovolemia within 24 hours post birth** **Causes** * *Early (within 24 hourso f birth):* atony or bladder distension * *late (> 24 hours but less than 6 weeks of birth):* infection, subinvolution, coagulation

Question 37

**Causes of early postpartum hemorrhage** | **KNOW THIS!!!!!**

Answer 37

**within 24 hours of birth** * atony * bladder distension

Question 38

**Causes of late postpartum hemorrhage** | **KNOW THIS!!!!!**

Answer 38

**> 24 hours but less than 6 weeks after birth** * infection * subinvolution * coagulation

Question 39

**Uterine Atony** | **KNOW THIS!!!!!**

Answer 39

**uterus doesn't return to firm, pre-birth state** (uterus is boggy, weak, etc.) * **most common cause of PP hemorrhage** * **RF:** more pregnancies, large fetus, obesity, multifetal gestation

Question 40

**Placental Complications**

Answer 40

* retained placenta * fragments of placenta * *placenta accreta:* slight penetration of myometrium * *placenta increta:* deep penetration of myometrium * *placenta percreta:* perforation of myometrium & uterine serosa * hematomas * lacerations * inversion of the uterus * subinvolution of the uterus

Question 41

**Placenta accreta**

Answer 41

**slight penetration fo myometrium** (middle layer of the uterine wall)

Question 42

**Placenta increta**

Answer 42

**deep penetration of myometrium** (middle layer of the uterine wall)

Question 43

**Placenta percreta**

Answer 43

**perforation of myometrium** (middle layer of uterine wall) **and uterine serosa** (tissue coating the outside of the uterus)

Question 44

**Postpartum Management** | **KNOW THIS!!!!!**

Answer 44

**MASSAGE THE FUNDUS** (void before) * increase oxytocin / hemabate / methergine **(caution w/ HTN & asthma)** * Surgical management

Question 45

**VTE**

Answer 45

**venous thromboembolism** * DVT / PE * pain & tenderness in the lower extremity, edema, warmth

Question 46

**Postpartum Infection**

Answer 46

**Infection of the genital tract** that occurs **within 28 days after miscarraige, abortion, or birth** **S/S: fever > 100.4 for 2+ days during first 10 days PP** * **Endometritis:** infection of lining of uterus * most common PP infection * TX = IV abx * **Wound infections:** * develop after being discharged * 3 - 5% in c-sections * **UTIs:** occur in 2 - 4% of PP women

Question 47

**Pelvic floor disorders**

Answer 47

Cystocele, rectocele, uterine prolapse * avoid lifting / straining * kegels