Labor, Birth, & Placental Complications Flashcards
(50 cards)
Premature Rupture of Membranes (PROM)
Rupture of amniotic sac before onset of true labor, regardless of gestational age
Preterm Premature Rupture of Membranes (PPROM)
Amniotic sac rupture before end of 37 weeks, w/ or w/o contractions
Causes of PROM/PPROM
Infection of vagina, cervix - C/G, GBS, BV Weak amniotic sac Prior preterm birth Incompetent or short cervix (<25 mm) Uterine overdistention (multi, LGA) Hormonal changes Recent intercourse (sperm PGs) High stress Low SES Nutritional deficiencies
When do contractions typically begin after PROM/PPROM?
6-8 hours
PROM/PPROM Management
Delivery - may start spontaneously, reasonable induction if 34-36 weeks
Tx of PPROM/Triple I infection - ampicillin, gentamicin (if allergic, cefazolin, clindamycin, vancomycin)
Admin IV for duration of labor & 24 hrs PP
Monitor for signs of infection - HR, temp, tenderness
Tylenol for fever
Management of PROM/PPROM <34 weeks
Maintain pregnancy, IV/oral abx prophylaxis, extended hospital stay until 34 weeks
PROM/PPROM complications
Maternal fetal risk for infection increased if >18 hrs
Umbilical cord compression
Reduced lung volume
Compression deformities
Sepsis risk for newborn
PROM/PPROM Infection
Intrauterine infection and/or inflammation = Triple I due to chorioamnionitis
Signs - maternal fever >39C w/o other sx OR fever PLUS 1+ of:
Fetal tachycardia, increased WBC count (>15k), maternal tachycardia, purulent vaginal discharge/fluid
Preterm labor (PTL)
Documented labor between 20 & end of 37 weeks
Why has PTB increased in last 15 years?
Better data, multifetal pregnancies, increased use of artificial reproductive technologies (ARTs)
What is the top cause of infant death in the US?
PTL/PTB
What is the top cause of neurologic disabilities in children?
PTL/PTB
PTL/PTB Risk Factors
Hx of PTB Multiple gestation Uterine anomaly (bicornuate uterus) Fetal conditions (IUGR, low AMI, chromosomal abnormalities) Infection Smoking, polysubstance abuse Chronic conditions - HTN, DM, CT disorders Racism Cervical surgery - LEEP Extremes of maternal age Low/high pre-pregnancy weight IVF conception Psychosocial - abuse, mental health
PTL Symptoms
Palpable contractions (painful or painless) Pelvic/vaginal pressure Low backache Pain/discomfort in vulva/thighs Cramps (abdominal, menstrual-like) Increased/changed vaginal discharge Rupture of membranes Vaginal bleeding/spotting Possible diarrhea Sense of 'feeling badly'
*Sx vary by patient
PTB Risk Assessment
Cervical length <25 mm 16-24 weeks - use US > digital exam
Contractions
Fetal fibronectin (fFn) - excellent negative predictive value
Infection - UTI, BV, STI
Dehydration status
Trauma/stress
PTL Diagnosis
Documented contractions - 4 in 20 mins or 8 in 60 mins AND either:
ROM
OR
Cervical change OR dilation of 2 cm OR effacement 80% (high false + rate, 30% of labors cease spontaneously)
PTL Management
If prior PTB - start progesterone at 16 weeks
Limited, individualized activity reductions
ID cause, relieve factor(s)
- Polyhydramnios - remove fluid w/ amniocentesis
- Poor nutrition - consult, improved intake
- Treat infections
Betamethasone for fetal lung maturity between 24-34 weeks; 2 inj 24 hours apart
Hydrate w/ IV fluids as needed
Med management by provider - tocolytics through betamethasone window
PTL Management
Tocolytics - Mg sulfate (<32 weeks), Ca antagonists (nifedipine), PG synthesis inhibitors, beta adrenergics
GBS prophylaxis
Umbilical Cord Prolapse
Medical emergency where cord prolapses out of uterus ahead of fetus, subject to compression & interruption of blood flow to fetus
Cord Prolapse Management
Position hips higher than head
Sterile glove, lift presenting part off cord and stay there until emergency C-section
Cord Prolapse Risk Factors
PROM, polyhydramnios, long umbilical cord, malpresentation, multiparity/gestation, high fetal station, IUGR
Cord Prolapse Nurse Role
Support fetal head, get help, set up for immediate delivery, consider O2 for mom, continuous fetal monitoring
Dystocia
Dysfunctional labor due to the 5 P ‘s of labor
Shoulder dystocia
Arrest of delivery of anterior shoulder after successful delivery of head; chin becomes retracted against vulva & neck not visible b/c shoulder(s) impacted behind pubic bone
*Common OB litigation causes
