Labor complications

Question 1

What is preterm labor and delivery

Answer 1

Is labor that is cervical dilation and uterine contractions between 20-36.6 weeks gestation

Question 2

What are the common causes of preterm labor?

Answer 2

• Dehydration is a huge cause
• Birth preeclampsia
• Fetal distress
• IUGR (lack of fetal growth)
• Demise (when baby passes away)
• Increase bleeding

Question 3

What women are at risk for preterm labor?

Answer 3

• Infections
• 2nd trimester bleeding
• History of preterm labor. They have a 50% chance or greater of having a pre-term delivery
• Being non-white
• Women who are under weight or over weight

Question 4

What are some intervention to prevent preterm labor?

Answer 4

•Early detection to reduce
neonatal morbidity and morality

• Administering magnesium sulfate, terbutaline, indocin
• Decrease activity
• Bedrest

Question 5

What medications are administered to mothers at risk for preterm labor?

Answer 5

• Magnesium sulfate
• Terbutaline
• Indocin

Question 6

What type of medication is Indocin?

Answer 6

NSAID

Question 7

What must you look out for when administering magnesium sulfate to mothers?

Answer 7

• Deep tendon reflexes
• Mental status
• Urine for serum levels

Question 8

What is the goal of preterm and delivery

Answer 8

• Stop uterine contracts

* Administer betamethasone IM for lung maturity

Question 9

Why are African/Americans more likelihood to have preterm labor

Answer 9

•This is a due to the racism and negative ill outcomes that come with African American woman.

Question 10

What does PROM stand for?

Answer 10

Premature ruptured of membranes

Question 11

What is the definition of PROM?

Answer 11

• It is a spontaneous rupture of amniotic sac and leakage of fluid prior to onset of labor
• Ruptures before 37 weeks gestation

Question 12

What color will we see with PROM?

Answer 12

clear straw color

Question 13

What is the interventions/management of PROM

Answer 13

• Bed rest
• Monitor intrauterine infection because without the barrier they are at risk.
• Monitor FHT’s

Question 14

What do we not do when PROM occurs?

Answer 14

We don’t do vaginal exam because you are introducing bacteria

Question 15

What is prolapsed umbilical cord?

Answer 15

When the umbilical cord lies below the presenting part of the fetus

Question 16

What does prolapsed umbilical cord result in?

Answer 16

Cord compression which compromises fetal circulation

Question 17

What are the risk factors for prolapsed umbilical cord?

Answer 17

• Long cord
• Multifetal pregnancy
• Small for gestational age fetus
• Transverse lie
• Abnormal fetal presentation

Question 18

When do prolapsed umbilical cord occur?

Answer 18

• AROM or SROM

* When head is not engaged in pelvis -2, -3, -4 stations

Question 19

What are the signs and symptoms of prolapsed umbilical cord?

Answer 19

• Variable or prolonged decelerations
• They report feeling the cord after ROM
• Cord is seen or felt in or protruding from vagina.

Question 20

What are the nursing interventions for a prolapse umbilical cord?

Answer 20

1. Call for help STAT
2. Notify provider
3. Check cervix and exert upward pressure against the presenting part to relieve cord compression. DON”T MOVE HAND
4. Place in extreme Trendelenburg (so that gravity and manipulation to relieve compression)
5. Monitor FHR

Question 21

What do you not do when you see a prolapse umbilical cord?

Answer 21

Do not attempt to push cord back into vagina or cervix!!

Question 22

What is a shoulder dystocia?

Answer 22

• The anterior shoulder of the fetus gets stuck on the pubic symphsis
• Obstetric emergency
• Requires obstetric maneuvers
• It requires obstetric maneuvers

Question 23

What do you do as a nurse when you see a shoulder dystocia?

Answer 23

• Stay calm
• Call for help, need more nurses
• Help patient assume positions that facilitate birth of the shoulders

Question 24

What are the complications related to trauma with shoulder dystocia?

Answer 24

We see brachial plexus injuries

Question 25

What maneuver is preferred?

Answer 25

McRoberts Maneuver

Question 26

What is the McRoberts maneuver?

Answer 26

* Legs flexed onto abdomen * This causes rotation of pelvis * Suprapubic pressures is applied to fetal anterior shoulder

Question 27

What is an operative vaginal birth

Answer 27

* Performed using forceps or vacuum extractor | * Evaluate the station of head in relationship to the maternal pelvis

Question 28

What are the associated risks with using operative vaginal birth equipment?

Answer 28

* Increase to postpartum hemorrhage * Increases vaginal lacerations * Increases fetal head trauma

Question 29

What are the nursing actions when assisting with birth by operate delivery

Answer 29

* Assess FHR continuously * Encourage the women to push during contractions * Document number of pulls attempted (3 times) * Document a number of pop offs that occur (3 times vacuum only) * After three times, c-section

Question 30

The forceps assisted birth equipment is used only when

Answer 30

* Cervix is fully dilated * Bladder is empty * Presenting part is engaged * Membranes must be ruptured

Question 31

What is meconium staining?

Answer 31

Meconium passes into the amniotic fluid

Question 32

What are the expected findings of meconium staining?

Answer 32

* Liquor look like green, yellow, or brownish in color | * Can be thin or thick

Question 33

What are the risk factors associated with meconium staining?

Answer 33

* Uncommon prior to 38 weeks but increases after 40 weeks * When the fetal is distress and are hypoxic or acidosis * With a mature fetus (post term) 40-42 weeks.

Question 34

What are some of the complication

Answer 34

* Develop meconium aspiration syndrome (MAS) causes pneumonia * Newborns cant aspirate meconium which is toxic to lungs * Evidence that it inactivates surfactant