Module 10 (Exam 3) Intrapartal Complications Flashcards Preview

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Flashcards in Module 10 (Exam 3) Intrapartal Complications Deck (31)
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1

What are intrapartal complications?

  1. Dysfunctional Labor
  2. Precipitate Labor (fast)
  3. Preterm Labor
  4. Obstetrical Emergencies

2

Single Dysfunction

Causes:

  • Irregular contraction pattern
  • Ineffective Pushing
  • Fetal size or position
  • Maternal pelvic size or shape

3

Multifaceted Dysfunction (Dystocia)

  1. Prolonged Labor
    1. Combination of issues
    2. Depletion of resource (maternal fatigue, dehydration, energy stores)
    3. Maternal and/or fetal infection is a concern if membranes ruptured for greater than 24 hours
    4. Treat underlying causes
    5. Comfort measures and emotional support
    6. Monitor for infection
    7. C-section
  2. Precipitate Labor
    1. Birth occurs within 3 hours of onset
    2. No gradual change in contraction pattern
    3. May be associated with drug use (vasoconstrictor)
    4. Potential result: fetal oxygen compromise, precipate birth, newborn respiratory depression, postpartum hemorrhage
    5. Assist mother with breathing and relaxation
    6. Monitor fetal heart rate (rapid pelvic descent = variable decels or bradycardia)
    7. Call for help for patient room
    8. Don gloves
    9. Support infant's head as it emerges onto perineum
    10. Encourage blowing or puffing to slow bearing down efforts but allow patient to bear down

4

Irregular Contraction PAttern

  1. Increase maternal movement (walk)
  2. Rest
  3. IV hydration
  4. Amniotomy (so then the head can act like a dilating wedge to open up the cervix)
  5. Augmentation with Pitocin
  6. Pain relief
  7. Emotional support

5

Ineffective Pushing

  1. Passive descent or "laboring down"
  2. Education regarding correct technique
  3. Emotional support
  4. Rest during some contractions
  5. Repositioning
  6. Feedback

6

Fetal Size or Position

 

  1. If fetal size is an issue = c-section
  2. If fetal position is an issue:
    1. (shoulder dystocia) McRoberts Maneuver, Suprapubic pressure
    2. C-section

7

Maternal Pelvic Size or Shape

  1. Maternal position change
  2. Maintain empty bladder
  3. C-section

8

9

PROM (premature rupture of membranes)

  1. Membranes rupture before the onset of labor
  2. Greater than 24 hours before birth occurs

10

PPROM (Preterm/Premature Rupture of membranes)

  1. Rupture of membranes happens before the end of the 37th week gestation
  2. Happens before the onset of labor (greater than 24 hours before birth of baby)

11

Etiology of PROM and PPROM

  1. Infection of maternal reproductive tract
  2. Incompetent cervix
  3. Polyhydraminos (puts pressure on cervix)
  4. Invasive tests or procedures

12

Effects of PROM

  1. Chorioamnionitis and newborn infection (ascending pathway for infection)
  2. Umbilical cord compression

13

Effects of PPROM

  1. Respiratory distress syndrome
  2. Complications related to prematurity

14

Medical management of PROM

  1. Maternal antibiotics
  2. Avoid vaginal examination
  3. Near term - induce labor

15

Medical management of PPROM

  1. Management determined by stability of fetus
  2. Assess lung maturity if 32-35 weeks
  3. Steroids
  4. Frequent nonstress test/biophysical profile
  5. Home management if stable

16

Nursing management or PROM or PPROM

  1. Labor inducted as indicated OR labor prevention
  2. Monitor FHR and contraction pattern if any
  3. Monitor for infection (VS q4h, WBC, amniotic fluid color, odor, clarity)
  4. Home care edcuation: activity restriction, signs/symptoms of labor and infection, importance of follow-up care

17

Preterm Labor

Onset of labor after 20 weeks but before 37 weeks' gestation

18

Etiology and Risk Factors of Preterm Labor

  • Etiology unknown
  • Risk Factors:
    • Short cervical length
    • Previous preterm labor or PROM
    • Positive fetal fibronectin
    • Smoking
    • Infection during pregnancy
    • Smoking
    • Infection during pregnancy

19

Signs/Symptoms of Preterm Labor

  1. Uterine contractions or "cramps"
  2. Back pain
  3. Pelvic pressure
  4. Bleeding or spotting
  5. Cervical effacement and/or dilation

20

Medical and Nursing Management of Preterm Labor

  1. Prevention
  2. Prenatal care
  3. Education (signs of labor)
  4. Identification of risk factors
  5. High risk group testing and monitoring

21

Treatment of Preterm Labor

  1. Treat underlying cause if possible
  2. Labor suppression by use of tocolytics
  3. Decrease activity
  4. Hydration (decrease uterine irritabiltiy)
  5. Steroids
  6. Home monitoring: decreased contraction pattern, no further cervical effacement and dilation

22

Tocolytics

  • Magnesium sulfate
    • High alert medication
    • Smooth muscle relaxation
    • IV
  • Beta-adrenergic- Terbutaline
    • Smooth muscle relaxation
    • SQ, PO
  • Prostaglandin Inhibitors - Indomethacin
    • Decrease cervical effacement
    • PO
  • Calcium Channel Blockers - Nifedipine
    • Inhibits contractions
    • IV, PO

23

Nursing Considerations of Preterm Labor

  1. Education
  2. Medication Therapy
  3. Diagnostic tests/procedures
  4. Warning signs: similar to initial signs/symptoms of labor
  5. Infant milestones based on gestational age

24

Fetal Lung Maturity

  1. Corticosteriods
    1. Betamethasone/Dexamethasone
    2. Administered to mother for fetus
    3. Accelerates lung maturity
    4. Minimum of two spaced doses
    5. Anticipated birth less than 34 weeks OR Amniocentesis L/S less than 2:1 PG absent

25

What are some intrapartal emergencies?

  1. Placental Abruption
  2. Umbilical Cord Prolapse
  3. Uterine Rupture

26

Umbilical Cord Prolapse

  • Fetal vertex not engaged
  • Membranes rupture
  • Umbilical cord slips toward fetal head
  • Cord compressed by head
  • Umbilical blood flow decreased to fetus
  • May be occult or complete

27

Signs of Umbilical Cord Prolapse

  • FHR change associated with ruptured membranes (occult prolapse)
  • Protrusion of umbilical cord (complete prolapse)

28

Immediate Nursing Management of Umbilical Cord Prolapse

  1. Initial care for FHR pattern unless cord is visible
  2. Call for help
  3. Brief, calm explanations

If it is a confirmed prolapse or visible cord:

  1. Knee-chest or trendelenberg position
  2. Elevate fetal head with sterile gloved hand
  3. Anticipate emergency c-section

29

Classifications and Risk Factors of Uterine Rupture

Classifications: separation (dehiscence) at site of past uterine incision, complete rupture of uterus

Risk Factors: previous surgery, uterine overdistention, multiparity, pitocin induction/augmentation

30

Signs and Symptoms of Uterine Rupture

  1. Sudden onset
  2. Abdominal pain
  3. Hypovolemic shock
    1. Decreased BP, Elevated P, Change in LOC, Disphoresis
  4. FHR pattern change or loss of FHR (bradycardia)

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