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Flashcards in Reproductive Risk Deck (28):
1

dystocia

difficult birth
baby doesn't fit through the birth canal
slow progression of labor possibly due to insufficient contractions
lack of progress of cervical dilation and effacement
lack of decent

2

Pelvic dystocia:

Pelvic dystocia: passage is too small, or passenger is too large.
Cephalopelvic disproportion (CPD): if attempt to deliver vaginally, there is a very good chance that there will be damage to her genitourinary system, 4th degree tear, head trauma to baby
CPD - cephlo pelvis distortion
Babies head will have trauma

3

soft tissue dystocia

r/t mom's pelvis
if a mom is fat then fat in pelvis
maternal fibroids which are growths w/n uterus
get her moving, then baby can get further down into the pelvis

4

passenger macrosomia risk to mom

*greater than 8 lbs than increased risk of dystocia and postpartum hemorrhage because uterus *distended and uterus may not be able to contract because atony
*4th degree cares

5

passenger macrosomia risk to baby

brachial plexus may be harmed or damaged
head trauma
fractured clavicles - shoulder dystocia
baby can be asphyxiated
can be big due to gestational diabetes

6

fetal abnormalities leading to large head

Omphalocele: the baby’s abdominal contents are externalized
Hydrocephalus
mylomenigocele

7

clues to back labor

increased back pain really sore
normally occiput anterior
softness or symphasis pubis
fetal heart tones better on woman's sides
arrestive descent

8

interventions w/ back labor

counter pressure push back with tennis balls
rocking chair
birthing ball

pillow so leg way up and twist of pelvis so baby rotate

9

hypertonic contractions

increased baseline
increased resting tone, so not completely relaxing in-between contractions
contractions <2 min apart lasting more than 90 seconds
*VERY PAINFUL BECAUSE UTERUS NEVER RELAXING
*do not see dilation and effacement with cervix
*will give C-section and give terbutaline to relax uterus

10

women's response to labor

patients with depression, bipolar schizophrenia will influence labor
anyone with previous sexual trauma will experience more difficult labor mentally

11

preterm labor

27-36 wks
number one cause of mortality
11% of births preterm
huge costs


12

Risk factors for preterm labor based on fetus

polyhydramios
multiple gestation
fetal infection

13

risk of preterm labor mother

Risks:
*decidual hemorrhage
*cervical incompetence
*cervical inflammation and infection
*hormonal changes
*IUGR
*advanced maternal age and teen pregnancy
cardiovascular problems: HTN, diabetic, renal problems, and preeclamptic
*uterine anomolies, bicormic uterus
*vaginal infection ex GBS
*h/o of preterm labor
*smoking
*stressful situations
*placental previa

14

S/S of preterm labor

achy low back pain
abdominal cramping
diarrhea
increased pelvic pressure
sensation of menstruation cramps
braxton-hicks are irregular and dissipate when relaxed and don't cause cervical changes so not indication of preterm labor

15

Interventions preterm labor

relax
stay well hydrated
keeping bladder empty
avoid lifting heavy objects
avoid breast stimulation - causes oxytocin release
avoid intercourse

if you're having contractions empty bladder and lay on side, drink lots of fluid and start to palpate and time contractions, and stay in bed to see whether they decrease.

encourage mother's to come in without being judged for concern

encourage mother's on bed rest to get up and move to couch but that it.

Keep up mental health

close surveillance of cervical length

16

if having preterm labor that can't be stopped

want to keep baby in mother as long as can to get to where baby will be safest.

17

drugs for preterm

Magnesium Sulfate:
Very common
Relaxes smooth muscles
Higher doses than in PIH
Will complain of: headaches

Terbutaline:
Licensed for use for asthma
Smooth muscle relaxant-beta-adrenergic agonist
Very commonly used to halt preterm labor
Side Effects:
Tachycardia
Shakiness
Hyperglycemia (carefully monitor in diabetics)
Take heart rate before administering
0.25 subcutaneously on an outpatient basis, can be given as a pill form to be taken at home

Procardia (Nifedipine): Calcium channel blockers
Decrease uterine contractility

Corticosteroids:
Betamethasone given to mature the baby’s lungs
Given between 24 and 32 weeks
2 doses 12 hours apart
Can be given once a week
Risk for immunosuppression

***can't combine magnesium and pericardia because will slow down heart way too much

18

Fetalfibronectin Test:

predictor if preterm labor will continue, negative test gives you some confidence that this will not progress.

Protein that is found in the vaginal cervical fluid
Take a swab of the secretions and send to the lab
Done between 24 and 35 weeks
Used as a predictor if preterm labor is going to continue
Only done if there is no cervical change with the contractions
If the test is negative 96% of women will not give birth within the next 2 weeks and 92% will not give birth before 37 weeks.
If the test is positive rou

19

PROM

bag of water breaks before the onset of labor after 37 wks gestation

20

PPROM

bag of water breaks before the onset of labor and before 37 wks so you will be preterm

21

risk for PPROM

previous PPROM
socieconomic status
leap procedure - destroy cells on cervix
urinary infection
substance abuse
intraamniotic
amniocenticious
plental previa or abruption
polyhydramios
multiples gestation
Blunt trauma - MVA
smoking

22

Dx ruptured membrane

amniosure stick q-tip in to test whether positive
look at amniotic fluid on slide and look at ferrying
speculum exam
amniocentissis and inject dye

23

ferrying of amniotic fluid

makes crystal looking structures.

24

complications of PPROM

infection
prolapsed cord
abruption which can be a cause or a result
immaturity of infant: respiratory distress
pulmonary hypoplasia - where lungs not developing very well
inside uterus but up against wall so facial or limb deformities may happen

25

interventions PPROM

chorioamnitis - have to get baby out right away.
mother will be on antibiotics and baby will get corticosteroids

26

PRECIPITATE LABOR AND BIRTH:

abnormally low resistance of maternal soft tissues, labor of 5 cm in hr in primip, 10 cm in hr in multip

27

PRECIPITATE LABOR AND BIRTH risk

more common in multi
cocaine
abruption

28

complications PRECIPITATE LABOR AND BIRTH:

Hemorrhage
meconium
Low apgar scores
Petechial bruising
Postpartum hemorrhage
Lacerations of the cervix and vagina
Tears of the perineum
Intracranial trauma (to baby)
In most precipitous births the baby is ok