T4 - Labor Birth at Risk (Josh) Flashcards Preview

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Flashcards in T4 - Labor Birth at Risk (Josh) Deck (48):
1

What is preterm labor?

cervical change and UC after 20 wks and before 38 wks

2

What is preterm birth?

any birth occurring b/t 20 wks and 36.6 wks

3

Overdistention of Uterus can cause Preterm Labor.

What causes overdistention of uterus?

Multips

Hydramnios

Macrosomic fetus

4

Lifestyle conditions that contribute to Preterm Labor

Smoking > 10 cigs/day

Substance abuse (Cocaine)

Standing for long hrs

5

S/S of Preterm Labor

UC q 10 mins with or without pain

Abdominal cramping or Pelvic Pressure

Low Backache

Increased vaginal discharge (pink tinged)

Leaking AF

6

What is Fetal Fibronectin?

Flue that holds the cervix together

Sample can tell who is likely to go into labor early
***high negative predictive value

Increases before preterm birth

7

When would Fetal Fibronectin predict a preterm labor?

if it appears b/t 24-34 wks gestation

***tells who will NOT go into PTL, not who WILL go into PTL

8

Home mgmt of Preterm Labor

Bedrest w/ fetus off of cervix

Empty bladder frequently

Hydration

Left side-lying

Resume activity lightly if symptoms stop

9

Hospital mgmt of Preterm Labor

BR on LEFT side

Continuous EXTERNAL FM

IV fluids

Strict I's and O's

Tocolytic Therapy to inhibit UC

10

What Tocolytics are given to prevent UC in Preterm Labor?

Mag Sulfate

Terbutaline
***Hold if HR > 125

11

When would we stop using Tocolytics for preterm labor?

after 34 wks b/c fetus can survive past this point

12

What is the best reason to use tocolytics prior to 34 wks?

allows opportunity to administer glucocorticoids to accelerate fetal lung maturity

13

What are the Tocolytics we talked about?

Mag Sulfate (CNS depressant)

Terbutaline (raises BP)

Nifedipine (Calcium Channel Blocker)

NSAIDs

14

How do we help mature the lungs of fetus?

Glucocorticoids (Betamethasone)

***two doses 24-48 hrs before delivery
***used 24-34 wks

15

What is pPROM

Preterm Premature ROM

**done before 37 wks

16

AF looks like a --- on a slide.

fern

***helps differentiate it from semen and urine

17

Regarding pPROM, what is the leading cause of death of fetus and mom?

sepsis

18

Management for pPROM

Temp q 2-4 hrs

Modified Bedrest

Kick counts (10 in 1 hr)

NO TUB BATHS

NST, BPP

Avoid vag exams if possible

19

After ROM, when can mom ambulate safely?

after fetal head is engaged

20

What do you test for after pPROM?

Beta Hemolytic Strep (risk to fetus)

21

What is Chorioamnioitis?

bacterial infection of amniotic cavity

leads to:
- maternal fever
- maternal and fetal tachycardia
- uterine tenderness
- foul odor of AF

22

--- is a term used to describe any difficult labor or birth.

Dystocia

23

What causes Dystocia?

Ineffectivity of any one of the 5 P's of Labor:

- Powers (UC)
- Passengers (Fetus and Placenta)
- Passage
- Position
- Psychologic

24

What are the top two reasons that C/S are performed?

#1: Repeat C/S

#2: Dystocia (shoulder presentation)

25

Hypotonic UC vs. Hypertonic UC:

Which one results in poor labor prognosis if it persists?

BOTH

***need normal UC 2-3 mins apart for good labor

26

When are Dysfunctional Labor patterns classified?

according to Latent and Active phase of First Stage of Labor

27

When do Hypertonic UC usually occur?

Latent Phase of Stage 1

28

Interventions for Hypertonic UC

Therapeutic Rest

Warm Shower/Bath

Analgesics

Mild Sedation

29

When do Hyotonic UC usually occur?

Active Phase of Stage 1

30

What classifies as Hypotonic UC?

31

Interventions for Hypotonic UC

Rule Out CPD (Cephalopelvic Disproportion)

Ambulation

Hydrotherapy

Enema

ROM

Nipple Stimulation (oxytocin release)

Pitocin

Position Change

32

--- is active labor in which birth occurs within 3 hours of onset of UC.

Precipitate Labor

***abrupt increase in UC instead of gradual

33

Risk Factors associated w/ Precipitous Birth

Maternal Lacerations / Hematoma

Fetus may become hypoxic r/t short relaxation period b/t UC

Non reassuring EFM patterns (bradycardia and Late Decels)

Intracranial Hemorrhage (fast passage through birth canal)

34

Interventions for Precipitous Labor

Side-Lying position to promote perfusion

IV Fluids to maintain BV

O2 per facemask

35

Why would pharmacological measures not usually be used with Precipitous Labor?

not enough time for them to take effect

cause respiratory depression in neonate

36

Is meconium always a sign of distress?

non necessarily

37

Nulliparous client w/ fetus in breech position almost always has ---

C/S

38

What is McRoberts Maneuver?

thighs flexed sharply against abdomen

opens pelvic curve if shoulder dystonia (shoulders stuck in canal)

39

Which clients at risk for Shoulder Presentation

Obesity

Previous Macrosomic baby

Chronic or Gestational DM

Prolonged 2nd Stage of Labor

40

Which presenting position results in longer labor and back pain?

Occiput Posterior

41

Maternal Positions that promote head rotation to Occiput Anterior

Knee Chest (rocking pelvis)
***Best

Side Lying (on opposite side of occiput)

Lunges

Squatting

Birth Ball

42

When would a version be attempted?

attempt to turn baby in utero

***After 37 wks

43

What do we use to chemically ripen the cervix?

Prostaglandin E

44

--- cannot be the primary IV fluid.

Pitocin

***piggyback it

45

When would we stop Pitocin?

UC frequency less than 2 mins

UC duration greater than 240 secs

Fetal destress (Late Decels)

46

What is Uterine Tachysystole?

more than 5 contractions in 10 mins over a 30 min window

series of single contractions lasting longer than 2 mins

47

Amniotomy is ---, not ---

augmentation, not induction

48

Terms:

VBAC

TOLAC

ASP

C/S

VBAC = Vaginal Birth after Cesarean

TOLAC = Trial of Labor after Cesarean

ASP = Anaphylactoid Syndrome of Pregnancy (AF Embolism)

C/S = Cesarean Section