Week 5: Labour and Birth with Risks Flashcards
(28 cards)
how much is low birth weight
2500g or less
spontaneous pre-term birth
early initiation via PPROM, cervical insufficiency
- gestational age 20-37 weeks, contractions, progressive cervical changes
indicated preterm birth
induced in order to resolve maternal or fetal risks related to continuing pregnancy
- ex. preeclampsia, GDM, seizures
risk factors for spontaneous preterm birth
- history of one
- genital tract infection
- oral health
- multigetal gestation (increase in pressure)
- second-trimester bleeding
- race
- low pre-pregnancy weight
- low SES
- lack of prenatal care access
preventative strategies for spontaneous preterm birth
- modify activity levels
- tocolytics (corticosteroids) to delay (relax uterus)
- antenatal glucocorticoids to stimulate fetal lung maturity
- MgSO4 to reduce or prevent neonatal neurological morbidity (24-32 weeks) - used when birth is inevitable
Preterm premature rupture of membranes (when, how, interventions)
rupture before completion of 37 weeks
- weakening of amniotic membranes, inflammation, increased uterine pressure, UTI
- hospitalization, antenatal glucocorticoids, broad-spectrum antibiotics
maternal complications of PPROM
- chorioamnionitis: bacterial infection occurring in lining of chorion and amnion (amniotic cavity)
- placental abruption
- retained placenta
- post partum hemorrhage
- sepsis
chorioamnionitis: signs and symptoms, treatment
signs and symptoms
- maternal fever
- maternal and fetal tachycardia
- uterine tenderness
- foul odour of amniotic fluid
treatment
- IV broad spectrum antibiotics
fetal complications of PPROM
- intrauterine infection
- cord compression
- cord prolapse
- hypoxia
- premature birth
oligohydraminos - what is it, when does it occur usually
- post date labour and birth
decreased amniotic fluid leading to increased cord compression
maternal risk factors for postdate labour
- perineal injury
- post partum hemorrhage
- infection
fetal risks for postdate labour
- birth injuries
- meconium aspiration
- stillbirths
what is maconium aspiration
baby’s first poop in amniotic fluid, eats it and it ends up in the lungs
- increases infection risk
nursing interventions for post date labour
- daily movement counts (6 movements min in 2h)
- non-stress test, biophysical profile
- amniotic fluid volume assessment
- cervical assessment (Bishops score)
- cervical ripening assessment
- breast stimulation, position changes, stretch and sweep membranes
- amniotomy (ARM - artificial rupture of membranes)
- induction (foley: pressure on cervix to release prostaglandins)
why do we use oxytocin induction
stimulates uterine contractions
what are maternal risks of uterine contractions
- placental abruption
- uterine rupture
- c-section
- post partum hemorrhage
- infection
- UTERINE TACHYSYSTOLE: uterus stimulates too much leading to contractions too close together (6 in 10 min or when longer than 90sec)
why would uterine tachysystole be concerning?
no perfusion/oxygen to baby due to no resting time
meconium aspiration syndrome
- term or postpades
- severe form of aspiration pneumonia due to eating their own poo
external cephalic version
- 36/37 weeks
- manually rotate baby to get into cephalic position
- increases risk of rupturing membranes, cord prolapse, fetal distress
- 30-40% success rate
shoulder dystocia (risk factors, signs, interventions)
- when shoulders get stuck
risk factors
- Fetopelvic disproportion, macrosomia, history of shoulder dystocia
signs
- Retraction of the fetal head at the perineum (turtling)
Interventions
- Position changes (legs flexed apart with knees to abdomen, hands and knees position/squatting), apply suprapubic pressure
forceps - operative vaginal birth (indications, maternal risks, newborn risks)
- prolonged 2nd stage
- maternal exhaustion
- abnormal FHR
- abnormal fetal presentation
- rotation arrest
- head extraction in breech
maternal risks
- vaginal and cervical lacerations
- hematomas
- injuries to the urethra or bladder
newborn risks
- Subdural hematoma
- bruising
- abrasions
- facial palsy
vacuum assisted birth (prerequisites, newborn risks, maternal risks)
prerequisites
- fully dilated
- ruptured membranes
- engaged head
- vertex presentation
- greater than 34 weeks gestation
newborn risks
- cephalhematoma
- scalp laceration
- subdural hematoma
- hyperbilirubinemia (jaundice)
maternal risks (less common)
- Perineal
vaginal and cervical lacerations
- hematoma
C section indications (maternal-fetal)
Placenta previa
Placental abruption
Dysfunctional labour (CPD, FTP)
Active herpes lesions
C-section indications (fetal)
Abnormal FHR pattern Malpresentation
Congenital anomalies
Maternal HIV with high viral load
