Week 5: Pre-Birth complications

Question 1

What is low birth weight?

Answer 1

2500g or less

Question 2

What is more dangerous, low birth weight or premature birth?

Answer 2

Premature birth because gestation impacts the development of the fetus

Question 3

Describe spontaneous pre-term birth

Answer 3

Early initiation of the labour process (PPROM, cervical insufficiency)

Question 4

If a patient presents with GA 20-37 weeks, contractions, and progressive cervical changes what is the Dx? What could be causing this?

Answer 4

Dx: Spontaneous pre-term birth
Causes: PROM

Question 5

Describe indicated pre-term birth?

Answer 5

A mean to resolve the maternal or fetal risks related to continuing the pregnancy

Question 6

What are some possible reasons for indicated preterm birth?

Answer 6

Pre-eclampsia, GDM, seizures, IUGR, a pt would be induced because of the risk.

Question 7

A pt presents with menstrual cramps, diarrhea, back pain what should you do and what does this indicate?

Answer 7

Symptoms of preterm labour, check the dilation

Question 8

What are some risk factors for preterm birth?

Answer 8

-Hx spontaneous PB
-Genital track infection
-Multifetal gestation
-Racism
-Low pre-pregnancy weight
-Low SES
-Lack of access to prenatal care
-Maternal age (under 18, over 35)
-Smoking

Question 9

What happens when there is an increase in an inflammatory response in the genital tract of a mother

Answer 9

Increase in histamine which weakens the amniotic fluid, to increase the risk of preterm birth

Question 10

How can nurses manage patients who are at risk for preterm birth?

Answer 10

Use preventative strategies which address risk factors and modify

Question 11

Tocolytics

Answer 11

Delay birth long enough for corticosteroids to reach the maximum benefit

Question 12

Antenatal gluccorticoids

Answer 12

Stimulate fetal lung maturity

Question 13

MgSO4 administration

Answer 13

can reduce or prevent neonatal neurological morbidity- Neuroprotection

Question 14

Describe PROM (premature rupture of membranes)

Answer 14

Not the dance- rupture of membranes before the completion of week 37

Question 15

What is the ethology of PROM

Answer 15

Weak amniotic membranes, inflammation, increased uterine pressure, and infection of urogenital tract

Question 16

How would you manage PROM ?

Answer 16

Hospitalization
Monitor fetal movement
BPP (Biophysical profile)
NST (non-stress test)

Question 17

Pharmacological measures for PROM

Answer 17

Antenatal glucocorticoids, broad spectrum antibiotics

Question 18

How would you engage in health teaching in a patient who is at risk for PROM?

Answer 18

How to look for signs of infection
(i.e. changes in amniotic fluid, fever, feeling unwell, odour, uterine pain)

Question 19

List the maternal PROM complications

Answer 19

Chrorioamnionitis, placental abruption, retained placenta, PPH which can lead to sepsis

Question 20

List the fetal PROM complications

Answer 20

Intrauterine infection, cord compression, cord prolapse, premature birth

Question 21

What is chorioamnionistis?

Answer 21

Bacterial infection go the amniotic cavity

Question 22

Signs and symptoms of chorionamnionistis

Answer 22

Maternal fever, both tachycardia, uterine tenderness, foul odour of amniotic fluid

Question 23

When is the an increase risk in PROM?

Answer 23

With a prolonger rupture, multiple vaginal exams, internal FHR and IUCP

Question 24

How do we treat chorioamnionistis?

Answer 24

IV broad spectrum antibiotics

Question 25

What does chorionamnionistis increase your risk of?

Answer 25

Chances of experiencing labour dystocia, and operative birth (wound infection or pelvic abscesses)

Question 26

What happens when the umbilical cord prolapses?

Answer 26

Cord occlusion and the leads to inadequate blood flow for the fetus. There will be an abrupt deceleration in fetal heart rate.

Question 27

What increases the risks of umbilical cord prolapse?

Answer 27

Lung cord, low-lying placenta, fetus unengaged with pelvis as there is extra space below

Question 28

Describe a prolapsed umbilical cord

Answer 28

Cord lies below the presenting part of the fetus. Increasing risk for fetal hypoxia if this becomes prolonged. | Cord is popping out to say hello, this is bad :(

Question 29

As a nurse, how would you intervene if a patient presented with a prolapsed umbilical cord?

Answer 29

sterile gloved hand in vagina, hold presenting part off the umbilical cord to relieve pressure, trendelenburg or knee-chest position

Question 30

WWYD: A patient presents with a prolapsed umbilical cord and they are fully dilated

Answer 30

Forceps or vacuum can be performed BUT often emergency caesarean birth-done very quickly

Question 31

How is a mother anesthetized if they need a caesarean because of a prolapsed umbilical cord but they have not had an epidural yet?

Answer 31

GA because there is no blood flow to the baby

Question 32

What is a postdates labour ?

Answer 32

Beyond end of 42 weeks

Question 33

What happens if a pregnancy is postdated?

Answer 33

Beyond the 42 weeks, the placenta begins to age (ew) and there are enlarging areas of infarctions and calcium deposits. Also concerned about oligohydroamninos

Question 34

What are the maternal risks for postdates labour?

Answer 34

Perineal injury related to fetal marcosomia, PPH, infection (meconium) | Marcosomia: Big Baby

Question 35

What are some risks that the baby faces if there is a post-dated birth beyond the end of 42 weeks?

Answer 35

Birth injuries, MEC aspirations, still births

Question 36

When is induction offered in a post-dated labour?

Answer 36

After 4 weeks because of increased rates of stillbirth, it reaches 0.19 at 42 weeks

Question 37

As a nurse, how would you assess a patient with post-dated pregnancy?

Answer 37

Daily fetal movement counts (6 move in 2h) NST BPP AFV Cervical assessment/bishops score

Question 38

What interventions would you use with a patient who has a post-dated labour?

Answer 38

Aim to ripen the cervix with balloon catheter or pharmacological interventions, amniotomy (manually rupture membrane), induction

Question 39

What pharmacological interventions would you use to ripen the cervix?

Answer 39

Vaginal or cervical prostaglandin E, misoprostol PO