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N330 > 3 Labor & Birth Complication Part 2 > Flashcards

3 Labor & Birth Complication Part 2 Flashcards

1
Q

C-section birth

Pre- op care

A

Informed consent
NPO
Iv w/ fluids
CBC/type and cross
FHR and mom VS

Spinal anesthesia
Foley catheter

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2
Q

C-section

Intra-op care

A

Table tilt/ hip wedges

Strap legs to table

SCDs

FHR

VS/IVF/UOP

Time out

Support person brought in

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3
Q

C-section

Immediate post-op care

A

VS q15 for 2hrs

Assess incision/fundus/lochia

Skin to skin for baby

Assess for HOTN from anesthesia

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4
Q

Dysfunctional (dystocia) labor

A

Difficult or abnormal labor

Indications leading to c-section usually due to:
5 P’s passenger, passageway, powers, position, psychologic response

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5
Q

How the passanger and passageway can cause dysfunctional labor

A

Narrow pelvic inlet

CPD (cephalopelvic disproportion)

Malposition (OP) head rubbing down spine

Malpresentation: breech, shoulder

Multifetal pregnancy (twins/triplets)

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6
Q

How powers can cause dysfunction labor

A

Hypertonic uterine dysfunction

Hypotonic uterine dysfunction

Secondary power problems

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7
Q

Hypertonic uterine dysfunction
Tx

A

Therapeutic rest (bedrest w/ BRP)

D/c oxytocin

Tocolysis

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8
Q

Hypotonic uterine dysfunction rx

A

Augmentation: amniotomy, oxytocin

Encourage regular voiding

Encourage ambulation, position changes

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9
Q

Secondary power problem (pushing problem) tx

A

Reduce epidural infusion

Favorable position for pushing

Forcep/vacuum assisted birth

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10
Q

Precipitous delivery

A

Labor lasting less than 3 hours from onset of contractions

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11
Q

Precipitous delivery RF

A

Multiparous client (multiple babies)

Oxytocin use

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12
Q

Precipitous delivery care

A

Do not leave pt alone

Prepare for delivery

Apply light pressure on perineal area to ease delivery

Support head, assess for nuchal cord, suction mouth and nose

Delivery anterior shoulder then posterior

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13
Q

Precipitous labor

Assess for complications
Mother vs fetus

A

Mother:
Cervical/vaginal/perineal lacerations
Uterine rupture
Postpartum hemorrhage

Fetus:
Hypoxia
Head trauma/intracrania hemorrhage

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14
Q

Prolapsed cord contributing factors

A

Long cord
SGA
Breech
Transverse lie
Unengaged

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15
Q

Prolapsed cord tx

Do
Dont

A

Call for help

Used sterile gloves and elevate presenting part

Place mom trandelenburg knees to chest

O2 NRB 10L

IVF

Prepare for emergency birth

DONT TRY TO REPLACE CORD

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16
Q

Shoulder dystocia

Risks

Management

A

Risk:
Macrosomia
Hx of shoulder dystocia

Management:
Mcroberts maneuver (knees to chest)
Suprapubic pressure (not fundal pressure)

17
Q

Shoulder dystocia

Mom and fetus effects

A

Mom:
PPH
Trauma to vag/rectum

Fetus:
Asphyxia
Brachial plexus damage
Fx clavicle

18
Q

Chrorioamnionitis

Clinical manifestations

Neonatal risks

Tx

A

CM:
Mom fever
Mom/baby tachycardia
Foul odor of amniotic fluid

Neonatal risks: ifection and sepsis

Tx:
Birth
Ampicillin/PCN & gentamicin IV

19
Q

Risk of meconium aspiration syndrome (MAS)

Tx
What needed
Person needed
Assess what

If good then we can do what
If bad what do we do

A

Equipment for resuscitation
Person for ET tube
Assess newborn respiratory effort

Suction newborns mouth and nose if Baby has:
-strong respirtory efforts
-good muscle tone
HR 100+

If respirtory support needed then:
-tracheal suction performed prior to assisted ventilations
Do this if:
-Depressed RR, muscle tone
-HR less100

20
Q

Uterine rupture

Types

Risks during labor

A

Complete vs incomplete

Risks:

-Uterine tachysystole (oxytocin use)
-Previous c-section w/ (TOLAC/VBAC)
-Multigravida women
-Overdistended uterus
-Malpresentation (external/internal version)
-Difficult forceps assisted birth

21
Q

Uterine rupture clinical manifestations

A

Pt in sharp pain feel ripping

Abd pain, uterine tenderness

Stopping of contractions, change in uterine shape

Non reassuring FHT (⬇️100bpm, ⬇️ variablility)

S/s of hypovolemic shock
(⬇️BP,⬆️HR,⬇️UOP,⬆️RR, pale,⬇️LOC)

22
Q

Uterine rupture management

A

O2
IVF/Blood Product
Prep for surgery
Need repair for torn segment, may need hysterectomy for some completes

23
Q

AFE (amniotic fluid embolus)

AKA
What is happening

A

AKA: anaphylactoid syndrome

Amniotic fluid penetrated vascular space

24
Q

AFE (amniotic fluid embolus) RF

A

Placenta previa/ abruption

Preeclampsia/eclampsia

HTN disorder

DM

C-section birth

25
Q

AFE (amniotic fluid embolism)

Clinical manifestations

A

Sudden chest pain/SOA

S/s of:
Respiratory distress
Circulatory collapse
Coagulation failure (DIC)

26
Q

AFE (amniotic fluid embolism)

Tx

A

O2 NRB/ assist with intubation/ventilartions

CPR if needed

IVF, blood products

Foley to monitor hourly urine output

N330 (17 decks)

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