3 Labor & Birth Complications With Additional Lbaor Topics Flashcards
Preterm birth
Any birth occuring between 20-36/6
RF to put you into preterm labor
Infections (5)
5 more
UTI, yeast infection
HIV, HSV, chorioamnionitis
Hx of PTL
Multifetal gestation
Smoking/substace abuse
Violence/domestic abuse
Lack of prenatal care
Things to help us predict PTL/birth
2 things that combined is best way to determine risk for PLT
Endocervical length
Fetal fibronectin (fFN) test
How we check endocervical length
What we use
When does the shortening occur
What length is indicating of low risk
Use transvaginal US
Cervical shortens before uterine contractions
30mm+ indicated low risk
Fetal fibronectin (fFN) test
What is done (when)
What is expected early and late pregnancy
What does fFN during this time tell us
Vaginal swab (22-34wks)
Expected to find fFN in early and late pregnancy
During 22-34 wks it can indicate inflammation (⬆️ risk of PLT)
Teaching S/S for PTL
Change in vaginal discharge
Pelvic/low abdominal pressure/cramping (may have diarrhea)
Low back ache
Uterine tightening
Interventions for PTL
Teach s/s
FHR/contraction moniotred
Activity restriction
Hydration
Treat infection
Tocolytics
Glucocorticoids (lung maturity)
Activity restrictions for PTL
Modified bedrest with BRP
Rest in left lateral position
Avoid sexual intercourse
Why is hydration important when it comes to PTL
Dehydration can cause uterine contractions
Tocolytic meds
Nifedipine
What it does
Route
Suppresses contractions by inhibiting Ca entering smooth muscles
Route: PO
Nifedipine
SE
Do what to prevent one of them
HA
Flushing
Dizziness
HOTN
Stay hydrated to combat HOTN
Nifedipine
Do not adminiter with what
Mg sulfate
Terbutaline
(TOCOLYTICS)
Tocolytic meds
Mg sulfate
Does
Contraindication (6)
Inhibit uterine contractions
CI:
-Active vag bleeding
-cervix 6cm+
-34wk gestation
-chorioamnionitis
-acute fetal distress
-if you have taken nifedipine
Mg sulfate
adverse effects/toxicity
(7)
(2) NST and FHR resultes
Toxicity relearn from 1st exam
Tx
Flushed/sweating
Muscle weakness
Flu-like symptoms
N/V
Pulmonary edema
Chest pain
HOTN
Nonreasctice NST
Reduced FHR variability
Tx: Ca gluconate
Tocolytic meds
Terbutaline
What it does
Route
Inhibit uterine activity
Route (SQ q4h for up to 24hrs)
Terbutaline
CI (4)
Cardiac disease
DM
Preeclampsia
Pregnancy induced HTN
Terbutaline
Adverse effects
cardiac(5)
Neuro (3)
Labs (2)
Cardiac:
Chest discomfort
Palpitations
Dysrhythmias
Tachycardia
HOTN
Neuro:
N/V, tremors, nervousness
LABS:
Hypokalemia
Hyperglycemia
Terbutaline
When to notify provider
Nortify provider if :
HR >130
BP <90/60
CP
Cardiac dysrhthmias
Tocolytic meds
Indomethacin(NSAID)
When would this med be chosen
Does
Route
Blocks prostaglandins suppressing uterine contractions
Route: PO: no longer than 48hrs
Indomethacin
Can cause what sever thing
Administer only if baby is what age
Can narrow or prematurely close ductus arteriosus
Adminiter only if <32wks gestation
Indomethacin
adverse effects
1st one (4)
2nds one
Pulmonary edema:
CP,SOA,wheezing/crackles, productive cough
Postpartum hemorrahe d/t reduced plt aggregation
Indomethacin puts pressure on what by narrowing the ductus arteriosus
The foramen ovale, leading to increased pressures.
Causing pulmonary edema
What meds promote lung maturity and what are they
Antenatal glucocorticoids
Betamethasone or Dexamethason
Antenatal glucocorticoids (betamethason/dexamethasone)
Given between what weeks when at risk of what
Stimulates what
Reduces what 3 things
Given 24-34 wks if at risk or threatening PTL/birth
Stimulates production of surfactant
Reduces:
Intraventricular hemorrhage (IVH)
Necrotizing enterocolitis
Death in neonates
Betamethasone or dexamethasone
Route and how many injections (how far apart)
Monitor what
Need to be given when to be effective
Route: IM
2 injections
24hr apart
Monitor blood sugars if Diabetic
Need given at least 24hrs before delivery
PPROM
What is it
Preterm prelabor ROM
spontaneous rupture between 20-36/6 wks
(3)PPROM RF
Infection of urogential tract
Hx of PTL or PPROM
Shortening of cervix
PPROM
Do what (8) things if ROM
monitor FHR and uterine contractions
GBS cultures/vag cultures for chlamydia and gonorrhea
Limit vaginal exams (prevent infection)
Daily (NST, BPP, kick counts)
Glucocorticoids if <34wks
Recommended 7-day course of broad Abx
Maintain hydration
Bedrest with BRP
PPROM/PROM pt education (6)
Bedrest with BRP
Record daily kick counts/self-assess uterine contractions
Pelvic rest
Avoid tub baths
Monitor for foul smell (infection)
Temp q4hrs (notify if 100.4+)
Theraeutic procedures: labor and delivery
External cephalic version (ECV)
What is it
Use what to help during procedure
Performed what wks
What two things are done before procedure
Med given
Attempt to turn fetus form breech/shoulder to vertex
US scanning during procedure
Performed 37-38wk inpatient setting
NST and informed consent done before procedure
Terbutaline SQ to relax uterus
External cephalic version
CI (6)
Previous C/S
Multifetal gestation
Cephalopevic disproportion
Plecenta previa
Uteroplacental insufficiency
Nuchal card
Cephalic version
Preparing the pt for procedure (5)
Infromed consent
Perform US prior to procedure
NST (fetal well being)
Rhogam administered at 28wks if mother Rh-
IVF and tocolytics given
Cephalic version monitoring(5) and interventions (1)
Monitor:
FHR during and after
Uterine contractions
ROM
Bleeding
Moms VS
Interventions:
Rhogam post procedure for Rh- mom
Induction of labor
How we do it
Its elective and not recommended before when UNLESS
Chemical (drugs) or mechanical intitiation of uterine contractions
Not recommended before 39wks unless:
-HTN/preeclampsia
-IUGR
-diabetes
-chorioamnionitis
-post-term
Induction of labor CI (5)
Fetal distress
Transverse lie
Shoulder/breech presentation
Placental previa
Previous classical (vertical) uterine incision
induction of labor
Bishop score
Cervical ripening meds we use
Bishop score: tells us how well her cervix will be for labor and delivery
-8+ means its good
Cervical ripening meds:
Dinoprostone
Misoprostol
Augmentation of labor
What is it
Meds/intervention to do this (2)
Risks of the interventions (3)
Stimulation of contractions once labor has begun but progress is inadequate
Meds:
Oxytocin
Amniotomy (AROM)
Risks:
Compressed cord
Prolapsed cord
Infection
Oxytocin
Route
Does: begin at/increase rate every
Assess what and how often
Contractions should be what freq/duration/intensity
Assess relaxation of what
Interventions if tachysystole
Route: IV
Begin at 1miliunit/min
Increase rate 1-2/min every 30-60 mins
Asses fetus and contraxctions q15mins
Contraction: q2-3mins/80-90secs/strong palpation
Assess relaxation of uterus
Uterine tachysystole:
-⬇️ or D/c oxytocin
-give tocolytic
-oxygen
Operative vag birth (forceps, vaccume assisted delivery)
Indication
Maternal exhaustion
Ineffective pushing
Fetal compromise in 2nd stage
Operative vag birth (forceps, vaccume assisted delivery)
Have to have what: (4)
Skilled clinician
Vertex presentation/full cervical dilation
Fetal head engaged or lower
Empty bladder
Episiotomy
What is it
2 types
Incision in perineum to enlarge vaginal opening to facilitate birth
Median (midline) episiotomy
Mediolateral episiotomy
Cesarean birth
2 types
Scheduled c-section
Unplanned c-section
Scheduled c-section
Why you may have (5)
Repeat
Malpresentation
Placental previa
Active genital herpes
HIV+ w/ high viral load
Unplanned c-section
Why you may have (3)
Non-reassuring fetal status
Cervicopelvic disproportion (dont fit in pelvis)
Placental abruption
TOLAC and VBAC
VBAC contraindications (3)
TOLAC (trial of labor after cesarean)
VBAC (vaginal birth after cesarean)
CI:
Previous classical c-section incision
Uterine surgeries
Previous uterine rupture
