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N330 > 3 Labor & Birth Complications With Additional Lbaor Topics > Flashcards

3 Labor & Birth Complications With Additional Lbaor Topics Flashcards

1
Q

Preterm birth

A

Any birth occuring between 20-36/6

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2
Q

RF to put you into preterm labor

Infections (5)
5 more

A

UTI, yeast infection
HIV, HSV, chorioamnionitis
Hx of PTL
Multifetal gestation
Smoking/substace abuse
Violence/domestic abuse
Lack of prenatal care

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3
Q

Things to help us predict PTL/birth

2 things that combined is best way to determine risk for PLT

A

Endocervical length

Fetal fibronectin (fFN) test

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4
Q

How we check endocervical length

What we use
When does the shortening occur
What length is indicating of low risk

A

Use transvaginal US

Cervical shortens before uterine contractions

30mm+ indicated low risk

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5
Q

Fetal fibronectin (fFN) test

What is done (when)
What is expected early and late pregnancy
What does fFN during this time tell us

A

Vaginal swab (22-34wks)

Expected to find fFN in early and late pregnancy

During 22-34 wks it can indicate inflammation (⬆️ risk of PLT)

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6
Q

Teaching S/S for PTL

A

Change in vaginal discharge

Pelvic/low abdominal pressure/cramping (may have diarrhea)

Low back ache

Uterine tightening

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7
Q

Interventions for PTL

A

Teach s/s
FHR/contraction moniotred
Activity restriction
Hydration
Treat infection
Tocolytics
Glucocorticoids (lung maturity)

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8
Q

Activity restrictions for PTL

A

Modified bedrest with BRP

Rest in left lateral position

Avoid sexual intercourse

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9
Q

Why is hydration important when it comes to PTL

A

Dehydration can cause uterine contractions

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10
Q

Tocolytic meds
Nifedipine

What it does
Route

A

Suppresses contractions by inhibiting Ca entering smooth muscles

Route: PO

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11
Q

Nifedipine

SE
Do what to prevent one of them

A

HA
Flushing
Dizziness
HOTN

Stay hydrated to combat HOTN

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12
Q

Nifedipine

Do not adminiter with what

A

Mg sulfate
Terbutaline

(TOCOLYTICS)

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13
Q

Tocolytic meds
Mg sulfate

Does
Contraindication (6)

A

Inhibit uterine contractions

CI:
-Active vag bleeding
-cervix 6cm+
-34wk gestation
-chorioamnionitis
-acute fetal distress
-if you have taken nifedipine

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14
Q

Mg sulfate

adverse effects/toxicity
(7)
(2) NST and FHR resultes
Toxicity relearn from 1st exam
Tx

A

Flushed/sweating
Muscle weakness
Flu-like symptoms
N/V
Pulmonary edema
Chest pain
HOTN

Nonreasctice NST
Reduced FHR variability

Tx: Ca gluconate

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15
Q

Tocolytic meds
Terbutaline

What it does
Route

A

Inhibit uterine activity
Route (SQ q4h for up to 24hrs)

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16
Q

Terbutaline

CI (4)

A

Cardiac disease

DM

Preeclampsia

Pregnancy induced HTN

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17
Q

Terbutaline

Adverse effects
cardiac(5)
Neuro (3)
Labs (2)

A

Cardiac:
Chest discomfort
Palpitations
Dysrhythmias
Tachycardia
HOTN

Neuro:
N/V, tremors, nervousness

LABS:
Hypokalemia
Hyperglycemia

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18
Q

Terbutaline

When to notify provider

A

Nortify provider if :

HR >130
BP <90/60
CP
Cardiac dysrhthmias

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19
Q

Tocolytic meds
Indomethacin(NSAID)

When would this med be chosen
Does
Route

A

Blocks prostaglandins suppressing uterine contractions

Route: PO: no longer than 48hrs

20
Q

Indomethacin

Can cause what sever thing

Administer only if baby is what age

A

Can narrow or prematurely close ductus arteriosus

Adminiter only if <32wks gestation

21
Q

Indomethacin

adverse effects
1st one (4)
2nds one

A

Pulmonary edema:
CP,SOA,wheezing/crackles, productive cough

Postpartum hemorrahe d/t reduced plt aggregation

22
Q

Indomethacin puts pressure on what by narrowing the ductus arteriosus

A

The foramen ovale, leading to increased pressures.
Causing pulmonary edema

23
Q

What meds promote lung maturity and what are they

A

Antenatal glucocorticoids

Betamethasone or Dexamethason

24
Q

Antenatal glucocorticoids (betamethason/dexamethasone)

Given between what weeks when at risk of what
Stimulates what
Reduces what 3 things

A

Given 24-34 wks if at risk or threatening PTL/birth

Stimulates production of surfactant

Reduces:
Intraventricular hemorrhage (IVH)
Necrotizing enterocolitis
Death in neonates

25
Q

Betamethasone or dexamethasone

Route and how many injections (how far apart)

Monitor what

Need to be given when to be effective

A

Route: IM
2 injections
24hr apart

Monitor blood sugars if Diabetic

Need given at least 24hrs before delivery

26
Q

PPROM
What is it

A

Preterm prelabor ROM
spontaneous rupture between 20-36/6 wks

27
Q

(3)PPROM RF

A

Infection of urogential tract

Hx of PTL or PPROM

Shortening of cervix

28
Q

PPROM
Do what (8) things if ROM

A

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

29
Q

PPROM/PROM pt education (6)

A

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+)

30
Q

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

A

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

31
Q

External cephalic version

CI (6)

A

Previous C/S
Multifetal gestation
Cephalopevic disproportion
Plecenta previa
Uteroplacental insufficiency
Nuchal card

32
Q

Cephalic version

Preparing the pt for procedure (5)

A

Infromed consent

Perform US prior to procedure

NST (fetal well being)

Rhogam administered at 28wks if mother Rh-

IVF and tocolytics given

33
Q

Cephalic version monitoring(5) and interventions (1)

A

Monitor:
FHR during and after
Uterine contractions
ROM
Bleeding
Moms VS

Interventions:
Rhogam post procedure for Rh- mom

34
Q

Induction of labor

How we do it
Its elective and not recommended before when UNLESS

A

Chemical (drugs) or mechanical intitiation of uterine contractions

Not recommended before 39wks unless:
-HTN/preeclampsia
-IUGR
-diabetes
-chorioamnionitis
-post-term

35
Q

Induction of labor CI (5)

A

Fetal distress
Transverse lie
Shoulder/breech presentation
Placental previa
Previous classical (vertical) uterine incision

36
Q

induction of labor

Bishop score

Cervical ripening meds we use

A

Bishop score: tells us how well her cervix will be for labor and delivery

-8+ means its good

Cervical ripening meds:
Dinoprostone
Misoprostol

37
Q

Augmentation of labor

What is it
Meds/intervention to do this (2)
Risks of the interventions (3)

A

Stimulation of contractions once labor has begun but progress is inadequate

Meds:
Oxytocin
Amniotomy (AROM)

Risks:
Compressed cord
Prolapsed cord
Infection

38
Q

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

A

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

39
Q

Operative vag birth (forceps, vaccume assisted delivery)

Indication

A

Maternal exhaustion

Ineffective pushing

Fetal compromise in 2nd stage

40
Q

Operative vag birth (forceps, vaccume assisted delivery)

Have to have what: (4)

A

Skilled clinician

Vertex presentation/full cervical dilation

Fetal head engaged or lower

Empty bladder

41
Q

Episiotomy

What is it
2 types

A

Incision in perineum to enlarge vaginal opening to facilitate birth

Median (midline) episiotomy

Mediolateral episiotomy

42
Q

Cesarean birth

2 types

A

Scheduled c-section

Unplanned c-section

43
Q

Scheduled c-section

Why you may have (5)

A

Repeat

Malpresentation

Placental previa

Active genital herpes

HIV+ w/ high viral load

44
Q

Unplanned c-section

Why you may have (3)

A

Non-reassuring fetal status

Cervicopelvic disproportion (dont fit in pelvis)

Placental abruption

45
Q

TOLAC and VBAC

VBAC contraindications (3)

A

TOLAC (trial of labor after cesarean)

VBAC (vaginal birth after cesarean)

CI:
Previous classical c-section incision
Uterine surgeries
Previous uterine rupture

N330 (17 decks)

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