Additional PP Complications Flashcards
what does HELLP stand for?
Hemolysis, Elevated Liver enzymes, Low Platelets
how is HELLP characterized?
Hemolysis/elevated liver enzymes: inflammation of the liver, characterized by pain under the right ribcage, which is caused by inflamed liver capsule
Low platelets: signals an impending disorder of clotting status that if left unchecked can progress to disseminated intravascular coagulopathy (must be less than 100 x10^9)
how does hemolysis work in HELLP?
RBC’s are damaged as they pass through narrowed blood vessels and become hemolyzed,, resulting in a decreased RBC and platelet count and hyperbilirubinemia
complications of HELLP?
Renal failure
Pulmonary edema
Ruptured liver hematoma
DIC
Placental abruption
interventions for HELLP?
Protein or salt restriction
Zinc
Magnesium
Fish oil
Vitamins C and E
Use of diuretics or other anti-hypertensive medications
Use of heparin or low-dose aspirin
nursing care for HELLP?
assess BP, deep tendon reflexes, fetal surveillance, recommend activity restriction
what does magnesium sulphate prevent and treat?
convulsions (seizures) caused by pre-eclampsia or eclampsia
how is magnesium sulphate administered?
via infusion
what is bilirubin a by product of?
RBC hemolysis
where do fetal RBC go at the time of birth?
mothers circlulation
what is ABO coagulation?
antibodies in the plasma of one blood group produce agglutination (clumping) when mixed with antigens of a different blood group. In the ABO blood group system, the antibodies occur naturally
does AB blood group contain antibodies?
no
what is the most common blood group incompatibility in the newborn and mother?
mother is O blood group and an infant with A or B blood group
how are Rh and ABO incompatibility different?
ABO incompatibility may occur in the first pregnancy
when can Complications arise with Rh incompatibility (isoimmunization)?
mother is Rh negative and the newborn is Rh positive.
When fetal RBCs enter maternal circulation during childbirth, the natural defense mechanism of the childbearing parent responds to these alien cells by:
producing anti-Rh antibodies
isoimmunization has no effect during the first pregnancy with an Rh-positive fetus because:
the initial sensitization to Rh antigens rarely occurs before the onset of labor
how does the fetus attempt to compensate for progressive hemolysis and anemia?
accelerating the rate of erythropoiesis (red blood cell production). As a result, immature RBCs (erythroblasts) appear in the fetal circulation. This is called erythroblastosis fetalis
what is hydrops fetalis?
progressive hemolysis = fetal hypoxia
is a prolapsed cord more of a complication in labour or post partum?
Labour
what is a prolapsed cord?
occurs when the cord lies below the presenting part of the fetus.
the prolapsed cord can be hidden during labour. T or F
T
when would you typically see a prolapsed cord?
directly after rupture of membranes, when gravity washes the cord in front of the presenting part.
what are contributing factors to a prolapsed cord?
long cord (longer than 100 cm), malpresentation (breech or transverse lie)
what are risk factors of a prolapsed cord?
fetal hypoxia, newborn asphyxia, neurological brain injury, or death of the fetus.
how can the nurse help with a prolapsed cord?
Pressure on relieved by putting a sterile gloved hand into the vagina, holding the presenting part off of the umbilical cord
what positions can help gravity keep the presenting part off the prolapsed cord?
lateral recumbent, Trendelenburg, or knee–chest,
when the pt has a prolapsed cord but is fully dilated that should be done?
vacuum-assisted birth can be performed for the fetus in a cephalic presentation; otherwise, emergent Cesarean surgery is likely to be performed
signs of a prolapsed cord:
prolonged deceleration during uterine contraction
Patient reports feeling the cord after membranes rupture
Cord is seen or felt in or protruding from the vagina
what is Dystocia?
abnormally slow progress of labor; it is caused by various conditions related to the five P’s of labor (passenger, passageway, powers, position of the labouring patient, and psychological response)
causes of Dystocia:
- Ineffective uterine contractions (most common cause)
- Alterations in the pelvic structure
- Fetal causes (size, position)
- position of pt during birth
- Psychological responses
when should dystocia be suspected?
when there is an alteration in the characteristics of uterine contractions, a lack of progress in the rate of cervical dilation, or a lack of progress in fetal descent and expulsion.
what is the most common fetal malposition?
persistent occipitoposterior position
when does fetal malposition usually occur?
during the latent phase of the first stage of labor
- 2nd stage is usually prolonged (back pain from pressure)
what is AROM?
Artificial rupture of membranes
define AROM
when the doctor or health care provider intentionally breaks the pregnant woman’s amniotic sac
why is AROM done?
to progress labor and if the baby needs to be monitored more closely
how is AROM performed?
physician takes a hook like device and inserts it into the woman’s vaginal cavity, in through the cervix and reaches the amniotic sac
causes of a C:
Fetal macrosomia
Advanced maternal age
Obesity
Gestational diabetes
Multifetal pregnancy
Labour dystocia
risks of a C:
- endometritis, blood transfusion and venous thrombosis
- A longer hospital stay and recovery time
- Increased risk for resp issues for baby
- Greater complications in subsequent pregnancies
C should not be perfumed unless they are at what gestational age?
39 weeks
when are C’s not recommended?
- pt who want more kids
indications for a C (preg pt):
Specific cardiac disease
Specific respiratory disease
Conditions associated with increased intracranial pressure
Mechanical obstruction of the lower uterine segment (tumours, fibroids)
Mechanical vulvar obstruction
History of two or more previous Csection births
Elective csection birth
indications for a C (infant:
Abnormal HR or pattern
Malpresentation (breech or transverse lie)
Active herpes lesions in labouring patient
Maternal HIV
Congenital anomalies
complications of a C:
Anaesthesia events
Hemorrhage
Bowel or bladder injury
Amniotic fluid embolism
Air embolism
postpartum complications of a C:
Atelectasis
Endometritis
UTI
Abdominal wound hematoma formation
Dehiscence
Infection
Necrotizing fasciitis
Thromboembolic disease
Bowel dysfunction
when can Fetal asphyxia occur?
if the uterus and placenta are poorly perfused as a result of hypotension in the labouring patient caused by regional anaesthesia
