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OB Exam 2 > At Risk Labor & Birth > Flashcards

At Risk Labor & Birth Flashcards

1
Q

Nursing Responsibilities

A
  • Nurse & OB team must use knowledge & skills in a concerted effort to provide care in event of complication
  • Uderstand normal borth processes
  • Prevent & detect deviations from normal labor & birth
  • Implement nursing measure if complication arise
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2
Q

Preterm Labor & Birth

A
  • Preterm Labor
    > cervical changes & uterine contractions occuring btwn 20 & before end of 37 wks
  • Preterm Birth
    > birth tht occurs before the completion of 37 wks
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3
Q

PROM

A

Spontaneous rupture of membranes is the spontaneous rupture of amniotic membranes 1 hour or more before the onset of true labor

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4
Q

PPROM

A

Preterm, premature rupture of membranes is a premature, spontaneous rupture of membranes after 20wks of gestations and prioir to end of 37wks

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5
Q

How to Confirm Rupture of Membranes

A

Positive nitrazine paper test: blue, pH 6.5-7.5
Positive ferning test

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6
Q

Spontaneous Preterm Birth

A
  • Birth w/out being induced
  • An early initiation of labor process
  • 75% of preterm births happen on their own
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7
Q

Indicated Preterm Birth

A
  • A means to resolve maternal or fetal risk
    > induced labor due to maternal/fetal risk
  • Preeclampsia, HTN, seizures, abnormal FHR
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8
Q

Causes of Preterm Birth

A
  • Immune
    > infections: GBS, UTI
  • Bleeding at site of placental attachment
    > placenta previa
    > placenta abruption
  • Psychosocial
    > stress
    > trauma
  • Endocrine
    > dcr in progesterone; will be started on progesterone to hopefully wait until term
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9
Q

Preterm Labor & Birth Risk Factors

premies

A
  • Preeclampsia
  • Race (AA)/Record of hx
  • Elevated BP
  • Maternal age incrd
  • Infection of urinary tract
  • Excess/little amniotic fluid
  • Second tri bleeding/Second baby (multifetal getation)
  • low weight like anorexia
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10
Q

Preterm Labor & Birth - Prevention

A
  • Infections
    > hlth promotion & disease prevention
    > prenatal care
  • Prior Hx of SPB
    > preconception counseling
  • Pharma for SPB
    > Indomethacin: blocks prostaglandins
    > Nifidepine: stop contractions/inhibit Ca
    > Magnesium Sulfate: slow down preterm labor
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11
Q

S/S of Preterm Labor

A
  • More than 4-6 contractions in an hour or longer
    > every 10-15mins w/in the hr
    > it is full term you would not tell her to come in but preterm she must come in
  • Discomfort
    > dull, intermittent lower back pain
    > menstrual-like cramps
    > pelvic pressure/heaviness
  • Vaginal Discharge
    > rupture of membranes
    > change in discharge
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12
Q

What Meds will Help Mature Fetal Lungs

A

Steroids
betamethasone and dexamethasone

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13
Q

Ruptured Membranes Risks

A
  • After rupture immediately assess FHR
    > take temp regualry; if mom’s temp incrs baby’s HR incrs
  • Biggest Risk:
    > prolapsed cord: med emergency, cord cannot be delivered before baby, big variable decels, cannot take fingers off cord once found - prep for c-section
    > chorioamnionitis: an ascending infection, originating in the lower genitourinary tract and migrating to the amniotic cavity.
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14
Q

Ruptured Membranes Documentation

A
  • Time
  • Amount
  • Color
  • Odor (bleachy)
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15
Q

Chorioamnionitis

A
  • Infection tht occurs when bacteria invades membranes, placenta, amniotic fluid, or surrounding tissue of fetus
  • Mom’s VS:
    > tachy
    > fever
  • Physical Assessment Findings
    > uterine tenderness
    > purulent amniotic fluid
    > odor
  • FHR Pattern
    > tachy
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16
Q

External Cephalic Version

A

Ultrasound guided procedure to externally turn fetus from breech into cephalic lie

17
Q

Induction/Augmentation of Labor

A
  • Oxytocin/Pitocin
    > assess every 30-60 minutes
    > adequate contraction 2-3 min in frequency, 60-90 sec in duration
18
Q

Cervical Ripening Prostaglandins

A
  • Cervidil
  • Misoprostol
19
Q

Oxytocin/Pitcon IV Delivery

A

Needs to be administered as its own separate infusion, not as a piggyback

20
Q

Focused Assessment Post Administration of Prostaglandinds

gi/gu

A
  • GI/GU
    > urinary retention
    > rupture of membranes
    > uterine tenderness/pain
    > contractions
    > bleeding
    > fetal distress
  • Interventions
    > sidelying position
    > monitor for hyperstim of uterus/fetal distress
21
Q

Forcep-Assissted Birth

A
  • Indication
    > providers fingers are too large to grip fetal head
    > provider needs skill
  • Forceps placed on zygomatic bones of fetus
  • Traction applied
  • Maternal/Fetal Risk
    > laceration to perineum
    > facial nerve palsy/bruising neonate
22
Q

Vacuum-Assisted Birth

A
  • Indication
    > pts tht are tired/poor pushing efforts
    > more often used than forceps
    > have to see baby’s head
    > vacuum removed before delivery
  • Vacuum positioned on fetal head
  • Traction applied
  • Maternal/Fetal Risk
    > laceration to perineum
    > facial nerve palsy/bruising neonate
  • Nurses role is just documentation & placing vacuum
23
Q

Cesarean Birth - Complications/Risks

A
  • Aspiration
  • Clots
  • Infection
  • Bladder injury
24
Q

Cesarean Birth - Pre-Op Care

A
  • NPO at midnight
  • Foley
  • Antibiotic
  • meds for her stomach
  • IV fluids
25
Q

Cesarean Birth - Post-Op Care

A
  • Bleeding/Infection precautions
  • Uterine activity
    > fundal massage
  • I&Os
  • Post-op respiratory care
26
Q

Cesarean Birth - Recovery Time

A

Can take up to a year

27
Q

Cesarean Birth - Indications

A
  • Placenta complications
    > placenta previa
  • Malpresentation
    > breeched
  • Active infection
  • Cord prolapse
  • Fetal compromise
28
Q

Cesarean Birth - Horizontally Incision

A

Heals easy, goes w/ mom’s fibers

29
Q

Cesarean Birth - Vertical Incision

A
  • Will always have to have c-section
  • Does not heal a good
30
Q

Baby’s that go through stress of labor then transitioned to c-section tend to handle external uterine life better

A

True
They are able to remove fluid during the labor process compared to infants that have scheduled c-sections

31
Q

Meconium-Stained Amniotic Fluid

A
  • Medical emergency
  • Fetus has passed 1st stool before birth
  • Fluid is thick
  • Risk for
    > meconium aspiration syndrome/pneumonia
32
Q

Shoulder Dystocia

A
  • Medical emergency
  • Head is born, but anterior shoulder cannot pass under pubic arch
  • Risk for (infant)
    > brachial plexus injury
  • Maternal Complications
    > hemorrhage
    > rectal injury
  • Interventions
    > hyperflex hips
    > Mc Roberts maneuver
33
Q

What sign indicated that the infant is experiencing shoulder dystocia

A

Turtle sign
Retraction of fetal head toward perineum

34
Q

Prolapsed Umbilical Cord

A
  • When cord lies over presenting part of fetus
  • DO NOT move hand!
    > Call for help
    > 100% O2
    > Prep for c-section
  • Other nurses will position mother in trendelenburg or knee to chest
35
Q

Amniotic Fluid Embolism

A
  • Amniotic fluid enters maternal blood stream
  • S/S
    > acute onset of hypotension
    > hypoxia
    > CV collapse
    > coagulopathy (bleeding)
  • Maternal mortality 61%+
  • Neonatal outcome is poor
36
Q

Uterine Rupture

A
  • Abnormal FHR tracing
    > late decels, bradycardia
  • Physical Exam
    > abdominal rigid/pain
    > shock: due to massive blood loss, hypovolemix shock
  • Vaginal Exam
    > blood
    > loss of fetal station: “destationing”; during contraction baby is trying to deliver into rupture
  • Causes
    > miss management of oxytocin

OB Exam 2 (11 decks)

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