At Risk Labor & Birth Flashcards
Nursing Responsibilities
- 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
Preterm Labor & Birth
-
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
PROM
Spontaneous rupture of membranes is the spontaneous rupture of amniotic membranes 1 hour or more before the onset of true labor
PPROM
Preterm, premature rupture of membranes is a premature, spontaneous rupture of membranes after 20wks of gestations and prioir to end of 37wks
How to Confirm Rupture of Membranes
Positive nitrazine paper test: blue, pH 6.5-7.5
Positive ferning test
Spontaneous Preterm Birth
- Birth w/out being induced
- An early initiation of labor process
- 75% of preterm births happen on their own
Indicated Preterm Birth
-
A means to resolve maternal or fetal risk
> induced labor due to maternal/fetal risk - Preeclampsia, HTN, seizures, abnormal FHR
Causes of Preterm Birth
-
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
Preterm Labor & Birth Risk Factors
premies
- 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
Preterm Labor & Birth - Prevention
-
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
S/S of Preterm Labor
-
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
What Meds will Help Mature Fetal Lungs
Steroids
betamethasone and dexamethasone
Ruptured Membranes Risks
-
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.
Ruptured Membranes Documentation
- Time
- Amount
- Color
- Odor (bleachy)
Chorioamnionitis
- 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
External Cephalic Version
Ultrasound guided procedure to externally turn fetus from breech into cephalic lie
Induction/Augmentation of Labor
-
Oxytocin/Pitocin
> assess every 30-60 minutes
> adequate contraction 2-3 min in frequency, 60-90 sec in duration
Cervical Ripening Prostaglandins
- Cervidil
- Misoprostol
Oxytocin/Pitcon IV Delivery
Needs to be administered as its own separate infusion, not as a piggyback
Focused Assessment Post Administration of Prostaglandinds
gi/gu
-
GI/GU
> urinary retention
> rupture of membranes
> uterine tenderness/pain
> contractions
> bleeding
> fetal distress -
Interventions
> sidelying position
> monitor for hyperstim of uterus/fetal distress
Forcep-Assissted Birth
-
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
Vacuum-Assisted Birth
-
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
Cesarean Birth - Complications/Risks
- Aspiration
- Clots
- Infection
- Bladder injury
Cesarean Birth - Pre-Op Care
- NPO at midnight
- Foley
- Antibiotic
- meds for her stomach
- IV fluids
Cesarean Birth - Post-Op Care
- Bleeding/Infection precautions
-
Uterine activity
> fundal massage - I&Os
- Post-op respiratory care
Cesarean Birth - Recovery Time
Can take up to a year
Cesarean Birth - Indications
-
Placenta complications
> placenta previa -
Malpresentation
> breeched - Active infection
- Cord prolapse
- Fetal compromise
Cesarean Birth - Horizontally Incision
Heals easy, goes w/ mom’s fibers
Cesarean Birth - Vertical Incision
- Will always have to have c-section
- Does not heal a good
Baby’s that go through stress of labor then transitioned to c-section tend to handle external uterine life better
True
They are able to remove fluid during the labor process compared to infants that have scheduled c-sections
Meconium-Stained Amniotic Fluid
- Medical emergency
- Fetus has passed 1st stool before birth
- Fluid is thick
-
Risk for
> meconium aspiration syndrome/pneumonia
Shoulder Dystocia
- 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
What sign indicated that the infant is experiencing shoulder dystocia
Turtle sign
Retraction of fetal head toward perineum
Prolapsed Umbilical Cord
- 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
Amniotic Fluid Embolism
- Amniotic fluid enters maternal blood stream
-
S/S
> acute onset of hypotension
> hypoxia
> CV collapse
> coagulopathy (bleeding) - Maternal mortality 61%+
- Neonatal outcome is poor
Uterine Rupture
-
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
