Birth Complications Flashcards
What are the risk factors for placental abruption (6)
- Placental abruption in previous pregnancy not caused by abdominal trauma
- Chronic HTN
- HTN related problems during pregnancy like preeclampsia, HELLP syndrome, eclampsia
- Fall/blow to abdomen
- Smoking/cocaine use during pregnancy
- Older than 40
What are the s/s of placental abruption (3)
- Painful vaginal bleeding
- Shock if severe
- Board-like abdomen
What are the interventions for a placental abruption (4)
- Evaluate with ultrasound
- No vaginal exams to avoid inducing hemorrhage
- If minimal bleeding, +FHR, near delivery = attempt NSVD
- Most require a c-section
What is placenta previa
Placenta implants in lower uterine segment near/over cervical os
What is a total placenta previa
Covers entire internal os
What is a partial previa
Incomplete coverage of internal os
What is a marginal previa
Edge is 2-3 cm from os
What are the s/s of placenta previa (2)
- Painless vaginal bleeding after 24 weeks
- No abdominal tenderness
What are the interventions for placenta previa (4)
- Evaluate with ultrasound
- No vaginal exams to avoid hemorrhage
- Most require a c-section
- Monitor for hemorrhage
What are the complications of a placenta previa (5)
- Hemorrhage
- Malpresentation
- Preterm birth
- Fetal anoxia/death
- Placenta accreta
What is a cord prolapse
Cord is below the presenting part of the fetus and is being compressed
What positions relieve pressure on the cord
- Trendelenberg
- SIMS
What are the risk factors for a cord prolapse (8)
- Breech
- Footling
- Transverse
- Unengaged presenting part
- Polyhydramnios
- Preterm/small fetus
- SROM/amniotomy
- Long cord
How is preeclampsia diagnosed
- HTN past 20 weeks
- BP >140/90
- Proteinuria >300 mg
What must be present in preeclampsia if there is no proteinuria (5)
- Thrombocytopenia
- Renal insufficiency
- Impaired liver function
- Pulmonary edema
- Cerebral/visual symptoms
What is the first line treatment for preeclampsia
- Labetalol
- Methyldopa
What is the 2nd line treatment for preeclampsia
Nifedipine
What is the emergency treatment for preeclampsia
- Magnesium sulfate
- Hydralazine
What position improves blood flow to fetus, decrease BP, and promotes diuresis during preeclampsia
left lateral recumbent
What are the s/s of severe preeclampsia(16)
- Epigastric pain
- Headache
- Visual disturbances
- SOB
- Dyspnea
- BP >160/110
- Proteinuria >3 g
- Hyperreflexia
- Clonus
- Oliguria
- Thrombocytopenia
- Impaired liver function
- Systemic edema
- Pulmonary edema
- IUGR
- Fetal distress
What are the s/s of eclampsia (5)
- Seizures
- Respirations stop and then are long and deep after
- Hypotension
- Disorientation, amnesia, coma after
- Hyperactive reflexes before seizure
What is the antidote to magnesium sulfate
Calcium gluconate
How is calcium gluconate administered
10ml of 10% solution or 1g IV over 3 minutes
What are the side effects of magnesium sulfate (12)
- Decreased deep tendon reflexes
- Respiratory depression, sedation
- Muscle weakness
- Slurred speech
- Decreased consciousness
- Hypotension
- Decreased urine output
- Feeling of warmth
- Flushing/burning at IV site
- Nausea
- Decreased cardiac function
- Bradycardia
