Challenges in Labour + Birth Flashcards
What causes preterm labour?
Race, age extremes (<17 or >35), smoking/alcohol/drugs, infection, stress, HTN in pregnancy, previous PTB (earlier gestation of previous PTB=increased risk of even earlier PTB the next time), use of ART, poor oral care/nutrition, placental problems, uterine distension
S+S of preterm labour?
Low abdominal pain/cramps/backache, bleeding/spotting/bloody show/ROM, pelvic pressure, increased amount/changes in vaginal discharge, and contractions every 10 min or more often
What is fetal fibronectin?
Glycoprotein released into cervical/vaginal fluid in response to inflammation/separation of amniotic membranes. Normal in cervical-vaginal secretions until 22 week and again near labour time. Negative test=no FN and pregnancy is likely to continue for at least another 2 weeks. Positive test=FN present 24-34 weeks indicates increased risk of preterm delivery
How to manage PTL?
Ask should it be stopped, assess/monitor VS/contractions/fetus status, avoid stimulation (no vaginal exams, sexual inter course, or nipple stimulation, keep bladder empty)
What are tocolytics? and types
Medications that stop contractions. Types:
- Indomethacin- anti prostaglandin that inhibits uterine activity, delays delivery for 48 hrs, not recommended long term (premature close of ductus arteriosus)
- Calcium channel blocker- nifedipine
- Vaginal progesterone- may prevent/reduced PTB if previous hx of PTB or short cervical length
What is cervical insufficiency?
Cervix doesn’t stay closed and causes premature painless dilation of cervix. Leads to miscarriages because of Infections, multiple gestation, polyhydramnios, DES
How to treat cervical insufficiency and who is at risk?
Bed rest/pelvic rest to keep weight off cervix, avoid heavy lifting. Cervical cerclage (stitch cervix so it stays closed until fetus is term). Some risk of that are infection, blood loss, PPROM, preterm labour, and damage to cervix.
What are corticosteroids used for in PTL?
Clients between 24-34 weeks at risk for PTD within 7 days should be given a single course of corticosteroids to reduce respiratory distress syndrome, intraventricular hemorrhage, and reduce perinatal mortality. Can either get betamethasone or dexamethasone.
Magnesium sulfate in PTL and required criteria?
Given for neuroprotection if client present with imminent preterm birth at <31=6 weeks. They need to be in active labour with >4cm dilated without/with PROM. Give 4g IV loading dose over 30 min then 1g/hr maintenance until delivery
Causes of bleeding in pregnancy?
Miscarriage, ectopic pregnancy, placental previa, abruption placenta, uterine rupture, and gestational trophoblastic disease
What is an abortion?
Expulsion of fetus before 20 weeks or less than 500 g. Spontaneous occurs naturally (miscarriage), and therapeutic/induced occurs medically
Spontaneous abortion care for minimal vs heavy bleeding?
Minimal bleeding=bed rest and abstinence from sex
Heavy bleeding/pain/fever= use cytotec/cervidil to help with uterine contractions, use WinRho is Rh- and baby is Rh+, IV therapy, blood transfusion, may need surgical dilation/curettage or suction evacuation to evacuate membranes/fetus
Provide emotional and physical support
What is an ectopic pregnancy?
Implantation of fertilized ovum outside uterus (usually in fallopian tube) and its not a viable pregnancy. Initially causes symptoms of pregnancy but leads to rupture/bleeding in abdominal cavity (sharp pain, decrease BP, shoulder pain/low abdomen, vaginal bleeding, hypovolemic shock).
What is gestational trophoblastic disease? s+S
Rare pathological tumour of childbearing age client. Causes abnormal development of placenta, trophoblastic cells obliterate pregnancy, mole is formed that benign but can develop into choriocarcinoma.
S+S: signs of pregnancy but very exacerbated (uterine enlargement >gestational age, vaginal bleeding, clots, development of pre-eclampsia prior to 24 weeks, hyperemesis gravidarum (can’t keep anything down)
What is antepartum hemorrhage? and causes
Vaginal bleeding after 20 weeks-delivery. 2 main causes are placental previa or abruptio placentae
What does change in fetal status indicate when experiencing blood loss?
That client might be having hemorrhage
What is placenta previa? and 4 types of
Implantation of placenta in the wrong spot. Can be complete (over cervix opening), partial (partly over cervix), marginal (touches cervix opening), or low lying (not over cervix but it can move so need to monitor)
How to detect placenta previa?
Routine U/S or U/S at time of presentation with bleeding. Goal is to get them to 36-37 weeks
Risk factors for placenta previa and S+S?
Previous placenta previa, large placental mass, uterine abnormalities/edometrial scarring (reduce area that placenta can implant), impeded endometrial vascularization, and unknown
S+S: bleeding (bright red), no pain, uterine tone soft/relaxed, FHR normal, fetus not engaged (may be breech or transverse), bleeding is always visible then slight then profuse
What is abruption placenta?
Premature separation of normal implanted placenta from uterine wall. Complete- apparent hemorrhage in client, fetal death. Partial- half of placenta no longer attached to wall, can have apparent or concealed hemorrhage , fetus can tolerate 30-50% abruption
Risk factors for abruption placenta?
Previous abruption, HTN, abdominal trauma, over distended uterus, PPROM <34 weeks, previous C/S, cocaine/alcohol use, smoking, short umbilical cord, advanced age (>35), high parity, uterine abnormalities (fibroids at implant site).
S+S of abruptio Placenta?
Sudden onset, bleeding concealed or visible, blood darker colour, pain constant, uterine tenderness, uterus firm to rigid, fetus distress or absent
Implications of abruptio p for mom and fetus/baby?
Mom- PPH, ante/intra hemorrhage, DIC, hemorrhagic shock
F/B- hypoxia, anemia, brain damage, fetal demise, prematurity
What is placenta accreta, increta, and percreta?
A- placenta attaches itself too deep into surface of myometrium
I- placenta penetrates into myometrium
P- placenta through myometrium into tissue/organs
Care for AP bleeding?
Assess pregnant client CVS status, LOC, output, O2 stats, fluid resuscitation if active bleeding/unstable, montior fetus/uterus electronically, pain relief, coping mechanisms, prepare for C/S as needed, review dx tests
Care for placenta previa/abruptio?
Bed rest, avoid sexual activity, no vaginal exams (stimulates uterus), assess blood loss/pain/uterine contractions/coping
What is velamentous insertion of cord?
Vessels of umbilical cord aren’t imbedded on body of placenta and they divide some distance away from it in the placental membranes. Torn vessels can lead to fetal hemorrhage
What is uterine rupture? and risk factors
Spontaneous rupture or rupture of previous scare. Risk factors- previous uterine surgery (C/S), multi-parity, trauma, intrauterine manipulation, mid-forceps rotation of fetus, and short inner delivery interval
S+S of uterine rupture?
Initially asymptomatic, abdomen pain not delivery by meds, uterine activity can stop/dilation ceases, vomit, syncope, vaginal bleeding, abnormal FHR, tachycardia, shape of abdomen changes, fetal parts palpable through abdominal wall, sharp/tearing pain in abdomen or shoulder, and complete CVS collapse
