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NURS 414: OB > Chapter 21Complications Occurring Before Labor and Delivery > Flashcards

Chapter 21Complications Occurring Before Labor and Delivery Flashcards

Exam 2

1
Q

Preterm Premature Rupture of Membranes (PPROM) #1-

Preterm Rupture of Membranes: What is it?

A

Preterm rupture of membranes (PROM) is the rupture of membranes prior to the start of contractions at or after 37 weeks.

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2
Q

Preterm Premature Rupture of Membranes (PPROM) #1:

What does PROM increase the risk for?

A

PROM increases the risk of:

prolapsed cord,

placental abruption,

chorioamnionitis, and

cord compression.

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3
Q

Preterm Premature Rupture of Membranes (PPROM) #1:

What is PRETERM premature rupture of membranes (PPROM)?

A

Preterm premature rupture of membranes (PPROM) is the rupture of membranes prior to 37 weeks of gestation.

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4
Q

Preterm Premature Rupture of Membranes (PPROM) #1:

What are major concerns for patients with PPROM?

A

Major concerns for patients with PPROM include

infection,

cord prolapse,

fetal malpresentation, and

precipitous labor.

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5
Q

Preterm Premature Rupture of Membranes (PPROM) #1:

What are the identifiable risk factors of PRROM?

A

Most patients with PPROM do not have identifiable risk factors.

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6
Q

Preterm Premature Rupture of Membranes (PPROM) #1:

Who is the incidence of PPROM higher in?

A

The incidence of PPROM, is higher in patients who smoke,

had a previous pregnancy with PPROM,

infections of the genital tract, and

had any vaginal bleeding during pregnancy.

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7
Q

Preterm Premature Rupture of Membranes #2:

Treatment for PPROM includes:

A

Corticosteroids

Antibiotic therapy

Tocolytics

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8
Q

Preterm Premature Rupture of Membranes #2:

Treatment for PPROM includes:

What is the treatment of PPROM in pregnancies under 34 weeks? Why?

A

Corticosteroids in pregnancies under 34 weeks gestation to promote fetal lung maturity.

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9
Q

Preterm Premature Rupture of Membranes #2:

Treatment for PPROM includes: What is used because of infection?

A

Antibiotic therapy because PPROM may have been caused by infection.

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10
Q

Preterm Premature Rupture of Membranes #2:

Treatment for PPROM includes:
What is used off label? How long and why?

What is thought about the use of this drug?

A

Tocolytics may be used off label for 48 hours to allow time for a full course of corticosteroids to be administered to the patient. Use of tocolytics for PPROM is controversial.

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11
Q

Preterm Premature Rupture of Membranes #2:

What should nurses monitor patients for closely in patients with PPROM?

A

Nurses should monitor patients with PPROM closely for signs of infection.

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12
Q

Preterm Labor #1:

What is preterm labor?

A

Preterm labor is contractions that cause cervical dilation prior to 37 weeks and may be spontaneous or induced.

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13
Q

Preterm Labor #1:

Approximately how many births are preterm labor?

A

Approximately 10% of births are preterm.

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14
Q

Common Reasons for Premature Induction of Labor:

A

Placental Problems

History of uterine scarring

Fetal grown restriction

Chronic hypertension

Preeclampsia

Poorly controlled gestational diabetes

Pregestational diabetes, poor controlled or with vascular complications

Preterm premature rupture of membranes

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15
Q

Preterm Labor #2: Symptoms of Labor Include:

A

Irregular contractions, often mild

Report of “menstrual-like” cramping

Low back pain

Feelings of vagina or pelvic pressure

Light bleeding or spotting

Bloody show

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16
Q

Preterm Labor #2:

Diagnosis of preterm labor may include:

A

Cervical dilation of 3 cm or more

Cervical shortening on ultrasound

Positive fetal fibronectin test (fFN):

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17
Q

Preterm Labor #2

Diagnosis of preterm labor may include:

Positive fetal fibronectin test (fFN):

A

Evaluation of a protein concentrated between the placenta and the decidua of the uterus

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18
Q

Preterm Labor: Risk Factors

Risk Factors for Spontaneous Preterm Birth

A

Low maternal education level

Low maternal income level

Infection

Family history of preterm birth

Pregnancy with more than one fetus

There are more….

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19
Q

Preterm Labor: Treatment

What do interventions include:

A

Interventions include suppression of labor, physical activity restriction, and management of medications.

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20
Q

Preterm Labor: Treatment

What is commonly recommended to be restricted in preterm labor?

A

Physical activity restriction is commonly recommended but lacks supportive evidence.

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21
Q

Preterm Labor: Treatment

Administration of what is not supported by current research?

A

Progesterone supplementation is not supported by current research.

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22
Q

Preterm Labor: Treatment

What may be administered to pregnant women? When?

A

Corticosteroids may be administered to pregnant patients at 23 to 34 weeks.

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23
Q

Preterm Labor: Treatment

What do corticosteroids promote?

A

Corticosteroids promote fetal lung maturity and reduce the risk of ventricular bleeding and necrotizing enterocolitis

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24
Q

Preterm Labor: Treatment

What are corticosteroids reserved for?

A

is reserved for pregnancies that would benefit from a 48-hour delay.

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25
Q

Preterm Labor: Treatment

What do antibiotics do and not do?

A

Antibiotics administered because preterm labor may be caused by infection, but they do not halt contractions.

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26
Q

Preterm Labor: Tocolytics #1

What are tocolytic agents used?

A

Indomethacin:

Nifedipine:

Terbutaline:

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27
Q

Preterm Labor: Tocolytics #1

More effective tocolytic agents:

Indomethacin- who is it contraindicated in?

A

Contraindicated with maternal bleeding disorders, renal dysfunction, asthma, and aspirin allergy.

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28
Q

Preterm Labor: Tocolytics #1

More effective tocolytic agents:

Nifedipine: Who is it contraindicated in?

A

Contraindicated with maternal hypotension, drug allergy, and certain cardiac conditions.

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29
Q

Preterm Labor: Tocolytics #1

More effective tocolytic agents:

Terbutaline: How long it is administered?

A

every 20 to 30 min until contractions cease for a total of 48 hours.

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30
Q

Preterm Labor: Tocolytics #1

More effective tocolytic agents:

Terbutaline: Who is it contraindicated in?

A

Contraindicated with some cardiac disease, poorly controlled diabetes, placenta previa, and placental abruption.

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31
Q

Preterm Labor: Tocolytics #1

What are they used for?

A

Suppress labor

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32
Q

Preterm Labor: Tocolytics #2

Less effective tocolytic agents:

A

Magnesium sulfate:

Nitrous oxide:

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33
Q

Preterm Labor: Tocolytics #2

Less effective tocolytic agents:

Magnesium sulfate: What are you monitoring for?

A

Monitoring for signs of toxicity is critical.

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34
Q

Preterm Labor: Tocolytics #2

Less effective tocolytic agents:

Magnesium sulfate: What must be readily available to reverse toxicity?

A

Calcium gluconate 1 g IV over 5 to 10 minutes must be readily available to reverse toxicity.

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35
Q

Preterm Labor: Tocolytics #2

Nitrous oxide:

What form are they in? How long it is used?

A

10 mg patch on abdomen for 1 hour.

If ineffective, add second patch.

Patches left in place for 24 hours and then removed.

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36
Q

Preterm Labor: Tocolytics #2

Nitrous oxide: Who are they contraindicated in?

A

Contraindicated in patients with hypotension and some cardiac problems.

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37
Q

Chorioamnionitis #1: What is it?

A

An infection of the amnion, chorion, or both that complicates almost 4% of pregnancies.

38
Q

Chorioamnionitis #1 :

What is it commonly caused in?

A

Commonly caused by the ascent of bacteria through the cervix.

39
Q

Chorioamnionitis #1 :

What are risk factors?

A

Some risk factors for chorioamnionitis include PPROM, PROM, multiple digital vaginal exams, prolonged labor, and preterm labor.

40
Q

Chorioamnionitis #1 :

Maternal complications from chorioamnionitis include “

A

Maternal complications from chorioamnionitis include:

maternal sepsis and risk for postpartum hemorrhage.

41
Q

Chorioamnionitis #1 : Neonatal complications include:

A

Neonatal complications include:

sepsis,

perinatal death,

asphyxia,

cerebral palsy,

pneumonia,

meningitis,

intraventricular hemorrhage,

and neurodevelopmental delay.

42
Q

Chorioamnionitis #2:

What is diagnostic criteria? (Having to do with temperature)

A

Diagnostic criteria include maternal fever of 102.2 F once or of 100.4 F to 102 F twice plus one or more of the following:

43
Q

Chorioamnionitis #2

Diagnostic criteria include maternal fever of 102.2 F once or of 100.4 F to 102 F twice plus one or more of the following:

A

fetal tachycardia,

maternal tachycardia,

uterine tenderness,

foul-smelling discharge,

or elevated white blood cell count (over 15,000 cells/mm3).

44
Q

Chorioamnionitis #2

What is the treatment?

A

Prompt treatment with broad spectrum antibiotics (often ampicillin and gentamicin) indicated.

45
Q

Postterm Pregnancy:

What is it?

A

A postterm pregnancy has reached or exceeded 42 weeks gestation.

46
Q

Postterm Pregnancy: What are risks?

A

Risks include fetal macrosomia which creates a risk for protracted or arrested labor, dystocia, birth injury, operative birth, and postpartum hemorrhage.

47
Q

Postterm Pregnancy:

What is treatment?

A

Treatment may include expectant management or induction of labor.

48
Q

Postterm Pregnancy:

What is expectant management? What does it include?

A

Expectant management may include twice weekly assessment of fetus by NST and assessment of amniotic fluid volume or by biophysical profile beginning at 41 weeks.

49
Q

Postterm Pregnancy:

How does induction of labor begin?

A

Induction of labor begins with an evaluation of the patient’s cervix using a Bishop score which evaluates cervical dilation, effacement, station, consistency, and position.

50
Q

Postterm Pregnancy:

What does Bishop’s score do?

A

Bishop score which evaluates cervical dilation, effacement, station, consistency, and position.

51
Q

Postterm Pregnancy:

How should Bishop score be?

A

A Bishop score of 6 or higher is considered favorable and has a greater chance of a successful vaginal birth.

52
Q

Postterm Pregnancy: Cervical Ripening

What does that include?

A
  1. Pharmaceutical ripening
  2. Mechanical ripening
53
Q

Postterm Pregnancy: Cervical Ripening

What does Pharmaceutical ripening include:

A

Prostaglandins

54
Q

Postterm Pregnancy: Cervical Ripening

Pharmaceutical ripening includes:

When is Prostaglandins used?

A

Prostaglandins often used prior to oxytocin for labor induction.

55
Q

Postterm Pregnancy: Cervical Ripening

Who are Pharmaceutical ripening contraindicated in?

A

Contraindicated for patients with previous cesarean birth or previous uterine surgery due to risk of uterine rupture.

56
Q

Postterm Pregnancy: Cervical Ripening

What is a common prostaglandin? How is it administered?

A

A common prostaglandin is misoprostol, which may be administered vaginally or orally (usually 25 to 50 mcg every 3 to 6 hours).

57
Q

Postterm Pregnancy: Cervical Ripening

Pharmaceutical ripening includes:
What should nurses monitor for?

A

Nurses should monitor for uterine tachysystole (excessively frequent contractions).

58
Q

Postterm Pregnancy: Cervical Ripening

Mechanical ripening includes:

How is it done?

A

Insertion of a balloon catheter or hygroscopic dilators into the cervical canal.

59
Q

Postterm Pregnancy: Cervical Ripening

Mechanical ripening includes:

What is there an increased risk for? Decreased risk for?

A

Increased risk for infection but decreased risk of uterine tachysystole.

60
Q

Postterm Pregnancy: Labor Induction

After cervical ripening, what is administered?

A

After cervical ripening, oxytocin (Pitocin) is administered by IV.

61
Q

Postterm Pregnancy: Labor Induction

What may oxytocin cause?

A

Oxytocin (Pitocin) may cause nausea and vomiting, headache, flushing, tachycardia, hypotension, arrhythmias, and uterine tachysystole.

62
Q

Postterm Pregnancy: Labor Induction

What should you do if uterine tachysystole occurs?

A

Uterine tachysystole with oxytocin and a nonreassuring fetal heart rate change requires stopping the oxytocin infusion and notifying the obstetric provider.

63
Q

Placental Abruption #1:

What is placental abruption?

How is it classified?

A

Placental abruption is the premature detachment of the placenta from the decidua of the uterus after 20 weeks of gestation and is often classified as mild or severe.

64
Q

Placental Abruption #1:

Causes of placental abruption include:

A

Often unknown cause
Blunt force trauma
Smoking
Cocaine

65
Q

Placental Abruption #1:

Prognosis: What is prognosis of mild abruption?

A

A mild abruption may have limited impact.

66
Q

Placental Abruption #1:

Prognosis: What is prognosis of severe abruption?

A

A severe abruption may result in complete detachment of the placenta and risk the life of the patient and the fetus.

67
Q

Placental Abruption #2:

What are the various degrees of separation of normally implanted placenta?

A

Partial separation

Marginal separation

Complete separation with concealed hemorrhage

Complete separation with heavy vaginal bleeding

68
Q

Placental Previa #1:

When does placental previa occur?

A

Occurs when placental tissues overlies the internal cervical os.

69
Q

Placental Previa #1:

What is a major complication of placental previa?

A

The major complication of placenta previa is maternal hemorrhage.

70
Q

Placental Previa #1:

Risk factors for a placenta previa include:

A

Placenta previa in a prior pregnancy
Multiple gestation
Multiparity
Prior cesarean birth
Advanced maternal age
Treatment for infertility
Previous intrauterine surgical procedure
Maternal smoking or cocaine use

71
Q

Placental Previa #2:

Signs of a placenta previa include:

A

Painless vaginal bleeding

72
Q

Placental Previa #2:

What is contraindicated for patients with known or suspected placental previa?

A

A digital exam is contraindicated for patients with known or suspected placenta previa

because palpation is associated with acute bleeding.

72
Q

Placental Previa #3:

What should nurses instruct patients about?

A

Nurses should instruct patients to seek care urgently if they experience bleeding or contractions.

72
Q

Placental Previa #3:

When is birth generally recommended in patients with placental previa?

A

Birth is generally recommended from 36 to 37 weeks.

72
Q

Placental Previa #2:

How is placental previa confirmed?

A

Placenta previa is confirmed by ultrasound.

72
Q

Placental Previa #2:

Why is a digital exam contraindicated in patients with known or suspected placental previa?

A

A digital exam is contraindicated for patients with known or suspected placenta previa

because palpation is associated with acute bleeding.

72
Q

Placental Previa #3:

What is treatment for placenta previa?

When does it occur?

A

Treatment may include the administration of corticosteroids prior to 34 weeks.

73
Q

Placental Previa #3:

What is necessary for patients at time of admission who has known/suspected placental previa?

A

Because the rate of blood transfusions is high, patients may have their blood typed and cross-matched at the time of admission.

73
Q

Placental Previa #3:

What type of birth is almost always indicated for placental previa?

A

Cesarean birth is almost always indicated for placenta previa.

74
Q

Vasa Previa:

Type 2 previa

A

type 2 previa with a succenturiate placenta where the placenta is made of different lobes (usually 2) and blood vessels connect them

74
Q

Vasa Previa:

Type 1 previa

A

Type 1 previa occurs with a velamentous cord insertion where blood vessels run along the fetal membrane over the cervix

74
Q

Vasa Previa:

How many types of Vasa previa are there?

A

Type 1

Type 2

Type 3

74
Q

Vasa Previa:

When does it occur?

A

Occurs when fetal blood vessels overlie the cervical os.

75
Q

Vasa Previa:

Type 3 previa

A

A type 3 previa includes vessels that pass through the membranes at the margin of the placenta.

76
Q

Vasa Previa:

What are complications of vasa previa?

A

Complications include fetal hemorrhage and exsanguination with rupture of membranes.

77
Q

Vasa Previa:

What is treatment of vasa previa?

A

Treatment may include the administration of corticosteroids prior to 34 weeks and cesarean birth between 34 and 35 weeks, unless an early delivery indicated.

78
Q

Disseminated Intravascular Coagulopathy (DIC):

What is it caused by?

A

DIC is caused by pathological activation of the clotting cascade

that results simultaneously in blood clots, platelet and clotting factor depletion, and thus bleeding.

79
Q

Disseminated Intravascular Coagulopathy (DIC):

What does it result in?

A

DIC is caused by pathological activation of the clotting cascade

that results simultaneously in blood clots, platelet and clotting factor depletion, and thus bleeding.

80
Q

Disseminated Intravascular Coagulopathy (DIC):

What complication is DIC considered?

A

DIC is always a complication of another pregnancy condition.

81
Q

Disseminated Intravascular Coagulopathy (DIC):

Common antecedent conditions include:

A

Placental abruption
Postpartum hemorrhage
Preeclampsia/eclampsia/HELLP syndrome
Amniotic fluid embolism
Prolonged fetal demise
Maternal sepsis

82
Q

Disseminated Intravascular Coagulopathy (DIC):

What is treatment of DIC and when does it occur?

A

Treatment of DIC usually happens rapidly and must address DIC and the underlying cause.

83
Q
A

NURS 414: OB (15 decks)

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