Chapter 32 Flashcards
Describe the criteria for very preterm, early preterm, late preterm and the implications of each.
Very Preterm: < 32 weeks
Early Preterm: 32-34 weeks
Late Preterm: 34-26 weeks
Discuss major risk factors associated with preterm birth.
Dangerous due to less time in the uterus that correlates with immaturity of body systems
Discuss the use of tocolytics and antenatal glucocorticoids for management of preterm
labor.
Tocolytics suppress uterine activity and decrease contractions
Antenatal glucocorticoids promote fetal lung maturity by reducing the incidence of respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and death in neonates
Design a nursing care plan for women with preterm premature rupture of the membranes
(preterm PROM).
Determined individually for each woman
Full-term birth is the best option
PPROM less than 32 weeks is managed expectantly and conservatively
Vigilance for signs of infections
Fetal assessment
Antenatal glucocorticoids
Explain the care of a woman with post-term pregnancy.
Monitor for dysfunctional labor and birth canal trauma
Prepare for shoulder dystocia, postmaturity syndrome, uterine atony
Explain the challenge of caring for obese women during labor and birth.
Likely to begin pregnancy with preexisting conditions
Increased incidence of post-term pregnancy
More likely to require cesarean
At risk for thromboembolism and wound disruption and infection
Summarize the nursing care for a trial of labor, the induction and augmentation of labor, forceps- and vacuum-assisted birth, cesarean birth, and vaginal birth after a cesarean birth (VBAC).
Version is not performed successfully very often
Induction of labor can be performed using cervical ripening methods, amniotomy, and/or oxytocin
Augmentation is the stimulation of uterine contractions after labor has spontaneously started and progress is unsatisfactory
Forceps- and vacuum-assisted birth used in prolonged 2nd stage of labor
Vaginal birth after cesarean is contraindicated if there is a classic uterine incision
Discuss obstetric emergencies and their appropriate management.
Meconium-stained amniotic fluid indicates fetus has passed stool prior to birth (dark green, caused by normal physiologic function, breech presentation, hypoxia-induced peristalsis, umbilical cord compression)
Shoulder dystocia occurs when head is born but shoulder cannot pass under pubic arch (mother at risk for hemorrhage, baby at risk for birth injuries); McRoberts Maneuver used
Prolapsed umbilical cord occurs when cord lies below presenting part (caused by long cord, malpresentation, transverse lie, or unengaged presenting part)
Rupture of the uterus is a rare but serious emergency that occurs after a separation of a scar from a previous cesarean, uterine trauma, or congenital uterine anomaly
Amniotic fluid embolism can obstruct pulmonary vessels, causing respiratory distress and circulatory collapse
