Childbirth at Risk Flashcards
What is abruptio placenta?
Premature separation of the placenta from the uterine wall
What is placenta previa?
Placenta covering the opening of the cervix
What condition is often associated with placenta previa?
Placenta accreta
What is placenta accreta?
Placenta deeply embedded into the uterine wall via chorionic villi - becomes retained during labor and causes serve hemorrhage
What is the most severe variation of placenta accreta?
Placenta precreta
Placenta precreta usually requires ______
Emergency hysterectomy
What is battledore placenta?
Umbilical cord implanted at placental margin rather than center of the placenta
Variation of umbilical cord insertion occurs more frequently in what type of pregnancy?
Multiple gestation - twins, triplets
What is circumvallate placenta?
Amnion and chorion fold back over the edge of the placenta
Circumvallate placenta is a form of ______
Placenta extrachorialis
Describe the management / treatment of circumvallate placenta
Benign - no intervention required
What is succenturiate placenta?
Placenta contains extra accessory lobes (morphological abnormality)
Describe the management / treatment of succenturiate placenta
No major risk to fetus - no intervention needed
What is the average umbilical cord length?
55 cm
Describe the risks associated with short umbilical cords
Rarely cause complications because fetus has decreased ability to move
Describe the risks associated with long umbilical cords
Risk of variable decelerations because cord is likely to twist / tangle
Describe the composition of the umbilical cord (2)
- 2 small / firm arteries
- 1 large / soft vein
The umbilical arteries carry ______ blood
Deoxygenated
The umbilical vein carries ______ blood
Oxygenated
What is the most common umbilical cord abnormality?
Congenital absence of 1 artery
What should take place if there is absence of an umbilical artery?
Examination for other neonatal organ anomalies
What is cord prolapse?
Umbilical cord descends below the fetus after ROM
What is the greatest risk factor of cord prolapse?
Breech position (especially incomplete / footling)
When membranes rupture it is important to palpate and assess for ______
Cord prolapse
Cord prolapse causes …
Bradycardia due to cord compression
What is the primary intervention to prevent cord prolapse if there is a vulnerable cord?
Bedrest
Describe the treatment of cord prolapse (2)
- Leave hand in vagina to prevent compression
- Emergency c-section
How much fluid is considered polyhydramnios?
> 2000 cc
How much fluid is considered oligohydramnios?
< 500 cc
Oligohydramnios often results in ______
Cord compression
______ is common for a multiple gestation of 3 or more fetuses
C-section
Difficultly during labor is known as ______
Dystocia
During active labor, the cervix should dilate at a rate of ______ in primigravida
1.2 cm / hr
During active labor, the cervix should dilate at a rate of ______ in multigravida
1.5 cm / hr
Describe hypertonic contractions
Excessive / erratic contractions
Hypertonic contractions can cause ______
Fetal distress
When do hypertonic contractions typically occur?
The latent phase
Describe the treatment of hypertonic contractions (2)
- Bedrest
- Tocolytics
Describe hypotonic contractions
Weak / infrequent contractions (not dangerous)
Hypotonic contractions can cause ______
Slow / prolonged labor
When do hypotonic contractions typically occur?
The active phase
No cervical change for 2 hours is considered ______
Arrest of labor progress
Describe the treatment of hypotonic contractions (3)
- Augment pitocin
- Amniotomy
- Reposition
Which type of contractions are more common?
Hypotonic contractions
What are the signs of fetal compromise? (3)
- Non-reassuring FHR
- Fetal acidosis
- Meconium
What are the signs of maternal compromise? (2)
- Maternal exhaustion
- Maternal infection
Describe the nursing interventions associated with ineffective pushing (4)
- Increase fluids
- Intermittent pushing
- Squatting position
- McRoberts maneuver
Describe McRoberts maneuver
Thighs flexed up to abdomen to increase angle of pelvic outlet
What is considered macrosomia?
> 9 lbs
Macrosomia creates an increased risk of ______
Shoulder dystocia
What is shoulder dystocia?
Fetal shoulder gets stuck behind symphysis pubis
______ is a network of nerves that run from the spine through the shoulder and to the tips of the fingers
The brachial plexus
What brachial plexus injury can result from shoulder dystocia?
Erb’s palsy
What is Erb’s palsy?
Arm paralysis due to injury of cranial nerves 5 and 6
If the fetal head is unengaged early in labor in primigravida, what condition should the nurse suspect?
Cephalopelvic disproportion (CPD)
What is precipitous birth?
Entire process of labor / birth occurs within 3 hours
What fetal risks are associated with precipitous birth? (4)
- Low apgar score
- Facial deformities
- Cone-shaped head
- Intracranial trauma
What is the primary cause of postpartum pregnancy (extending > 42 weeks)?
Error in EDC
What is the primary fetal risk associated with postmaturity?
Decreased amniotic fluid volume (AFI < 5 cm)
Intrauterine fetal demise is also known as ______
Stillborn fetus
What is the primary compilation associated with intrauterine fetal demise?
DIC - systemic clotting (life threatening for mother)
What are the manifestations of uterine rupture? (3)
- Stopped labor
- Sudden fetal bradycardia
- Tearing sensation
What is the treatment for a retained placenta if manual removal fails?
D&C
Describe the prevention of uterine inversion
Do not pull on umbilical cord until placenta separates
Describe the treatment of uterine inversion (3)
- Tocolytics
- Laparotomy
- Hysterectomy
Describe 1st degree vaginal laceration
Extends through perineal skin
Describe 2nd degree vaginal laceration
Extends through underlying perineal muscles
Describe 3rd degree vaginal laceration
Extends through the perineal body to the anal sphincter
Describe 4th degree vaginal laceration
Extends through the rectal mucosa to the rectal wall
What is the primary cause of a 4th degree vaginal laceration?
Extension of a midline episiotomy
