childbirth at risk Flashcards
preterm labor
20-37 6/7 weeks
predictors of preterm labors
- overdistention: multiple gestation, polyhydraminoas
- bleeding
- infection
- vascular: DM, preeclampsia, substance abuse
- stress/trauma
- history of preterm birth
- cervical insufficiency
signs and symptoms of preterm labor
- uterine contraction every 10 minutes or less, pain in abdomen, pelvis, back
- mild menstrual like cramps felt low in the abdomen with or without diarrhea
- pelvic pressure
- rupture of membranes or vaginal bleeding
preterm labor screening
- fetal fibronectin
- cervical length
- bacterial vaginosis
- UTI
- bishop score
preterm labor: goals of clinical therapy
- detect uterine contractions
- maintain good uterine blood flow
- ensure that fetus is stable
preterm labor: nursing interventions
- lateral positioning: Iv fluids, labs
- ultrasounds
- preterm birth prevention programs: HUAM: bedrest, pelvic rest, hydration
preterm labor: clinical theraoy
short term therapy
-tocolytic drug therapy
delayed birth and allow course of betamethasone
-mag sulfate protect against CP, nifedipine, indomethacin
betamethasone
What? Risks?
- single course (24-34wk)
- given if at risk for delivery within 7 days.
- decreases chances fo neonatal complication
- risk: maternal hypoglycemia and fetal hypoglycemia and sepsis
maternal risk of preterm labor
- what caused it: hemorrhage, trauma, infection
- treatment: side effects of meds and stress
fetal risk of preterm labor
- correlate to gestational age
- mortality increase and maturational deficiencies
nursing care of PTL
- assess educational needs
- teach about important of recognizing onset of labor
- identify risk for PTL
(primary: universal interventions, secondary: intervention for those at risk, tertiary: intervention for those with disease/PTL)
fetal malpresentation
cephalic: sinciput (military), brow, face
- breech
- transverse/shoulder
- compound
nursing and clinical interventions for breech presentation
- external cephalic version
- planned c/s
- continuous EFM, assess FHR
- Ongoing assessment of labor progress
- emotional support
fetal malposition (OP): fetal and maternal risks
- not much for baby
- maternal: severe back pin
nursing assessment of fetal malpostion
- intesive back pain in first stages of labor
- dysfunctional labor pattern
- FHR may be hear laterally on maternal abdomen
fetal malposition close monitoring and birth
- vaginal exam: anterior fontanelle
- intrapartum u/s, Leopold maneuvers
- possible vaginal birth, force assisted birth
abruption/abruptio placenta
premature separation of implanted placenta from the uterine wall
risk factors for abruption
- maternal hypertension
- trauma (IPV)
- prior abruption
- advanced maternal age
- cigarette smoking/ cocaine abuse
maternal risk for abruption
- hemorrhage
- hypovolemic shock
- possible hysterectomy
-fetal risks of abruption
complications from preterm labor, anemia, hypoxia
-demise
nursing assessment/ intervention of abruption
- immediate priorities are maintain maternal cardiovascular status and developing a delivery plan
- hypovolemia: blood transfusion, evaluate clotting factors, administer IV fluids
- delivery plan: c/s is safest, induction of labor may be indicated, if still born: vaginal delivery unless hemorrhaging
placenta previa
placenta improperly implanted in the lower uterine segment
risk facets of placenta previa
- prior previa
- multiparty
- increasing age
- prior c/s or uterine surgery
- smoking/cocaine abuse
- previous spontaneous or induced abortion
signs and symptoms of placenta previa vs abruptio
previa: slow onset, bright red blood, soft and palpable fundus
- abruption: immediate onset, dark blood color, firm and hard fundus
nursing interventions for placenta previa
- administer IV fluid, betamethasone
- emotional status
- assessment of fetal status: FHR continue
- monitor blood loss, pain, uterine contractility: no vaginal exams, blood transfusion, VS, complete lab evaluation
prolapsed umbilical cord
- umbilical cord precedes fetal presenting part: it get trapped between presenting part and maternal pelvis and presenting part not firmly against cervix
- higher incidence in malpresentation(breech)
maternal and fetal risks of prolapsed cords
- maternal: stress
- fetal: compression of cord:impaired gas exchange, bradycardia, persistent variable desecrations–> late
nursing intervention of prolapsed cord
- push presenting part back in
- positioning: hips high
indications for C/S
- prolapsed cord
- cephalopelvic disproportion
- placental abruption
- malpresentation
- non reassuring fetal HR tracing
- placenta previa
maternal risk for C/S
- infection
- reaction to anesthesia agents
- blood lots
- ureteral injury, bladder laceration
- wound infection
preparations for C/s
- possible preferences: choice of anesthetic, present of partner, audio, video, physical contact, or holding newborn while on operating table
- preop teaching: coughing, deep breathing exercises, splinting, what to expect
nursing management before C/S
- assisting with epidural
- monitor maternal VS and FHR
- insert urinary catheter
- preparing abdomen and perineum
- all necessary personal and equipment present
- position woman on operating table
- supporting the couple
- instrument count
nursing management after C/S
- normal newborn post delivery care
- monitor VS post anesthesia
- checking the surgical dressing
- palpating the fundus and checking lochia
- monitoring intake/output
- administration of oxytocin and pain management
