collab 2 Flashcards
factors/complications associated with polyhydramnios
preterm labour
unstable fetal lie / malpresentation
cord prolapse
placental abruption
PPH
uterine rupture
labour and birth considerations for polyhydramnios
- controlled ARM
- active 3rd stage
- communications with women regarding rupture of membranes at home
risks of VBAC
- 30% chance of CS
- uterine rupture (0.5% risk)
benefits of VBAC
70% chance of NVB
shorter recovery period
lower risk of PPH
lower risk of infection
transition for baby
breastfeeding
maternal satisfaction
uterine wall integrity for future pregnancies
VBAC midwifery considerations / assessments in labour
- communication with woman
- continuous EFM recommended
- 4 hourly obs and VE
- consider discouraging epidural
symptoms of uterine rupture
fetal distress
shoulder tip pain
high or absent presenting
cessation of contractions
risk factors for uterine rupture:
- previous caesarean
- LGA
- more increased the number of caesareans prev
- previous uterine rupture
- induction of labour
- malpresentation
- high or low BMI
- short birth intervals
risk factors for PET?
- anti-phospholipid syndrome
- previous PET
- family Hx of PET
- first baby
- new partner
- ART with donor egg
- multiple pregnancy
- diabetes
- hypertension
- renal disease
- abnormal placentation
- molar pregnancy
Lab investigations and rationale
- MSU (PCR)
- Bloods (CBC with diff, LFTs, renals, coags)
pathophys of PET?
inadequate erosion of spiral arteries during trophoblastic implantation
leading to decreased uteroplacental perfusion > placental ischaemia.
in response, vasoactive substances are released from the endothelium (vasoconstrictors and progcoagulants) leading to endothelial damage.
causing: increased TPR, capillary permeability, liver damage, neurological dysfunction and widespread coag
maternal collapse sequence of events
Danger
response
send for help
move away from wall, drop bed
airway
breathing
circulation - start CPR (displace uterus) (compressions and bag ventilation 30:2)
Defibulator
continue CPR
documentation
secondary PPH
- assess woman
- assess blood loss
- tone of uterus
- bladder
- perineum
- placental condition
- send for help
- IV access
- fluids
- USS - retained placenta
11, refer for consultation
Actions for hyperstimulation
- stop oxy
- left lateral
- facial oxygen
- inform OB
- tocolytic
- prepare for CS
- or recommence infusion with caution
- increase obs
- appropriate documentation
side effects of epidural for mum:
- hypotension
- nausea and vomiting
- sedation
- constipation
- urinary retention
- immobility
- respiratory depression
- blockade of SNS
- fevery
epidural obs
BP and pulse = 5 minutely for 20 min then hourly
resps, sedation and pain score = initially then hourly
block level = after 20 min then hourly
EFM = continuous
fluid balance = continuous
pressure areas = 2 hourly
VE= 4 hourly
GDM GTT normal ranges
fasting = _>5.5mmol/l
1hour post = >11.0mmol/L
2 hour post =>9.0mmol/L
risk factors for developing GDM:
prev GDM
high BMI
PCOS
high HbA1c
prev LGA baby
advanced maternal age
common manifestations of GDM / diabetes in general
polyuria
polydipsia
polyphagia
fatigue
complications associated with GDM:
- polyhydramnios (and associated risk i.e cord prolapse, PPH, malpresentation)
- LGA baby/macrosomia
- shoulder dystocia (and BPI, HIE, PPH)
- PET and cholestasis
PROM 12hrs actions
- assess woman, assess ROM with speculum or ACTIM prom with consent
- information sharing about PROM and EOGBS
- consult before 24hrs
- offer IOL and IAP at 24 hrs
- if in labour but no baby, offer IAP at 24hrs
- continue conservative for now but call if any concerns (mec, blood, RFM, cord prolapse, established labour, fever, tachycardia)
polyhydramnios and waters rupture, there is a cord prolapse what are the actions?
- note liquor colour
- ask woman to change position (knees to chest or exaggerated sims) explain quickly what is happening.
- call emergency bell and have someone ring 7777
- gain consent from woman for PV fingers and or catheter and bladder filling.
- supplies (terbutyline, catheter, urology giving set, 500ml normal saline).
- move to theatre as soon as practicable
- support the woman and stay calm
- documentation
