Complications 2: Labour, Delivery and Postpartum

Question 1

What is preterm labour and posterm pregnancy

Answer 1

Labour induced before 37weeks gestation
Cause -
Hx of prem.labor, genetics, PPROM, abd.surgery, uterine or cervical trauma /anomalies, infection, tobacco/cocaine use, physical / emotional trauma, maternal age 35 yrs, poor prenatal care, hypertension, diabetes

Management-
Prevent in those at risk e.g., progesterone th.
If PTL, take fibronectin assay (24-34 wks)
Will not stop prem.labour if complications
Meds-tocolytics (up to 32/33wks gest.) and corticosteroids (↓ RDS in premie) (no if >34wks)

posterm is after 42 weeks
Potential problems:
Maternal- Psychological stress, induction, dystocia, assisted delivery, perineal trauma (lg. Babe), ↑risk of infection & hemorrhage, ↑ CD, ↑DVT’s.

Fetal- ↓ placenta perfusion, fetal demise, oligohydramnios, macrosomia, meconium aspiration syndrome, low apgar, SIDS, injury to nerve and bone (#’s), Cerebral palsy

Medical Interventions @ 41 wks- Daily fetal movement counts, NST 2/wk., U/S for fetal size & Amniotic fluid index (AFI) 2/wk.
Elective induction or could wait until 42 wks (if above satisfactory)

Question 2

Explain Induction

Answer 2

Mat. conditions- Post-term, diabetes, renal, Pregnancy induced hypertension (PIH), PROM, chorioamnionitis, prev. precipitous L&D.
Fetal conditions- IUGR, demise, hemolytic disease, macrosomia, mild abruptio placenta

1.“Unripe cervix (cx)”/Bishop’s score 6
-“sweep of membranes”
Amniotomy / ARM
-Intravaginal PGE2 gel or IV Oxytocin

Nursing Care: Baseline assessment (V/S, Leopold’s, vaginal exam, Electronic fetal monitoring (EFM )
Induction commenced by MD / midwife
RN to follow MD’s orders / induction protocol
Assess pt & fetus x 2 hours
If cervidil / Prostaglandins (PE2) pt may be sent home until active labor begins.

Question 3

Explain Augmentation with oxytocin

Answer 3

Augmentation with Oxytocin (?)

Indications: hypotonic (weak) / infrequent contractions, lack of progress (1st or 2nd stage)

Question 4

Explain forceps and vacuum extraction

Answer 4

Maternal-maternal exhaustion, lack of progress, health conditions (PIH/heart disease), ↓ motor innervation with epidural
Fetal-fetal distress, placenta separation (2nd stage), OP position, macrosomia, breech (after coming head)

Fetal risks- ↓flexion of head, echymosis, edema, caput, cephalhematoma, paralysis
Important (NB) to inspect perineum and head for complications

Question 5

Describe perinatal mental health

Answer 5

Post partum blue
-mild depression followed by happier feelings
-Teach re Adjustment Reactions and Mood Disturbances prior to discharge
Provide info re community resources

postpartum post-traumatic stress disorder
-Presenting data: feeling numb, dazed, flashbacks, intrusive thoughts, difficulty thinking, sleeping
Treatment: Discuss the event and compare to reality. Supportive, pharmacological & psychotherapy

Postpartum psychosis = emergency
-Presenting data: agitation, irrationality, delusions, hallucinations
Treatment: Hospitalization & supportive, pharmacological & psychotherapy