Complications Flashcards
Risk Factors associated with Pre-term Labor
Previous pre-term Labor, genetics, cervical and uterine trauma, infections, PPROM, Maternal age 35 yrs, tobacco and cocaine use, hypertension
Preterm Labor
Labor that occurs between 20 to 36 weeks
Fetal and Placental Cause of PTL
Multiple Gestation, Twins, hydramnous, placental ischemia, previa, and abruptio
Management of PTL
Fetal Fibronetic test viable between 24 to 34 weeks. If negative -> low risk of PTL up to 14 days. If positive -> higher risk of PTL within 7 days
Administer tocolytic if 32 to 34 weeks to delay labor and relaxes smooth uterine muscle
Administer corticosteroid to increase maturity of lungs if under 34weeks
Progesterone therapy
Nursing care for PTL
- Monitor uterine contractions and PV loss
- Monitor fetus
- prepare for preterm birth if contraction continues
Post Term Labor
-Any labor that occurs after 42 weeks
Causes of Post Term Labor
-usually error in determining ovulation and conception
Data for Post term labor
Weight loss, decrease in fetal movement
Maternal Risk Associated with Post Term Labor
- increase psychological stress, induction, dystocia, assisted delivery
- perineal trauma, increased laceration, risk for bleeding and infections
- increase caesaren - increase DVT
Risk Associated for Fetus in Post Term Labor
-decrease placental perfusion, fetal demise, oligohydramious, macrosomia, low abgar score, SIDS, nerve and bone damage ->paralysis, cerebral palsy, meconium aspiration
Medical Intervention for Post-Term Labor
- at 41 weeks daily fetal movement count
- nonstress test (NST) 2/week
- U/S for fetal size
- Amniotic fluid index (AFI) 2/week
- Elective induction if viable
Precipitous Labor and Delivery
Labor - any labor that last for less than 3 hours
Delivery - any birth that is unplanned, sudden, or unexpected
Factors Associated with Precipitous Labor
-multiparity, small fetus, large pelvis, previous precipitous labor
Maternal Risk for Precipitous Labor
-increase laceration and trauma, decreased coping abilities, PPH
Fetal Risk Associated with Precipitous Labor
-hypoxia, fetal distress caused by intense uterine contraction, bracial nerve injury
Induction
the artificial initiation of uterine contraction, resulting in the birth of a baby
Maternal Condition Indication of Induction
-Post term Labor, diabetes, renal disease, PROM, chorionamnionitis, previous precipitous labor
Fetal Condition for Induction
- intrauterine fetal growth restriction (IUGR)
- Fetal demise
- Macrosomia
- HYMOLYTIC DISEASE
- mild abuptio
Management of Induction
Unripe Cervix - (6 on Bishop score)
-sweep membrane, amniotomy, prostaglandin gel intravaginal, IV oxytocin
Nursing care for Induction
V/S, Leopold’s Maneuver, vaginal exam, EFM
RN to follow induction protocol
PT and Fetus monitor q2h
-if cervidil or prostaglandin - pt may be sent home until active labor
Forcep and Vacuum Extraction Maternal and fetal Indication
- exhaustion, lack of progress, health condition (heart disease and PIH), decrease motor innervation from epidural
- fetal distress, placenta seperation, OP position, macrosomia, breech
Maternal Risk and Fetal risk for Forceps and Vacuum
Maternal: increase laceration and trauma, increased bleeding, infection and hemorrhage
Fetus: decrease flexion of head, echymosis, edmema, caput, cephalohematoma, paralysis
Fetal Distress Causes
-cord compression, placenta insufficiency, maternal, fetal and placenta disease
Fetal Distress Warning Signs
- meconium stained liquoi, omnious FHR patterns
- CODE OB
Nursing Intervention for Fetal Distress
-give O2, tilt uterus on left side, EFM, internal monitoring, D/C induction, give tocolytic, I/V, fetal scalp blood sample
Prolapsed Cord
-cord that descends through the vagina prior to birth of baby
Risk factors Associated with Prolapsed Cord
-breech, polyhydramnious
OB EMERGENCY OF Prolapsed CORD
-Knee to chest (mcroberts maneuver), hand in vagina to relieve pressure off the cord
Shoulder Dystocia
-after delivery of head further expulsion of infant is prevented due to impaction of fetal shoulders in the maternal pelvis
causes of Shoulder Dystocia
-Macrosomia, maternal diabetes, obesity, multiparity, post term
What to do when there is Shoulder Dystocia
alert ALARMER
- Ask for help
- Lift hips/hyperflex of hips
- Anterior shoulder disimpaction
- Rotation of the posterior shoulders
- Manual removal of posterior shoulders
- Episiotomy
- Roll women on all fours
Maternal and Fetal complications of Shoulder Dystocia
PPH, Trauma, and infection
- Brachial plexus injury
- fractures, asphyxia, neurological damage, demise
DVT Associated factors
-hydramnious, preeclampsia, operative birth, history of clots, obesity
DATA involving DVT
-color, warmth, movement, sensation, edema, low grade fever
TX for DVT
Prevention - ambulate early, no crossing legs
-heparin, increase fluids
Inversion of Uterus Prevention and TX
Prevented by
- waiting for signs of separation
- cord extending, gush of blood
- no fundal pressure
TX
-put back in, call MD
Hyperemsis Gravidarium
-excessive and persistent nausea and vomiting during pregnancy associated with ketosis and weight loss
HG causes
- increase HCG and TSH in the first trimester, increase estradiol and decrease in prolactin
- genetic
Objective and subjective DATA for HG
- progressive vomiting and retching
- dehydration
- fluid and electrolytes imbalance
- hypotension, tachycardia
- K+ loss
- Fetal loss
TX for HG
Assess physical and emotion state NPOx48H Monitor I&O antiemetic correct F&E imbalance TPN PRN control environment
Spontaneous Abortion
-spontaneous loss of pregnancy prior to viability (20 weeks)
Types of SA
Threatened - bleeding, cramping, closed cervix
Imminent/inevitable - bleeding, cramping, dilation of cervix
incomplete - not all expelled, placenta retained
complete - all product expelled
Miss Abortion - fetus dies, brownish discharge, risk of DIC if not expelled
Recurrent pregnancy loss
Septic abortion - presence of infection
Causes of SA
Chromosomal and placental abnormalities implantation problems teratogens (hot tubs) endocrine imbalance infections
Data for SA
Spotting, cramping, backaches
TX for SA
Determine source of blood cross match blood, HBG, HCT bed rest no sex If imminent -> hospitalize -> IV, suction emotional support
Placenta Previo
low implantation of the placenta
Types of Previo
Low lying - lower segment
Marginal - on the margin of the internal OS
Partial - partially covering the internal OS
complete - completely covering the internal OS
Causes for Previa
Multiparity, previous c-sec, previous induced abortion, age, large placenta, smoking, asian women
Data for Previa
U/S
Bleeding abruptly, painless, bright red
TX for Previa
Bed rest, BR only privilege, side lying, oxygen PRN FHR VS U/S HBG and HCT, cross match and urinalysis Delay birth until 37 weeks administer corticosteroids C-sec if complete previa Vag delivery if low lying or marginal
Placenta Abruption
Premature separation of the normally implanted placenta from the wall of the uterus
Types of Abruption
Marginal, Control, Complete
Grade 1 - Mild separation (mild bleeding, stable V/S and FHR)
Grade 2 - partial separation (uterine irritability)
Grade 3 - Complete (fetal death)
Causes of Abruption
increase age, multi parity PIH, trauma, sudden uterine pressure change previous abruption cocaine and smoking PPROM
Data for Placenta Abruption
Pain (sharp, stabbing, high in fundal area) bleeding (only marginal) overt Covert - uterine becomes hard (central) Shock DIC
TX for Abruption
IV Monitor V/S of PT and Fetal PV loss contraction O2 Stat blood work, HBG, HCT, Cross match, Fibrogen levels -ARM & Induction , Vacuum
Cervical Insufficiency
Cervix dilates early and cannot hold a fetus to term
painless dilations occurring between 4th to 5th month
Cause and types of Cervical Insufficiency
Congenital
acquired (infection, trauma, multiple gestations)
Biochemical (relaxin)
Objective & Subjective data of CI
Painless dilation of cervix
Increased pelvic pressure
contraction
birth of premature baby
Medical treatment and Nursing care for CI
Vaginal U/S @ 15 to 28 weeks
bed rest, no sex, heavy lifting
Cerclage/suture @ 14 to 18 weeks
progesterone, anti-inflammatories, antibiotics
Hypertensive Disorders in pregnancy
Preeclampsia (mild to severe) is the increase of BP after 10 weeks gestation accompanied by proteinuria in a previously normaltensive women
Eclampsia - severe form of preeclampsia with generalized edema or coma
Predisposing Factors of Hypertensive orders in preg
Teens and older primips previous history large placental mass Rh incompatibility diabetes
Objective and Subjective DATA for Preeclampsia and Eclampsia
mild disease - 140/90 4 hours apart, Proteinuria +1-+2
edema >3.3/month
Severe preeclampsia - 160/110, 6 hours apart, proteinuria +3 to +4
-oliguria, visual or cerebral disturbances, cyanosis/pulmonary and generalized edema
TX of Preeclampsia and Eclampsia
Freq assessment of VS, I&O, FH, Uterus, PV loss, edema, weight, reflexes, signs of eclampsia, LOC and psychosocial
- bed rest (left side) & diet
- anticonvulsant, antihypertensive, corticosteroids
- lab test (Hct, BUN, creatinine, uric acid levels, liver enzymes, F&E imbalances and MG levels
TX for Severe PIH
stabilize then deliver baby by induction or C-sec
HELLP SYNDROME
hemolysis, elevated liver enzymes, low platelet count
- sometimes associated with severe preeclampsia
DIC - Disseminated intravascular coagulation associated with
preeclampsia, eclampsia, HELLP (occur as complication)
- placenta abruptio
- amniotic fluid embolism
- maternal liver disease
- septic abortion
- dead fetus
Diabetes Mellitus S&S
Polyuria
polydipsia
polyphagia
wt.loss
Rh Alloimmunization
- Rh+ cells invade maternal circulation and stimulate production of antibodies
- produced in 72hours
- if antibodies are formed, future pregnancies the antibody will cross placenta barrier and hemolyse fetal RBC’s
Rh Isoimmunization TX and Nursing CARE
-early testing
If Rh-, indirect coombs done (determine the presence and amt of antibodies
- AntiD or Rhogam given at 28weeks if no antibodies present
- if at birth, mom is Rh neg, direct coomb’s test on cord’s blood
- if negative, mom will receive anti D in 72 hours of birth
Rh immunoglobulin not given if mom is Rh positive
ABO Incompatibility
Mother O (no antigenic sites on RBC), Baby A, B, AB (may be affected
- become aware in preg
- monitor baby for jaundixe
- phototherapy PRN
Premature Rupture of Membranes PROM
PROM before onset of labor
Risk associated with PROM
Smoking, low BMI, infections, history of PROM, incompetent cervix, trauma, hydramnious, multiple gestation, previa/abruptio
Risks - infection (chorioamnionitis, endometritis), Abruptio
Fetal - premature birth, neonatal sepsis, cord prolapse
Diagnose for PROM and TX
Nitrazine test
fern test
TX
- avoid vag exam unless in active labor
- if less than 37 weeks, bedrest, CBC, weekly NST, V/S q4h, antibiotics, betamethasone, no sex and baths
- if >37 induce delivery
What is Ectopic Pregnancy
-implantation of the fertilized ovum in a site other than the endometrial lining of the uterus
Causes of Ectopic Pregnancy
- pelvic inflammatory disease
- endometriosis
- previous ectopic pregnancy
- presence of IUD
Diagnose of Ectopic Pregnancy
- Assess menstrual history
- careful pelvic exam to identify any abnormal pelvic masses or tenderness
Treatments for EP
- methotrexate is given if detected early with low Hcg level
- surgically to remove by the process of salpingostomy to gently remove
Objective and subjective data for Ectopic Pregnancy
- acute pain related to abdominal bleeding
- shoulder pain
- vaginal bleeding
Nursing care for EP
- If using methotrexate, no sun exposure
- Start IV, assess for shock/bleeding, assess pain level
Hydatidiform mole
disease in which abnormal development of placenta occurs, resulting in a fluid filled grape like clusters; the trophoblastic tissue proliferates
Types of Hydatidiform Mole
Complete Mole is when an ovum containing no maternal genetic material fertilizes with a sperm.
Partial Mole is when an ovum fertilizes with a sperm in which contains 46 chromosome
Subjective and Objective data for HM
- brownish vaginal bleeding
- uterine enlargement is greater than the expected gestation week is common in complete HM
- vesicles may be passed
- Hyperemesis gravidarium
- symptoms of preeclampsia before week 24
- no FH or movement
Treatment for HM
- suction to remove all fragments
- hysterectomy to reduce risk of choriocarcinoma
Nursing Care for HM
- assess emotional support
- VS
- vaginal bleeding for hemorrhage
- assess pain
- blood work Hct, cross match
- oxytocin is given to keep uterus contracted
- Rh immunity is given if women is Rh-
