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Complications Flashcards

0
Q

Risk Factors associated with Pre-term Labor

A

Previous pre-term Labor, genetics, cervical and uterine trauma, infections, PPROM, Maternal age 35 yrs, tobacco and cocaine use, hypertension

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1
Q

Preterm Labor

A

Labor that occurs between 20 to 36 weeks

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2
Q

Fetal and Placental Cause of PTL

A

Multiple Gestation, Twins, hydramnous, placental ischemia, previa, and abruptio

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3
Q

Management of PTL

A

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

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4
Q

Nursing care for PTL

A
  • Monitor uterine contractions and PV loss
  • Monitor fetus
  • prepare for preterm birth if contraction continues
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5
Q

Post Term Labor

A

-Any labor that occurs after 42 weeks

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6
Q

Causes of Post Term Labor

A

-usually error in determining ovulation and conception

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7
Q

Data for Post term labor

A

Weight loss, decrease in fetal movement

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8
Q

Maternal Risk Associated with Post Term Labor

A
  • increase psychological stress, induction, dystocia, assisted delivery
  • perineal trauma, increased laceration, risk for bleeding and infections
  • increase caesaren - increase DVT
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9
Q

Risk Associated for Fetus in Post Term Labor

A

-decrease placental perfusion, fetal demise, oligohydramious, macrosomia, low abgar score, SIDS, nerve and bone damage ->paralysis, cerebral palsy, meconium aspiration

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10
Q

Medical Intervention for Post-Term Labor

A
  • 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
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11
Q

Precipitous Labor and Delivery

A

Labor - any labor that last for less than 3 hours

Delivery - any birth that is unplanned, sudden, or unexpected

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12
Q

Factors Associated with Precipitous Labor

A

-multiparity, small fetus, large pelvis, previous precipitous labor

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13
Q

Maternal Risk for Precipitous Labor

A

-increase laceration and trauma, decreased coping abilities, PPH

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14
Q

Fetal Risk Associated with Precipitous Labor

A

-hypoxia, fetal distress caused by intense uterine contraction, bracial nerve injury

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15
Q

Induction

A

the artificial initiation of uterine contraction, resulting in the birth of a baby

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16
Q

Maternal Condition Indication of Induction

A

-Post term Labor, diabetes, renal disease, PROM, chorionamnionitis, previous precipitous labor

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17
Q

Fetal Condition for Induction

A
  • intrauterine fetal growth restriction (IUGR)
  • Fetal demise
  • Macrosomia
  • HYMOLYTIC DISEASE
  • mild abuptio
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18
Q

Management of Induction

A

Unripe Cervix - (6 on Bishop score)

-sweep membrane, amniotomy, prostaglandin gel intravaginal, IV oxytocin

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19
Q

Nursing care for Induction

A

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

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20
Q

Forcep and Vacuum Extraction Maternal and fetal Indication

A
  • exhaustion, lack of progress, health condition (heart disease and PIH), decrease motor innervation from epidural
  • fetal distress, placenta seperation, OP position, macrosomia, breech
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21
Q

Maternal Risk and Fetal risk for Forceps and Vacuum

A

Maternal: increase laceration and trauma, increased bleeding, infection and hemorrhage

Fetus: decrease flexion of head, echymosis, edmema, caput, cephalohematoma, paralysis

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22
Q

Fetal Distress Causes

A

-cord compression, placenta insufficiency, maternal, fetal and placenta disease

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23
Q

Fetal Distress Warning Signs

A
  • meconium stained liquoi, omnious FHR patterns

- CODE OB

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24
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
25
Prolapsed Cord
-cord that descends through the vagina prior to birth of baby
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Risk factors Associated with Prolapsed Cord
-breech, polyhydramnious
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OB EMERGENCY OF Prolapsed CORD
-Knee to chest (mcroberts maneuver), hand in vagina to relieve pressure off the cord
28
Shoulder Dystocia
-after delivery of head further expulsion of infant is prevented due to impaction of fetal shoulders in the maternal pelvis
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causes of Shoulder Dystocia
-Macrosomia, maternal diabetes, obesity, multiparity, post term
30
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
31
Maternal and Fetal complications of Shoulder Dystocia
PPH, Trauma, and infection - Brachial plexus injury - fractures, asphyxia, neurological damage, demise
32
DVT Associated factors
-hydramnious, preeclampsia, operative birth, history of clots, obesity
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DATA involving DVT
-color, warmth, movement, sensation, edema, low grade fever
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TX for DVT
Prevention - ambulate early, no crossing legs -heparin, increase fluids
35
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
36
Hyperemsis Gravidarium
-excessive and persistent nausea and vomiting during pregnancy associated with ketosis and weight loss
37
HG causes
- increase HCG and TSH in the first trimester, increase estradiol and decrease in prolactin - genetic
38
Objective and subjective DATA for HG
- progressive vomiting and retching - dehydration - fluid and electrolytes imbalance - hypotension, tachycardia - K+ loss - Fetal loss
39
TX for HG
``` Assess physical and emotion state NPOx48H Monitor I&O antiemetic correct F&E imbalance TPN PRN control environment ```
40
Spontaneous Abortion
-spontaneous loss of pregnancy prior to viability (20 weeks)
41
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
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Causes of SA
``` Chromosomal and placental abnormalities implantation problems teratogens (hot tubs) endocrine imbalance infections ```
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Data for SA
Spotting, cramping, backaches
44
TX for SA
``` Determine source of blood cross match blood, HBG, HCT bed rest no sex If imminent -> hospitalize -> IV, suction emotional support ```
45
Placenta Previo
low implantation of the placenta
46
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
47
Causes for Previa
Multiparity, previous c-sec, previous induced abortion, age, large placenta, smoking, asian women
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Data for Previa
U/S | Bleeding abruptly, painless, bright red
49
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 ```
50
Placenta Abruption
Premature separation of the normally implanted placenta from the wall of the uterus
51
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)
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Causes of Abruption
``` increase age, multi parity PIH, trauma, sudden uterine pressure change previous abruption cocaine and smoking PPROM ```
53
Data for Placenta Abruption
``` Pain (sharp, stabbing, high in fundal area) bleeding (only marginal) overt Covert - uterine becomes hard (central) Shock DIC ```
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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 ```
55
Cervical Insufficiency
Cervix dilates early and cannot hold a fetus to term | painless dilations occurring between 4th to 5th month
56
Cause and types of Cervical Insufficiency
Congenital acquired (infection, trauma, multiple gestations) Biochemical (relaxin)
57
Objective & Subjective data of CI
Painless dilation of cervix Increased pelvic pressure contraction birth of premature baby
58
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
59
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
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Predisposing Factors of Hypertensive orders in preg
``` Teens and older primips previous history large placental mass Rh incompatibility diabetes ```
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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
62
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
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TX for Severe PIH
stabilize then deliver baby by induction or C-sec
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HELLP SYNDROME
hemolysis, elevated liver enzymes, low platelet count | - sometimes associated with severe preeclampsia
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DIC - Disseminated intravascular coagulation associated with
preeclampsia, eclampsia, HELLP (occur as complication) - placenta abruptio - amniotic fluid embolism - maternal liver disease - septic abortion - dead fetus
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Diabetes Mellitus S&S
Polyuria polydipsia polyphagia wt.loss
67
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
68
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
69
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
70
Premature Rupture of Membranes PROM
PROM before onset of labor
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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
72
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
73
What is Ectopic Pregnancy
-implantation of the fertilized ovum in a site other than the endometrial lining of the uterus
74
Causes of Ectopic Pregnancy
- pelvic inflammatory disease - endometriosis - previous ectopic pregnancy - presence of IUD
75
Diagnose of Ectopic Pregnancy
- Assess menstrual history | - careful pelvic exam to identify any abnormal pelvic masses or tenderness
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Treatments for EP
- methotrexate is given if detected early with low Hcg level | - surgically to remove by the process of salpingostomy to gently remove
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Objective and subjective data for Ectopic Pregnancy
- acute pain related to abdominal bleeding - shoulder pain - vaginal bleeding
78
Nursing care for EP
- If using methotrexate, no sun exposure | - Start IV, assess for shock/bleeding, assess pain level
79
Hydatidiform mole
disease in which abnormal development of placenta occurs, resulting in a fluid filled grape like clusters; the trophoblastic tissue proliferates
80
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
81
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
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Treatment for HM
- suction to remove all fragments | - hysterectomy to reduce risk of choriocarcinoma
83
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-

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