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OB Exam 3 > Complications of Birth > Flashcards

Complications of Birth Flashcards

1
Q

Recognition of signs of poor fetal perfusion

A
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2
Q

Interventions for poor fetal perfusion

A
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3
Q

Uterine rupture

A

OBSTETRIC EMERGENCY
caused by scarring on the uterus

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4
Q

Risk factors for uterine rupture

A
  • multiple C-sections
  • no previous vaginal deliveries
  • induced labor
  • multifetal gestation
  • infection
  • short interval between pregnancies
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5
Q

S/S of uterine rupture

A
  • fetal distress
  • loss of fetal station
  • severe lower abd pain
  • shock
  • pale skin
  • tachycardia
  • diaphoresis
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6
Q

Nursing Interventions for uterine rupture

A
  • O2
  • IV fluids
  • Continuous fetal monitoring
  • prepare for immendiate C-section
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7
Q

Indications for VBAC

A
  • Women with 1 or 2 previous C-sections & low transverse uterine incision
  • Clinically adequate pelvis based on pelvimetry or prior vaginal birth.
  • Undocumented uterine scars unless there is a high suspicious there was a classic incision performed previously.
  • Absence of other uterine scars or Hx of previous uterine rupture
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8
Q

Cord Prolapse

A

MEDICAL EMERGENCY; fetus O2 supply is cut off
cord enters the pelvis in front of the fetal head & as the head descends it puts pressure on the cord.

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9
Q

Risk factors for cord prolapse

A
  • polyhydramnioes
  • premature rupture of membrane
  • fetal malpresentation
  • fetus small for gestational age
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10
Q

Nursing Intervention for cord prolapse

A
  • Displacement of the presenting part by knee chest position OR
  • Manual displacement with your hand
  • -followed by a STAT c-section
  • indicators of transient cord compression are variable decels on the fetal heart tracing
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11
Q

Assessment & Interventions for dysfunctional labor pattern

(2 types)

A
  1. Hypertonic (tachysystolic)
    * there is more than 5 contractions in 10 min window.
    * can decrease fetal perfusion
    Interventions:
    * turn pitocin off if its running
    * provide O2 & IV fluids to help perfusion
  2. Hypotonicity
    * there is too few contractions which prolong labor
    **Interventions **
    administer pitocin to increase strength & frequency of contraction
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12
Q

Interventions for both dysfunctional labor patterns

A
  • Monitor fetal heart rate & maternal VS
  • watch for infection
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13
Q

Chorioamniontitis

A

infection of the amniotic cavity; bacteria in the vagina can be introdiced into uterus due to frequent vaginal exams
thats why we only want to check cervix when membranes are ruptured

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14
Q

Risk factors for chorioamnionitis

A

prolonged ruptures of membranes & frequent vaginal exams are the two main causes

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15
Q

Signs for chorioamnionitis

clinical manifestations

A
  • maternal fever
  • fetal tachycardia
  • uterine tenderness
  • foul odor of amniotic fluid
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16
Q

Shoulder Dystocia

A
  • when the head is delivered but the shoulders are stuck
  • can cause brachial plexus injuries, fractured clavicles in newborn, hemorrhage, perineal, & rectal injuries in mothers
17
Q

Care for shoulder dystocia

NURSE & PROVIDERS

A
  1. Nursing interventions:
    * Mc Roberts maneuvers
    * Suprapubic pressure
  2. Providers may cut episiotomy, perform :
    * screw maneuver
    * Zavagnelli maneuver (last ditch effort try to push head back in & perform C-section)
18
Q

Care of pt who has experience FETAL DEMISE

9 bullets

A
  • Mom is at risk for infection if baby died in utero
  • We wait for labor or can induce it
  • nurses should support mother & family
  • encourage to share feelings
  • offerst to take pictures & create memory box
  • prepare family for what hte baby will look like & allow them to hold, touch & say goodbye
  • help actualize loss of by: actualizing birth, use honesty dealing w/ situation; its ok to grieve, if baby was name use it, treat baby as if its still alive, dont rush the process, autopsy if ordered otherwise its expensive, perinatal hospice; support services
  • attend moms physcial needs, encourage communication, adress spiritual needs as well
  • After death: follow up, phone calls to check up on emotions of family dont forget sibilings & grandparents
19
Q

Precipitous Delivery

A
  • when the entire labor occurs w/in 3 hrs
  • Can cause fetal distress, placental abruption, perineal lacerations, PPH, meconium stained amniotic fluid, meconium aspiration, fetal creanial trauma
20
Q

Care of pt experiencing Precipitous Delivery

nursing interventions

A
  • close monitoring
  • have delivery pack nearby for pts with this Hx
  • encourage pt to pant & blow instead of pushing to slow down the fetal decent
  • dont attemp to stop baby from coming out
  • support the mother
  • if delivery happens; dry baby, suction mouth & nose & stabilize as you normally would
21
Q

Care of pt during operative vaginal delivery

A
  • ensure bladder is empty
  • assess FHR durin procedure
  • assess mom & newborn for trauma after birth
  • manage pain
22
Q

Assessment & management of Oxytocin infusion

A

AKA Pitocin
ASSESS:
* FHR; frequency, duration & intensity of contractions, delcels, accelerations & uterine resting tone every 15 mins & before increasing infusion rate
* cervical dilation as needed
* ADRs or SE: FHR; bradycardia, late or deep repetitive variable decels, contractions every 2 mins, exceed duration of more than 60 secs or insufficient relaxation of uterus between contractions or steady increase in resting tone
Management
*contractions every 2 mins should decrease (or d/c) infusion

23
Q

Duramorph

A

morphine sulfate injection via epidural or spinal anesthesia cath
Provides 16-24 hrs of pain relief

24
Q

what should you monitor for Duramorph

A

*** RR airway/breathing is the priority **
* Bleeding
* pulse ox
* BP
* pulse
* pain
* return of sensation
* urine output

OB Exam 3 (3 decks)

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