Complications of Labor Flashcards
Pre-term Labor
- how many weeks gestation is this?
- describe this in regards to the uterus and cervix.
- risk factors
Prior to 37wks gestation is considered preterm.
Describe:
-regular uterine contractions associated with cervical change*
Risk:
- multiple gestation*
- prior preterm birth*
- preterm uterine contractions
- premature rupture of membranes
- low maternal prepregnancy weight
- smoking
- substance abuse
- short interpregnancy interval
- infection
Preterm Labor;
- causes
- signs and sx
Causes:
1. activation of maternal or fetal HPA d/t maternal of fetal stress
- Decidual-chorioamniotic or systemic inflammation caused by infection
- Decidual hemorrhage (Abruption of placenta)
- Pathologic uterine distention:
- multiple pregnancy
- polyhdramnios
- uterine abnormality
Signs and Sx:
- menstrual like cramps
- low, dull back ache
- abd pressure
- pelvic pressure
- abd cramping with our without diarrhea
- increase or change in vaginal discharge
- uterine contractions
Preterm Labor:
- dx (of the cause)
- managment
Dx:
- fetal monitoring
- UA, test for Group B Strep, CBC
- US: eval amount of amniotic fluid, estimate cervical length if less than 26wks
- Amniocentesis: not a routine test but can determine intramniotic infection, and fetal lung maturity.
Management:
- delay delivery until fetal maturity is attained*
- tocolytics (stop preterm labor)
Tocolytics:
- medications
- CI
Meds:
- calcium channel blockers (nifedipine)
- NSAIDS (indocin)
- B-adrenergic receptor agonists (terbutaline)
- magnesium sulfate
CI :
- advanced labor
- mature fetus
- intrauterine infection
- significant vaginal bleeding
- severe preeclampsia or eclampsia
- placental abruption
- advanced cervical dilation
- fetal compromise
- placental insufficiency
Corticosteroids:
- used at what weeks gestation?
- purpose?
Used from 24-34wks gestation
Purpose: to enhance fetal lung maturity
Group B Strep
- when do we screen for this? (wks gestation)
- when do you treat?
- sx
- Tx
- what does prophylactic tx prevent in the mother and baby?
Screen between 35-36wks gestation
When to treat:
-if positive GBS administer abx prophylaxis in labor or with premature rupture of membranes, OR if pregnant mother has had prior infant with GBS infection.
-sx: may be asymptomatic bacteriuria
Tx:
- PCN G 5million U IV followed by two 5-3million U q 4hrs until delivery
- if PCN allergy then: Cefazolin(ancef), clindamycin, or vancomycin
Tx prevents postpartum endometritis, sepsis, and meningitis in the mother. It prevents group B sepsis of the neonate.
Dystocia:
- definition
- aka
- leading indication for what?
- tx
Definition:
- abnormal progression of labor
- a lack of progressive cervical dilation or lack of descent of fetal head into the birth canal, or both.
aka: “failure to progress”
Leading indication for C-section
Tx:
- augmentation: amniotommy, oxytocin
- C-section (if maternal/fetal distress, unstable condition of mother)
Progression of labor:
- cervix should dilate how many cm/hr?
- the fetus should descend at least how many cm/hr.
- how long should labor be if region anesthesia? no anesthesia?
Cervix should dilate:
- 1cm/hr in nulliparous
- 1.5cm/hr in multiparous
Fetus should descend at least 1cm/hrs.
Labor should not be longer than 3hrs if regional anesthesia, no longer than 2hrs if no anesthesia.
What is amniotomy?
Indications for C-section?
Amniotomy is manual rupture of membranes with “hook”
C-section indications
- failure to progress during labor*
- nonreassuring fetal status*
- fetal malpresentation*
- abnormal placentation
- maternal infection (HIV, HSV)
- fetal bleeding diathesis
- umbilical cord prolapse
- macrosomia
- obstruction of birth canal
- urterine rupture.
Assisted delivery:
- how is this done?
- complications
How:
- forceps
- vacuum
Complications:
- forceps:
- -mother: perioneal trauma, hematoma, pelvic floor injury
- -baby: injuries to brain or spine, corneal abrasion, should dystocia
- Vacuum:
- -baby: intracranial hemorrhage, scalp laceration, hyperbilirubinemia, retinal hemorrhage
Umbilical cord prolapse
- what happens with cord compression?
- management
cord compression: causes fetal bradycardia and can eventually cause fetal demise.
Management:
- prompt delivery usually by c section
- maneuvers to reduce chord pressure:
- -steep trendelenberg position
- -filling the bladder with 500-700ml of NS
- -tocolytic such as terbutaline to stop contractions
- -examiners hand maintained in vagina to elevate presenting part off the cord until c-section
Shoulder Dystocia:
- emergency or nah?
- describe this
- signs
- tx
EMERGENCY!!!!
Description:
-fetal shoulders remain in an anterior-post position during descent, or descend simultaneously. The anterior should can become impacted behind the pubic symphysis.
Signs:
- turtle sign- fetal head retracts into the perineum after expulsion
- when routine gentle, downward traction of the fetal head fails to accomplish delivery of the anterior shoulder.
Tx:
- drain if distended bladder
- McRoberts Maneuver (flexion at the hip and knee)
- Suprapubic pressure
- Rubin manuever (adduction of the fetal shoulder, displacing them from the anteroposteroir diameter).
- barnum maneuver: delivery of posterior arm.
- place mother on her hands and knees
Breech Presentation:
- management
- describe delivery of the breech baby
management:
- may attempt external cephalic version to get the baby in the vertex position so the mother may attempt to have a vaginal birth
Breech baby delivery: after spontaneous expulsion to the umbilicus, external rotation of the fetal pelvis results in flexion of the knee and delivery of each leg.
When scapulae appear under the symphisis, the operator reaches over the L shoulder, sweeps the arm across the chest and delivers the arm.
Gentle rotation of the shoulder girdle facilitates delivery of the R arm.
following delivery of the arms, the fetus is wrapped in a towel for control and slightly elevated.
**Its important to maintain cephalic flexion by applying pressure on the fetal maxilla
Retained Placenta
- definition
- cause of what?
- tx
Definition: placenta that has not been expelled 30-60mins after delivery of the baby
-cause of postpartum hemorrhage
Tx:
- pharm interventions: IV nitro given to relax the uterus & intraumbilical injection of a solution of oxytocin in saline
- manual removal w/ your HAND!!
Uterine Inversion
- what is this?
- tx
What; uterine fundus collapses into the endometrial cavity
Tx:
- uterine relaxation: magnesium sulfate, terbutaline, nitroglycerin
- manual correction (“PUNCH IT BACK IN”)
- removal of placenta
- uterotonic agents
