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Women's Health > Complications of Labor > Flashcards

Complications of Labor Flashcards

1
Q

cervical change and uterine contractions occurring at 20-37 wks of pregnancy (costly and deadly)

A

preterm labor (PTL)

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2
Q

birth that occurs before the completion of 37 wks

A

preterm birth

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3
Q

length of gestation regardless of birth wt
more dangerous than birth wt alone because less time in uterus means immature body systems and decreased surfactant levels

A

preterm birth or prematurity

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4
Q

what is low birth wt

A

less than or equal to 2500 g at birth

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5
Q

what is the cause and effect of low birth wt

A

cause is preterm or IUGR

effect is low amount of brown fat which in turn causes respiratory distress, hypoglycemia, and cold stress

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6
Q

describe spontaneous preterm births

A

responsible for 75% of preterm births

cause:infection, placental causes

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7
Q

describe indicated preterm births

A

responsible for 25% pf preterm births

typically a C section d/t known complications like DM and HTN

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8
Q

how to predict spontaneous preterm labor/birth

A

risk factors
cervical length (if length is greater than 30 mm unlikely to be premature birth)
Fetal Fribronectin test (fFN test)

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9
Q

describe fFN test

A

glycoprotein “glue” found in plasma and produced during fetal life

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10
Q

______ can cause premature contractions

A

dehydration

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11
Q

PTL (preterm labor) management

A

pt teaching (loss of mucus plug, hydrate, rest)
prevention and early recognition and diagnosis
activity restriction (sexual)
**Tocolytic medication
promotion of getal lung maturity

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12
Q

describe Tocolytic meds

A

used for suppression of uterine activity

CANNOT give if HR is >130

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13
Q

spontaneous rupture of amniotic sac and leakage of fluid prior to onset of labor at ANY gestational age (no contractions)

A

Premature Rupture of Membranes (PROM)

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14
Q

membranes rupture before 37 wks gestation
responsible for 10% of preterm births
proceeded by infection
<32 wks is managed expectantly and conservatively

A

PPROM

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15
Q

what does infection d/t amniotic fluid often lead to

A

choriomnionitis

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16
Q

PROM and PPROM management

A

watch for infection
fetal assessment
antenatal glucocorticoids can raise blood sugar

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17
Q

describe why magnesium sulfate would be given before 32 wks

A

**contraindicated in myastheria gravis

reduces severity and risk of cerebral palsy in birth before 32 wks

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18
Q

what does ACOG recommend for pregnant women between 24 and 34 wks at risk of delivery in 7 days

A

single course of corticosteroids (takes 2 days for injectionto reach baby)

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19
Q

how do we know if woman is at risk of delivery soon

A

positive fFN test

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20
Q

antibiotics not used for _____ membranes

A

INTACT

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21
Q

what is usually the cause of chorioamnioitis and what is the treatment

A

gonorrhea and chlamydia

antibiotics and glucocorticoids

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22
Q

bacterial infection of amniotic cavity
major cause of complications
maternal fever, maternal and fetal tachy, uterine tenderness, foul odor of amniotic fluid

A

chorioamnionitis

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23
Q

what is term versus full term

A

term 37 wks

full term 40 wks

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24
Q

describe post term pregnancy

A

pregnancy > 42 wks gestation

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25
Q

maternal risks with post term pregnancy

A

dysfunctional labor and birth canal trauma, labor interventions, maternal fatigue and psychological reactions

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26
Q

fetal risk with post term pregnancy

A

macrosomia, prolonged labor, shoulder dystocia (stuck), trauma, aging placenta, postmaturity syndrome

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27
Q

describe postmaturity syndrome complications

A

become apoxic
relaxed anal sphincter can cause aspiration of meconium
high risk for resp distress

28
Q

five factors affecting labor

A

powers, passage, passenger, maternal position, psychological response

29
Q

describe hypertonic uterine dysfunction

A

greater than 4 contractions in 10 min
too many contractions
do not change cervix, decreases oxygen to baby
give Tocolytic to relax and recommend rest

30
Q

suppresses contractions/premature labor

A

Tocolytic

31
Q

describe hypotonic uterine dysfunction

A 
initially normally progresses, then first contractions become week and inefficient, then stop completely
give Oxytocin (pitocin) to increase contractions
32
Q

what are secondary powers

A

problems with bearring down effects

33
Q

what tells you how often labor should take place (depending on gravida/parity)

A

Friedman’s curve

34
Q

lasts < 3 hrs from onset of contractions to birth
high risk for lacerations and tearing
slow involutions, risk of hemorrhage

A

precipitus labor (intense)

35
Q

contractions of pelvic diameters that reduce capacity of bony pelvis, inlet or outlet

A

pelvic dystocia

36
Q

obstruction in birth passage

can be adipose tissue d/t obesity

A

soft tissue dystocia

37
Q

what is recommended for pelvic or soft tissue dystocia

A

c section

38
Q

mother needs to be in ____ to help prevent dystocia

A

upright position

39
Q

fetal causes of dystocia

A

abnormalities, malposition, malpresentation
cephalopelvic disproportion (CPD AKA FPD)
multifetal pregnancy

40
Q

maternal _____ can also cause dystocia

A

psychological stress

41
Q

describe obesity parameters

A

obestity: BMI > 30 kg

extreme obesity: BMI >40 kg

42
Q

pregnancy complications d/t obesity

A

venous thromboembolism and c sections

43
Q

describe external cephalic version (ECV)

A
  • attempt to turn fetus from breech or shoulder presentation into a vertex presentation
  • ultrasound screening to verify and check placenta
  • NST and informed consent before procedure
  • easy if small baby or multifetal
44
Q

what is ECV contraindicated in

A

anyone with a scarred uterus

45
Q

describe internal version

A

rarely used, safety questionable

used in twin gestation to deliver second fetus

46
Q

chemical or mechanical initiation of uterine contractions

electively or for indicated reasons

A

induction of labor

47
Q

labor induction without medical indication

risks: increased risk of c section, neonate morbidity, cost

A

elective induction

48
Q

elective induction should not be initiated until woman is ____ wks

A

39

49
Q

how do you know if good candidate for induction

A

> 9 on Bishop’s scale

50
Q

cervical ripening methods

A

prostaglandins, Foley bulb to traction

51
Q

what is an amniotomy

A

break waters

52
Q

what med is used to induce labor

A

pitocin- synthetic oxytocin used when labor is progressing slowly or induction is necessary

53
Q

normally produced by posterior pituitary gland

stimulates uterine contractions and aids in milk let down

A

oxytocin

54
Q

help contractions get longer

stimulation of uterine contractions AFTER labor has started spontaneously or progresses slowly

A

augmentation of labor

methods: oxytocin infusion or amniotomy

55
Q

transabdominal incision of uterus

birth rate over 32% in US

A

c section

56
Q

what is VBAC and TOLAC

A

VBAC: vaginal birth after c section (only can be done if horizontal uterine incision)
TOLAC: trial of labor after c section

57
Q

risks of c section

A

bleeding, infection, anesthesia complications

58
Q

what are the obstetric emergencies

A 
meconium stained amniotic fluid
shoulder dystocia 
prolapsed umbilical cord
rupture of uterus
amniotic fluid embolus
59
Q

fetus passed stool prior to birth (dark black/green)

causes: breech , hypoxia, umbilical compression

A

meconium stained amniotic fluid

60
Q

if baby aspirates meconium…

A

can cause resp distress

61
Q

head born, shoulder cannot pass
newborn experience birth injury
maternal risk: excessive blood loss, lacerations, extension of episotomy, enbdometrisis

A

shoulder dystocia

62
Q

interventions of shoulder dystocia

A

McRobert’s position (knees to ears)

suprapubic pressure

63
Q

cord comes out before baby

d/t: long cord (>100 cm), malpresentation (breech), transverse lie, unengaged head in cervix

A

prolapsed umbilical cord

64
Q

interventions for prolapsed umbilical cord

A 
elevate presenting part (insert 2 fingers into cervix and press up)
Trendelenburg position (feet up and head down)
OR knee chest position
65
Q

this is a rare but serious emergency

d/t scarring of C section, uterine trauma, congential uterine anomaly

A

rupture of uterus

66
Q

MAJOR emergency
amniotic fluid containing particles or debris enters maternal circulation
typically occurs during 3rd stage of labor

A

amniotic fluid embolus (AFE)

67
Q

what does AFE cause

A 
major anaphylaxis (resp distress)
CODE- start bagging with amboo bag

Women's Health (31 decks)

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