Complications of Labor Flashcards
cervical change and uterine contractions occurring at 20-37 wks of pregnancy (costly and deadly)
preterm labor (PTL)
birth that occurs before the completion of 37 wks
preterm birth
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
preterm birth or prematurity
what is low birth wt
less than or equal to 2500 g at birth
what is the cause and effect of low birth wt
cause is preterm or IUGR
effect is low amount of brown fat which in turn causes respiratory distress, hypoglycemia, and cold stress
describe spontaneous preterm births
responsible for 75% of preterm births
cause:infection, placental causes
describe indicated preterm births
responsible for 25% pf preterm births
typically a C section d/t known complications like DM and HTN
how to predict spontaneous preterm labor/birth
risk factors
cervical length (if length is greater than 30 mm unlikely to be premature birth)
Fetal Fribronectin test (fFN test)
describe fFN test
glycoprotein “glue” found in plasma and produced during fetal life
______ can cause premature contractions
dehydration
PTL (preterm labor) management
pt teaching (loss of mucus plug, hydrate, rest)
prevention and early recognition and diagnosis
activity restriction (sexual)
**Tocolytic medication
promotion of getal lung maturity
describe Tocolytic meds
used for suppression of uterine activity
CANNOT give if HR is >130
spontaneous rupture of amniotic sac and leakage of fluid prior to onset of labor at ANY gestational age (no contractions)
Premature Rupture of Membranes (PROM)
membranes rupture before 37 wks gestation
responsible for 10% of preterm births
proceeded by infection
<32 wks is managed expectantly and conservatively
PPROM
what does infection d/t amniotic fluid often lead to
choriomnionitis
PROM and PPROM management
watch for infection
fetal assessment
antenatal glucocorticoids can raise blood sugar
describe why magnesium sulfate would be given before 32 wks
**contraindicated in myastheria gravis
reduces severity and risk of cerebral palsy in birth before 32 wks
what does ACOG recommend for pregnant women between 24 and 34 wks at risk of delivery in 7 days
single course of corticosteroids (takes 2 days for injectionto reach baby)
how do we know if woman is at risk of delivery soon
positive fFN test
antibiotics not used for _____ membranes
INTACT
what is usually the cause of chorioamnioitis and what is the treatment
gonorrhea and chlamydia
antibiotics and glucocorticoids
bacterial infection of amniotic cavity
major cause of complications
maternal fever, maternal and fetal tachy, uterine tenderness, foul odor of amniotic fluid
chorioamnionitis
what is term versus full term
term 37 wks
full term 40 wks
describe post term pregnancy
pregnancy > 42 wks gestation
maternal risks with post term pregnancy
dysfunctional labor and birth canal trauma, labor interventions, maternal fatigue and psychological reactions
fetal risk with post term pregnancy
macrosomia, prolonged labor, shoulder dystocia (stuck), trauma, aging placenta, postmaturity syndrome
describe postmaturity syndrome complications
become apoxic
relaxed anal sphincter can cause aspiration of meconium
high risk for resp distress
five factors affecting labor
powers, passage, passenger, maternal position, psychological response
describe hypertonic uterine dysfunction
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
suppresses contractions/premature labor
Tocolytic
describe hypotonic uterine dysfunction
initially normally progresses, then first contractions become week and inefficient, then stop completely give Oxytocin (pitocin) to increase contractions
what are secondary powers
problems with bearring down effects
what tells you how often labor should take place (depending on gravida/parity)
Friedman’s curve
lasts < 3 hrs from onset of contractions to birth
high risk for lacerations and tearing
slow involutions, risk of hemorrhage
precipitus labor (intense)
contractions of pelvic diameters that reduce capacity of bony pelvis, inlet or outlet
pelvic dystocia
obstruction in birth passage
can be adipose tissue d/t obesity
soft tissue dystocia
what is recommended for pelvic or soft tissue dystocia
c section
mother needs to be in ____ to help prevent dystocia
upright position
fetal causes of dystocia
abnormalities, malposition, malpresentation
cephalopelvic disproportion (CPD AKA FPD)
multifetal pregnancy
maternal _____ can also cause dystocia
psychological stress
describe obesity parameters
obestity: BMI > 30 kg
extreme obesity: BMI >40 kg
pregnancy complications d/t obesity
venous thromboembolism and c sections
describe external cephalic version (ECV)
- 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
what is ECV contraindicated in
anyone with a scarred uterus
describe internal version
rarely used, safety questionable
used in twin gestation to deliver second fetus
chemical or mechanical initiation of uterine contractions
electively or for indicated reasons
induction of labor
labor induction without medical indication
risks: increased risk of c section, neonate morbidity, cost
elective induction
elective induction should not be initiated until woman is ____ wks
39
how do you know if good candidate for induction
> 9 on Bishop’s scale
cervical ripening methods
prostaglandins, Foley bulb to traction
what is an amniotomy
break waters
what med is used to induce labor
pitocin- synthetic oxytocin used when labor is progressing slowly or induction is necessary
normally produced by posterior pituitary gland
stimulates uterine contractions and aids in milk let down
oxytocin
help contractions get longer
stimulation of uterine contractions AFTER labor has started spontaneously or progresses slowly
augmentation of labor
methods: oxytocin infusion or amniotomy
transabdominal incision of uterus
birth rate over 32% in US
c section
what is VBAC and TOLAC
VBAC: vaginal birth after c section (only can be done if horizontal uterine incision)
TOLAC: trial of labor after c section
risks of c section
bleeding, infection, anesthesia complications
what are the obstetric emergencies
meconium stained amniotic fluid shoulder dystocia prolapsed umbilical cord rupture of uterus amniotic fluid embolus
fetus passed stool prior to birth (dark black/green)
causes: breech , hypoxia, umbilical compression
meconium stained amniotic fluid
if baby aspirates meconium…
can cause resp distress
head born, shoulder cannot pass
newborn experience birth injury
maternal risk: excessive blood loss, lacerations, extension of episotomy, enbdometrisis
shoulder dystocia
interventions of shoulder dystocia
McRobert’s position (knees to ears)
suprapubic pressure
cord comes out before baby
d/t: long cord (>100 cm), malpresentation (breech), transverse lie, unengaged head in cervix
prolapsed umbilical cord
interventions for prolapsed umbilical cord
elevate presenting part (insert 2 fingers into cervix and press up) Trendelenburg position (feet up and head down) OR knee chest position
this is a rare but serious emergency
d/t scarring of C section, uterine trauma, congential uterine anomaly
rupture of uterus
MAJOR emergency
amniotic fluid containing particles or debris enters maternal circulation
typically occurs during 3rd stage of labor
amniotic fluid embolus (AFE)
what does AFE cause
major anaphylaxis (resp distress) CODE- start bagging with amboo bag
