Complications of Labor and Birth Flashcards
Preterm labor risks factors?
- dehydration
- diabetes
- hypertensive disorders
- infection
- multiparity
- multiple gestation
- obesity
- polyhydramnios
- prior preterm birth
- stress
- substance abuse
- trauma
Preterm labor S/S?
- Regular uterine contractions that produce cervical change prior to 37 weeks gestation
- 34-36 6/7 weeks= late preterm birth/infant
- < 34 weeks= preterm birth/infant
- Patients may report:
- uterine contractions
- low back pain
- pelvic pressure
Preterm labor nursing care?
- Patient education on signs and symptoms of PTL
- Hydration (PO or IV depending on protocol)
- Screen for infections (VS, urinalysis, labs)
- Rule out UTI
- Fetal monitoring
- Palpate abdomen for contractions and/or tenderness
- Bed and/or pelvic rest
What is PROM?
- Premature Rupture of Membranes
- Spontaneous rupture of the amniotic membranes before the onset of labor (sometimes called pre-labor ROM)
What is PPROM?
preterm premature rupture of membranes
What does PROM/PPROM cause increased risk for?
Increased risk of infection as barrier to external environment is gone
PROM/PPROM nursing care?
- Treatment based on gestational age, could include antibiotics and prolonged bed rest
- Nursing care:
- Teaching
- Vital signs
- Fetal surveillance
What happens during Umbilical Cord Prolapse?
- Cord slips ahead of presenting part and can lead to significant compression/comprise to fetus
- May see deep, recurrent variable decels on fetal monitoring
When can Umbilical Cord Prolapse occur?
Can occur anytime during labor with or without ruptured membranes
Umbilical Cord Prolapse risk factors?
- breech or transverse lie
- non-engaged presenting part
- polyhydramnios
Umbilical Cord Prolapse management?
- Trendelenburg
- elevate presenting part off the cord
- emergency c/s
What happens during Shoulder Dystocia?
- Head is delivered vaginally, anterior shoulder can’t pass under pubic arch
- May see head “turtle”
Shoulder Dystocia risk factors?
macrosomia (greater than 4000gm)
Shoulder Dystocia management?
- widen pelvis
- McRoberts and suprapubic pressure
- rotation
- hands and knees, etc.
What risks does Shoulder Dystocia pose to the infant and birthing parent?
- Risk to infant: broken clavicle, brachial plexus injury, neurological compromise, death
- Risk to birthing parent: perineal trauma, psychological trauma
What is Magnesium Sulfate used for in high-risk pregnancies?
- Given IVPB to prevent seizures in patients with preeclampsia
- Reduces the risk of intraventricular hemorrhage leading to cerebral palsy
- Can temporarily slow or stop preterm labor
- Neuroprotection for preterm baby
Magnesium Sulfate nursing considerations?
- Recommended for gestational ages < 33 weeks
- Loading dose followed by maintenance infusion for 24 hrs
What are Antenatal steroids used for in high-risk pregnancies?
Stimulates fetal surfactant production (helps baby’s lungs mature)
Commonly used Antenatal steroid?
- Typically betamethasone
- 2 IM doses 24 hour apart
When are antenatal steroids indicated?
Indicated for preterm labor between 24-36 weeks (sometimes 34 weeks is upper limit)
What is Oxytocin (Pitocin) used for?
- Used to prevent or manage postpartum hemorrhage (1st-line)
- Used for induction of labor
- Stimulates uterine contractions
When is Pitocin given?
It’s used before delivery and postpartum
What route is Pitocin given?
Almost exclusively IV or IVPB but can be given IM (for postpartum bleeding or prevention)
