Complications of Labor and Birth

Question 1

Preterm labor risks factors?

Answer 1

• dehydration
• diabetes
• hypertensive disorders
• infection
• multiparity
• multiple gestation
• obesity
• polyhydramnios
• prior preterm birth
• stress
• substance abuse
• trauma

Question 2

Preterm labor S/S?

Answer 2

• 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

Question 3

Preterm labor nursing care?

Answer 3

• 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

Question 4

What is PROM?

Answer 4

• Premature Rupture of Membranes
• Spontaneous rupture of the amniotic membranes before the onset of labor (sometimes called pre-labor ROM)

Question 5

What is PPROM?

Answer 5

preterm premature rupture of membranes

Question 6

What does PROM/PPROM cause increased risk for?

Answer 6

Increased risk of infection as barrier to external environment is gone

Question 7

PROM/PPROM nursing care?

Answer 7

• Treatment based on gestational age, could include antibiotics and prolonged bed rest
• Nursing care:
  • Teaching
  • Vital signs
  • Fetal surveillance

Question 8

What happens during Umbilical Cord Prolapse?

Answer 8

• Cord slips ahead of presenting part and can lead to significant compression/comprise to fetus
• May see deep, recurrent variable decels on fetal monitoring

Question 9

When can Umbilical Cord Prolapse occur?

Answer 9

Can occur anytime during labor with or without ruptured membranes

Question 10

Umbilical Cord Prolapse risk factors?

Answer 10

• breech or transverse lie
• non-engaged presenting part
• polyhydramnios

Question 11

Umbilical Cord Prolapse management?

Answer 11

• Trendelenburg
• elevate presenting part off the cord
• emergency c/s

Question 12

What happens during Shoulder Dystocia?

Answer 12

• Head is delivered vaginally, anterior shoulder can’t pass under pubic arch
• May see head “turtle”

Question 13

Shoulder Dystocia risk factors?

Answer 13

macrosomia (greater than 4000gm)

Question 14

Shoulder Dystocia management?

Answer 14

• widen pelvis
• McRoberts and suprapubic pressure
• rotation
• hands and knees, etc.

Question 15

What risks does Shoulder Dystocia pose to the infant and birthing parent?

Answer 15

• Risk to infant: broken clavicle, brachial plexus injury, neurological compromise, death
• Risk to birthing parent: perineal trauma, psychological trauma

Question 16

What is Magnesium Sulfate used for in high-risk pregnancies?

Answer 16

• 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

Question 17

Magnesium Sulfate nursing considerations?

Answer 17

• Recommended for gestational ages < 33 weeks
• Loading dose followed by maintenance infusion for 24 hrs

Question 18

What are Antenatal steroids used for in high-risk pregnancies?

Answer 18

Stimulates fetal surfactant production (helps baby’s lungs mature)

Question 19

Commonly used Antenatal steroid?

Answer 19

• Typically betamethasone
• 2 IM doses 24 hour apart

Question 20

When are antenatal steroids indicated?

Answer 20

Indicated for preterm labor between 24-36 weeks (sometimes 34 weeks is upper limit)

Question 21

What is Oxytocin (Pitocin) used for?

Answer 21

• Used to prevent or manage postpartum hemorrhage (1st-line)
• Used for induction of labor
  
  • Stimulates uterine contractions

Question 22

When is Pitocin given?

Answer 22

It’s used before delivery and postpartum

Question 23

What route is Pitocin given?

Answer 23

Almost exclusively IV or IVPB but can be given IM (for postpartum bleeding or prevention)