Exam 2 - Intrapartum Complications Flashcards
lack of progress in labor for any reasons
dystocia
long, difficult, or abnormal labor
dysfunctional labor
Name at least 3 risk factors for labor dystocia / dysfunction
(1) AMA
(2) obesity
(3) nullip
(4) short stature
(5) possible IOL
(6) medical complications during preg
what is the problem with “powers” that can lead to dystocia / dysfunction?
ineffective contractions
the two types of ineffective contractions are ____
hypertonic and hypotonic labor dysfunction
one key nursing intervention for someone in hypertonic labor dysfunction is ____
therapeutic rest
2 key nursing interventions for someone in hypotonic labor dysfunction are ___
(1) position changes
(2) labor augmentation
name 4 nursing interventions for ineffective pushing during labor
(1) change positions
(2) contact anesthesia re: epidural infusion rate
(3) assisted delivery
(4) prep for C-section
what factors of the “passenger” can lead to dystocia?
(1) fetal size
(2) fetal presentation / position
(3) multifetal pregnancy
(4) fetal anomalies
STI can affect what part of the labor process and lead to dystocia?
problems with passage (pelvis)
If psyche is affecting the labor process, the nurse can…
provide a supportive and low-stimulus environment
falls outside of the normal labor curve
prolonged labor
rapid birth within 3 hours of labor onset
precipitate labor
____ is the biggest complication of precipitate labor.
risk of tears / lacerations
risks of prolonged labor are…
(1) maternal / neonatal infection
(2) maternal exhaustion
(3) high levels of fear / anxiety
(4) maternal hemorrhage
Name 3 health consequences of preterm birth
(1) developmental delays
(2) chronic respiratory problems
(3) vision and hearing impairments
Name at least 3 risk factors for preterm birth / labor
(1) low pre-pregnancy weight
(2) smoking
(3) substance use
(3) short interval b/w pregnancies
(4) H/o of preterm birth
(5) cervical length concerns
(6) infections
Name at least 4 s/s of preterm birth / labor
(1) palpable contractions
(2) pelvic / vaginal pressure
(3) low backache
(4) pain or discomfort in vulva or thighs
(5) cramps
(6) increased discharge
(7) rupture of membranes
(8) bleeding or spotting
(9) sense of “feeling badly”
preterm labor is diagnosed as
4 contractions in 20 minutes or 8 contractions in 60 minutes
preterm labor is labor before ___ weeks
37
___ and ___ are ineffective in preventing preterm birth.
bedrest; hydration
name the 4 meds that can be given for preterm labor managment
(1) betamethasone (corticosteroid)
(2) terbutaline
(3) nifedipine
(4) Mg sulfate
____ is given to enhance fetal lung maturity
betamethasone
betamethasone route
IM
terbutaline is used to _____
delay delivery in the short-term and allow time for steroid administration
terbutaline route is
SubQ
name the key side effect of terbutaline
tachycardia for mom and fetus
what are the two tocolytics used in preterm labor called?
terbutaline and nifedipine
Nifedipine will _____ delivery
delay
Nifedipine route
PO
Name at least 3 key side effects of Nifedipine
(1) hypotension
(2) headache
(3) dizziness
(4) flushing
(5) nausea
____ can be used for fetal neuroprotection before 32 weeks
Mg Sulfate
what is key in preventing preterm birth?
prenatal care
AROM means
artificial rupture of membranes completed by a clinician
water breaks at term and subsequent labor follows
Spontaneous Rupture of Membranes (SROM)
spontaneous rupture at term without subsequent labor
prelabor ROM (PROM)
preterm prelabor rupture of membranes
Preterm prelabor ROM (PPROM)
what is considered preterm?
after 20 weeks, before 37 weeks
if pt presents with watery vaginal discharge or gush of fluid, we should ask about…
(1) when, amt, color, odor
(2) bleeding
(3) contractions / pain / pressure
(4) presence of fetal movement
(5) gestational age
(6) come to clinic!
PPROM can lead to higher risk of ___, ___, and ___
infection, preterm labor, neonatal morbidity
name at least 3 risk factors for PROM and PPROM
(1) intra-amniotic infection
(2) h/o PROM/PPROM
(3) low BMI
(4) smoking
(5) 2nd/3rd tri bleeding
(6) illicit drug use
(7) short cervical length
(8) low SES
respiratory distress is a potential complication of _____
PROM and PPROM
PROM nursing management includes
(1) weigh risks/benefits of expectant management vs. IOL
(2) consider GBS status
(3) monitor – infection, fetal mon, etc.
PPROM nursing management includes
(1) hospitalization
(2) IOL at 34-36 weeks
(3) risk of preterm baby vs. infection
(4) monitor for s/s infection
____ can be given to prevent infection in PPROM
latency antibiotics
bacterial infection of the amniotic cavity
chorioamniotis
Triple I is
(1) intrauterine inflammation
(2) infection
(3) both
Name at least 3 risk factors for chorioamniotis
(1) prolonged ROM
(2) multiple vaginal exams
(3) prolonged labor duration
(4) low SES
(5) young age
(6) nullip
clinical presentation of chorioamnionitis
Maternal temp of >38 + one of the following:
(1) WBC < 15k
(2) Maternal HR > 100
(3) FHR >160
(4) tender uterus
(5) foul smelling amniotic fluid
neonatal effects of chorioamnionitis are
(1) pneumonia
(2) bacteremia
(3) meningitis
(4) RDS
(5) inflammatory response cascades
what do you give (drug) for chorioamnionitis?
Antibiotics - ampicillin / gentamicin, penicillin
postpartum chorioamnionitis, monitor for ___, ___, and ___
endometritis, UTI, and sepsis
if chorioamnionitis is severe, you would…
do an expedited C-section
____ and ____ obstetric emergencies
cord prolapse; shoulder dystocia
out of the uterus in front of the presenting part of the fetus is what?
cord prolapse
what is the major risk of cord prolapse?
interruption of blood flow and oxygenation
Name at least 3 risk factors for cord prolapse
(1) premature rupture of membranes
(2) polyhydramnios
(3) long umbilical cord
(4) fetal malpresentation (breech / transverse)
(5) multiparity
(6) multiple gestation
(7) fetus high station
(8) growth-restricted fetus
the main role of the nurse during cord prolapse is ___
to support the fetal head to avoid cutting off blood supply
descent of anterior shoulder obstructed by the symphysis pubis
shoulder dystocia
the head goes out and in from the vaginal canal
turtle sign
what is an indicator for shoulder dystocia?
turtle sign
the 3 maternal complications of shoulder dystocia are…
(1) increased rates of postpartum hemorrhage and perineal lacerations
(2) increase obstetric anal sphincter injuries
(3) symphyseal separation and lateral femoral cutaneous neuropathy
name the 4 neonatal complications of shoulder dystocia
(1) brachial plexus injuries
(2) clavicle and humerus fractures
(3) encephalopathy
(4) death
name at least 3 risk factors for shoulder dystocia
(1) increased birth weight
(2) LGA
(3) maternal diabetes
(4) prolonged labor
(5) excessive wt gain during pregnancy
(6) h/o prior shoulder dystocia
what should you never do with shoulder dystocia?
Give fundal pressure
What are some of the nursing roles during shoulder dystocia delivery?
communicate, documentation, request assistance, assist with maneuvers, stay calm
knees to chest is what position
McRoberts Maneuver
