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Nursing Obstetrics & Pediatrics > health challenges in labour and birth > Flashcards

health challenges in labour and birth Flashcards

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1
Q

why is the rate of preterm births increasing?

A
  • average age of mothers is older
  • fertility treatment more common
  • increasing role of infection
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2
Q

what are some factors that may contribute to preterm labour?

A
  • inflammation
  • race
  • toxicology
  • stress
  • nutrition
  • cervical surgery
  • uterine distension
  • genetics
  • previous PTB
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3
Q

what is fetal fibronectin and why is it tested for?

A
  • it is a glycoprotein released into cervical/vaginal fluid in response to inflammation or separation of amniotic membranes
  • normally is present until 22 weeks and then not again until time of labour
  • a negative test means it is 98% likely a pregnancy will continue at least 2 more weeks
  • positive test between 24-34 weeks could indicate risk of preterm labour
  • negative is a more definitive result than a positive
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4
Q

what are some strategies to avoid stimulation that could trigger or progress preterm labour?

A
  • minimal or no vaginal exams as they can stimulate and increase risk of infection
  • no sex
  • no nipple stimulation
  • keep bladder empty

some other interventions that may or may not be helpful vs the risk:

  • bedrest
  • IV hydration
  • MgSO4
  • Sedation
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5
Q

what do tocolytic drugs do?

A

they are medications that stop contractions

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6
Q

what are some common tocolytics used to slow or stop preterm labour?

A
  • indomethacin (anti-prostaglandin)
  • Nifedipine (calcium channel blocker)
  • progesterone
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7
Q

how does indamethacin work as a tocolytic?

A
  • it is an anti-prostaglandin and inhibits uterine activity
  • effective short-term at delaying delivery 48 hours or so
  • ideal for creating window to give corticosteroids or MgSO4 for health of fetus
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8
Q

what tocolytic is appropriate for long-term prevention of preterm labour?

A

progesterone

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9
Q

what is cervical insufficiency?

A

-when there is premature, painless dilation of the cervix without contraction between 20-28 weeks

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10
Q

why may corticosteroids be given during preterm labour?

A

-to decrease prenatal mortality, the risk of respiratory distress syndrome and intraventricular hemorrhage

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11
Q

what medications are given to “mature” the lungs of a preterm infant?

A
  • corticosteroids

- usually betamethasone (12mg IM q24h x2) or dexamethasone (6mg IM q12hr x4)

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12
Q

why may MgSO4 be given during preterm labour?

A
  • new evidence suggests that there is a neuroprotective effect
  • women less than 37 weeks gestation could be given this once dilated to or greater than 4 cm
  • given a 4g loading dose over 30 min and then 1g/hr until delivery
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13
Q

what are some possible causes of bleeding during pregnancy?

A
  • spontaneous abortion
  • ectopic pregnancy
  • gestational trophoblastic disease
  • placenta previa
  • abruption placentae
  • uterine rupture
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14
Q

what criteria defines spontaneous abortion?

A
  • occurs naturally

- expulsion of fetus before 20 weeks gestation or expulsion of a fetus weighing less than 500 g

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15
Q

what are some interventions that may be done if a spontaneous abortion occurs?

A
  • give a drug to contract uterus (cytotec, RU486, cervidil)
  • give winrho if mom is rH -ve to prevent development of antibodies
  • IV therapy or blood transfusion if needed
  • dilation and curettage if needed
  • dilation and suction evacuation if needed
  • providing physical and emotional support
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16
Q

what is an ectopic pregnancy?

A

-when a fertilized ovum implants outside of the uterus

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17
Q

95% of ectopic pregnancy end up in the fallopian tube, but are risks and symptoms associated with this?

A
  • sharp unilateral pain
  • decreased BP
  • syncope
  • referred shoulder pain, lower abdominal pain
  • vaginal bleeding
  • rupture of tube if interventions not done before then
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18
Q

what is gestational trophoblastic disease?

A
  • a rare condition where abnormal development of the placenta occurs
  • trophoblastic cells obliterate the pregnancy
  • sometimes called molar pregnancy
  • can develop into choriocarcinoma
19
Q

what are signs of gestational trophoblastic disease?

A
  • classic signs of pregnancy, but exaggerated, excellerated, and exacerbated
  • uterine enlargement greater than gestational age
  • vaginal bleeding and passage of clots
  • hyperemesis gravidum
  • development of hypertension before 24 weeks
20
Q

what is an antepartum hemorrhage?

A
  • vaginal bleeding that occurs after 20 weeks gestation
  • 2 main causes are placenta previa and abruptio placentae
  • can also have uterine or cervical causes
21
Q

what is the blood flow to the uterus and placenta?

A

700-1000 mL/min

22
Q

what is the major maternal risk if the vascular integrity of uterus/placenta is disrupted during late pregnancy?

A

-exsanguination within 8-10 minutes

23
Q

how common is placenta previa?

A

4/1000 births

24
Q

how common is abruptio placentae?

A

1/100 births

25
Q

what is placenta previa?

A

when the location of the placenta is low and partially obscures the cervical opening

26
Q

what are the types of placenta previa?

A
  • total/complete
  • partial
  • marginal
  • low-lying placenta (not actually obscuring, but dangerously close to cervix)
27
Q

what kind of delivery is required if a woman has placenta previa?

A

a c/s

28
Q

what is the major risk associated with placenta previa?

A

bleeding

29
Q

how is placenta previa typically diagnosed?

A

-by ultrasound - either routine or when bleeding occurs and is invstigated

30
Q

why does placenta previa require frequent monitoring?

A

because 80% of the time the placenta moves - this can mean it gets better or worse

31
Q

what are some risks of developing placenta previa?

A
  • previous placenta previa
  • uterine abnormalities
  • endometrial scarring
  • large placental mass
32
Q

when bleeding occurs because of placenta previa, what is it typically like?

A
  • always visible bleeding
  • will be bright red
  • usually not painful
33
Q

what is abruptio placentae?

A
  • the premature separation of a normally implanted placenta from the uterus wall
  • aka separates before delivery as opposed to after
34
Q

what is the outcome of a total or complete abruptio placentae?

A

maternal hemorrhage

fetal death

35
Q

what is the outcome of a partial abruptio placentae?

A
  • depends how much separation

- a fetus can tolerate up to 30-50% abruption

36
Q

what can cause abruptio placentae?

A
  • short cord
  • hypertension
  • blunt abdominal trauma
  • crack/cocaine use
  • PPROM
  • overdistended uterus
  • previous C/S
  • short interpregnancy interval
  • smoking, especially more than 1 pack per day
  • uterine abnormalities
  • advanced maternal age
37
Q

what are some negative maternal implications of abruptio placentae?

A
  • intrapartum/postpartum hemorrhage
  • DIC
  • Hemorragic shock
38
Q

what is vasa previa?

A
  • when vessels of umbilical cord divide some distance from placenta in placental membranes
  • torn vessels can lead to fetal hemorrhage and non-reassuring fetal status
39
Q

what are possible symptoms of abruptio placentae?

A
  • decreased BP
  • pain in abdomen
  • may or may not be visible bleeding, it can be obscured
40
Q

what is uterine rupture?

A

-spontaneous rupture of uterus or rupture of a previous scar

41
Q

what are risk factors for uterine rupture?

A
  • previous uterine surgery, including C/S
  • short interdelivery interval (less than 18 months)
  • grand multiparity
  • trauma
  • intrauterine manipulation
  • midforceps rotation of fetus
  • attemptin VBAC and given oxytocin
42
Q

what are symptoms of uterine rupture?

A
  • may be initially asymptomatic
  • abdominal pain not relieved by analgesia
  • dilation ceases
  • vomiting
  • syncope
  • vaginal bleeding
  • maternal/fetal tachycardia
  • abnormal FHR
  • fetal parts palpable through abdominal wall
  • dramatic, sharp, tearing pain
43
Q

what is DIC?

A
  • disseminated intravascular coagulation
  • occurs when clotting factors initially increase, uses up platelet and clotting factors making microclots
  • then, serious bleeding can occur inside the body or outside
  • very life-threatening

Nursing Obstetrics & Pediatrics (26 decks)

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