High Risk Intrapartum Flashcards
5 factors of Bishop scale
Cervical dilation Cervical Effacement Fetal Station Cervical Consistency Cervical position
Most common cause of preterm labor
dehydration
PROM
Membranes rupture before labor begins. At any point during gestation (can be 40th week)
PPROM
Membranes rupture before the 37th week of gestation and labor hasn’t begun yet.
Direct correlation with smoking
Risk factors for preterm birth
Multiple gestations Hx of previous preterm births UTI during pregnancy B.V Poor weight gain Hx of cervical surgery Fetal abnormality Drug use Anything that elevates your BP (pre and eclampsia, drug use, smoking)
Predicting factors for preterm labor
Cervix of 1 inch or less
PPROM Hx
Positive Fetal Fiber Nectin test
Positive Fetal Fiber Nectin test
- False Positive
done 20-38th week
FiberNectn should be negative in those weeks. If positive: at term.
1. Sexual intercourse within 24 hrs of test, vaginal bleed/infection, cervical exam
Management of Preterm labor
goal
Point of no return
Stop labor 3 cm 1.Activity limitation (decreases uterine activity and increases uteroplacental flow) Increased risk for thrombophlebitis and clots. 2.Hydration: also with tocolytics: pulmonary edema 3. Tocolytics 4. Celestone at 32-36: deliver before 32: Meds before 26: amnioinfusion
Tocolytic therapy given Mom S/E Fetal S/E NI
given if labor starts before the 34th week
Will not be given if past 34 (delivery)
Mom: anxiety, restlessness, nervous, tachycardia, muscle cramps, pulmonary edema, increased blood glucose.
Fetal: tachycardia, irritable, hypoglycemia
NI: Monitor lung sounds before each dose
Celestone (betamethasone)
Used with and for what
S/E
NI
steroid
in conjugation with tocolytics
Given to hasten fetal lung maturity. (PROM)
S/E: nervous, insomnia, increased WBC, pulmonary edema. Sodium retention: swelling due to fluid retention.
NI: Gonna need more insulin if diabetic
check lung sounds prior.
Umbilical cord Prolapse
Compression of the cord between maternal pelvis and fetal presenting part
Complete cord prolapse
can be palpated
may or may not be seen
may have 2 presenting parts
Hidden cord prolapse
cannot see or feel it
severe bradycardia
Risk factors for cord prolapse
multiparity Low birth wt Premature Breech 2nd twin unengaged presenting part hydramnios oblique or transverse lie
Cord Prolapse NI
Knee chest position
Trandelenbergs
Put hand up vagina putting pressure on presenting part and get woman to OR
Foley catheter into woman so bladder pushes baby up
Warm, moist Saline towel on cord
Abruptio placentae Risk factors
Vasoconstriction (smoking, cocaine, alcohol)
High BP
Abdominal trauma (fall, car accident, punch to belly)
Advanced maternal age
Fibroid underneath her placenta
Short umbilical cord (<18)
Complete abruptio placenta
Entire placenta pulls away
Baby will die
Partial abruptio placenta tx
seen by
sonogram If > 50% pulled away: get baby out If < 50% and baby is 24 weeks or less: baby stays in, admitted, watched and tested if 38 weeks: get baby out if baby is dead: vaginal delivery
S&S of of abruptio placenta
Abdominal pan Rigid abdomen Vaginal bleeding Concealed (blood builds up inside: increased fundal height) S&S of hemorrhage
NI for abruptio placentae
Monitor VS maintain bedrest, give 02, IV fluids Trendelenburgs or lateral Monitor bleeding carefully (fundal height and pads) Monitor for DIC and hemorrhage
Complications of Tx of preterm labor
Thrombophlebitis (bed rest) Pulmonary edema (hydrating and tocolytics)
Brethine drug action class indication S/E NI
decreased effect of calcium in smooth muscles
decreases uterine activity
tocolytic
used to stop preterm labor (not FDA approved)
can increase blood glucose level in mother (monitor neonate for hypoglycemia)
S/E: anxiety, restless, tachycardia
Assess FHR, Mom VS, Lung sounds, pulmonary edema
PPROM etiology
hydramnios
stress
nutrition
multifetal
PPROM Tx
36-37 weeks: induce and deliver
<25: very poor fetal outcome
administer tocolytics, IV lines, I&O
