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
well contracted funds with continuous bright red bleeding
Suspect laceration
1st Degree laceration
Fourchette (vulvva, external)
perineum skin
vaginal mucus membranes
2nd degree laceration
all first lacerations and muscles of perineum
3rd degree laceration
all first and second lacerations and anal sphincter
4th degree laceration
all first,second and third and rectum
Indications for C-section
CPD Dystocia active herpes Placental abruptio/previa Twins breech presentation fetal distress cord proplase preeclampsia
Vertical incission/classic C-section
indications
Contraindications
emergencies
more than one any
gross obesity
–VBAC
Pfannenstiel C-section incision
bikini cut incision
VBAC possible
Longer
Doesn’t allow for extension
Preop for C-section
Inc.spir./CDB/T&P What time they ate last? Antacids 30 min before Abd prep Foley cath (stays for 24 hrs) IV hydration Wedge under hip Signed consent
Postop for C-section
TCDP
football hold for breastfeed
Maternal VS q 5 min till stable, 15 first hour, 30 until discharge
Check abd. dressing and peripad q 15 min
monitor fundus form side and support incision
Can she move legs?
Check foley. blood? nicked bladder?
Pain assessment
BS!!!
Gas in abdomen
Homan’s sign/lochia/Ambulate ASAP/Benodyne boots
Forceps delivery
Indications
Cardiac disease
Fetal distress
Maternal exhaustion
HEAD ROTATION IS DONE BETWEEN CONTRACTIONS
Forceps delivery prereqs
Fully dilated ROM know position and station of baby No CPD monitor FHR before and after Empty bladder Epidural/pudenal block
Post op care Forceps delivery
Check hematomas
baby facial bruising, facial nerve paralysis and cephalohematoma
Vacuum extraction
Fetal risks
same as forceps
NO ANESTHESIA
baby can develop chignon (area of swelling)
hyperbilirubenimia risk!!!
intracranial bleeding risk!! fontanelles bulging
Incompetent cervix
etiology
cervical trauma
LEEP procedure
exposed to DES
usually in 2nd trimester of pregnancy
incompetent cervix dx
hx of 2nd trimester abortions
things go will up to 16th week
Tx of incompetent cervix
week 14: Cerclage procedure (suture cervix)
McDonald’s procedure (temporary procedure, at 38 weeks take strings off, Normal vaginal delivery)
Ripe cervix
short
anterior
Partially dilated
Unripe
med to ripen it
long
posterior
firm
-Cervidil (a prostaglandin, need consent, given prior to pitocin) Give and antipyretic and antiemetic with it
ABO incomp med tx
NONE
Risk factors for hydatiform mole
Infertility hx ⬆️paternal age Extremes of age Asian women Low karotene and animal fats
Dx of hydatiform mole
Sonograms and HCG levels (high)
S&S of hydatiform mole
Hyperemesis gravidarum
HTN before 20 weeks
No FHR
Management of hydatiform mole
Evaluate uterus (D&C)
Monitor for a year (invasive chorion carcinoma)
Monitor HCG levels to make sure dont rise
Chest x ray (mets)
HIV diagnostics
NST at 32
Sonograms every week start at 32
HIV management
No internal monitoring (risk)
Ritgen maneuver
Early S&S of HIV in newborn
Thrush infection in mouth
Failure to thrive
Lymphadenopathy
Umbilical cord that constantly drains
DIC risk factors
HTN abruptio placenta Fetal demise Amnionic fluid embolism Hydatiform mole Infection
