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OB > high risk L&D > Flashcards

high risk L&D Flashcards

1
Q

incompetent cervix

A

cervical insufficiency; dilatation of the cervix (prematurely) without pain or contractions

  • this can be d/t congenital, acquired, or hormonal problems
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2
Q

what does an incompetent cervix put her at risk for?

A
  • early delivery
  • miscarriage
  • loss of pregnancy
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3
Q

cerclage

A

stitch is place in cervix with the goal of maintaining a pregnancy

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4
Q

what are the risks of a cerclage?

A
  • ROM
  • stimulation to cervix = put her in labor = some bleeding
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5
Q

nursing considerations for a cerclage

A
  • monitor for s/sx of labor
  • monitor for infection
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6
Q

premature ROM (PROM)

A
  • ROM prior to onset of labor
  • after 38 weeks
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7
Q

preterm premature ROM (PPROM)

A
  • ROM prior to onset of labor
  • before 37 completed weeks
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8
Q

prolonged ROM

A

ROM for > 24 hours prior to delivery

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9
Q

what are the maternal concerns for a premature ROM?

A
  • infection
  • chorioamnionitis (infection of chorion)
  • endometritis (infection of lining of uterus)
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10
Q

what are the fetal concerns for a premature ROM?

A
  • preterm delivery (lung development = issue)
  • infection
  • risk for cord prolapse
  • oligohydramnios
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11
Q

how can we assess for fetal infection while in utero?

A
  • assess fluid might be leaking –> foul smelling
  • FHR (tachy)
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12
Q

what do we do is ROM is suspected?

A

nitirizine test

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13
Q

management of PROM/PPROM patient:

A
  • monitor for infection
  • monitor for cx
  • bed rest (prevent cord prolapse)
  • fetal assessment (FHR, quickening)
  • corticosteroids (helps mature fetal lungs)
  • possible antibiotics
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14
Q

preterm labor

A

labor after 20 weeks and prior to 38 weeks

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15
Q

fetal fibronectin (FFN)

A

vaginal swab that tests for presence of fetal fibronectin

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16
Q

what does a negative FFN indicate?

A

woman will likely not deliver in the next 14 days

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17
Q

what does a positive FFN indicate?

A

doesn’t tell us much; it could be positive d/t vaginal manipulation (vag exam, sex)

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18
Q

maternal risks of preterm labor

A
  • underlying cause of PTL (bleeding, trauma, infection)
  • DVT
  • emotional concerns
  • S/E from meds used to treat PTL
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19
Q

fetal risks for preterm labor

A
  • mortality
  • immature body systems and lungs
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20
Q

if a baby born at ___ weeks (earliest a baby can survive) –> it has a ___% chance of acquiring respiratory distress syndrome and ___% survival rate.

A

24 weeks; 70%; 40%

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21
Q

management of preterm labor

A
  • pt education
  • tocolysis (tocolytic meds used to stop labor)
  • ritodrine
  • mag sulfate
  • CCB
  • prostaglandin synthetase inhibitors
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22
Q

what is the typical dosage of magnesium sulfate?

A

bolus: 4-6 g/20-30 min
maintenance: 2 g/hr

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23
Q

a patient presents with symptoms of visual changes, hot/flushed, and lethargic –> what do we do?

A

these are the expected symptoms of being on a magnesium drip

keep monitoring the patient

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24
Q

a patient on magnesium seems to have diminished reflexes upon her mag assessment –> what do we do?

A

we are concerned for mag toxicity, have the antidote on hand

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25
Q

antidote for magnesium sulfate

A

calcium gluconate

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26
Q

what do calcium channel blockers do in management of preterm labor?

A

reduce Ca from entering smooth muscle = prevent smooth muscles from contracting

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27
Q

what do prostaglandin inhibitors do in management of preterm labor?

A

prevent Ca from entering smooth muscles = prevent smooth muscles from contracting

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28
Q

what is a concern in contraction monitoring of management of preterm labor

A

concern if > 6 contractions/hr

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29
Q

placental abruption

A

separation of the placenta from the uterine wall

move toward emergent c/s!

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30
Q

how does a placental abruption affect the fetus?

A

isn’t getting blood, O2 & nutrients that it needs

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31
Q

how does a placental abruption affect the mother?

A

losing blood or could be hemorrhaging

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32
Q

marginal placental abruption

A

blood passes b/w fetal membranes and uterine wall and escapes vaginally = vaginal bleeding

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33
Q

central abruption placenta

A

separates centrally –> bleeding would be entrapped

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34
Q

complete abruption

A

most concerning!

massive vaginal bleeding, almost total separation –> fetus in tremendous amount of stress d/t not getting any nutrients or O2

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35
Q

how do we expect mom to look in a severe case of a placental abruption?

A

she will complain of rigid painful abdomen that can be enlarging

36
Q

placental previa

A

placenta improperly implants over the lower portion of the uterus and may cover the cervix

indication for c/s

37
Q

what is mom at risk for with a placental previa?

A

could be a hemorrhage situation = fetal distress

38
Q

nursing considerations for placental previa

A
  • no vag exams if bleeding
  • draw labs to see extent of blood loss
  • pad counts and frequency of which she’s saturating them
39
Q

previa vs. abruption

A

previa: bleeding!
abruption: painful! maybe, maybe not bleeding

40
Q

oligohydramnios

A

less than normal amount of amniotic fluid

41
Q

what is the fetus at risk for with olighydramnios?

A
  • practice breathing may be compromised = lung compliance issue
  • fluid is cushion for cord so if no cushion = variable decels
42
Q

polyhydramnios

A

great amount of amniotic fluid

43
Q

what does polyhydramnios put the pregnancy at risk for?

A
  • higher % of malpresentation or fetal presentations that are not vertex
  • if water breaks –> cord might prolapse = set up for lack of O2 to cord
44
Q

dystocia

A

abnormal labor pattern r/t cx, expulsion, fetal size, position, presentation, or size of the pelvis

45
Q

hypotonic labor patterns

A

hypotonic cx (lack tone)
- irregular cx
- lack intensity
- < 1 cm dilatation/hr

46
Q

interventions for hypotonic labor patterns

A
  • pitocin augmentation
  • amniotomy (AROM)
  • active management of labor
47
Q

tachysystole labor pattern

A

uterine hyperstimulation: > 5 cx per 10 min & not effective on dilation and effacement

can be very painful for moms

48
Q

management of tachysystole labor patterns

A
  • fetal assessment (ensure fetus isn’t stressed)
  • pain managment
  • pitocin (increases effect of cx)
  • amniotomy
49
Q

precipitous labor and delivery

A

entire labor and birthing process occurs within 3 hrs (cervix from being closed to delivering baby in 3 hrs)

50
Q

what can cause a precipitous labor and delivery?

A
  • low resistance of maternal soft tissues
  • abnormally strong cx
51
Q

maternal risks in precipitous labor and delivery

A
  • fear (little time for pain management)
  • lacerations
  • bleeding
52
Q

fetal risks in precipitous labor and delivery

A
  • hypoxia & fetal distress
  • meconium
  • injuries
  • low APGAR scores
53
Q

post dates pregnancy

A

pregnancy that lasts longer than 42 full weeks, beginning of 43 weeks

54
Q

risks of post dates pregnancy

A
  • induction
  • LGA
  • macrosomia
  • c/s
  • oligohydramnios
  • dysmaturity syndrome
55
Q

dysmaturity syndrome

A

associated with utero placental insufficiency; resembles IUGR

  • may be meconium aspiration
  • may be low blood sugar or seizures r/t low blood sugar
  • resp. distress
56
Q

macrosomia

A

fetal weight of more than 4000g

57
Q

what can contribute to macrosomia?

A
  • maternal obesity
  • diabetes
  • post term
  • multiparity
58
Q

maternal/fetal risks of macrosomia

A
  • dysfunctional labor
  • > chance of lacerations/episiotomy
  • > chance of instrumental delivery
  • bleeding
  • infection
  • shoulder dystocia
59
Q

what are the risks with a cord prolapse?

A

lack of blood flow = hypoxemia, bradycardia

59
Q

interventions of non-reassuring fetal status

A
  • 5 turns
  • scalp stimulation
  • internal monitors
59
Q

cord prolapse

A

umbilical cord falls into the vagina prior to delivery and becomes trapped b/w the pelvis and presenting part, interfering with blood flow

59
Q

what are the emergent interventions for a cord prolapse?

A
  • relieve cord compression
  • knee/chest position
  • prepare for c/s
60
Q

what causes a cord prolapse?

A

when the presenting part is not well applied

61
Q

retained placenta

A

30 minutes or more after delivery, the placenta has not delivered

manual removal or D&C (dilation & curettage surgery)

62
Q

placenta accreta

A

placental chorionic villi attach to the myometrium instead of endometrial lining

63
Q

placenta increta

A

placenta invades the myometrium

64
Q

placenta percreta

A

placenta penetrates the myometrium

65
Q

external version

A

manual movement of the fetus from breech or transverse to cephalic presentation

66
Q

when is an external version done?

A

done after 36 weeks

67
Q

criteria for an external version

A
  • must be adequate amniotic fluid and reassuring non-stress test and FHR
  • would not be done in high risk situations
68
Q

cervical ripening

A

softening and effacing the cervix prior to induction of labor

69
Q

medications for cervical ripening

A
  • cytotec
  • cervidil
70
Q

mechanical methods for cervical ripening

A

pressure from balloon on cervix

71
Q

labor induction

A

stimulation of cx prior to spontaneous labor

72
Q

labor augmentation

A

stimulation of cx in addition to spontaneously occurring cx

73
Q

bishop score

A

score of 9 is favorable
- < 9 is associated with long labor and higher c/s rates

74
Q

membrane stripping

A

manual separation of amniotic membranes
- thought to release prostaglandins and initiate labor b/w 24-48 hrs following

75
Q

oxytocin/pitocin infusion

A

goal is stimulate adequate cx that lead to dilatation

76
Q

nursing assessment following AROM

A
  • FHR and pattern
  • amount
  • color or fluid (abnormal: yellow, bloody, or green)
77
Q

amnioinfusion

A

administration of warmed sterile fluid into the uterus through an intrauterine pressure catheter

78
Q

what is the goal of an amnioinfusion

A

increase fluid volume to decrease umbilical cord compression or dilute meconium

79
Q

what are the risks associated with using forceps?

A

trauma to mom
- 3rd-4th degree lacerations
- more perineal pain PP

trauma to fetus
- small bruise/edema
- facial paralysis
- low APGAR score

80
Q

risks associated with using vacuum extraction

A
  • mom at increased risk for 3rd-4th degree laceration
  • fetus can have swelling, bruising to head = skin integrity issues
81
Q

vaginal birth after cesarean (VBAC)

A

viable and safe alternative for subsequent delivery if the prior indication is not recurring

82
Q

how successful are VBACs and what are their risks?

A
  • 60-80% successful (contraindicated in those with previous classical incision or uterine rupture)
  • risks: uterine rupture (RARE)

OB (8 decks)

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