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MIN Exam 2 > Intrapartal Complications > Flashcards

Intrapartal Complications Flashcards

1
Q

Premature ROM

A

-defined as SROM 1 hour or more before labor starts

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2
Q

PPROM

A

occuring before 37 weeks either as a slow leak of fluid or gush

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3
Q

Risk factors for PROM

A
  • infections
  • hx of PROM
  • hydraminos
  • multiple pregnancy
  • cervical insufficiency
  • anything that adds stress to amniotic structures
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4
Q

Chorioamnionitis

A

inflammation and infection in fetal membranes and amniotic fluid

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5
Q

endometritis

A

infection of the uterine endometritum

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6
Q

PPROM Fetal Risks

A
  • RDS
  • Sepsis
  • umbilical cord compression or prolapse
  • other complications r/t preterm birth
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7
Q

Diagnosis of PROM

A
  • speculum exam - pooling
  • nitrazine test
  • fern test
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8
Q

fern test

A

refers to detection of a characteristic ‘fern like’ pattern of cervical mucus when a specimen of cervical mucus is allowed to dry on a glass slide and is viewed under a low power microscope.

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9
Q

Management of PROM

A
  • fetal age and presence/absence of infection determine management plan
  • if infection is present, start antibiotics on mother and deliver
  • assess neonate and start antibiotics
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10
Q

Medical Management of PPROM

A
  • hospitalize
  • assess for infection
  • labs: CBC, CRP, UA, C/S and cultures
  • determine gestational age
  • assess fetal well being
  • betmethazone
  • by 24 wks, assess fetal lung maturity
  • patient and family support and teaching
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11
Q

Nursing Management of PPROM

A
  • hx: ROM time, quantity, quality of fluid, signifiant OB gyn problems
  • PE: continously assess for signs of infection and assess hydration status
  • assess knowledge base, coping ability and educate
  • monitor for infection
  • montior well being of mom and baby
  • maintain optimal comfort
  • prepare/support for C/S, neonatal care or demise
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12
Q

Preterm Labor

A
  • labor occurring between 20-36 weeks with documented CTX and cervical changes
  • disproportionate # of women are socio-economically underprivileged
  • ACOG defines PTL as prior to 37 weeks
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13
Q

Preterm birth and prematurity

A

describes length of gestation regardless of birth weight

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14
Q

Low birth weight

A

-only considers a birth weight of less than 2500 gm

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15
Q

Preterm births account for…

A

about 10 percent of all births

-US and state of florida gets a “C” grade for pre-term birth rates

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16
Q

Risk factors for PTL

A
  • age
  • infections esp UTI and vaginal
  • cervical incompetence
  • bleeding
  • substance abuse
  • multiple gestation
  • polyhydraminios
  • anatomic abnormalities
  • stress
  • sex
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17
Q

Shorter Cervical Length

A
  • Average CL at 24 weeks is 3.5
  • 20 percent probability of PTL is CL less than 2.2
  • when CL less than 1.5 risk of PTL reaches 50 percent
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18
Q

Fetal Fibronectin

A

negative predictive value of approx 96 percent for not delivering within next 2 wks

  • positive test has approx 20 percent predictive value for preterm delivery (bet. 24-34 wks)
  • so, a positive test means preterm delivery is: ????
  • negative test means: ????
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19
Q

Classic symptoms of preterm labor

A
  • UTI
  • cramping
  • CTX
  • pelvic pressure
  • backache
  • vaginal d/c or ROM
  • bleeding
  • diarrhea
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20
Q

Prevention and Tx of PTL

A
  • primary and secondary prevention suggests looking at high risk pts
  • approx 50 percent of preterm births occur in women considered low risk
  • current research reflects the use to tocolytics to be overrated and BR may not be as effective as was once believed
21
Q

BMS

A

Betamethasone

-halting labor progression for 48 hours can buy time to give mother 2 injections 24 hours apart to promote fetal lung maturity

22
Q

Tocolytics

A

drugs that attempt to stop labor

-potentially serious side effects necessitate close monitoring

23
Q

Magnesium Sulfate

A
  • CNS depression

- ADR: resp depression, pulmonary edema, hypotension, cardiac arrest

24
Q

Beta-agent: Terbutaline

A
  • B-adrenergic agonist

- ADR: hypotension arrhythmias, pulmonary edema, MI, hyperglycemia, and hypokalemia

25
Q

CA+ Channel blockers: Nifedipine

A
  • smooth muscle relax, vasodilation

- ADR: profound hypotension and decrease in placental perfusion

26
Q

Lifestyle modifications to decrease PTL

A
  • sex
  • riding long distanes in car/bus
  • carrying heavy loads
  • standing more than 50 percent of time
  • heavy housework or climbing stairs
  • hard physical work
  • being unable to stop and rest when tired
27
Q

Teaching self care for PTL

A
  • empty bladder
  • lie down tilted toward left side
  • drink 24-32 oz of fluid
  • soak in warm tub with uterus submerged
  • rest 30 minutes after symptoms stop
  • if symptoms persist contact practitioner
28
Q

Management of inevitable preterm birth

A
  • labor progressed to cervical dilation of 4 cm likely leads to inevitable preterm birth
  • perterm births in tertiary care centers lead to better mother/baby outcomes
  • women at risk should be transferred quickly to ensure best outcome
  • first dose of antenatal glucocorticoids should be given before transfer
29
Q

Progesterone to prevent preterm birth in high risk women

A
  • tx based on whomen who are considered high risk due to short cervix or hx of preterm birth
  • approved in 2011
  • given vaginal or IM until 36 wks gestation
  • Side effects include vaginal irritation, sleepiness, HA, and breast tenderness
30
Q

Umbilical Cord Prolapse

A

Umbilical cord passes through the cervix at the same time or in advance of the fetal presenting part

-cord can become compressed, leading to fetal hypoxia

31
Q

Risk factors for prolapsed cord

A
  • breech or transverse position
  • long cord
  • low lying placenta
  • hydraminos multi-gestation
  • small fetus
32
Q

What to do for prolapsed cord

A
  • position knee-chest or Sim’s and give O2
  • if head is pressing on cord, apply gentle pressure to head
  • consider tocolytic until help arrives
  • vago’s method: bladder filling
  • fetal and maternal monitoring
  • emergency C/S if rapid vaginal delivery not realistic
  • emotional support
33
Q

Placenta Previa

A
  • implantation of placenta is lower than normal in the uterus
  • may cover cervical os
34
Q

Symptoms of placenta previa

A
  • no pain, quiet onset
  • small to heavy external bleeding
  • BRB
  • normal uterine tone
  • abnormal fetal position
  • fundal ht unchanged
  • occasional shock
35
Q

Risk factors of placenta previa

A
  • multi-parity
  • increased age
  • prior C/S
  • large placenta
  • recent abortion
  • smoking
  • defective blood vessels in decidua

-exact cause unknown

36
Q

Management Plan for Placenta Previa

A
  • BR with BRP only if woman not bleeding
  • No vaginal exams
  • Monitor for blood loss, pain, contractions -Maternal and fetal VS monitoring
  • H&H, Rh, UA, chemistries
  • IV LR on pump
  • Type & Cross 2 units. -Betamethasone if needed
  • Assess need for C/S
37
Q

Placenta Abruptio

A

premature separation of the placenta from the uterine wall

-variable prognosis depending upon degree

38
Q

Greatest risk factor for abruptio placenta

A

HTN (chronic or gestational)

followed by advanced age, high parity, race, cocaine/tobacco, trauma, internal monitoring, and short cord

39
Q

Complete abruptio

A

usually results in certain fetal demise and maternal outcomes are often poor

40
Q

prognosis of abruptio

A

more than 50% placenta abruption ends in certain fetal demise

41
Q

Severe cases of abruptio requires…

A

hysterectomy and predispose mother to DIC

42
Q

Marginal

A

-blood passes between fetal membranes and uterine wall escaping through vagina with separation occurring at the edges

43
Q

Central

A

blood is trapped between placenta and uterine wall

44
Q

Complete

A

massive vaginal bleeding seen in presence of almost total separation

45
Q

DIC

A

Disseminated Intravascular Coagulation

  • a true obstetric emergency
  • DIC results in hemorrhage, anemia, and ischemia
  • obstetric causation r/t abruptio placenta, retained dead fetus, amniotic fluid embolus, severe preeclampsia, HELLP syndrome, or gram negative sepsis
46
Q

DIC Lab Findings

A
  • increased PT and PTT
  • thrombocytopenia
  • presence of fibrin split products will confirm diagnosis
47
Q

Uterine Rupture

A
  • rare and life threatening event
  • seen with tearing of a uterine scar, the result of abdominal trauma or when a congenital defect in the uterus is present
48
Q

Risk factors for uterine rupture

A
  • multips
  • multi-gestation pregnancies
  • hyper-stimulation of uterus
  • mal-position of fetus
  • difficult deliveries
49
Q

Management of Rupture

A
  • asses mother for syncope, shock, N/V, abdominal pain, FTP, and hypotonic CTX
  • assess fetus for late decels, decreased variability and changes in HR

Obstetric emergency: C/S

MIN Exam 2 (6 decks)

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