Intrapartum Care Flashcards
Preterm Labor and Birth
Preterm labor and birth Preterm birth vs. low birth weight Spontaneous vs. Indicated preterm birth Risk factors Cervical length Fetal fibronectin test
Signs and Symptoms of Preterm Labor
Vaginal discharge changes Pelvic or lower abdominal pressure Backache Abdominal cramps Contractions Ruptured membranes
Care Management
Continuous Assessment Interventions Prevention Early recognition and diagnosis Lifestyle modifications Activity restriction Restriction of sexual activity Home care Tocolytics
Premature Rupture of Membranes (PROM)
PROM
Rupture of amniotic sac and leakage of amniotic fluid beginning at least 1 hour before onset of labor at any gestational age
PPROM: Preterm premature rupture of membranes
Membrane rupture before 37 0/7 weeks of gestation
Infection is a major risk factor
Pathologic weakening of the amniotic membranes
Inflammation
Stress from uterine contractions
Other factors
Chorioamnionitis
Bacterial infection of the amniotic cavity Major cause of complications 1% to 5% of term births 25% of preterm births Clinical findings Maternal fever Fetal tachycardia Uterine tenderness Foul odor of amniotic fluid
Postterm Pregnancy, Labor, and Birth
A pregnancy that extends beyond the end of 42 weeks gestation
Maternal and fetal risks
Care management
Dysfunctional Labor (Dystocia)
Defined as long, difficult, or abnormal labor
Ineffective uterine contractions (powers)
Latent & active phase disorders
Secondary powers
Abnormal labor patterns
Precipitous labor
Conditions associated
Maternal and fetal complications
Alterations in pelvic structure (passage)
Pelvic dystocia
Soft-tissue dystocia
Obstetric Procedures
Version External cephalic version Induction of labor Elective induction Bishop score 39 weeks or greater Cervical ripening methods Chemical agents—Prostaglandins Mechanical and physical methods Alternative methods Amniotomy Oxytocin Hormone normally produced by posterior pituitary gland Stimulates uterine contractions Used to induce labor or augment a labor progressing slowly because of inadequate uterine contractions
Oxytocin—High alert medication
Placental abruption Uterine rupture Unnecessary cesarean birth After birth hemorrhage Infection Fetal hypoxemia and acidemia
Cesarean birth
Indications Elective cesarean birth Scheduled cesarean birth Unplanned cesarean birth Forced cesarean birth Surgical techniques Complications and risks Anesthesia Cesarean birth (Cont.) Care management Prenatal preparation Preoperative care Intraoperative care Immediate postoperative care Postoperative after birth care Nursing interventions
Trial of labor (TOL)
Observation of a woman and her fetus for a specified length of time to assess safety of vaginal birth
Vaginal birth after cesarean (VBAC)
Indications for primary cesarean birth such as dystocia, breech presentation, or fetal distress often are nonrecurring
May be a candidate to attempt vaginal birth
Meconium-stained amniotic fluid
Indicates that the fetus has passed the first stool before birth
Three possible reasons
Place of the infant at risk for meconium aspiration syndrome
Requires the team skilled in neonatal resuscitation
Shoulder dystocia
Head is born, but anterior shoulder cannot pass under pubic arch
Newborn is more likely to experience birth injuries
Brachial plexus
Maternal complications
Hemorrhage
Rectal injuries
Care management
Prolapsed umbilical cord
When cord lies below presenting part of fetus Contributing factors include Long cord (longer than 100 cm) Malpresentation (breech) Transverse lie Unengaged presenting part Care management
