Intrapartum Complication Flashcards
What is the definition of preterm labor?
Labor that occurs between 20 and 37 completed weeks of pregnancy is referred to as preterm labor
Who are at highest risk for preterm labor?
African-American women experience, preterm birth at higher rate than do women of other groups
Women who have had a previous preterm birth are also at high-risk
How do you recognize preterm labor?
Pain in abdomen, back or pelvis
Menstrual like cramps
Rupture of membranes
Vaginal bleeding
Vaginal discharge
Pelvic pressure
Urinary frequency
Diarrhea
What is the most critical risk for baby following pre term birth
An immature respiratory system that cannot support life
Prematurity is the number one cause of what?
Neurological disabilities. The more premature, the higher the risk of neurological disabilities
What are some clinical therapies to stop pre term labour!?
Bed rest
Primary prevention
Secondary prevention
What is primary prevention to stop preterm labor?
Cervical cerclage (sowing cervix shut)
Progesterone administration
Diagnosis and treatment of infections, such as:
- bacterial vaginosis (BV)
- trichomonas
- chlamydia
- group b strep
- gonorrhea
- urinary tract infections
What are secondary prevention to stop preterm labor?
Antibiotic treatment
Tocolysis (the use of medication’s in an attempt to stop or delay labor)
- magnesium sulfate
- Calcium channel blockers (nifedipine)
Also, strongly recommended for women in preterm labor is treatment with corticosteroids, which can boost fetal lung maturity. Examples in include: betamethasone, dexamethasone
What is the definition of prom?
Premature rupture of membranes is a spontaneous rupture of the membranes before the onset of labor
What is preterm prom (PPROM)?
Ruptures of the membrane before 37 weeks of gestation
What are the maternal risks of prom?
Infections such as:
- chorioamnionitis
- endometritis
Placental abruption
What are the fetal risks of prom?
Respiratory distress syndrome
Necrotizing enterocolitis
Intraventricular hemorrhage
Sepsis
Hypoxia due to umbilical cord prolapse, or cord compression
Oglihyramnios leading to pulmonary hypoplasia, fetal abnormalities, and growth restriction
What are the goals for treating prom?
Prolonging the gestation to at least 34 weeks to allow fetus more time to mature
Preventing infection
Inducing labor if 34 weeks gestation is reached
What is the nursing care for prom?
Record details of prom such as date, time, color, odor of fluid
Prevent umbilical cord prolapse
Be alert for signs of infections, such as elevated temperature or tachycardia in mom or baby
Evaluate electronic fetal monitoring tracing
Limit vaginal exams
Patient teaching
What is abruptio placentae (placental abruption)
Is premature separation of the placenta from the wall of the uterus
What is placenta previa?
The placenta is implanted improperly in the lower uterine segment, and may cover all or part of the cervical os (opening)
What is cervical insufficiency?
Cervical insufficiency is painless dilation of the cervix without contractions due to a structural or functional defect
Previously known as incompetent cervix
What are some contributing factors for cervical insufficiency?
Congenital
Acquired
Hormonal
What is multiple gestation?
Any pregnancy with two or more babies
Mom and babies have higher risk in a multiple gestation pregnancy, these risks include:
Spontaneous abortion (preganncy loss)
Gestational diabetes
Hypertension
HELLP syndrome
Pulmonary embolism
Preterm labor
Preterm rupture of membranes
What is HELLP?
hemolysis, elevated liver enzymes, low platelet count
Complication of hypertension during pregnancy
What is the medical care goals for multiple gestations?
Promote normal fetal development
Prevent maternal complications
Prevent preterm birth
Diminished fetal trauma during labor
For multiple gestation pregnancy what type of delivery is preferred?
Cesarean
What is the nursing care for multiple gestations in the prenatal phase?
Careful history taking
Report greater than expected fundal height
Teaching and support for parents
Nursing care for multiple gestations during the intrapartum phase
Monitor heart rates of both twins during labor
Prepare additional equipment and documentation
Additional staff on hand for delivery
What is hydramnios
Also known as polyhydramnios, it is defined as over 2000 ml of amniotic fluid, and occurs in about 1% of pregnancies
Associated with congenital anomalies and preterm birth
What is oligohydramnios
Defined as less than a normal amount of amniotic fluid (approx 500 ml)
Associated with:
Renal malformations
Post maturity
Placental insufficiency
Who is at the highest risk for placental abruption
Risk is highest for those women who have had previous abruption
What are risk factors for placental abruption?
Hypertension
Abdominal trauma
Smoking
Cocaine use
Advanced maternal age
Multiple gestation
Prom
Chorio
What are the three types of placenta abruption?
Marginal
Central
Complete
What is marginal placenta abruption
Separation begins at edges of placenta
Dark red blood can escape vaginally
May not cause increase abdominal pain
Can put baby at risk for preterm labor, anemia, hypoxia, and brain damage
What is central placenta abruption
Separation begins from center
Blood is trapped behind placenta
Extremely tender abdomen
Abdominal girth increases due to trapped bleeding
Can progress to rigid, board like abdomen
Wide range of consequences for mother and baby
What is complete placenta abruption
Massive vaginal bleeding due to almost complete separation of placenta
Most severe cases can progressive to fetal death
Hemorrhagic shock, or disseminated intravascular coagulation (DIC) possible for mother, which can be fatal
Nursing care for placental abruption
Evaluate FHR and uterine tone
Establish large bore IV line
Monitor intake and output carefully
Be prepared to hydrate with ringers lactate or blood products
Measure abdominal girth
What are the degrees of placenta previa
Grade 1: placenta lies in lower uterine
Grade 2: marginal
Grade 3: partial
Grade 4: total
