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Womens Health Exam 2 > Intrapartum Complication > Flashcards

Intrapartum Complication Flashcards

1
Q

What is the definition of preterm labor?

A

Labor that occurs between 20 and 37 completed weeks of pregnancy is referred to as preterm labor

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2
Q

Who are at highest risk for preterm labor?

A

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

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3
Q

How do you recognize preterm labor?

A

Pain in abdomen, back or pelvis

Menstrual like cramps

Rupture of membranes

Vaginal bleeding

Vaginal discharge

Pelvic pressure

Urinary frequency

Diarrhea

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4
Q

What is the most critical risk for baby following pre term birth

A

An immature respiratory system that cannot support life

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5
Q

Prematurity is the number one cause of what?

A

Neurological disabilities. The more premature, the higher the risk of neurological disabilities

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6
Q

What are some clinical therapies to stop pre term labour!?

A

Bed rest

Primary prevention

Secondary prevention

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7
Q

What is primary prevention to stop preterm labor?

A

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

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8
Q

What are secondary prevention to stop preterm labor?

A

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

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9
Q

What is the definition of prom?

A

Premature rupture of membranes is a spontaneous rupture of the membranes before the onset of labor

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10
Q

What is preterm prom (PPROM)?

A

Ruptures of the membrane before 37 weeks of gestation

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11
Q

What are the maternal risks of prom?

A

Infections such as:
- chorioamnionitis
- endometritis

Placental abruption

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12
Q

What are the fetal risks of prom?

A

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

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13
Q

What are the goals for treating prom?

A

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

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14
Q

What is the nursing care for prom?

A

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

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15
Q

What is abruptio placentae (placental abruption)

A

Is premature separation of the placenta from the wall of the uterus

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16
Q

What is placenta previa?

A

The placenta is implanted improperly in the lower uterine segment, and may cover all or part of the cervical os (opening)

17
Q

What is cervical insufficiency?

A

Cervical insufficiency is painless dilation of the cervix without contractions due to a structural or functional defect

Previously known as incompetent cervix

18
Q

What are some contributing factors for cervical insufficiency?

A

Congenital

Acquired

Hormonal

19
Q

What is multiple gestation?

A

Any pregnancy with two or more babies

20
Q

Mom and babies have higher risk in a multiple gestation pregnancy, these risks include:

A

Spontaneous abortion (preganncy loss)

Gestational diabetes

Hypertension

HELLP syndrome

Pulmonary embolism

Preterm labor

Preterm rupture of membranes

21
Q

What is HELLP?

A

hemolysis, elevated liver enzymes, low platelet count

Complication of hypertension during pregnancy

22
Q

What is the medical care goals for multiple gestations?

A

Promote normal fetal development

Prevent maternal complications

Prevent preterm birth

Diminished fetal trauma during labor

23
Q

For multiple gestation pregnancy what type of delivery is preferred?

A

Cesarean

24
Q

What is the nursing care for multiple gestations in the prenatal phase?

A

Careful history taking

Report greater than expected fundal height

Teaching and support for parents

25
Q

Nursing care for multiple gestations during the intrapartum phase

A

Monitor heart rates of both twins during labor

Prepare additional equipment and documentation

Additional staff on hand for delivery

26
Q

What is hydramnios

A

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

27
Q

What is oligohydramnios

A

Defined as less than a normal amount of amniotic fluid (approx 500 ml)

Associated with:
Renal malformations
Post maturity
Placental insufficiency

28
Q

Who is at the highest risk for placental abruption

A

Risk is highest for those women who have had previous abruption

29
Q

What are risk factors for placental abruption?

A

Hypertension

Abdominal trauma

Smoking

Cocaine use

Advanced maternal age

Multiple gestation

Prom

Chorio

30
Q

What are the three types of placenta abruption?

A

Marginal

Central

Complete

31
Q

What is marginal placenta abruption

A

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

32
Q

What is central placenta abruption

A

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

33
Q

What is complete placenta abruption

A

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

34
Q

Nursing care for placental abruption

A

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

35
Q

What are the degrees of placenta previa

A

Grade 1: placenta lies in lower uterine

Grade 2: marginal

Grade 3: partial

Grade 4: total

Womens Health Exam 2 (9 decks)

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