Intrapartum Complication

Question 1

What is the definition of preterm labor?

Answer 1

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

Question 2

Who are at highest risk for preterm labor?

Answer 2

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

Question 3

How do you recognize preterm labor?

Answer 3

Pain in abdomen, back or pelvis

Menstrual like cramps

Rupture of membranes

Vaginal bleeding

Vaginal discharge

Pelvic pressure

Urinary frequency

Diarrhea

Question 4

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

Answer 4

An immature respiratory system that cannot support life

Question 5

Prematurity is the number one cause of what?

Answer 5

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

Question 6

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

Answer 6

Bed rest

Primary prevention

Secondary prevention

Question 7

What is primary prevention to stop preterm labor?

Answer 7

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

Question 8

What are secondary prevention to stop preterm labor?

Answer 8

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

Question 9

What is the definition of prom?

Answer 9

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

Question 10

What is preterm prom (PPROM)?

Answer 10

Ruptures of the membrane before 37 weeks of gestation

Question 11

What are the maternal risks of prom?

Answer 11

Infections such as:
- chorioamnionitis
- endometritis

Placental abruption

Question 12

What are the fetal risks of prom?

Answer 12

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

Question 13

What are the goals for treating prom?

Answer 13

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

Question 14

What is the nursing care for prom?

Answer 14

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

Question 15

What is abruptio placentae (placental abruption)

Answer 15

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

Question 16

What is placenta previa?

Answer 16

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

Question 17

What is cervical insufficiency?

Answer 17

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

Previously known as incompetent cervix

Question 18

What are some contributing factors for cervical insufficiency?

Answer 18

Congenital

Acquired

Hormonal

Question 19

What is multiple gestation?

Answer 19

Any pregnancy with two or more babies

Question 20

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

Answer 20

Spontaneous abortion (preganncy loss)

Gestational diabetes

Hypertension

HELLP syndrome

Pulmonary embolism

Preterm labor

Preterm rupture of membranes

Question 21

What is HELLP?

Answer 21

hemolysis, elevated liver enzymes, low platelet count

Complication of hypertension during pregnancy

Question 22

What is the medical care goals for multiple gestations?

Answer 22

Promote normal fetal development

Prevent maternal complications

Prevent preterm birth

Diminished fetal trauma during labor

Question 23

For multiple gestation pregnancy what type of delivery is preferred?

Answer 23

Cesarean

Question 24

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

Answer 24

Careful history taking

Report greater than expected fundal height

Teaching and support for parents

Question 25

Nursing care for multiple gestations during the intrapartum phase

Answer 25

Monitor heart rates of both twins during labor Prepare additional equipment and documentation Additional staff on hand for delivery

Question 26

What is hydramnios

Answer 26

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

Question 27

What is oligohydramnios

Answer 27

Defined as less than a normal amount of amniotic fluid (approx 500 ml) Associated with: Renal malformations Post maturity Placental insufficiency

Question 28

Who is at the highest risk for placental abruption

Answer 28

Risk is highest for those women who have had previous abruption

Question 29

What are risk factors for placental abruption?

Answer 29

Hypertension Abdominal trauma Smoking Cocaine use Advanced maternal age Multiple gestation Prom Chorio

Question 30

What are the three types of placenta abruption?

Answer 30

Marginal Central Complete

Question 31

What is marginal placenta abruption

Answer 31

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

Question 32

What is central placenta abruption

Answer 32

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

Question 33

What is complete placenta abruption

Answer 33

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

Question 34

Nursing care for placental abruption

Answer 34

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

Question 35

What are the degrees of placenta previa

Answer 35

Grade 1: placenta lies in lower uterine Grade 2: marginal Grade 3: partial Grade 4: total