Intrapartum complications Flashcards
Nursing, Care, PPROM
determine duration
Assess gestational age
Observe for infection
Assess fetal status
Maternal corticosteroid
Preterm labor
20–36 weeks
Uterine contractions, 4/20 minutes, 8/1 hour
Cervical change, dilation
ROM
Tocolytic meds
used to stop contractions
nifedipine
Magnesium sulfate
Terbutaline
Progesterone
What are corticosteroids used for in pregnancy?
to improve fetal lung development
Betamethasone
Cervical insufficiency
incompetent cervix
Painless, dilation of cervix without contractions
<25 mm before term
cerclage
Surgical option for closure of cervix with stitches
Prophylactic in multiple pregnancies
warning, signs of birth
Lower back pain
Pelvic pressure
Changes in discharge
Bleeding
Placenta previa
placental implantation in lower, uterine segment
Placental villi are torn from uterine wall
Painless, bleeding
Types of placenta previa
complete – placenta covers, full cervix
Partial – partial coverage
Marginal – near cervix
Low lying now on cervix
what is the main difference between placenta, previa and placenta abruption?
Placenta previa has soft, relaxed, uterine tone
T/F vaginal exams can be conducted with placenta previa
False
Placenta abruption
Premature separation of a center from uterine wall
types of placenta abruption’s
Marginal – placenta, separate at edges, vaginal bleeding
Central – separates centrally, concealed bleeding
Complete – total, separation, massive, bleeding
How is the severity of placenta abruption measured?
Grades one through three
What is the uterine tone with placenta abruption’s?
firm, board like
Normal weight gain for multiple gestation’s
40–45 pounds total
24 pounds x 24 weeks
amniotic fluid complications
hydramnios > 2000 ML
Oligohydramnios < 500
What’s the normal amount of amniotic fluid?
600–1000 ML
amniotic fluid embolism
Amniotic fluid leaks into maternal circulation through small tear of the uterus during placental separation or through cervical tears
Blocks vessels of lungs
High mortality
sx AF embolism
Chest pain
Dyspnea
Cyanosis
Frothy sputum
Tachycardia, hypotension
what is a key step to complete during CPR?
Displace the uterus
dystocia
Hypertonic contractions – tachysystole
> 5/10 minutes
Hypotonic, low intensity – <2-3/10 minutes
Nursing care for tachysystole
turn off Pitocin
Administer tocolytic
Change positions
nursing care for hypotonic
Consider CPD
Rule out malpresentation
Stimulate contractions – oxytocin augmentation
how many weeks is considered post term?
Greater than or equal to 42 weeks
Greater than estimated delivery date
Malposition care
mother rotate side to side
Knee to chest
Hands to knees
Rotate fetal head during labor
Malpresentation
shoulder, brow or face
Breach
Version
Turning fetus counterclockwise in utero
nursing care for version
Consent
ultrasound
IV access
Terbutaline
NPO eight hours
Reactive, NST
RhoGAM if negative
Examples of non-reassuring fetal status
meconium stained AF
Persistent late decelerations
Bradycardia, tachycardia
Decrease movement
Umbilical cord prolapse
Umbilical cord proceeds presenting fetal part and is compressed against the pelvis
Nursing care for umbilical cord prolapse
bedrest
Keep gloves, fingers in vagina to relieve pressure during vaginal exam
Position for gravity
02 if needed
cephalic, disproportion, maternal risks
Prolonged labor
Risk of rupture
Risk of forceps assisted or vacuum assisted delivery
Risk for C/S
cephalic disproportion fetal risks
Cord prolapse
Excessive molding
Bruising
Head nerve trauma
what should be done if true cephalic disproportion is occurring
C-section
Macrosomia
Large fetus greater than 4000 g
Shoulder dystocia
Shoulders and trapped behind, super pubic bone
What should be done to care for shoulder dystocia?
Superpubic pressure downward
T/F fundal pressure should be applied in shoulder dystocia
False
how long is considered retained placenta?
Greater than 30 minutes post delivery
lacerations
Spontaneous, tearing of perineal area, despite firm fundus
Bright red blood persists
placenta accreta
Chorionic villi attached directly to uterine myometrium
Attaches
placenta increta
Myometrium invaded
placenta percreta
Myometrium penetrated, sometimes attaches to other organs
What delivery or procedure method should be completed during the different types of placenta adherences
hysterectomy
Deliver less than 38 weeks
