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NUR 332 > Intrapartum Complications > Flashcards

Intrapartum Complications Flashcards

1
Q

PROM

A

premature rupture of membranes
- before onset of labor

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2
Q

PPROM

A

preterm premature rupture of membranes
- before 37 weeks

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3
Q

fetal new born risks with PROM

A
  • resp distress syndrome (need fluid for lung development)
  • fetal sepsis
  • malpresentation (need fluid for rotation)
  • prolapse of cord
  • non reassuring FHR pattern
  • compression of umbilical cord (inc variables bc dec cushion)
  • premature birth
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4
Q

betamethasone

A

corticosteroid that enhances fetal lung maturity

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5
Q

preterm labor or premature onset of labor

A

labor that occurs between 20-36 weeks

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6
Q

s/s of preterm labor

A
  • uterine contractions at least 4 in 20 mins or 8 in 1 hr
  • cervical changes (dilation)
  • cramps felt in low abdomen
  • constant or intermittent feelings of pelvic pressure
  • ruptured membranes
  • low, dull backache
  • inc vaginal discharge
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7
Q

strongest predictors of preterm birth

A
  • fetal fibronectin: +
  • cervical length: shortening or thinning (less than 25 mm before birth)
  • hx of preterm
  • infection
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8
Q

what is fibronectin

A

what keeps everything like the amniotic sac in the uterus

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9
Q

what are tocolytics

A

meds that stop contractions

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10
Q

what meds are tocolytics

A

nifedipine
mag sulfate
terbutaline
progesterone therapy

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11
Q

nifdipine

A

helps relax uterine muscles
- dont give if SBP under 90
- monitor BP closely

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12
Q

mag sulfate

A

smooth muscle relaxer
- monitor alertness, RR, BP, reflexes, I&Os
s/s might be lower but should still be present

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13
Q

terbutaline

A

relaxes muscle contractions
- can cause tachycardia so do not give if over 120

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14
Q

progesterone therapy

A

helps sustain therapy
- given at night time
- delays birth

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15
Q

what is cervical insufficiency

A

painless dilation of cervix without contractions cervical defect
- less than 25 mm
- previous miscarriages without contractions

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16
Q

treating cervical insufficiency

A
  • ultrasound to assess
  • bed rest
  • progesterone
  • abx if cerclage (dont need whole pregnancy)
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17
Q

what is cerclage

A

surgical closure of cervix using sutures
- prophylactic if twins +
- monitor for bleeding
- cut before delivery

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18
Q

diagnosis cervical insufficiency

A

transvaginal ultrasound 16-24 weeks

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19
Q

warning signs of impending birth

A
  • back pain
  • pelvic pressure
  • changes in vaginal discharge
  • bleeding
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20
Q

placenta previa

A

placenta implantation in the lower uterine segment

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21
Q

problems with placenta previa during birth

A

lower uterine segment contracts and dilates
placental villi are torn from uterine wall
bright red, painless bleeding occurs

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22
Q

types of placenta previa

A

complete
partial
marginal
low lying

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23
Q

nursing care for placenta previa

A

no vaginal exams
assess for bleeding
VS, fetal status
anticipate unengaged fetal presenting parts
transverse lie is common
consent for c/s

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24
Q

drugs used for placenta previa

A

mag sulfate
nifedepine
terbutaline

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25
abruption placentae
premature separation of a normally implanted placenta from the uterine wall
26
types of abruption plancentae
marginal: separates at edges central: separates centrally complete: total separation, BLEEDING
27
grades of abruption placentae
grade 1: mild, slight vaginal bleeding grade 2: partial, moderate bleeding grade 3: moderate to severe bleeding
28
main differences between placenta previa and abruption placentae
abruption: severe and steady plain, tenderness, firm and stony hard, likely enlarges and changes shape
29
care for abruption placentae
- external fetal monitoring - monitor for pain - monitor abdominal growth - monitor for DIC (coags) - maintain stable cardio status - c/s is safest
30
multiple gestation discomforts
- shortness of breath - backache - heart burn - round ligament pain - pedal edema
31
comfort measures for multiple gestation
- frequent rest period - side lying with lower legs and feet elevated - relief of back discomfort: pelvic rocking, good posture, good body mechanics
32
multiple gestation nursing care
- frequent prenatal visits - prenatal vitamins - 1 mg folic acid - 24 wt gain my 24 wks (40-45 lbs gain) - serial ultrasounds - c/s likely
33
normal amniotic fluid
600-1000 ml
34
hydramnios (poly)
more than 2000 ml - amniocentesis
35
oligohydramnios
less than 500 ml - renal and urinary malformations - skin and skeletal abnormalities - pulm hypoplasia (underdeveloped lungs) - cord compression
36
amniotic fluid embolism - anaphylactoid syndrome
amniotic fluid leaks into maternal circulation through a small tear in amniotic sac - happens during placental separation or contracting - embolism blocks vessels in the lungs - rare but 80-90% mortality
37
amniotic fluid embolism sx
chest pain dyspnea cyanosis frothy sputum tachycardia hypotension massive hemorrhage
38
amniotic fluid embolism care
stabilize cardio and resp system CPR --> displace uterus if 20 wk + bc will prevent good blood flow blood infusion CVC maybe immediate birth
39
dysfunctional labor patterns
hypotonic and hypertonic contractions
40
hypertonic contractions
more than 5 contractions in 10 mins
41
hypotonic contractions
2-3 contractions in 10 mins - low intensity
42
hypertonic contraction care
- change positions - turn off oxy - terbutaline - sedation, pain meds
43
hypotonic contraction care
- consider CPD - rule out malpresentation - adequate hydration - s/s of infection - give oxy
44
post term pregnancy
beyond estimated date of birth post term: beyond 42 wks
45
maternal risk of post term pregnancy
perineal damage hemorrhage inc risk of c/s anxiety emotional fatigue persistance of normal discomforts
46
fetal risks of post term pregnancy
dec perfusion oligohydramnios small for gest age macrosomia inc risk for meconium stained fluid which inc risk for aspiration
47
malposition
persistent occiput posterior position - mother rotates from side to side - knee to chest position - hands and knees position - HCP may manually rotate fetal head
48
malpresentation
- shoulder presentation - brow presentation - face presentation - breech (frank, complete, footling)
49
version
turning of the fetus in utero - external cephalic version: external manipulation of maternal abdomen to change fetus from breech to cephalic - podalic version: internal, used in delivery of 2nd twin, less common
50
care during ECV
- consent - ultrasound - IV access - terbutaline - fasting 8 hrs - fetal monitoring - rhogam if in -
51
non reassuring fetal status
- brady or tachy - dec fetal movement - meconium stained amniotic fluid - persistent late variables
52
umbilical cord prolapse
umbilical cord precedes presenting fetal part and gets compressed against pelvis - prevention is key
53
umbilical cord prolapse nursing care
- keep gloved fingers in vagina to relive pressure - position for gravity to help relieve pressure - position in knee to chest or trendelenburg - oxygen - prepare for c/s
54
cephalopelvic disproportion
head is too big to pass through pelvis - c/s
55
macrosomia
large fetus (4000+ g) - risks: dysfunctional labor, uterine rupture, perineal laceration, postpartum hemorrhage, shoulder dystocia
56
if vaginal delivery for macrosomia baby
- lack of fetal descent should be indicator - unexpected shoulder dystocia - McRoberts maneuver or apply suprapubic pressure - application of fundal pressure contraindicated
57
shoulder dystocia
shoulder entrapped behind suprapubic bone
58
dangers of shoulder dystocia
brain damage from hypoxia brachia plexus damage umbilical cord compression
59
interventions for shoulder dystocia
- lower HOB - McRobert's maneuver - suprapubic pressure - document intervention and length of time
60
third and fourth stage of labor complication
retained placenta lacerations placental adherence (accreta, increta, percreta)
61
retained placenta
retention of placenta beyond 30 mins after birth - bleeding can be excessive - may require manual removal - possible blood transfusion
62
lacerations
spontaneous tearing of the perineal area - bright red vaginal bleeding that persists despite well contracted uterus - observe bleeding and approximation during postpartum
63
accreta
chorionic villi attach directly to the uterine myometrium
64
increta
chorionic villi invade myometrium
65
percreta
chorionic villi penetrate myometrium, sometimes attaching to nearby organs
66
placenta adherence
abnormal adherence of placenta to uterine wall - associated with hemorrhage and failed separation at birth - high incidence of abdominal hysterectomy
67
care for placenta adherence
monitor for bleeding deliver before 38 wks type and cross hysterectomy to prevent maternal hemorrhage general surgeon may be need to repair

NUR 332 (3 decks)

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