INTRAPARTUM COMPLICATIONS: Flashcards
Dystocia
Cause:?
Difficult Labor/ birth
- Caused by: dysfunctional or uncoordinated contractions.
— Irregular in strength, timing or both.
Shoulder Dystocia:
- Urgent-umbilical cord can be compressed
- Turtle sign- Head retracts into perineum after delivery-*may prevent respirations
McRobert’s maneuver:
Used to treat Shoulder dystocia
Hypertonic Labor:
- More frequent but less intense and ineffective.
- Painful- related to no resting phase; (causes tissue ischemia)
- Delays dilation and effacement
- Prolonged latent stage
- Prolonged pressure on the fetal head
Precipitous Labor & Birth:
- contributing factors:
Labor that lasts less than 3 hours
Contributing factors:
- Multiparity
- Placental abruption
- Infection (causes uterine cramping and contractions)
- Large pelvis
- Previous precipitous labor
- Small fetus in favorable position
Precipitous Labor & Birth: Priority
Interventions: ?
promote fetal oxygenation and maternal comfort
Interventions:???
- Side-Lying
- Administer O2
- Stop Pitocin
- Administer tocolytic
- Breathing techniques
Risks to the Mother of precipitous Labor:
- Loss of coping abilities
- Lacerations
- Postpartum hemorrhage
Risks to the Baby of precipitous Labor:
- Hypoxia due to uteroplacental insufficiency related to intense contractions
- Cerebral trauma
- Brachial plexus injury
PROM Premature Rupture of Membranes Earlier than 37 weeks gestation
Causes:
- Chorioamnionitis
- Infections
- Weak Amniotic sac
- Fetal abnormalities or malpresentation
- Incompetent cervix
- Overextension of uterus
- Hormonal changes or nutritional deficiencies
PROM Premature Rupture of Membranes Earlier than 37 weeks gestation:
Complications
- Infection to mother and fetus
- Preterm labor
- Oligohydramnios: a disorder of amniotic fluid resulting in decreased amniotic fluid volume for gestational age
- *Umbilical cord prolapse
PROM Management:
- Labor is induced if term
- prevent further loss of fluid.
- avoid intercourse or orgasm and nipple stimulation.
- *If Preterm: administer Betamethasone to accelerate fetal lung maturity
- Administer antibiotics
- Activity restricted and possible bed rest
- Monitor fetus for signs of distress
Preterm Labor
- After 20th week and before end of 37th week
- Affects 1 of 8 babies in US
- No scheduled C-sections prior to 39 weeks gestation.
- Newborn mortality doubles each week before completing 39 weeks gestation
Preterm Labor Signs & Symptoms:
same/similar to normal labor
- Uterine contractions
- Sensation of the baby “balling up”
- Cramps
- Low backache
- Pelvic pressure
- Increase in spotting or vaginal discharge
- Abdominal cramps with or without diarrhea
- A sense of “not feeling well”
Preterm Labor Treatment
- Hydration
- Tocolytics: to inhibit contractions
— Magnesium Sulfate
— Calcium antagonists
— prostaglandin synthesis inhibitors
— beta adrenergics - Steroid (Betamethasone) for the fetus
Magnesium Sulfate
Route:
- Indication:
May be administered IV or PO to stop labor
- preterm labor
- seizures
- women with preeclampsia
Magnesium Sulfate
Reflex documentation
0= no reflex
+1= hypotonic
+2 reflex
+3-4= hypertonic
Magnesium Sulfate
Non-therapeutic: reflexes
hypotonic & hypertonic
Magnesium Sulfate: hypotonic & hypertonic
Theraputicness
- If hypotonic=too much.= d/c mag sulfate/ antidote
- If hypertonic=not enough
Magnesium Sulfate toxicity s/s
Antidote:
Blurred vision, headache
lethargy, weakness
nausea/Vomiting, constipation
- Calcium Gluconate (for hypotonic)
Calcium Channel Blockers for Preterm Labor Treatment
Nifidipine
Nifidipine
Theraputics:
Route:
Nursing implication
S/S
prevents muscle contractions, type of tocolytic
- Administered PO
- Assess BP
S/S:
- hypotension due to vasodilation
- flushing of skin
- headache
- transient tachycardia
Prostaglandin Synthesis Inhibitor
For Preterm Labor Treatment
Indomethacin
Indomethacin
Route:
Therapeutics:
Nursing implications:
- PO type of NSAID
- Limit use before 32 weeks gestation
- Use only for 48-72 hrs. to decrease chance of closing ductus arteriosis.
- Decreases amount of amniotic fluid
- Assess for GI bleed
Beta Adrenergic
For Preterm Labor Treatment
Terbutiline
Terbutiline:
Route:
Nursing implications:
S/S:
- IV or SubCut
- *black box warning.
- Not recommended anymore except in extreme cases.
- *Causes tachycardia and dysrhythmias (mom needs to be on a tele monitor)
- Only use for 48-72 hrs
Corticosteroid
For Preterm Labor Treatment
Betamethasone- for the fetus
Bethamethasone
Route:
Therapeutics:
- IM injection
- Used to accelerate fetal lung maturity (between 24- 34 weeks)
- Reduces RDS (respiratory distress syndrome), Intraventricular hemorrhage, and death
Postterm pregnancy
Longer than 42 weeks
Postterm pregnancy:
Maternal Risks:
- LGA
- Increased incidence of assisted delivery (forceps, vacuum or C-section)
- Increased psychological stress
Postterm pregnancy:
Fetal Risk:
- Decreased placental perfusion & Less amniotic fluid
- Oligohydraminos
- Meconium aspiration
Macrosomia:
large baby for term
Risks of Macrosomia:
Mother
- CPD- cephalopelvic disproportion
- Dysfunctional and prolonged labor
- Lacerations
- Postpartum hemorrhage
Risks of Macrosomia:
Infant
- *Hypoglycemia: not getting enough glucose when born
- *Polycythemia: if they are hypoxic, the bones produce more RBC’s
- *Hyperbilirubinemia: when the RBCs break down= increased bilirubin
- Meconium aspiration
- Asphyxia
- Shoulder Dystocia
- Brachial plexus injury or fractured clavicle
Prolapse of Umbilical Cord:
Cause
Occurs when umbilical cord comes out before the fetal presenting part
Causes:
- *Major cause: Breech presentation
- Fetus in high station
- Small fetus
- Transverse lie
- Polyhydramnios
Occult (hidden) prolapse:
The cord is compressed between the fetal, presenting part and pelvis, but cannot be seen or felt during vaginal examination
Cord prolapsed in front of the fetal head:
The cord cannot be seen, but can probably be felt as a pulsating mass during vaginal examination
Complete cord prolapse:
The cord has been seen protruding from the vagina
Management of Prolapsed Cord
- Knee chest position or trendelenburg
— Knee-chest uses gravity to shift the fetus out of the pelvis. The woman’s thighs should be at right angles to the bed and her chest flat on the bed
— The woman’s hips are elevated with 2 pillows; this is often combined with the trendelenburg (head down) position - Firm pressure on head to relieve cord compression
- *Administer O2
Uterine Rupture/Dihiscence
Causes:
- previous uterine surgery or C- Section
- intense labor
- High parity
Uterine Rupture/Dihiscence:
S/S:
- Abdominal pain and tenderness
- Chest pain between scapulae or on inspiration
- Hemorrhage
- Hypovolemic shock
- Cessation of contractions
- Fetal distress on monitor (you would see late decelerations)
Uterine Rupture/Dihiscence:
Treatment:
- Stabilize mother and fetus
- Delivery may be imminent
- Replace blood & fluid loss
- Repair if rupture is small
Uterine Inversion
Degrees:
Uterus completely or partly turns inside out, during the third stage of labor
- 1st degree: inverted fundus up to cervix
- 2nd degree: body of uterus protrudes through cervix into vagina
- prolapse of inverted uterus outside vulva
Uterine Inversion:
Causes:
- fundal pressure
- Pulling of umbilical cord
- Increased intraabdominal pressure
- Abnormally attached placenta
- weak uterine wall
Uterine Inversion:
S/S
- uterus may protrude into the uterus??
- Hemorrhage
- Shock
- Severe pelvic pain
Uterine Inversion:
Treatments
- stabilize mother and fetus
- Replace blood
- Replace uterus
- Possible hysterectomy
Anaphylactoid Syndrome/Amniotic Fluid Embolism
- Amniotic fluid is drawn into the maternal circulation and carried to woman’s lungs.
- Contains Fetal cells and matter (skin, vernix, hair, meconium); can obstruct pulmonary vessels
- *DIC (Disseminated intravascular coagulation) occurs due to thromboplastin in amniotic fluid
Treatment of Anaphylactoid Syndrome
- CPR
- Oxygen and mechanical ventilation
- Correction of hypotension
- Blood therapy to correct coagulation defects
- Immediate C-section
