Intrapartum Complications Flashcards
Preterm Labor
Actual labor before 38wks
* reg ctxs w/ cervical changes
* preterm birth: deliver baby before 38wks
Indicators preterm labor/Birth
* Shortening cervix -> cytoxcet (cervidil rippens the cervix)
* Fetal fibronectin -> presence of protein indicates preterm delivery
Predisposing factors:
* DM, cardio diseases, preeclampsia, placental previa, adolescent preg
* Infections (UTI)
* Uterus overdistention -> multi-fetal preg, polyhdramnios, LGA baby
Psychosoical: stress @ work, >2 kids < 5yrs, finanical stress, poor support system
Smoking > 10 cigs/day, cocaine use
Neonates >2000g or > 32 wks have the best chance of survival
> 5 CTXS/ hr with cerivcal change
PTL w/ or w/o ROM
GBS status is important, if unknown test as postitive
Preterm Care
Prevention -> early recognition & dx
Lifestyle mods -> restrict activity & sexual activity
* Pelvic rest: nothing in vag
* Strict bed rest doesn’t work
Home uterine activity monitoring
In hospital :
* IV hydration: pt could just be dehydrated, causing cells to ctx
* Tocolytics: meds that stop ctxs (Mg+ most common, CNS depressant)
* Steriods: help preemie lungs develop surfactant to speed up maturity
steriods: Betamethazone: 2 dose 2 hr apart @ 24- 34 wks GA ( sometimes 2nd wk later); DOES NOT WORK AFTER 34 WKS
MAY BE DANGER TO MOM: increase risk of infection, follow mom temp/VS
Mg+ assess RR
Tocolytics
Mg+ Sulfate
depresses the function of the
central nervous system (CNS), it is essential that the nurse frequently assesses the woman’s respiratory status, deep tendon reflexes, and level of consciousness for toxic level signs
Tocolytics
Terbutaline
Relaxes uterine smooth muscle by stimulating beta 2 receptors
Given SubQ
Fetal/Maternal Adverse reactions:
1. Tachycardia
2. Hyperglycemia
Don’t give to women w/:
1. heart disease,
2. preeclampsia with severe features or eclampsia, pregestational
3. gestational diabetes
4. hyperthyroidism
Tocolytics
Nifedipine
CCB
can suppress contractions, preventing calcium from entering smooth muscle cells, thus
reducing uterine contractions
Administering nifedipine and magnesium sulfate simultaneously can cause skeletal muscle blockade
calcium channel blocker can result in orthostatic hypotension and dizziness, it is essential to instruct
women to slowly change position from supine to upright and then sit until any dizziness disappears before standing.
Tocolytics
Indomethacin
nonsteroidal antiinflammatory
drug (NSAID), has been shown in some trials to suppress preterm labor by blocking the production of prostaglandins (pain).
limiting the use of indomethacin to a period of 48 hours or less in women with preterm labor at less than 32 weeks of gestation is recommended
Induction vs. Augmentation of Labor
Induction: starting labor before it begins on it’s own
Augmentation: Labor in progess but need help moving along
Indications: IUGR ,SROM w/o onset of labor @ term, postdates, chorioamnionitis, HTN w/ pregnancy or chronic HTN, IUFD (died in utero)
Tocolytics
are medications used to delay or stop premature labor.
2 Part Process of Induction
1. Soften cervix: give meds ( cytotec, cervidil) or insert foley bulb to stretch cervix
2. Uterine ctx: nipple stim, pitcoin
meds: prostagladin intra vag tabs; start rippening the cervix
Bishop sco
Admin of Pitocin
Assess FHR & ctx for baseline **20-30 mins **prior
* continuous fetal monitoring req (pt stays in bed)
Assess mom vs q15min
Tittered drug, ALWAYS on a pump!!!
* gradually titrate based on uterine ctx
* start @ 1mU/min, increase by 1-2 mU/min q15min
Admin thur second IV line, never main line
* Turn on full line of fluids when turn pitocin off to flush out
Need HCP in house
Antidiuretic effect: pt will stop peeing
* monitor I/O -> urine output >= ** greater than 60-80 mL/hr**
Assess for signs of hyperstimulation
* if uterine tetany occurs (ctx > 90 secs):
1. turn off pitocin
2. put side lying, O2 mask (re-breather mask)
3. IV fluids
4. Check urine output (60-80)
* can’t decrease when occurs, need to turn off and restart the process
Half life is 24hrs
Malpresentation (Breech)
Sacrum or feet presenting
C-Section common
Care: internal (multi bby) or external (ECV) version (turn fetus vertex) done with pts really don’t want C-Sections
ECV: Mechanically push on abd to turn when @ term
* US monitors FHT & guides maniplulations, IV line in
* Done in hospital @ 37wks (incase they need to deliver)
* Monitor FHT & mom’s VS at least q1hr after
* May induce right after -> risk for baby will turn baby
Apply constant pressure, also look for the placenta and cord, give SubQ terbutaline ( relaxes uterine so no ctxs) Monitor for 1 FHR/ctxs
Multifetal Pregnancy
twins, etc
high risk preg
Risk:
* Largest risk = preterm labor/delivery (due to uterine overdistention)
* Postpartum hemorrhage from uterine overdistention
* Abnormal presentation of 1 or both fetuses
* Fetal hypoxia in labor
* C-section common
Operative Births (Assistive)
Vaccum & Forceps
forceps placed ear to ear
Dr can use to assist vag birth -> shouldn’t use “just b/c”
* have to be fully dilated & head @ + station, bby must fit thru
Indications: shorten labor b/c mom exhausted (# 1 reason), FHR trace non-reassuring ( in distess)
Contraindication: Baby too big, not enough time
Risk:
* Baby: Facial or scalp laceration
(# 1 concern = cephalohematoma (bleeding under scalp) doesn’t cross the suture line
* Mom: vag laceration or hematoma
Care: empty bladder (striagth catheter), educate pt, informed consent, manage pain
Cephalohematoma = very prone to jaundice
C-Section
Surigically remove baby thru abdomen incision
* Normally horizontal incsion @ bikini line
* “Classical” c-section: uterus cut vertically
(uterus doesn’t fully heal, only c-section after)
Indications: Dystocia, CPD/FPD (head doesn’t fit), severe HTN, prolapsed cord, placenta abruption
* Automatic c-section: ACTIVE gential herpes @ time of delivery, breech baby, placenta previa, prior “classical” c-section
Contraindications: risk for mother MUST NOT outweigh risk of fetus
Risk:
* Maternal: infection, UTI, thrombophlebitis, paralytic ileus
* Infant: TTN (Newborn transient tachypea), inadvertent preterm birth, injury
* w/ anesthesia (spinal h/a): hemorrhage, bladder trauma, thromboembolism, atelectasis
Pre-op: labs (CBS w/ diff, blood type & screen, PT & PTT), >20 min on Fetal monitor, anesthesia interview & consent, IV hydration w/ 1 dose prophylactic abx, foley insertion
(need neonatologist present at delivery)
Post-op: mom VS, postpartum assessment duramorph for pain (give benadryl if causes pruristis), compression stockings, get up & foley out ASAP
* Asses incision w/ REEDA-> Redness, Edema, Ecchymosis, Drainage, Approximated (closed or opened)
Discharged teaching: No driving for 2 wks, no tampons/douching for 6 wks, access incision, follow up within 2 wks, no heavy lifting for 2 wks
can stay in hospital 3 to 5 days
IV toradol q6hr for 24 hrs, don’t eat; have to have bowel sound and gas in all 4 quads, keep incision dry, draining, DM have healing problems
Different types of C-Sections
Elective- cesarean on request or cesarean on demand, refers to a primary cesarean
birth without medical or obstetric indication
Reasons to give: fear of pain during labor
and birth and the mistaken belief that the surgery will prevent future problems with pelvic support, bladder/bowel incontinence, or sexual dysfunction
Unplanned- emergency cesarean birth are usually more pronounced and negative when
compared with the outcomes associated with a scheduled or planned cesarean birth.
Forced- court ordered
