Intrapartum Complications Flashcards

1
Q

Preterm Labor

A

Actual labor before 38wks
* reg ctxs w/ cervical changes
* preterm birth: deliver baby before 38wks

Indicators preterm labor/Birth
* Shortening cervix -> cytoxcet
* 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

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2
Q

Preterm Care

A

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 hydrated, 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

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3
Q

Tocolytics

Mg+ Sulfate

A

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

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4
Q

Tocolytics

Terbutaline

A

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

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5
Q

Tocolytics

Nifedipine

CCB

A

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.

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6
Q

Tocolytics

Indomethacin

A

nonsteroidal antiinflammatory
drug (NSAID), has been shown in some trials to suppress preterm labor by blocking the production of prostaglandins.

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

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7
Q

Induction vs. Augmentation of Labor

A

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)

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7
Q

Tocolytics

A

are medications used to delay or stop premature labor.

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8
Q

2 Part Process of Induction

A

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

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9
Q

Admin of Pitocin

A

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 off fluis when turn pitocin off to flush out

Need HCP in house
Antidiuretic effect: pt will stop peeing
* monitor I/O -> urine output >= 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

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10
Q

Malpresentation (Breech)

A

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

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11
Q

Multifetal Pregnancy

A

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

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12
Q

Operative Births (Assistive)

Vaccum & Forceps

forceps placed ear to ear

A

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

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13
Q

C-Section

A

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

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14
Q

Different types of C-Sections

A

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

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15
Q

VBAC

not all VBAC are

A

Stands for vag birth after C-Secton
Criteria: low transverse incision, document proof, < 2 prior c-sections

need the document proof b/c outer scar doesn’t confirm inside incision

16
Q

Emergency Delivery

A

DO NOT LEAVE CLIENT ALONE
1. HEE-HEE breathing to slow expulsion of head over perineum
2. Apply gentle pressure against presenting part
3. Check for nuchal cord & remove if loose
4. Apply downward pressure to deliver posterior shoulder
5. Suction baby w/ bulb syringe, mouth 1st then nose
6. Place baby on mom’s abd

17
Q

beyond 41 wks gestation

Post Term

A

Maternal risk: dysfunctional labor, birth canal trauma, fatigue, psychological rxn
* Bigger baby
* C-Section more common

Fetal risk: shoulder dystocia (turtle sign), birth trauma, asphyxia (deprived of oxygen) from macrosomia
* “Aging placenta” compromises fetal wellbeing
* Meconium aspiration - baby moved bowels in utero & aspirated on way out during labor
* baby won’t cry when coming out & is immediately suctioned ( mouth, then nose)
* Highly fatal
* meconium in utero indicates stress & hypoxia

18
Q

Emergerncy Delivery

Shoulder Dystocia

Turtle Sign

A

Head born, but anterior shoulder cannot pass under pubic arch
Newborn risk: Birth injuries r/t asphyxia, brachial plexus damage & fracture

Mother risk: Excessive blood loss from uterine atony or rupture, lacerations, extension of episiotomy, or endometritis

Risk factors: macrosomia ( .9.5lbs), failure to dilate or progress in station

TURTLE SIGN: retraction of head against perineum or failure of shoulders to complete external rotation (you assume shoulder dystocia)

Interventions:
* Start to think SD when: prolonged labor, DM, Large baby, post date
* Prep: stool in room, get help, tell NICU
* Jump on stool & give ( 2nd) SUPRAPUBIC PRESSURE
* (1st) MCROBERT’S MANEUVER: pull legs back to chest

clinical finding: slow ot dilate, turtle sign
Brachial plexus palsy : can’t lift one arm in moro reflex

19
Q

Emergency Delivery

Prolasped Umbilical Cord

A

Cord comes out 1st
might decrease blood flow to baby- need c-section
Risk factors: Polyhydramnios ( lots of amniotic fluid), really long cord ( >100 cm), breech, transverse lie, unengaged presenting part

** Interventions**: prepare prompt delivery (c-section ASAP), GET HELP
* priorty= elevate presenting part to relieve cord pressure
* will need to get in bed w/ pt as wheeled to c-section
* if not helping, 2nd try: knee chest, trendelenberg, hips elevated w/ pillow, side lying