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NUR 359: OB > Intrapartum Complications > Flashcards

Intrapartum Complications Flashcards

1
Q

def Pre-term labor/birth

A

cervical changes and uterine cxns bx 20-37 wks gest

-any birth before completion of 37 weeks

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2
Q

what is considered low birth wt

A

<2500 g

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3
Q

what do biochemical markers do

A

predict whether or not a mom is going into pre-term labor

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4
Q

name the biochemical markers

A

fetal fibronectins

salivary estriol

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5
Q

what is the endocervical length

A

cervical length and fibronectins together

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6
Q

what criteria makes mom a high risk for pre-term labor

A

less than 30 mm

test positive for fibronectins

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7
Q

how do you collect fibronectins

A

cervical swab and send off to lab

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8
Q

causes of pre-term labor and birth

A

infecs
preg complications
sociodemo factors

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9
Q

sociodemographic factors that cause pre-term labor

A 
poverty
low edu level
lack of social support
smoking
little/no prenatal care
dv
stress
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10
Q

prevention of pre term labor

A

address risk factors

edu pts abt s/s

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11
Q

dx of pre-term labor

A 
gest age bx 20-37 wks
cxns (uterine activity)
progressive cervical changes
      effacement 80%
      dilation 2 cm or >
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12
Q

activities that could result in preterm labor

A 
sex
long car rides
carrying heavy loads
standing more than 50% of the time
heavy housework
climbing stairs
hard physical work
not being able to stop and rest when tired
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13
Q

what may be prescribed by MD to prevent pre term labor

A

bed rest

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14
Q

describe home care of high risk preg pt

A
  • modify env for conveniences
  • home uterine monitoring system
  • home nurse may come to check monitor
  • pt may be taught to put it on, take it off, or check monitor
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15
Q

what med may be given to suppress uterine activity

A

tocolytics

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16
Q

tocolytics allows …

A
  • opportunity to begin admin antenatal glucocorticoids
  • accel fetal lung maturity
  • reduce severity of sequelae in preterm births
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17
Q

name a tocolytic

A

terbutaline

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18
Q

what med promotes fetal lung maturity

A
  • antenatal glucocorticoids
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19
Q

when can you not give antenatal glucocorticoids?

A
  • cord prolapse
  • chorioamniotitis
  • abruptio placenta
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20
Q

name an antenatal glucocorticoid

A

betamethasone

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21
Q

what criteria makes a pre term birth inevitable

A

dilation of 4 cm or more

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22
Q

how many doses of antenatal glucocorticoids can mom receive

A

up to 2

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23
Q

def Premature ROM

A

rupture of amnio sac and leakage of amnio fluid beginning at least 1 hr before onset of labor at any gest age

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24
Q

def Preterm Premature ROM

A

membranes rupture before 37 weeks gest

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25
Q

PPROM is often preceded by

A

infec

26
Q

when is a PPROM dx’d

A

after woman c/o sudden gush or slow leak of vaginal fluid

27
Q

def dystocia

A

long, difficult, or abnormal labor

28
Q

dystocia can prevent the normal progression of

A
  • cxns
  • dilation
  • effacement
  • descent
29
Q

what factors incr risk for uterine dystocia

A
  • body build
  • uterine abnormalities
  • malpresentation and position of fetus
  • cephalopelvic disproportion
  • overstim of oxytocin
  • maternal fatigue
  • dehydration
  • electrolyte imbalance
  • fear
  • inappropriate timing of analgesics
  • dysfx uterine cxns
30
Q

what is cephalopelvic disproportion

A

when the babys head is bigger than opening to the pelvis

31
Q

name the classification of dysfx uterine cxns

A
  • hypertonic (primary dysfx labor)

- hypotonic (secondary uterine inertia)

32
Q

name 2 alterations in pelvic structure

A
  • pelvic dystocia

- soft tissue dystocia

33
Q

def pelvic dystocia

A

contractures of pelvic diameters that reduce capacity of bony pelvis, inlet, midpelvis, or outlet

34
Q

def soft tissue dystocia

A

obstruction of birth passage by an anatomic abnormality other than the bony pelvis

35
Q

fetal causes of dystocia

A 
anomalies
CPD- cephalopelvic disproportion
malposition
malpresentation
multifetal preg
36
Q

what else can cause dystocia

A

hormones and NT’s

37
Q

def precipitous labor

A

labor lasting less than 3 hrs from onset of cxns to birth

38
Q

medical mgmt of dystocia

A 
external version
internal version
trial of labor
induction/augmentation w/ oxy
cervical ripening
amniotomy
39
Q

what is oxytocin

A

a hormone that stim uterine cxns

40
Q

where is oxy produced

A

posterior pituitary

41
Q

what is oxy used for

A

induce or augment labor due to inadequate uterine cxns

42
Q

what situations do we use oxy cautiously?

A 
multifetal position
breech presentation
presenting part above pelvic inlet
abnormal FHR
polyhydramnios
grand multiparity
maternal cardiac disease
43
Q

def augmentation of labor

A

stim of uterine cxns after labor has started but progress is unsatisfactory

44
Q

indications for augmentation of labor

A

hypotonic uterine dysfx

45
Q

common augmentation methods

A

oxy infusion
amniotomy
nipple stim

46
Q

what is the McRoberts maneuvre?

A

moms legs up

press on pelvis and apply pressure to get baby out

47
Q

what is zavanelli’s maneuvre

A

push baby back in for c sec

48
Q

what is the mortality rate for zavanelli’s maneuvre

A

50%

49
Q

post term maternal risks

A
  • risks related to excessively large infant
  • dysfx labor
  • birth canal trauma
  • fatigue
  • psych rxns
50
Q

post term fetal risks

A 
prolonged labor
shoulder dystocia
birth trauma
asphyxia from macrosomia
aging placenta
51
Q

when should a post-term mom be induced?

A

41-42 weeks

some allow up to 43 weeks

52
Q

when would a HCP allow the mom to continue preg for up to 3 weeks

A
  • assesment tests of fetal well being normal
53
Q

def shoulder dystocia

A

head is born nut shoulder cannot pass under pubic arch

54
Q

a newborn is likely to experience birth injuries from _______

A

shoulder dystocia

55
Q

what are the mothers risks if shoulder dystocia occurs

A
  • excessive blood loss
  • lacerations
  • extension fo episiotomy
  • endometritis
56
Q

if prolapsed cord is discovered, what should we have mom do?

A

put mom facing down with hips high

- modified sims position

57
Q

what factors contribute to cord prolapse

A
  • long cord
  • malpresentation (breech)
  • transverse lie
  • unengaged presenting part
58
Q

most frequent causes of rupture of uterus

A
  • separation of scar of previous c sec
  • uterine trauma: accidents, surgery
  • congenital uterine anomaly
59
Q

other causes of rupture of uterus

A
  • intense spontaneous cxns
  • labor stim- oxy, prostaglandins
  • overdistended uterus: multifetal gest
  • malpresentation
  • internal or external version
  • difficult forceps assisted birth
60
Q

rupture of the uterus is more common in which women

A

multigravida

61
Q

s/s of amnio embolism

A
  • acute dyspnea

- severe hypotension

NUR 359: OB (15 decks)

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