Intrapartum Complications Flashcards
def Pre-term labor/birth
cervical changes and uterine cxns bx 20-37 wks gest
-any birth before completion of 37 weeks
what is considered low birth wt
<2500 g
what do biochemical markers do
predict whether or not a mom is going into pre-term labor
name the biochemical markers
fetal fibronectins
salivary estriol
what is the endocervical length
cervical length and fibronectins together
what criteria makes mom a high risk for pre-term labor
less than 30 mm
test positive for fibronectins
how do you collect fibronectins
cervical swab and send off to lab
causes of pre-term labor and birth
infecs
preg complications
sociodemo factors
sociodemographic factors that cause pre-term labor
poverty low edu level lack of social support smoking little/no prenatal care dv stress
prevention of pre term labor
address risk factors
edu pts abt s/s
dx of pre-term labor
gest age bx 20-37 wks
cxns (uterine activity)
progressive cervical changes
effacement 80%
dilation 2 cm or >activities that could result in preterm labor
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
what may be prescribed by MD to prevent pre term labor
bed rest
describe home care of high risk preg pt
- 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
what med may be given to suppress uterine activity
tocolytics
tocolytics allows …
- opportunity to begin admin antenatal glucocorticoids
- accel fetal lung maturity
- reduce severity of sequelae in preterm births
name a tocolytic
terbutaline
what med promotes fetal lung maturity
- antenatal glucocorticoids
when can you not give antenatal glucocorticoids?
- cord prolapse
- chorioamniotitis
- abruptio placenta
name an antenatal glucocorticoid
betamethasone
what criteria makes a pre term birth inevitable
dilation of 4 cm or more
how many doses of antenatal glucocorticoids can mom receive
up to 2
def Premature ROM
rupture of amnio sac and leakage of amnio fluid beginning at least 1 hr before onset of labor at any gest age
def Preterm Premature ROM
membranes rupture before 37 weeks gest
PPROM is often preceded by
infec
when is a PPROM dx’d
after woman c/o sudden gush or slow leak of vaginal fluid
def dystocia
long, difficult, or abnormal labor
dystocia can prevent the normal progression of
- cxns
- dilation
- effacement
- descent
what factors incr risk for uterine dystocia
- 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
what is cephalopelvic disproportion
when the babys head is bigger than opening to the pelvis
name the classification of dysfx uterine cxns
- hypertonic (primary dysfx labor)
- hypotonic (secondary uterine inertia)
name 2 alterations in pelvic structure
- pelvic dystocia
- soft tissue dystocia
def pelvic dystocia
contractures of pelvic diameters that reduce capacity of bony pelvis, inlet, midpelvis, or outlet
def soft tissue dystocia
obstruction of birth passage by an anatomic abnormality other than the bony pelvis
fetal causes of dystocia
anomalies CPD- cephalopelvic disproportion malposition malpresentation multifetal preg
what else can cause dystocia
hormones and NT’s
def precipitous labor
labor lasting less than 3 hrs from onset of cxns to birth
medical mgmt of dystocia
external version internal version trial of labor induction/augmentation w/ oxy cervical ripening amniotomy
what is oxytocin
a hormone that stim uterine cxns
where is oxy produced
posterior pituitary
what is oxy used for
induce or augment labor due to inadequate uterine cxns
what situations do we use oxy cautiously?
multifetal position breech presentation presenting part above pelvic inlet abnormal FHR polyhydramnios grand multiparity maternal cardiac disease
def augmentation of labor
stim of uterine cxns after labor has started but progress is unsatisfactory
indications for augmentation of labor
hypotonic uterine dysfx
common augmentation methods
oxy infusion
amniotomy
nipple stim
what is the McRoberts maneuvre?
moms legs up
press on pelvis and apply pressure to get baby out
what is zavanelli’s maneuvre
push baby back in for c sec
what is the mortality rate for zavanelli’s maneuvre
50%
post term maternal risks
- risks related to excessively large infant
- dysfx labor
- birth canal trauma
- fatigue
- psych rxns
post term fetal risks
prolonged labor shoulder dystocia birth trauma asphyxia from macrosomia aging placenta
when should a post-term mom be induced?
41-42 weeks
some allow up to 43 weeks
when would a HCP allow the mom to continue preg for up to 3 weeks
- assesment tests of fetal well being normal
def shoulder dystocia
head is born nut shoulder cannot pass under pubic arch
a newborn is likely to experience birth injuries from _______
shoulder dystocia
what are the mothers risks if shoulder dystocia occurs
- excessive blood loss
- lacerations
- extension fo episiotomy
- endometritis
if prolapsed cord is discovered, what should we have mom do?
put mom facing down with hips high
- modified sims position
what factors contribute to cord prolapse
- long cord
- malpresentation (breech)
- transverse lie
- unengaged presenting part
most frequent causes of rupture of uterus
- separation of scar of previous c sec
- uterine trauma: accidents, surgery
- congenital uterine anomaly
other causes of rupture of uterus
- intense spontaneous cxns
- labor stim- oxy, prostaglandins
- overdistended uterus: multifetal gest
- malpresentation
- internal or external version
- difficult forceps assisted birth
rupture of the uterus is more common in which women
multigravida
s/s of amnio embolism
- acute dyspnea
- severe hypotension
