Intrapartum complications Flashcards
a process the cervix softens (like a pear)
•Ripe cervix is shortened, centered, soft and partially dilated
•Induction/Augmentation will more likely to be success if cervix is ripe
•Guidelines:
•Bishop Score >6 (higher score = more successful of having vaginal birth)
•Membranes intact
•No active contraction pattern (less than 10 mild contractions/hour
cervical ripening
induction of labor
Naturally occurring prostaglandin E2
•Stimulates the myometrium of the gravid uterus to contract in a manner that is similar to the contractions seen in the term uterus during labor
•Prostaglandin Gel –placed in posterior vaginal fornix
-Can’t be removed
•Cervidil Pessary placed intravaginally
-Can be removed if s/s of hypertonic contractions or fetal/maternal distress
Naturally occurring prostaglandin E2
Dinoprostone (Cervidil& Prostaglandin Gel)
Adverse Effects: •Headache, dizziness, fever •Maternal and fetal arrhythmias* •N&V, diarrhea •Uterine hypertonicity •Uterine rupture
Dinoprostone (Cervidil& Prostaglandin Gel) 2
naturally occurring prostaglandin E1
• stimulates the myometrium of the gravid uterus to contract in a manner
that is similar to the contractions seen in the term uterus during labor
• Oxytocin can not be initiated until 4 hours after last dose
Misoprostol (Cytotec)
Adverse Effects: • Headache, dizziness, fever • Maternal and fetal arrhythmias • N&V, diarrhea • Uterine hypertonicity • Uterine rupture • Toxicity treated by administering terbutaline • Also used for PP hemorrhage – PR X 1
Misoprostol (Cytotec) 2
- Assess for patient understanding and consent
- Monitor maternal VS, LOC, LS, Pain
- Monitor fetal heart rate (must be reactive)
- Assess contraction pattern
- Assess for vaginal bleeding, ROM
- Assess maternal abdomen
- Assess for fetal movement
- Bed rest required for 1-2 hours after insertion
nursing implications of induction of labor
• For the prevention and control of excessive bleeding following vaginal
childbirth (Muscle fatigue and cannot contract so constricts blood vessels)
• Stimulates smooth muscle of the uterus to sustain a contracted state of the
uterus postpartum and decrease heavy bleeding related to uterine atony
• Contra-indications: Hypertensive disorder, use caution with hepatic or cardiac
disease and sepsis or recent administration of vasoconstrictive agents
(ephedrine)
Methylergonovine maleate (Methergine) Hemorrhage
Adverse Effects: • Headaches, dizziness, tinnitus • HTN (if given to rapidly) hypotension, arrhythmias, dyspnea and chest pain* • N&V, sweating, • Uterine cramping Nursing Implications: • Route: IV or IM • Administer every 2-4 hours • If no response to first dose, response unlikely to additional doses • Monitor VS and bleeding • Administer pain medications
Methylergonovine maleate (Methergine) Hemorrhage
Reduces blood loss related to uterine atony by stimulating uterine contractility*
• stimulates the smooth muscle of the human gastrointestinal tract
• Contraindications:
• Acute cardiac, pulmonary or renal disease
• Cautious use in hypotension, HTN, asthma, adrenal disease, diabetes, fibroids, epilepsy and
previous uterine surgery
Carboprost tromethamine (Hemabate) hemorrhage
Adverse Effects:
• N&V, explosive diarrhea, chills, fever, joint pain, severe cramping
• Hypertension, bronchoconstriction
Nursing Implications:
• IM – Do not give IV*
• Administer every 15-90 minutes (Not to exceed 8 doses)
• Assess VS and respiratory system closely
• Provide pain medication
Carboprost tromethamine (Hemabate) hemorrhage 2
Drug classification: Alpha and Beta Adrenergic Agonist
• It causes more norepinephrine to be released from synaptic
storage sites causing increased BP due to arteriolar
constriction and cardiac stimulation.*
• Indication: Counteracts the hypotensive effects of anesthesia.
• Metabolism: Hepatic and excreted Renally
Ephedrine
anesthesia - hypotension
Adverse Effects:
• Headache, restlessness, anxiety, tension, tremor,
weakness, dizziness, confusion, fetal tachycardia
• Hypertension, pallor, respiratory difficulty, palpitation
• Sweating, nausea or vomiting, urinary retention
Nursing Action:
• Monitor VS and I&O’s closely
• Administer slowly over at least 1-3 minutes*
Patient Teaching:
• Report nervousness, palpitations, sweating
Ephedrine
anesthesia - hypotension
Drug classification: Opioid antagonist
• Antagonizes the opioid effects by competing for the same receptor sites,
especially the opioid mu receptor
• Reversal of opioid depression (respiratory depression)
• Metabolism: Hepatic
Naloxone (Narcan)
narcotic adverse effects
Adverse Effects:
• Acute opioid abstinence syndrome (withdrawal symptoms leading to seizures)
• Hypo and Hypertension, cardiac arrhythmias, pulmonary edema
Nursing Action:
• Assess for opioid addiction prior to administration
• Monitor VS, respiratory effort closely – may need to repeat dose
• Patient Teaching:
• Important to notify if opioids used during pregnancy
Naloxone (Narcan)
narcotic adverse effects
Drug classification: Antibiotic
• Bactericidal: Inhibits synthesis of cell wall causing cell death (explodes cell wall so cant replicate)
• Given in known and unknown cases of Group Beta strep, preterm labor and
preterm premature rupture of membranes
• Metabolism: Hepatic
Penicillin G
Group beta streptococcus
