intrapartum complications Flashcards
PREMATURE RUPTURE OF MEMBRANES
SROM
-1hr or more before labor starts
PPROM
- occurring before 37 weeks
- either as a leak or gush of fluid
RISK FACTORS FOR PROM
- infections
- hx of PROM
- hydramios
- multiple pregnancy
- cervical insufficeiency
-anything that adds stress to amniotic structures
METERNAL RISKS AFTER OR BEFORE DELIVERY
- chorioamniionitis: inflammation and infection in fetal membranes and amniotic fluid
- infection of the uterine endometrium
PPROM FETAL RISKS
- respiratory distress
- sepsis
- umbilical cord compression or prolapse
- other complication r/t preterm birth
DIAGNOSIS OF PROM
SPECTRUM EXAM :pooling
NITRAZINE TESTS
-strip is dipped in vaginal secretions,blue=aminiotic fluid (basic), blood and semen can give a false false positive
FERN TEST
-sodium chloride and proteins from amniotic fluid will crystalize on a slide
MANAGMENT OF PROM
- fetal age and presence/absence of infection determine management plan
- if infection is present start antibiotics on mother and deliver
- assess neonate and start antibiotics
MEDICAL MANAGEMENT OF PROM
- hospitalize
- assess for infection
- labs: CBC,CRP,UA/ C&S and cultures
- determine gestational age
- assess fetal well being
- betmethazone
- by 34wks, assess fetal lung maturity
- patient /family support and teaching
PRETERM LABOR
- labor prior to 37 weeks
- describes length of geststion regardless of birth weight
- more dangerous
low birth weight
<2500gm
RISK FACTORS FOR PTL
- age
- infections,TORCH
- cervical incompetence
- bleeding
- substance abuse
- multiple gestation
- polyhydraminos
- stress
- sexual activity
- anatomic abnormalities
TOCOLYTICS
drugs that attempt to stop labor
potentially serious side effects necessitate close monitoring
BETAMETHASONE BMS
halting labor progression for 48hrs can buy time to give mother 2 injections 24hrs apart to promote fetal lung maturity
MAGNESIUM SULFATE
-CNS depression
adverse reactions:
- pulmonary edema
- hypotension
- cardiac aresst
- respiratory depression
BETA AGENT TERBUTALINE
-b adrenergic agonist
adverse reactions:
- hypotension
- PE
- hyperglycemia and hypokalemia
- arrhythmias
CA CHANNEL BLOCKERS NIFEDIPINE
-smooth muscle relax vasodilation
adverse reactions :
-profound hypotension and decrease in placental perfusion
PLACENTA PREVIA
implantation of placenta is lower than normal in the uterus .may cover cervical os
