Intrapartum Emergencies Flashcards
The placenta is abnormally adherent or sticky, which can cause immediate or delayed haemorrhage immediately after birth because the placenta does not separate cleanly.
Placenta Accreta
What are the two types of placenta accreta?
Placenta Increta – placenta penetrates the uterine muscle itself
Placenta Percreta – most severe form, where the placenta penetrates through the entire uterus and can attach to other organs, such as the bladder or bowels
Give at least four manifestations of prolapsed umbilical cord.
Client has a feeling that something is coming through the vagina
Umbilical cord is palpable or visible
Fetal heart rate is irregular and slow
Variable decelerations
If fetal hypoxia is severe, rapid fetal activity may occur and then cease
True or False: If a nurse sees the cord protruding from the vagina, for as long as the FHR is normal, she may push the cord back into the uterus.
False: The nurse should never attempt to push the cord into the uterus.
Give three positions which might help elevate the presenting part AWAY from the cord to prevent compression.
Extreme Trendelenburg
Knee-Chest
Side-lying with hips elevated with pillows
What are the immediate interventions that need to be done in the event of a cord prolapse? HINT: A TO G
Airway: administer oxygen 8 to 10 L per minute
By their side: stay with the client
Change positions: Trendelenburg, left-lateral or knee-chest
Displace: elevate fetal presenting part with finger
Escalate: ask for help
Fluid: warm moist towels to exposed cord, fluid replacement
Give birth via C-section
A type of uterine rupture where there is partial separation of an old uterine scar; there may be little or no bleeding and there may be no signs and symptoms.
Dehiscence
A woman with a previous C-section is at REDUCED risk for uterine rupture with future pregnancies if she had which type of incision?
Low Transverse or Bikini - incision made horizontally
Name at least 3 risk factors for uterine rupture:
5 C’s:
C-section
Classic incision
Children – multipara
CPD
Contractions – hypertonic contractions, induced contractions i.e. oxytocin
Pain during uterine rupture is usually felt in the abdomen and where else? What causes this?
Woman may also feel chest pain, pain in the shoulder area, between the scapula, or pain on inspiration.
This is caused by the irritation of the diaphragm by blood, which stimulates the phrenic nerve, which also provides sensation to the shoulder area.
A depression on the fundal area during the third stage of labour can indicate that which complication has occurred?
Uterine Inversion
How would you position a woman to prevent vena cava syndrome?
On the side or place a pillow or wedge under the client’s hip to displace gravid uterus off vena cava.
Which complication may occur because of entry of thromboplastin rich amniotic fluid into the circulation?
Disseminated intravascular coagulation
What manifestations would you expect to see in a fetus in distress? HINT: HELP ME!
Heart rate changes
Excessive baseline variability
Late decelerations
Poor fetal movement
Meconium stained amniotic fluid
Excessive variable decelerations
