Labor and Birth Complications Flashcards
What is preterm labor?
Regular uterine contractions that produce cervical change prior to 37 weeks gestation
- 34-36 6/7 weeks = late preterm birth/infant
- < 34 weeks = preterm birth/infant
What are signs and symptoms of preterm labor?
- uterine contractions
- low back pain
- pelvic pressure
What are risk factors for preterm labor?
- dehydration
- diabetes
- hypertensive disorders
- infection
- multiparity (has more than one child)
- multiple gestation (twins/triplets)
- obesity
- stress
- substance abuse
- trauma
- polyhydramnios (excess amniotic fluid)
- prior preterm birth
Describe preterm labor nursing care.
- Patient education on signs and symptoms of PTL
- Screen for infections (VS, urinalysis, labs)
- Hydration (PO or IV depending on protocol)
- Rule out UTI
- Fetal monitoring
- Palpate abdomen for contractions and/or tenderness
- Bed and/or pelvic rest
What is PROM?
- Premature Rupture of Membranes
- Spontaneous rupture of the amniotic membranes before the onset of labor (sometimes called pre-labor ROM)
What is PPROM?
preterm premature rupture of membranes
What does PROM/PPROM cause increased risk for?
Increased risk of infection as barrier to external environment is gone
How to treat PROM/PPROM?
- Treatment based on gestational age, could include antibiotics and prolonged bed rest
Describe nursing care for PROM/PPROM.
- Teaching
- Vital signs
- Fetal surveillance
What happens during Umbilical Cord Prolapse?
- Cord slips ahead of presenting part and can lead to significant compression to fetus
- May see abnormal fetal heart rate patterns (decelerations)
When can Umbilical Cord Prolapse happen?
Can occur anytime during labor with or without ruptured membranes
What are risk factors for Umbilical Cord Prolapse?
- breech or transverse lie (abnormal fetal position)
- non-engaged presenting part
- polyhydramnios
How to manage Umbilical Cord Prolapse?
- Trendelenburg
- elevate presenting part off the cord
- emergency c/s
What happens during Shoulder Dystocia?
- Head is delivered vaginally, anterior shoulder can’t pass under pubic arch
- May see head “turtle”
What are risk factors for Shoulder Dystocia?
macrosomia (bigger baby: greater than 4000 grams)
How to manage Shoulder Dystocia?
- widen pelvis
- McRoberts (legs flexed tightly towards abdomen)
- suprapubic pressure (pressure above the pubic bone)
- rotation
- hands and knees
What risks does Shoulder Dystocia pose to the infant?
- broken clavicle
- brachial plexus injury
- neurological compromise
- death
What risks does Shoulder Dystocia pose to the birthing parent?
- perineal trauma
- psychological trauma
What is Magnesium Sulfate used for in high-risk pregnancies?
- Given IVPB to prevent seizures in patients with preeclampsia
- Reduces the risk of intraventricular hemorrhage leading to cerebral palsy
- Can temporarily slow or stop preterm labor
- Neuroprotection for preterm baby
Magnesium Sulfate nursing considerations?
- Recommended for gestational ages < 33 weeks
- Loading dose followed by maintenance infusion for 24 hrs
- Double verification drug
- Patient education on side effects
What are Antenatal steroids used for in high-risk pregnancies?
Stimulates fetal surfactant production (helps baby’s lungs mature)
What’s a commonly used Antenatal steroid and how is it given?
- Typically betamethasone
- 2 IM doses 24 hour apart
Antenatal steroids indication?
preterm labor between 24-36 weeks (sometimes 34 weeks is upper limit)
What is Oxytocin (Pitocin) used for?
- Used to prevent or manage postpartum bleeding (1st-line)
- Used for induction of labor
- Stimulates uterine contractions
When is Pitocin used?
- It’s used before delivery and postpartum
- Used for induction of labor
What route is Pitocin given?
- Almost exclusively IV or IVPB but can be given IM (for Postpartum bleeding or prevention)
