Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OB > labor and birth complications (unit 3) > Flashcards

labor and birth complications (unit 3) Flashcards

1
Q

pre-term labor (PTL)

A
  • gestation b/t 20-37 wks
  • AND uterine ctx
  • AND cervical change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PTL risk factors

A
  • hx of PTB (greatest predictor)
  • low SES
  • non-white
  • maternal age extremes
  • low pre-pref rate
  • substance abuse
  • inc. uterine volume
  • uterine abnormalities
  • infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

subjective s/sx PTL

A
  • cramping
  • low back pain/pressure
  • abd. tightening
  • vag. bleeding/discharge
  • urinary freq.
  • malaise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

objective s/sx PTL

A
  • > 6 ctx/hr
  • vag. bleeding/discharge
  • cervical dilation/effacement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

labs for PTL

A
  • UA/culture
  • NST
  • BPP
  • U/S (cervical length)
  • fetal fibronectin (FFN)
  • swab for infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PTL tx

A
  • prevention/early recognition
  • tocolysis drug
  • steroids for fetal lungs
  • bedrest/pelvic rest
  • hydration
  • abx for infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

tocolysis

A
  • tx used to stop uterine activity

* goal is to but time for steroid admin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

tocolytic

A
  • med to stop uterine activity
  • off label
  • MgSO4
  • terbutaline
  • Nifedipine
  • indomethacin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MgSO4

A
  • CNS depressant to prevent seizure
  • Relaxes smooth muscle (↓ vasoconstriction)
  • SE is that BP is lowered
  • Next to Pit, most common drug used in labor and delivery
  • Given IVPB via pump
  • Effect is immediate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

terbutaline

A
  • tocolytic
  • SQ q20min for 3 doses
  • then PO q 4-6 hr
  • monitor VS, lung sounds, I/O
  • DONT give if HR > 120
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Nifedipine/Indomethacin

A
  • tocolytics
  • PO (not as fast as others)
  • Indomethacin not used after 32 wks or longer than 48 hrs (last choice med)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

steroids

A
  • best PTL intervention
  • most common is Celestone
  • speeds FLM, by stimulating surfactant production
  • given b/t 24-34 wks gestation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

low birth weight (LBW)

A
  • any baby born < 2500g REGARDLESS of gestation

* usually caused by IUGR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

greatest preterm survival prognosis

A

•27+ wks have 90% chance of survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

oligohydramnios

A
  • not enough amniotic fluid
  • AFI < 5
  • usually caused by renal issue, PROM, post dates, or UPI
  • tx: FHR monitoring; amnio-infusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

risks r/t oligohydramnios

A
  • cord accident
  • fetal malformation
  • hypoplastic lungs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

polyhydramnios

A
  • too much amniotic fluid
  • AFI > 20
  • caused by CNS/GI track malformations and mat. diabetes
  • tx: FHR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

risks r/t polyhydramnios

A
  • unsuccessful labor
  • cord prolapse
  • PROM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

PROM

A
  • premature rupture of membranes

* water breaks 1+ hr before onset of labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

PPROM

A

•preterm premature rupture of membranes
•water breaks 1+ hr before onset of labor AND gestation < 37 wk
•hospitalized for rest of PG
*goal to get to 34 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

PROM/PPROM risk factors

A
  • infection
  • incomp. cervix
  • fetal abnormalities
  • nutritional deficiencies
  • polyhydramnios
  • recent OB procedure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

risks r/t PROM

A
  • INFECTION

* cord prolapse (olighydramnios)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

risks r/t PPROM

A
  • INFECTION
  • cord prolapse (olighydramnios)
  • fetal abnormalities (musculoskeletal and lung)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how is ROM diagnosed

A

•Fern Test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

chorioamnionitis

A

•infection of chorion and amnion
•higher risk if membranes ruptured long
•s/sx: fetal tachy, maternal fever, foul fld.
*notify MD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

dystocia

A
  • long, difficult, or abnormal labor r/t 5 Ps (power, passageway, passenger, position, psyche)
  • can lead to infection, C/S, and PPH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

dystocia risk factors

A
  • short
  • overweight
  • > 40 y/o
  • uterine abnormalities
  • pelvic soft tissue issues
  • CPD
  • fetal macrosomia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

precipitate labor

A
  • < 3 hrs form labor onset to delivery

* can cause trauma, FHR disturbance, abruption, PPH

29
Q

precipitate labor risk factors

A
  • hypertonic labor
  • induced labor
  • hx of precipitate labor
30
Q

power

A
  • fxn of uterine ct. and maternal pushing
  • hypotonic/hypertonic labor
  • ineffective pushing (fear, exhaustion, epidural, etc)
31
Q

hypotonic labor

A 
•slowing or arrest of cervical change
•weak ctx (corrdinated)
•no fetal distress
•need augmentation
**occurs during ACTIVE phase
32
Q

augmentation

A
  • IV Oxy***, AROM or nipple stim

* increased risk of fetal distress and C/S

33
Q

intrauterine resuscitation (IUR)

A
  • turn pt on side (correct hypoten)
  • turn off pit (rlx uterus)
  • open main IV (correct hypovol.)
  • O2 mask
  • vag. exam (r/o prolapse)
34
Q

hypertonic labor

A 
•ctx uncorrdinated
•inc. resting tone
•painful, but ineffective
•false labor b/c NO cervical change
**occurs during LATENT phase
35
Q

risks r/t hypertonic labor

A
  • fetal distress (UPI)
  • fetal head trauma
  • maternal exhaustion
36
Q

RN care hypertonic labor

A
  • MONITOR FHT
  • IUR if necessary
  • may give ambien or narcotics
  • if FHTs reactive, false labor and can DC
37
Q

problems r/t passageway

A
  • maternal pelvic structure abnormalities

* soft tissue obstruction

38
Q

pelvic abnormalities

A

•small or abnormal shape
•genetics, rickets, young age, trauma
*gynecoid preferred shape (oval)

39
Q

causes of soft tissue obstruction

A

•full bladder (#1)
•cervical edema
•HPV
*empty bladder and don’t push until complete dilation

40
Q

problems r/t passenger

A
  • macrosomia
  • malposition
  • multifetal PG
  • fetal anomalies
41
Q

macrosomia

A
  • > 4,000 g

* r/t GDM, obesity, multiparity

42
Q

macrosomia risks to neonate

A
  • head trauma
  • shoulder dystocia
  • brachial plexus injury
  • fractured clavicle
  • asphyxia
  • underdevelopment
  • hypoglycemia
43
Q

turtle sign

A

•head retracts agains perineum and external rotation doesn’t occur
•r/t shoulder dystocia
*can lead to nerve injury or asphyxia

44
Q

shoulder dystocia interventions

A 
•call MD
•McRobert's maneuver
•suprapubic pressure
•Gaskin maneuver
•Zavanelli maneuver (last resort)
***NEVER apply fundal pressure
45
Q

McRobert’s maneuver

A

•hyperflex mom’s legs tightly to abd.

46
Q

Gaskin maneuver

A

•all fours

47
Q

Zavanelli maneuver

A

•push fetal head back in and do C/S

48
Q

problems r/t postions

A 
•interfere w/ dilation/descent
•long dysfunctional labor
•poor pain control (back)
•inability to push
*freq. position changes crucial
49
Q

breech

A
  • feet or butt first
  • requires C/S
  • associated w/ fibroid, hydrocephalus, fetal tumor, ONTD
50
Q

complications of breech delivery

A

•prolapsed cord
•cord compression
•head entrapment
*only do vag. if no time for C/S

51
Q

multiples

A
  • only vag. delivery if both vert

* r/o dysfunctional labor and PPH

52
Q

problems r/t psyche

A
  • previous experience/knowledge
  • culture
  • lack of support
  • loss of control
  • fear/stress
53
Q

complication of post date PG

A
  • > 42 wks
  • placental failure
  • UPI
  • oligo
  • r/o fetal distress, IUGR, IUFD
54
Q

intrapartum emergencies

A
  • prolapsed cord
  • uterine rupture
  • amniotic fld. embolism
55
Q

risks for cord prolapse

A
  • polyhydramnios
  • malpresentation
  • multiples
  • high station
  • small fetus
56
Q

signs of cord prolapse

A

•sudden severe variable FHR
•sudden fetal bradycard
•see/feel cord
*ALWAYS vag. exam if suspected

57
Q

uterine rupture

A
  • complete rupture of uterine scar
  • rare
  • r/t C/S, myomectomy, over-distended uterus, trauma
58
Q

s/sx uterine rupture

A
  • sudden loss of ct.
  • loss of fetal station
  • sudden fetal distress
  • shock
  • back/shoulder pain
  • vag. bleeding
59
Q

uterine rupture intervention

A
  • call MD
  • start IUR
  • prepare for C/S
  • anticipate infant resuscitation
  • have lots of blood products
60
Q

uterine dehiscence

A
  • incomplete rupture of uterine scar
  • usually little pain
  • does NOT involve fetal distress
  • labor slows/stops
  • if no tx, will complete rupture
61
Q

amniotic fluid embolism (AFE)

A
  • embolism of amniotic fld. enters maternal circulation
  • r/t hypertonic ctx, precipitous birth, uterine rupture, placenta abruption
  • rare, but high mortality rate
62
Q

s/sx AFE

A
  • Abrupt onset of respiratory distress, chest pain, cyanosis
  • Hypotension and shock
  • Frothy sputum
  • HF/arrest
  • Coma
  • Fetal Bradycardia
  • DIC
  • Massive hemorrhage
63
Q

AFE intervention

A
  • CPR
  • large bore IV
  • foley
  • MD chooses if delivery or save mom
64
Q

placenta accreta

A
  • slight abnormal growth of placenta into uterine muscle tissue (myometrium)
  • high risk of AFE, hemorrhage, hysterectomy, and death
65
Q

placenta increta

A

•deep placental growth into myometrium

66
Q

placenta percreta

A

•placenta grows completely thru myometrium and may adhere to structures of surrounding uterus

67
Q

uterine inversion

A
  • involution of uterus during delivery of placenta
  • results in massive hemorrhage
  • tx: replace blood and hysterectomy
68
Q

retained placenta

A
  • failure of entire or parts of placenta to deliver after 30 min
  • may require surgical removal
  • fragments can go unnoticed and lead to PPH

OB (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions