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Maternal Exam 4 > Labor & Birth Complications > Flashcards

Labor & Birth Complications Flashcards

1
Q

How many types of Rupture of Membranes are there?

A

2
PROM
PPROM

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2
Q

What is PROM?

How can this become prolonged?

A

Premature rupture of membranes that is after 37 weeks but before onset of labor (so there’s a gap between the two)

Can become a prolonged rupture of membranes if the labor doesn’t begin within 24 hours
- very common

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3
Q

What is the concern with a prolonged rupture of membranes?

A

Infection risk due to the sac being ruptured and allowing organisms from genital tract to infect

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4
Q

What is PPROM?

Is this common? And in who?

A

PPROM = Preterm Pre-mature ROM or rupture of membranes so it happens before 37 weeks

1/3 of births are PPROM and more common in African Americans

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5
Q

What history may indicate a pregnant woman might be PPROM or preterm PROM before 37 weeks?

A) Hx of PPROM
B) High gravida
C) Nulligravida
D) HX of pre-term labor or symptoms of it currently
E) cervical insufficiency or procedure of cervix

A

These history findings could indicate a PPROM

Hx of PPROM
HX of Pre-term labor or symptoms of it
Cervical insufficiency or procedure (leep or colposcopy)

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6
Q

What history may indicate a pregnant woman might be PPROM or preterm PROM before 37 weeks?

A) UTI or other infections of tract
B) Multiple gestations
C) Diabetes
D) Smoking and substance abuse
E) Low Socioeconomic status
F) Being overweight
D) nutritional deficiency and low BMI
A

These history findings are also indicative of PPROM

UTI/infection
Multiple gestations
Smoking/substance abuse
Low SES due to poor healthcare 
Nutritional deficiency and low BMI
  • could also be unknown
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7
Q

With a rupture of membranes, what is some subjective data mom will report?

A

“I felt a pool of fluid”

“It is abnormally wet down there”

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8
Q

What will the objective data look like for rupture of membranes upon exam?

A

Vaginal pooling with speculum exam

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9
Q

Objective testing for rupture of membranes?

A

Gold nitrazine paper turning dark blue
Positive ferning
Positive Amnisure or ROM + swab

Ultrasound AFI being lower than 5
Amniocentesis - instill blue dye and monitor for blue staining

Uterine surveillance or monitoring UC’s
FHR for variable decels and wellbeing

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10
Q

What is the latency period?

A

Between rupture and onset of labor
- only a couple cm dilated
(comes before the active labor)

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11
Q

What are latency antibiotics?

A

Antibiotics given in the latency period or period right BEFORE onset of labor to prevent infections of mom and baby
- 7 day course of broad spectrum

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12
Q

When will doctors give Magnesium Sulfate to mom?

A

For neuroprotection of the baby. They give it between 24-34. The baby has a chance to survive yet has immature lungs and so brain vessels are fragile and could lead to hemorrhage
- prevents cerebral palsy, hearing loss, seizures etc

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13
Q

First nursing care step for PROM and PPROM

Second nursing care step?

A

First, determine how long the rupture has been present because that may determine infection risk
- not all people come to hospital once they rupture

Second find out her gestational age to determine if she can get corticosteroids/mag
sulfate if between 24-34

(mag sulfate for neuro protection
mag sulfate and terbutaline for slow of preterm labor for transport
corticosteroids for lung development)

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14
Q

At what gestation will early rupture (PROM and PPROM) moms actually be induced and why?

Major complication with early rupture (PROM and PPROM) that may stop a mom from getting to that 34-35 week mark?

What will they do?

A

Around 34-35 weeks to reduce risk of infection
- sooner the baby is out, the better at this point since her sac is ruptured

Chorioamnionitis - infection of chorion and amnion or two membranes that make up amniotic sac.
And they can give antibiotics and expectant management if she still isn’t at 32 week mark but if she is septic they have to deliver

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15
Q

Major complication with early rupture (PROM and PPROM) that may stop a mom from getting to that 34-35 week mark?

Symptoms?

What will they do?

A

Chorioamnionitis - infection of two membranes that make up amniotic sac

fever & therefore tachycardia in mom and baby
uterine tenderness
bad smelling discharge

And they can give antibiotics and expectant management if she still isn’t at 32 week mark but if she is septic they have to deliver

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16
Q

Daily assessment of fetus you do when caring for a early rupture (PROM or PPROM)?

A

BPP or biophysical profile
NST or non stress test
Daily kick counts

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17
Q

Newborn risks of early rupture?

A

Pneumonia since the fluid can get in the lungs
Sepsis due to infection possibility
Preterm birth
Cord compression if delivered vaginally due to a lack of fluid being able to keep cord flexed

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18
Q

What med will they give to get mom transported with a PROM/PPROM?

A

Tocolytics again just so mom can get transported

Steroids for lung development

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19
Q

How should PROM/PPROM patient lay?

How is she hydrated?

What unit might she visit?

What do you as nurse provide?

A

On her side

PO or IV

Take her to nicu with wheelchair to show her where her baby might go

Comfort measures and education

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20
Q

Outcomes of PROM/PPROM ?

A

Even with conservative therapy the tis appropriate, 50% of women will labor between 28-34 weeks

(remember the goal is to have them deliver as close to due date as possible but sometimes they can’t always do that. They really do try to get them to 34 weeks tho so their lungs are adequate enough and then give mag sulfate and steroids)

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21
Q

Newborn of a woman with hx of oligohydraminos due to her PPROm may have what conditions are birth?

A

Pulmonary hypoplasia - so the lack of fluid means the baby can’t even practice breathing in utero

Limb positional defects - so baby isn’t able to float around and so limbs become stuck and you might even have handprint on face

fetal growth restriction could happen too from lack of o2

facial deformities from lack of fluid and no floating

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22
Q

During assessment for vaginal pooling what will the doctor ask mom to do to increase accuracy?

A

Perform Valsalva maneuver due to the baring down causing more fluid to be pushed out and confirm the rupture

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23
Q

What is Pre-term labor?

A

Labor onset between 20-37 weeks

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24
Q

What ethnicity is more likely to have preterm labor?

A

African Americans - double compared to whites. And leads to higher mortality

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25
Q

T/F

Preterm births are the 5th most common cause of death of newborns/infants

A

False.

They re the 1st most common cause of death in newborns/infants.

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26
Q

T/F

Multipel factors often play into the outcome of a preterm labor

A

True. The reasons combined usually cause the uterine contractions, cervical changes, and rupture to happen earlier between 20-37 weeks

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27
Q

In a mom who is having preterm labor, what will it feel like?

A

Contractions every 10 minutes or less with a pattern

Cramping in abdomen but also low back pain. May feel pressure in pelvic area

Increased discharge, rupture, and even a bloody show

Diarrhea

  • Really it is the same with normal labor. It is just earlier
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28
Q

Criteria for diagnosis of preterm labor?

A

Gestation must be between 20-37 weeks
Contractions with cervical change
- cervical effacement of 80%
- cervical dilation 1 cm

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29
Q

What is the fetal fibronectin test they give for diagnosis of preterm labor?

A

Fetal fibronectin test - collects fluid from vagina during speculum exam
- fFn shouldn’t be present after 20 weeks unless ofc you are preparing for labor so if you do see it, then it is a sign of labor. positive test 99% of delivery.

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30
Q

Why might there be a false positive on a Fetal fibronectin test (fFn)?

A

False positive due to recent coitus, recent vaginal exam within 24 hrs, bacterial vaginosis, vaginal bleeding

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31
Q

What is fibronectin?

A

A protein that acts as glue which is produced by fetal membrane to bind placenta and uterine wall
- fetal fibronectin test

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32
Q

How can Cervical length be a diagnostic tool for preterm labor?

A

Cervical length should be around 30 mm or 3 cm

  • so if it is greater than 25, that means you’re probably out of the woods and aren’t at risk of preterm labor.
  • if less than 25, you are seeing shortening of cervix

This test can be done at any point in PG
And is done transvaginal

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33
Q

Primary preventions done to prevent preterm labor?

A

Prevention of infections - Lactobacilli is good but yeast is bad. Good amount of lactobacilli = better outcomes

Cervical Cerclage - suture the cervix early in pregnancy for those who have a history of preterm

Progesterone therapy - quiets uterus . Given at 16-36 weeks. PO, vaginally, IM 250

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34
Q

Secondary prevention done to prevent preterm labor?

A

Treat infections aggressively upon onset

Tocolytics to suppress uterine activity

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35
Q

Early interventions for preterm labor at home?

A 
Empty bladder but also keep yourself hydrated 
Rest in side-lying position 
Warm tub bath
Nothing per vaginal route 
Light activity 
Palpate uterus to monitor contractions

But if the contractions don’t go away, go to hospital. At this point you need to be evaluated for triggers and meds given.

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36
Q

Early preterm intervention Meds given to stop preterm labor? Other meds?

A

Tocolysis drugs like Magnesium sulfate and terbutaline to stop labor
And then give corticosteroids to mom for lung maturity for 24 hours
- Giving too much has consequences of pulmonary edema
Antibiotics to prevent GBS in latent period

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37
Q

Forms of tocolytics

A

Magnesium sulfate
Terbutaline SQ
Calcium channel blockers (Nifedipine, Procardia) to inhibit contractions
Prostaglandin inhibitors to block muscle contraction of uterus (Celebrex, Sulindac, indomethacin, Ketorolac)

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38
Q

Magnesium sulfate

A

displaces Calcium and very common. Must be continued for 12 hours even after contraction stop

39
Q

Terbutaline

A

Don’t use longer than 48-72 hours

40
Q

Calcium channel blockers

A

Inhibits calcium and contractions

Nifedipine
Procardia

41
Q

Prostaglandin Inhibitors

Why is this the last resort?

A

Blocks calcium but last resort because it can cause premature closure of the ductus arteriosus.

Celebrex, Sulindac, Indomethacin, Ketorolac

42
Q

Tocolytic toxicity signs?

A

Depressed reflexes
Oliguria
Confusion
Respiratory and Cardiac depression

Check DTR , UO, and mag levels, do respiratory assessments

43
Q

Side effects of tocolytics?

A 
flushed/warm feeling
dry mouth
nasal congestion
pulmonary edema
hyperglycemia

people don’t love these drugs

44
Q

Dysfunctional labor patterns

A

Dystocia

45
Q

Dystocia labor meaning

How many types are there?

A

Labors that are prolonged and abnormal due to lack of progress.

Two
Hypertonic uterine contractions
Hypotonic uterine contractions

46
Q

Hypertonic uterine contractions meaning

When do these happen?

A

Tachysystole or lots of contractions.
Low amplitude, frequent, but no progress to open cervix

Tend to happen in the latent phase in primipara or first time PG.

47
Q

Treatment plan for hypertonic uterine contractions?

How do they figure out the cause?

More invasive treatment?

A

Wait a bit or give them meds like Benadryl or Morphine to sedate the mom so they can just rest.

Do sonogram to check for CPD or malpositian again (they do this on admission too)

AROM (amniotomy)
Pitocin

48
Q

Hypotonic uterine contractions meaning

A

Contracting really good up until the active labor phase that halts progress
Low amplitude and irregular contractions that can’t open the cervix

49
Q

Initial treatment for Hypotonic uterine contractions?

What comes next?

What do you calculate?

A

Definitely check with sonogram for CPD or malposition.

Augmentation next : 
Have her walk around
AROM (amniotomy)
Pitocin with IUPC
- can calculate MVU
50
Q

When a woman is having dystocia of either hypotonic or hypertonic uterine contractions, she may have rest of descent. And then what type of labor will she have?

A

She will go back to C section due to Lack of progress (not fetal distress)
- but only if the baby isn’t coming yet

51
Q

What is prolonged 2nd stage?

Causes?

A

So from 10 cm to dilation to birth, it takes too long because of pushing efforts aren’t good enough.

Heavy block or exhaustion

52
Q

Treatment options for prolonged 2nd stage?

Last resort?

A

Change mom’s pushing position
Tug of war
Vacuum/Forceps are an option to get the baby out

C section as last resort.

53
Q

What is a Precipitous birth? Isn’t this good?

When does this happen a lot?

A

Labor (like dilating and all) and birth occurs in less than 3 hours

Not necessarily good bc a fast birth means possible trauma to baby and mom bc normal labors are slow and progressive with stages. The pushing might take 3 hours but as whole big picture event, if less than 3 hours is not good.

Often occurs in unattended births.

54
Q

What is mom at risk of when she has a Precipitous or too fast of birth?

A

Post partum hemorrhage because her uterus may not contract and instead be atony.

55
Q

Post term or post date birth definition

A

Greater than 294 days or 42 weeks

56
Q

Post term birth causes

A

Error in determine EDD

Low estrogen levels

57
Q

How can an error in EDD cause post term?

Most accurate? And how?

A

Well if you have an inaccurate EDD, then the baby may come out sooner than expected.
This is common in women who don’t know they’re pregnant and come in later.
Most accurate in 1st trimester and can do C-R measurement.

58
Q

How can estrogen levels cause post term labor?

A

A lack of triggering labor onset w withdrawal

so less estrogen means your labor won’t be induced as easily?

59
Q

Treatment for post term moms?

A

Induction of labor

60
Q

What concerns arise with a post term mom?

A

An aged placenta bc it is past the mark

Meconium aspiration syndrome from expulsion bc the baby is mature enough to poop

Cord compression rt oligohydramnios bc the fluid start to dry up

Large birth weight

61
Q

What size will the baby be if post term?

What type of labor do post term moms often have? And why?

A

Probably a large baby

Post term moms often have c section because of fetal distress and intolerance. So check for late and variables.

62
Q

What is shoulder dystocia?

A

Head delivers but the shoulders and body don’t come out within 60 seconds and therefore prolonged due to shoulders being too big for pelvis.

63
Q

Who is more likely to cause shoulder dystocia? Micro or macrosomic? Large or small caput?

What aspects of mom can cause have a factor in shoulder dystocia?

A

A macrocosmic or large baby
Large caput

Diabetes bc if she is diabetic, increased odds of her baby being large.
Maternal obesity
High parity

64
Q

What is it called when the head goes in and out of the birth canal?

A

Turtle signs associated with shoulder dystocia

65
Q

What should nurses do if they see shoulder dystocia?

What can they do next?

A

Stay calm and call for help

Do maneuvers to get the baby out.

  • Mcrobert = sharp flexion of legs
  • Suprapubic = pressure on anterior shoulder not fundus
  • Rubin = push shoulder of fetus to chest
  • Woods corkscrew = put hand inside to put pressure on posterior shoulder
66
Q

Maternal complications of shoulder dystocia?

A

Episiotomy of 3rd or 4th tears.

Hemorrhage

67
Q

Fetal complications of shoulder dystocia while in birth canal?

Fetal injuries due to shoulder dystocia?

A

Cord compressoin
Hypoxia

Brachial plexus injury to nerves in shoulder/arm
- need to go to PT so they can learn to use it or it will atrophy
Fractures clavicle or humerus

68
Q

Persistent OP positioning malpresentation and management?

A

OP is when their right direction just facing wrong way aka forward looking at ceiling so will have to just rate 135 degrees or deliver as is

Brow presentation
- more cause of c section

Face presentation

  • head hyperextended
  • multiparous women
  • c section too
69
Q

Brow presentation ? What delivery is common?

A

When the baby’s head and neck is a bit distended

C-section is common

70
Q

Face presentation ?
Delivery requirement?
Who is it common in?

A

When the baby’s head and neck is so distended the full view of the face comes out

C -section needed

Common in multiparous women

71
Q

Do we deliver breeches vaginally?

Types?

How do we know?

A

No we do not.

Frank (feet up)
Single footling (feet get blue from sticking out) 
Complete breech (wrapped up)

We will feel softeners up near fundus.

72
Q

How are transverse lie or shoulder presentations done?

A

Turn them or do c section

73
Q

Dizygotic twins

A

Two separate ova’s so fraternal twins.
Each twin has separate everything.

60% so most twins are these and we prefer it

74
Q

Monozygotic twins defintion

Types?

A

Single ova that separated.
Could be sharing chorion, placenta, and amnion.

3 types ..

Dichorionic: all separate just came from same egg

Monochorionic diamniotic: placenta has one chorion and two amnions so each is in own sac

Monochorionic monoamniotic: same everything and one you least desire.

75
Q

What are pregnancy symptoms like with twins?

A

Exaggerated!

More SOB, backaches, pain, heartburn, pressure, hemorrhoids, and pedal edema.

76
Q

Who is more likely to have complications in pregnancy? Mom with one or with twins?

A

Twins make for more complications.
- such as pulmonary edema, hypertension, anemia
etc

77
Q

When malpresentation occur with twins, what is the hope? What if it doesn’t work?

A

Hopefully mom can deliver A vaginally and then have baby B flip. Otherwise they’ll need a C-section.

78
Q

What is a Succenturiate lobe? And concern? treatment?

A

A lobe develops on the placenta and the concern is that it gets left behind and cause PPH
- so they need to go back and clean out uterus

79
Q

Circumvallate placenta meaning?

Concern?

A

Amnion and chorion fold in and make the placenta circumference thicker

Baby can have hypoxia due to thickness

80
Q

What is Battledore placenta?

A

When the umbilical cord is inserted or or neat the placental margins

81
Q

Valementous insertion

A

Vessels of the cord divide away from the placental membrane

82
Q

Why is cord prolapse an emergency?

A

FHR It’s because the baby won’t have good access to oxygen and you only have crash emergency c section.

83
Q

What is important to check with cord prolapse?

A

Check FHR

84
Q

How is cord prolapse detected?

A

Pulsating rope felt with drop in Fetal heart tones that drop. Tachycardia first to compensate but then bradycardia.

85
Q

What will they do to get mom relaxed for c section for prolapse cord?

A

Sedation if she hasn’t been given any other epidural yet. They don’t have the time

86
Q

What positions can they do for cord prolapse?

A

Trendelenburg

want to change position to see if that helps basically

87
Q

What hand maneuvers will they be doing for cord prolapse?

Transportation?

A

Someone will have their hand up in the vagina to keep things off the cord

Throw a sheet on over you and mom and get her to the OR

88
Q

What do you administer for cord prolapse?

A

Administer oxygen to get to baby

Bolus IV fluids

89
Q

If the prolapsed cord is hanging out, what do you do?

A

Cover with wet sterile dressing. Do NOT reinsert bc it can cause infection.

90
Q

What is amniotic fluid embolism or Anaphylactoid syndrome of pregnancy?

A

When amniotic fluid debris get sucked into maternal circulation and causes a thrombus and embolism.

91
Q

Amniotic fluid embolism or Anaphylactoid syndrome of pregnancy symptoms?

A

Dyspnea, cyanosis , hemorrhage, hypotension, shock, coma

92
Q

When does Amniotic fluid embolism or Anaphylactoid syndrome of pregnancy happen?

A

Onset in labor, during birth, or up to 30 minutes after

93
Q

What to do if you suspect Amniotic fluid embolism or Anaphylactoid syndrome of pregnancy?

What if mom is already dead?

Is there anything you can do to prevent this from happening?

A

Call for help immediately. It is a code. Very fatal.

Intube and ventilate mom and do CPR

Rescue the baby

No there’s nothing you can do to prevent. A freak occurence

Maternal Exam 4 (6 decks)

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