Labor & Birth Complications (Week 6) Flashcards
preterm labor
regular contractions
cervical changes
- effacement
- dilation (2cm)
- presentation
preterm birth timeframe
20 0/7 and 36 6/7
preterm labor vs Braxton hicks
Braxton hicks are no cervical changes
why do we have decreased rates of preterm birth
improved fertility practices
quality improvement
increased use of strategies to prevent recurrent preterm birth
can we induce with out valid reason
no
very preterm
<32
moderatley preterm
32-34
late preterm
34 0/7 - 36 6/7
preterm birth vs birth weight
- preterm
preterm is the length of gestation regardless of birth weight
what is more dangerous birth weight or preterm
preterm since there is less time in the uterus that correlates with immaturity of body systems
low birth weight grams
<2,500
what is an example of intrauterine growth restriction
hypertension which leads to constrictions and decreased perfusion to cord which decreases nutrients to grow
is preterm birth normally spontaneous or indicated
spontaneous
some causes of spontaneous labor and birth
multifactoral
infection
placental
maternal and fetal stress
uterine over distention
what is the only definitive factor for preterm labor
congenital
what are some examples of infection
colonization of upper and lower genital tract leading to UTI
what percent of preterm labor don’t have risk factors
50%
cervical length of what in the 2nd and 3rd trimester means unlikely to give birth
> 30mm
what is the fetal fibronectin test
this is the glue found in plasma and produced during fetal life
want a negative
- negatove test means you are not likely to go into labor within next 2 weeks
age of viability
22-24
when do we need to have delivered after membranes ruptured
18 hours
does rupture of membranes mean labor
no
does preterm labor look like normal pregnancy symptoms
yes
what medication can help with preterm labor
progesterone
what do tocolytic medications do
stop contractions
arrest labor after contractions and cervical change has occurred
brethanone
off label of resp med for tocolytic
what med do we use for fetal lung maturity
betamethasone
betamethasone
12mg IM 2x apart
s/s of preterm labor
change in discharge - pink
dull back ache
pelvic abdominal pain
mild cramps
regular, frequent contractions
diarrhea
mag sulfate
decrease neural morbidity
not well understood
also get for preeclampsia
PROM
spontaneous rupture of aminitoci sac and leakage of fluid prior to the onset of labor at any gestational age
PPROM
membranes rupture before 37 0/7 weeks of gestation
what is PPROM often preceded by
infection
- choiro
for PROM what do we assess
color
time
odor
infection
non reassuring strip
steroids
antibiotics
mag
choiro
bacterial infection of the amniotic cavity
choiro s/s
maternal fever
maternal and fetal tachycardia
uterine tenderness
foul odor of amniotic fluid
how does choiro happen
vaginal flora bacteria ascend up the birth canal into amniotic fluids
risk of choiro
18 hr ruptured membrane
frequent vag exam
intruterine monitoring
young age
low SES
preexisting conditions
1st tiem pregnant
mom who is tachy
tender fundus
high WBC
purulent dischabge
choiro
- culture
possible steroids
antibiotics
choiro treatment
IV broad spectrum antibiotics and birth of fetus
choiro GBS
vaginal/rectal culture
35-37 weeks
only treated during labor
+GBS and no antibiotic increase risk of infant sepsis
how many doses do we want before birth
at least 2 doses q4
- preferably 4
postterm pregnancy date
> 42 weeks
what are we worried about with postterm
placenta starts to break down which disrupts O2 delivery during contraction leading to late decals
who is more likely to have oligo
post
who is more likley to have met stained fluids
post
what is the treatment for men stained fluid
treat same as no stained fluid
macrosomia
abnormal fetal growth
macrosomia leads to
shoulder dystocia
post maturity syndrome
dry cracker peeling skin with greenish tinged skin and cord with long nails
since the perinatal M&M increase greatly at 41 0/7 what do we do
kick count and seen in office 1-2 times a week
dystocia
lack go progress in labor for any reason
what is the most common indicaiton of c/s
dystocia
dystocia
- powers
ineffective contraction
ineffective bearing down
dystocia
- passage
cervical edema
dystocia
- passenger
position of the baby which influences the position of mom
dystocia
- psychological
catecholmines
precipitous labor
labor that lasts less than 3 hours from onset of cxn to time of birth
what happens during precipitous labor
hard on mom
doesn’t allow stretching
baby bruised
obese BMI
> 30
who is external cephalic version most successful in
non obese
multip
with abundant amniotic fluids
fetus not engaged
induction
chemical or mechanical intitation of uterine cxn before their spontaneous onset for the purpose of bringing about birth
what is bishops score
cervcial ripeness
what is a good score for bishops
8+ is good
score of 0 for bisphops
closed
0-30%
-3
firm
what station do you need for amniotomy
need station less than -3 cause you have to be ruptured
goal of oxytocin
produce contractions of normal intensity duration and frequency using lowest dose
what is a risk with oxytocin
tachysystole
if the initial outbreak of herpes during 3rd trimester
baby is likely to get it
augmentation
stimulation of uterine cxn after labor has started spontaneously and progress is unsatisfactory
amniotomy
rupture of membranes
common methods of augmentation
oxytocin and amnitomy
shorten labor and less c section
presence of nurse to provide emotional and physical support
forceps and vacuum are used in what phase of labor
2nd
do forceps and vacuum work alone
no in conjunction of contraction and bearing down
what do we need for for forceps and vacuum
fully dilated
ruptured
engaged
empty bladder
vertex
for the vacuum since it is placed on the on the occiput what do we do
check fontanelle
if the vacuum pops off how many times
3times
vacuum risk
cephalohematoma
which one crosses
caput
VBAC
vaginal birth after cesarean
TOLAC
trial of labor after cesarean
cesaran complicaton
difficulty with intubation
drug reaction
aspiration pneumonia
cesaran risks
infection
blood loss
pneumonia
clots
Mac stained amniotic fluid more common with
closer to term
what does mec stained fluid mean
fetus has passed stool prior to birth
do we do tracheal suction for mec
no
shoulder dystocia
head is born but anterior shoulder cannot pass under pubic arch
who is at risk for shoulder dystocia baby
large baby
who is at risk for shoulder dystocia mom
short mom
increase BMI
leading to atony and rupture
shoulder dystocia injuries
asphyxia
brachial plexus damage
fracture
shoulder dystocia
- turtle sign
when the head comes out and then back in
shoulder dystocia
- once head is delivered
mark time
shoulder dystocia
- mcroberts maneuver
bring legs up and out
shoulder dystocia what do we do
mcroberts maneuver and suprapubic pressure
shoulder dystocia do you do fundal pressure
no
prolapsed cord
occurs when cord lies below presenting part of fetus
how to treat prolapsed cord
push it back in
on hands and knees and put butt up
rupture of uterus s/s
recurrent late and variables with pronged deceleration
sharp abd pain
bright red bag bleeding
crazy strip
rupture of uterus risk
prev c/s or surgery
what is best treatment for rupture
prevention
amniotic fluid embolus
amniotic fluid containing particles of debris enter the maternal circulation and obstructs pulmonary vessels
amniotic fluid embolus s/s
sudden acute onset of hypotension, hypoxia, hemorrhage caused by coagulopathy
PPH blood loss amount
> 1000
signs of early PPH
atony
- distended bladder
or cervical laceration
saturation of pad in less than
15 min
signs of late PPH
sub involution
what is first priority for PPH
fundus
what is the leading cause of PPH
atony
placenta accreta
slight penetration of myometrium
placental increta
deep penetration of myometrium
placental percreta
perforation of mymetrum and uterine serosa. possible of involving adjacent organs
bright red blood
arterial/deep
dark red blood
venous/superfical
hematoma
collection of blood in connective tissue
-pressure and can block bladder
inversion of uterus
comes out backwards
sub involution s/s
prolonged lochial discharge
methergine
HTN
hematite
asthma
post PPH teaching
fatigue
increase iron
exhaustion
limit physical activity
when bleeding in contious and there is no identifiable source
a coagulopathy can be the cause
what coag state is preg
hypercoag
puerperal infection
any clinical infection of the genital tract that occurs within 28 days after miscarriage, induced abortion or birth
puerperal infection s/s
fever >100.4 for 2 or more days of the first 10 PP days
endometritis
infection of the lining of the uterus
endometritis tx
IV antibiotics
most common PP infection
endometritis
cystocele
bladder prolapse
rectocele
retctum prolapse
only lift as heavy as
the baby
