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OB Nursing > Labor, Birth, & Placental Complications > Flashcards

Labor, Birth, & Placental Complications Flashcards

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1
Q

Premature Rupture of Membranes (PROM)

A

Rupture of amniotic sac before onset of true labor, regardless of gestational age

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2
Q

Preterm Premature Rupture of Membranes (PPROM)

A

Amniotic sac rupture before end of 37 weeks, w/ or w/o contractions

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3
Q

Causes of PROM/PPROM

A 
Infection of vagina, cervix - C/G, GBS, BV
Weak amniotic sac
Prior preterm birth
Incompetent or short cervix (<25 mm)
Uterine overdistention (multi, LGA)
Hormonal changes
Recent intercourse (sperm PGs)
High stress
Low SES
Nutritional deficiencies
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4
Q

When do contractions typically begin after PROM/PPROM?

A

6-8 hours

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5
Q

PROM/PPROM Management

A

Delivery - may start spontaneously, reasonable induction if 34-36 weeks

Tx of PPROM/Triple I infection - ampicillin, gentamicin (if allergic, cefazolin, clindamycin, vancomycin)

Admin IV for duration of labor & 24 hrs PP

Monitor for signs of infection - HR, temp, tenderness

Tylenol for fever

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6
Q

Management of PROM/PPROM <34 weeks

A

Maintain pregnancy, IV/oral abx prophylaxis, extended hospital stay until 34 weeks

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7
Q

PROM/PPROM complications

A

Maternal fetal risk for infection increased if >18 hrs

Umbilical cord compression

Reduced lung volume

Compression deformities

Sepsis risk for newborn

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8
Q

PROM/PPROM Infection

A

Intrauterine infection and/or inflammation = Triple I due to chorioamnionitis

Signs - maternal fever >39C w/o other sx OR fever PLUS 1+ of:

Fetal tachycardia, increased WBC count (>15k), maternal tachycardia, purulent vaginal discharge/fluid

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9
Q

Preterm labor (PTL)

A

Documented labor between 20 & end of 37 weeks

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10
Q

Why has PTB increased in last 15 years?

A

Better data, multifetal pregnancies, increased use of artificial reproductive technologies (ARTs)

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11
Q

What is the top cause of infant death in the US?

A

PTL/PTB

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12
Q

What is the top cause of neurologic disabilities in children?

A

PTL/PTB

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13
Q

PTL/PTB Risk Factors

A 
Hx of PTB
Multiple gestation
Uterine anomaly (bicornuate uterus)
Fetal conditions (IUGR, low AMI, chromosomal abnormalities)
Infection
Smoking, polysubstance abuse
Chronic conditions - HTN, DM, CT disorders
Racism
Cervical surgery - LEEP
Extremes of maternal age
Low/high pre-pregnancy weight
IVF conception
Psychosocial - abuse, mental health
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14
Q

PTL Symptoms

A 
Palpable contractions (painful or painless)
Pelvic/vaginal pressure
Low backache
Pain/discomfort in vulva/thighs
Cramps (abdominal, menstrual-like)
Increased/changed vaginal discharge
Rupture of membranes
Vaginal bleeding/spotting
Possible diarrhea
Sense of 'feeling badly'

*Sx vary by patient

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15
Q

PTB Risk Assessment

A

Cervical length <25 mm 16-24 weeks - use US > digital exam
Contractions
Fetal fibronectin (fFn) - excellent negative predictive value
Infection - UTI, BV, STI
Dehydration status
Trauma/stress

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16
Q

PTL Diagnosis

A

Documented contractions - 4 in 20 mins or 8 in 60 mins AND either:

ROM

OR

Cervical change OR dilation of 2 cm OR effacement 80% (high false + rate, 30% of labors cease spontaneously)

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17
Q

PTL Management

A

If prior PTB - start progesterone at 16 weeks

Limited, individualized activity reductions

ID cause, relieve factor(s)

  • Polyhydramnios - remove fluid w/ amniocentesis
  • Poor nutrition - consult, improved intake
  • Treat infections

Betamethasone for fetal lung maturity between 24-34 weeks; 2 inj 24 hours apart

Hydrate w/ IV fluids as needed

Med management by provider - tocolytics through betamethasone window

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18
Q

PTL Management

A

Tocolytics - Mg sulfate (<32 weeks), Ca antagonists (nifedipine), PG synthesis inhibitors, beta adrenergics

GBS prophylaxis

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19
Q

Umbilical Cord Prolapse

A

Medical emergency where cord prolapses out of uterus ahead of fetus, subject to compression & interruption of blood flow to fetus

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20
Q

Cord Prolapse Management

A

Position hips higher than head

Sterile glove, lift presenting part off cord and stay there until emergency C-section

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21
Q

Cord Prolapse Risk Factors

A

PROM, polyhydramnios, long umbilical cord, malpresentation, multiparity/gestation, high fetal station, IUGR

22
Q

Cord Prolapse Nurse Role

A

Support fetal head, get help, set up for immediate delivery, consider O2 for mom, continuous fetal monitoring

23
Q

Dystocia

A

Dysfunctional labor due to the 5 P ‘s of labor

24
Q

Shoulder dystocia

A

Arrest of delivery of anterior shoulder after successful delivery of head; chin becomes retracted against vulva & neck not visible b/c shoulder(s) impacted behind pubic bone

*Common OB litigation causes

25
Q

Turtle sign

A

Fetal head impacted against vulva w/o neck visible

26
Q

Optimal time for survival and minimal brain damage to baby w/ shoulder dystocia

A

5-7 mins

27
Q

Intrapartum factors influencing shoulder dystocia

A

Failure, arrest of fetal descent
Significant molding
Macrosomia
Prolonged 2nd stage of labor

28
Q

Shoulder dystocia nursing interventions

A

Document time of each intervention

Assist w/ position changes

McRoberts maneuver - knees to ears in supine position

Suprapubic pressure (NEVER fundal pressure)

Prep resuscitation equipment

29
Q

Signs of laceration

A

Firm fundus w/ bright red blood trickling

30
Q

Signs of uterine atony

A

Boggy fundus w/ red blood flowing

31
Q

Signs of retained placenta

A

Boggy fundus w/ dark blood & clots

32
Q

Placental delivery methods

A

Shiny Schultz - fetal side appears first; shiny, membranous

Dirty Duncan - maternal side appears first; dull, muscular

33
Q

Retained placenta

A

Placenta does not detach and deliver w/in 30 minutes after delivery

34
Q

How does a retained placenta increase hemorrhage risk?

A

Retained placenta inhibits uterine contractions so vessels remain open and able to bleed

35
Q

When can retained placenta cause bleeding?

A

Immediately or delayed (hrs to days)

36
Q

Retained placenta removal

A

Manually; D&C

37
Q

Types of placentas

A

Normal - 1 lobe w/ single layer of amnion/chorion

Succenturiate - 1+ accessory lobes

Circumvallate - fetal side exposed thru ring opening around umbilical cord due to double fold of amnion & chorion

38
Q

Why can a succenturiate placenta be troublesome?

A

If worried about retention, one lobe may deliver providing false sense of placental removal b/c other lobe still retained

No other significant risk factors associated

39
Q

Risks of circumvallate placenta

A

Abruptio placentae, oligohydramnios, abnormal cardiotocography, PTB, miscarriage

40
Q

Where do the umbilical vessels normally insert in the placenta?

A

Centrally w/ firm rooting and covered in Wharton’s jelly

41
Q

Velamentous cord insertion

A

Cord inserts into fetal membranes rather than body of placenta & travels w/in membranes (between amnion, chorion) to placenta

42
Q

Complication(s) of velamentous cord insertion

A

Vessels are exposed/not covered by Wharton’s jelly –> vulnerable to rupture, esp if near cervix

43
Q

Battledore placenta

A

Cord insertion at/near placental margin; usually incidental finding at birth

44
Q

Vasa previa

A

Fetal vessels traverse fetal membranes over internal cervical os

(Similar to placenta previa but vessels cover cervix instead of body of placenta)

45
Q

Vasa previa risk factors

A

Placental abnormalities (velamentous insertion)
Hx of IVF
Multiple gestation

46
Q

Vasa Previa Signs/Sx

A

Classic triad - ROM, painless vaginal bleeding, fetal bradycardia (loss of blood supply)

47
Q

When is vasa previa typically diagnosed?

A

After delivery but can be seen on US

48
Q

Vasa previa treatment

A

Emergency C-section, often early to prevent labor & minimize risk of rupture

C-section often around 35-36 weeks

49
Q

Nurse role in vasa previa

A

Keep hands away from vagina

Maternal and fetal monitoring

Prepare for immediate delivery

50
Q

Other complications

A

Precipitous labor - L&D in <3 hrs

Meconium-stained amniotic fluid - postterm babies at risk for aspiration

Fetal distress - FHR <110, >160, minimal or no variability, fetal hyper- or no activity

Uterine rupture - complete (internal bleeding) vs incomplete (no internal bleeding)

Anaphylactoid syndrome of pregnancy - amniotic fluid embolism

OB Nursing (7 decks)

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