Labor complications Flashcards
What is preterm labor and delivery
Is labor that is cervical dilation and uterine contractions between 20-36.6 weeks gestation
What are the common causes of preterm labor?
- Dehydration is a huge cause
- Birth preeclampsia
- Fetal distress
- IUGR (lack of fetal growth)
- Demise (when baby passes away)
- Increase bleeding
What women are at risk for preterm labor?
- Infections
- 2nd trimester bleeding
- History of preterm labor. They have a 50% chance or greater of having a pre-term delivery
- Being non-white
- Women who are under weight or over weight
What are some intervention to prevent preterm labor?
•Early detection to reduce
neonatal morbidity and morality
- Administering magnesium sulfate, terbutaline, indocin
- Decrease activity
- Bedrest
What medications are administered to mothers at risk for preterm labor?
- Magnesium sulfate
- Terbutaline
- Indocin
What type of medication is Indocin?
NSAID
What must you look out for when administering magnesium sulfate to mothers?
- Deep tendon reflexes
- Mental status
- Urine for serum levels
What is the goal of preterm and delivery
- Stop uterine contracts
* Administer betamethasone IM for lung maturity
Why are African/Americans more likelihood to have preterm labor
•This is a due to the racism and negative ill outcomes that come with African American woman.
What does PROM stand for?
Premature ruptured of membranes
What is the definition of PROM?
- It is a spontaneous rupture of amniotic sac and leakage of fluid prior to onset of labor
- Ruptures before 37 weeks gestation
What color will we see with PROM?
clear straw color
What is the interventions/management of PROM
- Bed rest
- Monitor intrauterine infection because without the barrier they are at risk.
- Monitor FHT’s
What do we not do when PROM occurs?
We don’t do vaginal exam because you are introducing bacteria
What is prolapsed umbilical cord?
When the umbilical cord lies below the presenting part of the fetus
What does prolapsed umbilical cord result in?
Cord compression which compromises fetal circulation
What are the risk factors for prolapsed umbilical cord?
- Long cord
- Multifetal pregnancy
- Small for gestational age fetus
- Transverse lie
- Abnormal fetal presentation
When do prolapsed umbilical cord occur?
- AROM or SROM
* When head is not engaged in pelvis -2, -3, -4 stations
What are the signs and symptoms of prolapsed umbilical cord?
- Variable or prolonged decelerations
- They report feeling the cord after ROM
- Cord is seen or felt in or protruding from vagina.
What are the nursing interventions for a prolapse umbilical cord?
- Call for help STAT
- Notify provider
- Check cervix and exert upward pressure against the presenting part to relieve cord compression. DON”T MOVE HAND
- Place in extreme Trendelenburg (so that gravity and manipulation to relieve compression)
- Monitor FHR
What do you not do when you see a prolapse umbilical cord?
Do not attempt to push cord back into vagina or cervix!!
What is a shoulder dystocia?
- The anterior shoulder of the fetus gets stuck on the pubic symphsis
- Obstetric emergency
- Requires obstetric maneuvers
- It requires obstetric maneuvers
What do you do as a nurse when you see a shoulder dystocia?
- Stay calm
- Call for help, need more nurses
- Help patient assume positions that facilitate birth of the shoulders
What are the complications related to trauma with shoulder dystocia?
We see brachial plexus injuries
What maneuver is preferred?
McRoberts Maneuver
What is the McRoberts maneuver?
- Legs flexed onto abdomen
- This causes rotation of pelvis
- Suprapubic pressures is applied to fetal anterior shoulder
What is an operative vaginal birth
- Performed using forceps or vacuum extractor
* Evaluate the station of head in relationship to the maternal pelvis
What are the associated risks with using operative vaginal birth equipment?
- Increase to postpartum hemorrhage
- Increases vaginal lacerations
- Increases fetal head trauma
What are the nursing actions when assisting with birth by operate delivery
- Assess FHR continuously
- Encourage the women to push during contractions
- Document number of pulls attempted (3 times)
- Document a number of pop offs that occur (3 times vacuum only)
- After three times, c-section
The forceps assisted birth equipment is used only when
- Cervix is fully dilated
- Bladder is empty
- Presenting part is engaged
- Membranes must be ruptured
What is meconium staining?
Meconium passes into the amniotic fluid
What are the expected findings of meconium staining?
- Liquor look like green, yellow, or brownish in color
* Can be thin or thick
What are the risk factors associated with meconium staining?
- Uncommon prior to 38 weeks but increases after 40 weeks
- When the fetal is distress and are hypoxic or acidosis
- With a mature fetus (post term) 40-42 weeks.
What are some of the complication
- Develop meconium aspiration syndrome (MAS) causes pneumonia
- Newborns cant aspirate meconium which is toxic to lungs
- Evidence that it inactivates surfactant
