Labor & Delivery - Hemorrhagic Conditions/Complications - Unit 2 (Class) Flashcards
What is placenta previa?
When the placenta isn’t in the right spot.
What are the three types of placenta previa?
Marginal, partial, total.
Marginal = low lieing, but still greater than 3cm away from the opening of the cervix (oz).
partial = closer than 3cm/might somewhat cover oz.
Total = completely covers oz.
Placenta previa - happens _ in ___ cases.
1 in 300
What are the clinical manifestations of placenta previa?
Painless bleeding (painless because they are bleeding into an open cavity.
How do we manage placenta previa?
stable and baby is stable = we want to wait.
If patient is sent home, we need to educate - when do come back, NOTHING IN VAGINA, etc.
PP - blood that is bright red = active, pink = start, dark/red= old. T/F?
True
What is abruptio placentae?
late pregnancy - separation of a normally implanated placenta before the fetus is born. Can be partial or complete (complete is a huge problem).
What can cause an abruptio placentae?
cocaine, maternal HTN, cigarette smoking, multigravida, short umbilical cord, abdominal trauma, PROM, history of abruption.
What are some clinical manifestations?
Concealed - bleeding on inside.
Apparent - outside bleeding!
Dysfunctional labor: power - what does this mean?
Ineffective maternal pushing. Help her with positioning (gravity) and teach how to push.
Dysfunctional labor - passenger - what does this mean?
Fetal size, fetal presentation/position, multifetal pregnancy/fetal anomalies, etc.
Dysfunctional labor - passage & psyche - what do these mean?
Passage - pelvis and maternal soft tissue obstructions (a full bladder will impede contraction pattern and also hold the baby up there!)
Psyche - pain, fear, nonsupport, or personal situation - perception is important!
For a primigravida, they should dilate ___ cm ever hour (average).
___ CM for multiple children.
- 2
1. 5
What is precipitous labor?
3 hours from start to finish. Very intense contractions, baby might poop (meconium) because it’s under so much stress, facial bruising, low apgars, etc.
What is a precipitous delivery?
One before physician gets there.
What is premature rupture of membranes? Cause? PPROM?
ROM before onset of labor (pPROM = preterm premature rupture of membranes
What are some complications of premature rupture of membranes?
Infection, oliohydraminios, preterm birth infant respiratory distress syndrome.
How do we manage premature rupture of membranes?
First determine if actually ruptured, induction if contractions do not start on own (term), consider baby state/safety/lung maturity if not term, antibiotics given
PROM - orgasm is good?
NOT AT ALL. Could start contractions if you’re preterm. Avoid breast stimulation as well.
PROM - antibiotics given, but if there’s a foul smell..
it might be time for delivery!
What are dates for “preterm” ?
20-37 weeks
Tocolytics - What does magnesium sulfate do?
Decreases contractions - it stops labor AND can treat preeclampsia - Loading dose = 4-6 grams over 30 minutes and then maintenance 1-4 grams/hour.
What are the criteria for mag sulfate?
Urine output at least 30 ml/hr, presence of DTR, respirations at least 12 a minute, etc.
What is the antidote for magnesium sulfate? Give when?
Calcium Gluconate (10%) One reason to give is if RR is not above 12.
Mag sulfate - can it decrease variability of fetus?
yup
Calcium antagonist (tocolytic) - what does it do?
Nifedipine, CCB - reduces smooth muscle contractions. 10-20 mg every 3-6 hours (same as loading dose).
Terbutaline (Tocolytic) - what does it do?
Terbutaline is the drug of choice.
What is the antidote for terbutaline?
Propanolol
Tocolytics - what is the prostaglandin syntehsis inhibitor?
Indomethacin - only given before 32 weeks gestation and for 48-72 hours.
Corticosteroids - what are they used for?
NOT A TOCOLYTIC. Used to mature fetal lungs at 24-34 weeks. Delay birth 24 hours after giving if at all possible.
Prolonged pregnancy - longer than….
42 weeks.
What are some complications of prolonged pregnancy?
Insufficiency of the placenta, less reserves to tolerate labor, reduced amniotic fluid —> cord compression, meconium, large infant, etc.
What are some placental emergencies?
Placenta previa, placenta accrete (increta, perceta), prolapsed cord
what is placenta accrete?
When the placenta attaches too deep into the uterine wall, but not yet in the muscle.
What is placenta increta?
penetrates deep into the wall and into the muscle.
What is placenta percereta?
Attaches deep into the wall - so deep it goes through the muscle onto another organ even!
Prolapsed cord - if you feel it, YOU KEEP YOUR HAND THERE! T/F?
True
Prolapsed cord - #1 priority =….
getting pressure off the cord.
What is a partial rupture of the uterus? Complete?
contained (won’t go into perineal cavity). Complete = filling up the abdominal cavity.
Inversion of uterus - what is it?
uterus will turn itself inside out after baby is born.
What is anaphylactoid syndrome (amniotic emboli) ?
Fluid gets into blood stream of the mom and acts like an emboli and usually travels to lungs…very rare and fatal. :(
