Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Nursing 401 > Labour and Delivery Complications > Flashcards

Labour and Delivery Complications Flashcards

1
Q

What is the incidence of preterm birth in Canada?

A

7.7%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for preterm labour?

A

Demographic - age, low socioeconomic status, ethnicity
Biophysical - Hx of preterm labour, genetis, uterine/cervical/placenta abnormalities
Current Pregnancy Problems - Multifetal, hydraminous, infections, hypertension in pregnancy, fetal anomalies, PPROM
DOH - tobacco/drug use, violence, excessive physical activity, inadequate weight gain/poor nutrition, stress, inadequate prenatal care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is preterm labour managed?

A

Precent in those at risk, eg. progesterone injections
If in preterm labour, take fibronectin assay (24-34 weeks)
Will not stop preterm labour if complications
Meds - tocolytics (up to 32/33 weeks gestation) and corticosteroids (no if >34 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What should the nurse do with the patient in preterm labour?

A

Assess contractions and per vagina (PV) loss.
Monitor fetus.
Assess for side effects of meds.
Give betamethasone/dexamethasone to increase lung maturity (if <34 weeks) (MD’s order)
Prepare for a premature birth if labour continues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the incidence of post-term labour in Canada?

A

0.61% (Perinatal health, 2010)

12% (Laedwig, 2014)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the possible causes of post-term labour?

A

Error in determining ovulation and conception
Deficiency in placental estrogen (decrease in prostaglandin & decreased formation of oxytocin receptors in myometrium) & continued secretion of progesterone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some potential problems for the mother in post-term labour?

A

Psychological stress, induction, dystocia, assisted delivery, perineal trauma (large baby), increased risk of infection and hemorrhage, increased CD, increased DVT’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some potential problems for the baby in post-term labour?

A

Decreased placental profusion, fetal demise, oligohydramnios, macrosomia, meconiium aspiration syndrome, low apgar, SIDS, injury, CP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the medical interventions for post-term labour?

A

At 41 weeks - daily fetal movement counts. Follow-up biweekly with NST, ultrasound for fetal size and amniotic fluid index (AFI)
Elective induction or wait until 42 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are maternal conditions that are indications for induction?

A 
Post-term
Diabetes
Hypertension in pregnancy
PROM
Chorioamnionitis
Previous precipitoous labour and delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some fetal conditions that are indications for induction?

A 
Intrauterine Growth Retardation
Demise
Hemolytic disease
Macrosomia
Mild abruptio placenta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some logistical reasons for induction?

A

Maternal request

Health care delivery reasons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the rate of induction in Fraser Health Authority? (percentage)

A

21% in Fraser Health Authority

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is induction managed in the situation of an unripe cervix?

A

Prostaglandins E2 - intercervical intravaginal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is used in the induction of labour in a woman with an unripe cervix?

A

Cervidil - vaginal insert (10mg)

Cervical ripening balloon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is used to induce labour in a woman with a ripe cervix?

A

Sweep of membranes
Amniotomy/ARM
Intravaginal PGE2 gel or IV oxytocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What bishop’s score is considered a “ripe” cervix?

A

Bishop’s score of 6 or higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the nurse’s role in an induction?

A

Baseline assessment - vital signs, leopold’s maneuver, vaginal exam, electronic fetal monitoring (EFM)
Follow MD’s orders/induction protocol
Assess pt and fetus x2 hours
If cervidil/prostaglandins (PGE2), pt may be sent home until active labour begins.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Who initiates an induction?

A

Induction commenced by MD/midwife

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the rate of artificial rupture of membranes in canada?

A

in Canada, 17%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the indications for augmentation with oxytocin?

A

hypotonic (weak) / infrequent contractions, lack of progress (1st or 2nd stage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the indications/effects of ARM?

A

Usually done with inductions
May shorten labour (increased effectiveness in multips)
Increased pressure on head (caput)
May increase risk of infection and CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the etiology of fetal distress (decreased oxygen)?

A

Cord compression
Placenta insufficiency
Maternal/fetal/placenta disease or disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the warning signs of fetal distress?

A

Meconium stained liquoi, ominous FHR patterns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the nursing interventions for fetal distress?
Call code OB Nursing interventions - discontinue induction, change position to Lt./Rt. lateral, IV bolus, Vag Exam, O2 PRN, decreased maternal anxiety, EFM or internal monitor, assist with fetal scalp blood sample (>7.2), consider amnioinfusion
26
What are the maternal indications for forceps and vacuum extraction?
Maternal exhaustion Lack of progress Health conditions (Pregnancy Induced Hypertension, Heart Disease) Decreased motor innervation with epidural
27
What are the fetal indications for forceps and vacuum extraction?
``` Fetal distress Placenta separation (2nd stage) OP position Macrosomia Breech (after coming head) ```
28
What are the maternal risks with forceps?
Tears, hematomas
29
What are the fetal risks with forceps?
``` Decreased flexion of head Echymosis Edema Caput Cephalhematoma Paralysis ```
30
What is important for the nurse to do after a forceps delivery?
Important to inspect perineum and head for complications
31
What is the incidence of caesarean delivery in BC? Fraser Health?
30. 9% BC | 32. 9% FHA
32
What are factors that influence caesarean delivery rate?
``` Delayed childbearing Obesity Decreased number of midwives Legalities Decreased skill with breech deliveries VBAC rate Personal requests Inductions ```
33
What are the indications for C-section?
``` Placenta previa Placenta abruptio Prolapsed cord CPD Active herpes Transverse lie Maternal health issues Failure to progress Breech Fetal distress Repeat C-section ```
34
What are the different types of incisions in caesarian delivery?
Uterine Cut - Kerr (transverse) or Sellheim (vertical lower segment) Classic incision (rarely done) - on corpus of uterus (increased ruptures) Skin cut - Transverse (Pfannenstiel) or vertical
35
What is the incidence of use of general anesthetic for caesarean delivery?
7.7
36
What is used for general anesthetic in a caesarean delivery?
Combination of IV and inhalation agents
37
What are the benefits of general anesthetic in caesarean delivery?
Quick to administer
38
What are the disadvantages to general anesthetic for caesarean delivery?
Depresses fetal CNS, increased blood loss, maternal vomiting and depressed GI motility
39
What are the effects of regional anesthesia and analgesia for caesarean and vaginal deliveries (eg. spinals/epidurals)?
Alters motor and sensory function (anesthetic agents) Prolongs pain relief (post CD (morphine/fentanyl) Blocks afferent and efferent nerves
40
What is the incidence of using spinal analgesia/anesthesia for caesarean section?
56.4%
41
What are the benefits of spinal analgesia/anesthesia for Caesarean delivery?
immediate small amount of drugs used some pain relief for apprix. 24 hours after caesarean delivery
42
What are the disadvantages of spinal analgesia/anesthesia for Caesarean delivery?
Headache (CSF leak) | Decreased BP -> fetal distress
43
What is the incidence of epidural analgesia/anesthesia in labour and delivery?
47.8%
44
What are the benefits of epidural analgesia/anesthesia during labour and delivery?
Pain relief for vaginal deliveries
45
What are the disadvantages of using epidural analgesia/anesthesia labour and delivery?
Approx. 30 minutes to work Increased drugs required Hypotension -> fetal distress
46
What are the benefits of combined spinal-epidural block (CSE)?
For labour/Caesarean delivery Preserves motor function Small amount of drugs used
47
What is the rate of attempted and successful VBAC deliveries?
30. 7% attempted | 68. 6% success rate
48
What is the risk of uterine rupture in VBAC deliveries?
2-4 in 1000 VBACs
49
What is the nursing care of VBAC patients?
Frequent monitoring (fetal and maternal), EFM, vital signs, assess whether there is pain over the incision site (rupture), caution with induction
50
What are contrainducations for a VBAC?
"classic" or "T" uterine incision
51
what are some factors that can increase the risk of umbilical cord prolapse?
Polyhydramnious, long cord, breech, high, irregular pp
52
What should the nurse do in the situation of umbilical cord prolapse?
``` Call cod Put patient in knee-chest, modified sims, or trendelenburg position Hand in vagina to keep pressure off cord Wrap cord Give O2 Start IV Prepare for delivery (Tx depends on stage of labour) ```
53
What is shoulder dystocia? (definition)
After delivery of head, further expulsion of the infant is prevented due to impaction of the fetal shoulders in the maternal pelvis.
54
What is the incidence of shoulder dystocia? (how common is it)
<1% (Obs. conference, 2010)
55
What are some risk factors for shoulder dystocia?
``` Fetal macrosomia Maternal diabetes Maternal obesity Multiparity Post term ```
56
What should the nurse/physician do in the case of shoulder dystocia?
``` Activate ALARMER Ask for help Lift/hyperflex patient's hips (McRobert's Maneuver) Anterior shoulder disimpaction Rotation of the posterior shoulder Manual removal of the posterior shoulder Episiotomy Roll woman over to "all fours" ```
57
What are the potential maternal complications with shoulder dystocia?
Postpartum hemorrhage Trauma Infection
58
What are the potential neonatal complications with shoulder dystocia?
``` Brachial plexus injury Fractures Asphyxia Neurological damage Fetal demise ```
59
What is the definition of a precipitous labour and delivery?
Under 3 hours for labour and delivery
60
What are factors that can contribute to a precipitous delivery? (risk factors)
Multiparity Large pelvis Previous precipitous deliveries Small fetus
61
What are some associated problems for a mother during a precipitous delivery?
Lacerations Decreased coping Postpartum hemorrhage
62
What are some associated problems for the baby in a precipitous labour and delivery?
``` Fetal distress (hypoxia) Cerebral/nerve (brachial) trauma ```
63
How much blood loss after a vaginal delivery is considered a hemorrhage?
Loss of >500 mls
64
How much blood loss after a Caesarean section is considered a hemorrhage?
>1000 mls
65
When are postpartum hemorrhages considered late pph? Early pph?
Early PPH - during 3rd or 4th stage, or first 24 hours after delivery Late PPH - 24 hours to 6 weeks after delivery (usually 1-2 weeks after delivery)
66
What are the causes of hemorrhage? (Etiology)
The 4 T's Tone (i.e. uterine atony) Trauma (i.e. lacerations of genital tract) Tissue (i.e. retained placenta or membranes) Thrombin - (i.e. coagulation problems)
67
What are some factors that can impact the tone of the uterus (as a risk for postpartum hemorrhage)?
``` Over-distention of uterus Grand multiparity Anesthetics Prolonged or rapid labour Induction/augmentation Distortions of the uterus Distended bladder History of PPH ```
68
What are some factors that can impact the development of a postpartum hemorrhage related to trauma?
Uterine surgery, lacerations of the genital tract
69
What are some factors associated with the development of a postpartum hemorrage, other than the 4T's? (Tone, Trauma, Tissue, Thrombin)
Pregnancy induced hypertension Anemia Infection Asian/Hispanic heritage
70
What are some nursing interventions for hemorrhage, in order to prevent it before it happens?
``` Avoid traumatic procedures Predict those who may hemorrhage (i.e. start Iv, cross-match) Active 3rd stage best practice! Assess patient frequently Have pt. void every 2 hours ```
71
What are nursing interventions for postpartum hemorrhage?
RN to massage uterus Express clots Apply pressure PRN Give oxytoxic drugs IM/IV prn
72
What are the medical interventions for uterine atony?
Get help, call code MD to explore uterine cavity and lower genital tract, formulate diagnosis May perform uterine compression/massage Depending on cause MD may repair lacerations, remove tissue, pack, perform arterial ligation, B-lynch suture. Hysterectomy is last resort
73
What is a first degree perineal tear? (What tissues does it involve)
Perineal skin, vaginal mucosa
74
What is a second degree perineal tear? (What tissues does it involve?)
Perineal skin, vaginal mucosa, fascia, muscles of perineal body
75
What is a third degree perineal tear?(What tissues does it involve)?
Perineal skin, vaginal mucosa, fascia, muscles of perineal body, anal sphincter
76
What is a fourth degree perineal tear? (What tissues does it involve?)
Perineal skin, vaginal mucosa, fascia, muscles of perineal body, anal sphincter, rectal mucosa to lumen of rectum
77
What is done in the case of retained products of conception causing early postpartum hemorrhage?
Methylergonovine Cytotec Exploration and manual removal of products
78
What is the treatment for late postpartum hemorrhage due to infection?
Antibiotics
79
What is the treatment for late postpartum hemorrhage due to retained products of conception?
Methylergonovine
80
What is the etiology of a late postpartum hemorrage?
Abnormal involution related to retained products of conception, or infection
81
What are some potential sites for a postpartum infectioin?
``` Perineal infection C-section delivery incision innfection UTI's Group B Strep (risk for baby) Uterine infection Infectious mastitis/breast abscess STD/STI's ```
82
What is the incidence rate of Group B streptocccus?
10-30% of women
83
What are the problems caused by group B streptococcus during pregnancy?
Increased risk of premature labour and perinatal transmission Increased risk of chorioamnioitis and sepsis Increased risk of PROM
84
What parts of the body are colonized by group B streptococcus?
Genital and GI tracts, urethra
85
How can group B strep be acquired by newborns?
Can be acquired by aspiration or passage (or infected others)
86
What is considered "Early onset Group B strep"?
1st week of life
87
What is late onset group B strep? (How does it manifest)
Meningitis
88
What are the symptoms of early onset group B strep in the neonate?
Pneumoni Apnea Sepsis Shock
89
What is the incidence of group B strep being contracted by newborns? What is the mortality rate?
1-2% | Mortality rate 5-9% in Canada
90
How is group B strep managed/prevented from being passed on to baby?
Prevention - identify those who are group b strep positive (vaginal and recta swal at 35-37 weeks)
91
When should a mother be treated with IV antibiotics in labour?
``` Mom is group B strep positive (also if group B strep in urine) Temperature > 38 degrees Celcius PROM >18 hours Previous infected baby & PROM Preterm labour ```
92
What are common sites for deep vein thrombosis during the postpartum period?
Saphenous or pelvic veins
93
What is the etiology of DVT during the postpartum period?
Hypercoagulability Venous stasis Injury to the epithelium (blood vessel)
94
What are some associated risk factors for deep vein thrombosis postpartum?
``` Hydramnious Preeclampsia Operative births History of clots Varicose veins Obesity ```
95
What is the treatment for inversion of the uterus?
Put back in, call MD - if not, the patient will hemorrhage
96
What proportion of women experience mental health disorders in the perinatal period? (pregnancy to 1 year postpartum)
1 in 5
97
What are four common disorders experienced by women during the perinatal period? (pregnancy to 1 year postpartum)
Depression Generalized Anxiety Disorder Bipolar disorder Psychotic disorders and postpartum psychosis
98
What is the incidence of major depression in pregnancy?
5-16%
99
What is the incidence of major depression postpartum? (birth03 months)
4.2-9.6%
100
What is the incidence of major depression during the first year postpartum?
9.6-31% (similar to the non-perinatal populations)
101
What are the risk factors for major depressive disorder during the perinatal period?
Greater risk of personal or family history, previous pregnancies
102
What is the treatment for major depressive disorder during the perinatal period?
Treatment with non-pharmacological and pharmacological methods
103
What are the common types of anxiety disorders experienced during the perinatal period?
Generalized anxiety disorder Obsessive-compulsive disorder PAnic disorders
104
What are the risk factors for anxiety disorders during the perinatal period?
Previous personal/family or pregnancy history of anxiety disorders Perinatal period may act as a trigger
105
What is the treatment for anxiety disorders during the perinatal period?
Treatment non-pharmacological and pharmacological methods
106
What is the incidence of anxiety disorders during the perinatal period comparted to the general population'?
Rates of GAD may be slightly higher during perinatal period than non-perinatal population
107
What are the risks associated with a history of bipolar disorder during the perinatal period?
No increase in incidence of bipolar, but increased risk or relapse Increases risk of postpartum psychosis
108
What is the treatment of bipolar disorder during the perinatal period?
Supportive | Pharmacological
109
What is the incidence of postpartum psychosis?
1-2 cases per 1000 live births
110
When is the typical onset of postpartum psychosis?
72 hours to 4 weeks postpartum
111
What is the typical duration of postpartum psychosis?
1 day to 1 month and beyond
112
What are the treatments for postpartum psychosis?
Hospitalization Pharmacological Supportive This is a psychiatric emergency
113
What is the incidence of postpartum PTSD?
Rates vary 7-16% at one month (full/partial PTSD)
114
What are the signs and symptoms of postpartum PTSD??
Feeling numb, dazed, flashbacks, intrusive thoughts, difficulty thinking, sleeping
115
What are the consequences of postpartum PTSD?
Severe dysfunction Impaired bonding Avoidance of childbearing
116
What is the treatment of postpartum PTSD?
Discuss the event and compare it to reality. Supportive Pharmacological Psychotherapy

Nursing 401 (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions