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Nursing 401 > Labour and Delivery Complications > Flashcards

Labour and Delivery Complications Flashcards

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1
Q

What is the incidence of preterm birth in Canada?

A

7.7%

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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

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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)

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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

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5
Q

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

A

0.61% (Perinatal health, 2010)

12% (Laedwig, 2014)

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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.

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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

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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

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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

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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
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11
Q

What are some fetal conditions that are indications for induction?

A 
Intrauterine Growth Retardation
Demise
Hemolytic disease
Macrosomia
Mild abruptio placenta
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12
Q

What are some logistical reasons for induction?

A

Maternal request

Health care delivery reasons

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13
Q

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

A

21% in Fraser Health Authority

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14
Q

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

A

Prostaglandins E2 - intercervical intravaginal

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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

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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

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17
Q

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

A

Bishop’s score of 6 or higher

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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.

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19
Q

Who initiates an induction?

A

Induction commenced by MD/midwife

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20
Q

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

A

in Canada, 17%

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21
Q

What are the indications for augmentation with oxytocin?

A

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

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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

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23
Q

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

A

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

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24
Q

What are the warning signs of fetal distress?

A

Meconium stained liquoi, ominous FHR patterns

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25
Q

What are the nursing interventions for fetal distress?

A

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

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26
Q

What are the maternal indications for forceps and vacuum extraction?

A

Maternal exhaustion
Lack of progress
Health conditions (Pregnancy Induced Hypertension, Heart Disease)
Decreased motor innervation with epidural

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27
Q

What are the fetal indications for forceps and vacuum extraction?

A 
Fetal distress
Placenta separation (2nd stage)
OP position
Macrosomia
Breech (after coming head)
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28
Q

What are the maternal risks with forceps?

A

Tears, hematomas

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29
Q

What are the fetal risks with forceps?

A 
Decreased flexion of head
Echymosis
Edema
Caput
Cephalhematoma
Paralysis
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30
Q

What is important for the nurse to do after a forceps delivery?

A

Important to inspect perineum and head for complications

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31
Q

What is the incidence of caesarean delivery in BC? Fraser Health?

A
  1. 9% BC

32. 9% FHA

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32
Q

What are factors that influence caesarean delivery rate?

A 
Delayed childbearing
Obesity
Decreased number of midwives
Legalities
Decreased skill with breech deliveries
VBAC rate
Personal requests
Inductions
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33
Q

What are the indications for C-section?

A 
Placenta previa
Placenta abruptio
Prolapsed cord
CPD
Active herpes
Transverse lie
Maternal health issues
Failure to progress
Breech
Fetal distress
Repeat C-section
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34
Q

What are the different types of incisions in caesarian delivery?

A

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

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35
Q

What is the incidence of use of general anesthetic for caesarean delivery?

A

7.7

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36
Q

What is used for general anesthetic in a caesarean delivery?

A

Combination of IV and inhalation agents

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37
Q

What are the benefits of general anesthetic in caesarean delivery?

A

Quick to administer

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38
Q

What are the disadvantages to general anesthetic for caesarean delivery?

A

Depresses fetal CNS, increased blood loss, maternal vomiting and depressed GI motility

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39
Q

What are the effects of regional anesthesia and analgesia for caesarean and vaginal deliveries (eg. spinals/epidurals)?

A

Alters motor and sensory function (anesthetic agents)
Prolongs pain relief (post CD (morphine/fentanyl)
Blocks afferent and efferent nerves

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40
Q

What is the incidence of using spinal analgesia/anesthesia for caesarean section?

A

56.4%

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41
Q

What are the benefits of spinal analgesia/anesthesia for Caesarean delivery?

A

immediate
small amount of drugs used
some pain relief for apprix. 24 hours after caesarean delivery

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42
Q

What are the disadvantages of spinal analgesia/anesthesia for Caesarean delivery?

A

Headache (CSF leak)

Decreased BP -> fetal distress

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43
Q

What is the incidence of epidural analgesia/anesthesia in labour and delivery?

A

47.8%

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44
Q

What are the benefits of epidural analgesia/anesthesia during labour and delivery?

A

Pain relief for vaginal deliveries

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45
Q

What are the disadvantages of using epidural analgesia/anesthesia labour and delivery?

A

Approx. 30 minutes to work
Increased drugs required
Hypotension -> fetal distress

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46
Q

What are the benefits of combined spinal-epidural block (CSE)?

A

For labour/Caesarean delivery
Preserves motor function
Small amount of drugs used

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47
Q

What is the rate of attempted and successful VBAC deliveries?

A
  1. 7% attempted

68. 6% success rate

48
Q

What is the risk of uterine rupture in VBAC deliveries?

A

2-4 in 1000 VBACs

49
Q

What is the nursing care of VBAC patients?

A

Frequent monitoring (fetal and maternal), EFM, vital signs, assess whether there is pain over the incision site (rupture), caution with induction

50
Q

What are contrainducations for a VBAC?

A

“classic” or “T” uterine incision

51
Q

what are some factors that can increase the risk of umbilical cord prolapse?

A

Polyhydramnious, long cord, breech, high, irregular pp

52
Q

What should the nurse do in the situation of umbilical cord prolapse?

A 
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
Q

What is shoulder dystocia? (definition)

A

After delivery of head, further expulsion of the infant is prevented due to impaction of the fetal shoulders in the maternal pelvis.

54
Q

What is the incidence of shoulder dystocia? (how common is it)

A

<1% (Obs. conference, 2010)

55
Q

What are some risk factors for shoulder dystocia?

A 
Fetal macrosomia
Maternal diabetes
Maternal obesity
Multiparity
Post term
56
Q

What should the nurse/physician do in the case of shoulder dystocia?

A 
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
Q

What are the potential maternal complications with shoulder dystocia?

A

Postpartum hemorrhage
Trauma
Infection

58
Q

What are the potential neonatal complications with shoulder dystocia?

A 
Brachial plexus injury
Fractures
Asphyxia
Neurological damage
Fetal demise
59
Q

What is the definition of a precipitous labour and delivery?

A

Under 3 hours for labour and delivery

60
Q

What are factors that can contribute to a precipitous delivery? (risk factors)

A

Multiparity
Large pelvis
Previous precipitous deliveries
Small fetus

61
Q

What are some associated problems for a mother during a precipitous delivery?

A

Lacerations
Decreased coping
Postpartum hemorrhage

62
Q

What are some associated problems for the baby in a precipitous labour and delivery?

A 
Fetal distress (hypoxia)
Cerebral/nerve (brachial) trauma
63
Q

How much blood loss after a vaginal delivery is considered a hemorrhage?

A

Loss of >500 mls

64
Q

How much blood loss after a Caesarean section is considered a hemorrhage?

A

> 1000 mls

65
Q

When are postpartum hemorrhages considered late pph? Early pph?

A

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
Q

What are the causes of hemorrhage? (Etiology)

A

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
Q

What are some factors that can impact the tone of the uterus (as a risk for postpartum hemorrhage)?

A 
Over-distention of uterus
Grand multiparity
Anesthetics
Prolonged or rapid labour
Induction/augmentation
Distortions of the uterus
Distended bladder
History of PPH
68
Q

What are some factors that can impact the development of a postpartum hemorrhage related to trauma?

A

Uterine surgery, lacerations of the genital tract

69
Q

What are some factors associated with the development of a postpartum hemorrage, other than the 4T’s? (Tone, Trauma, Tissue, Thrombin)

A

Pregnancy induced hypertension
Anemia
Infection
Asian/Hispanic heritage

70
Q

What are some nursing interventions for hemorrhage, in order to prevent it before it happens?

A 
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
Q

What are nursing interventions for postpartum hemorrhage?

A

RN to massage uterus
Express clots
Apply pressure PRN
Give oxytoxic drugs IM/IV prn

72
Q

What are the medical interventions for uterine atony?

A

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
Q

What is a first degree perineal tear? (What tissues does it involve)

A

Perineal skin, vaginal mucosa

74
Q

What is a second degree perineal tear? (What tissues does it involve?)

A

Perineal skin, vaginal mucosa, fascia, muscles of perineal body

75
Q

What is a third degree perineal tear?(What tissues does it involve)?

A

Perineal skin, vaginal mucosa, fascia, muscles of perineal body, anal sphincter

76
Q

What is a fourth degree perineal tear? (What tissues does it involve?)

A

Perineal skin, vaginal mucosa, fascia, muscles of perineal body, anal sphincter, rectal mucosa to lumen of rectum

77
Q

What is done in the case of retained products of conception causing early postpartum hemorrhage?

A

Methylergonovine
Cytotec
Exploration and manual removal of products

78
Q

What is the treatment for late postpartum hemorrhage due to infection?

A

Antibiotics

79
Q

What is the treatment for late postpartum hemorrhage due to retained products of conception?

A

Methylergonovine

80
Q

What is the etiology of a late postpartum hemorrage?

A

Abnormal involution related to retained products of conception, or infection

81
Q

What are some potential sites for a postpartum infectioin?

A 
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
Q

What is the incidence rate of Group B streptocccus?

A

10-30% of women

83
Q

What are the problems caused by group B streptococcus during pregnancy?

A

Increased risk of premature labour and perinatal transmission
Increased risk of chorioamnioitis and sepsis
Increased risk of PROM

84
Q

What parts of the body are colonized by group B streptococcus?

A

Genital and GI tracts, urethra

85
Q

How can group B strep be acquired by newborns?

A

Can be acquired by aspiration or passage (or infected others)

86
Q

What is considered “Early onset Group B strep”?

A

1st week of life

87
Q

What is late onset group B strep? (How does it manifest)

A

Meningitis

88
Q

What are the symptoms of early onset group B strep in the neonate?

A

Pneumoni
Apnea
Sepsis
Shock

89
Q

What is the incidence of group B strep being contracted by newborns? What is the mortality rate?

A

1-2%

Mortality rate 5-9% in Canada

90
Q

How is group B strep managed/prevented from being passed on to baby?

A

Prevention - identify those who are group b strep positive (vaginal and recta swal at 35-37 weeks)

91
Q

When should a mother be treated with IV antibiotics in labour?

A 
Mom is group B strep positive (also if group B strep in urine)
Temperature > 38 degrees Celcius
PROM >18 hours
Previous infected baby &amp; PROM
Preterm labour
92
Q

What are common sites for deep vein thrombosis during the postpartum period?

A

Saphenous or pelvic veins

93
Q

What is the etiology of DVT during the postpartum period?

A

Hypercoagulability
Venous stasis
Injury to the epithelium (blood vessel)

94
Q

What are some associated risk factors for deep vein thrombosis postpartum?

A 
Hydramnious
Preeclampsia
Operative births
History of clots
Varicose veins
Obesity
95
Q

What is the treatment for inversion of the uterus?

A

Put back in, call MD - if not, the patient will hemorrhage

96
Q

What proportion of women experience mental health disorders in the perinatal period? (pregnancy to 1 year postpartum)

A

1 in 5

97
Q

What are four common disorders experienced by women during the perinatal period? (pregnancy to 1 year postpartum)

A

Depression
Generalized Anxiety Disorder
Bipolar disorder
Psychotic disorders and postpartum psychosis

98
Q

What is the incidence of major depression in pregnancy?

A

5-16%

99
Q

What is the incidence of major depression postpartum? (birth03 months)

A

4.2-9.6%

100
Q

What is the incidence of major depression during the first year postpartum?

A

9.6-31% (similar to the non-perinatal populations)

101
Q

What are the risk factors for major depressive disorder during the perinatal period?

A

Greater risk of personal or family history, previous pregnancies

102
Q

What is the treatment for major depressive disorder during the perinatal period?

A

Treatment with non-pharmacological and pharmacological methods

103
Q

What are the common types of anxiety disorders experienced during the perinatal period?

A

Generalized anxiety disorder
Obsessive-compulsive disorder
PAnic disorders

104
Q

What are the risk factors for anxiety disorders during the perinatal period?

A

Previous personal/family or pregnancy history of anxiety disorders
Perinatal period may act as a trigger

105
Q

What is the treatment for anxiety disorders during the perinatal period?

A

Treatment non-pharmacological and pharmacological methods

106
Q

What is the incidence of anxiety disorders during the perinatal period comparted to the general population’?

A

Rates of GAD may be slightly higher during perinatal period than non-perinatal population

107
Q

What are the risks associated with a history of bipolar disorder during the perinatal period?

A

No increase in incidence of bipolar, but increased risk or relapse
Increases risk of postpartum psychosis

108
Q

What is the treatment of bipolar disorder during the perinatal period?

A

Supportive

Pharmacological

109
Q

What is the incidence of postpartum psychosis?

A

1-2 cases per 1000 live births

110
Q

When is the typical onset of postpartum psychosis?

A

72 hours to 4 weeks postpartum

111
Q

What is the typical duration of postpartum psychosis?

A

1 day to 1 month and beyond

112
Q

What are the treatments for postpartum psychosis?

A

Hospitalization
Pharmacological
Supportive
This is a psychiatric emergency

113
Q

What is the incidence of postpartum PTSD?

A

Rates vary 7-16% at one month (full/partial PTSD)

114
Q

What are the signs and symptoms of postpartum PTSD??

A

Feeling numb, dazed, flashbacks, intrusive thoughts, difficulty thinking, sleeping

115
Q

What are the consequences of postpartum PTSD?

A

Severe dysfunction
Impaired bonding
Avoidance of childbearing

116
Q

What is the treatment of postpartum PTSD?

A

Discuss the event and compare it to reality.
Supportive
Pharmacological
Psychotherapy

Nursing 401 (21 decks)

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