Lecture 3 Flashcards
PROM
premature rupture of membranes prior to labor
- will only allow this state for 24 hours or there is risk for infection
why PROM is an issue
- infection
- if water isnt there and there are contractions then each one will start to try and push baby out
PPROM
preterm premature rupture of membranes
- want to keep pregnant for as long as possible in this situation
primary prevention for preterm birth
quit smoking, quit drugs, systemically address barriers to accessing prenatal care
secondary prevention for preterm birth
screening for bacterial vaginosis/UTI and STI’s
2 tocolytics acting as preterm labor management
stop or slow contractions
- nifedipine (calcium channel blocker), Indocid (NSAID)
magnesium sulfate used in management of preterm labor
neuroprotection
- improves neurodevelopment and used only for imminent preterm birth
dexamethasone and betamethasone in management of preterm labor
glucocorticoid steroids that cross placenta and help with fetal lung development
chorioamnionitis
ascending infection reaches the uterus and fetus
- can be a result of PROM
maternal complications of chorioamnionitis
prolonged labor, risk of PPH, wound infection
post term pregnancy
pregnancy reaching or exceeding 42 weeks gestation
risk of post term pregnancy on fetus
- macrosomia (10x greater risk)
- death because placenta does not function as well
normal placenta
stationed on top of baby
low-lying placenta
stationed beside baby’s head
- can lead to placenta previa
- can still attempt vaginal birth
placenta previa
placenta is stationed below baby
risk factors for placenta previa
previous c-section, AMA, multiple gestation, smoking/cocaine, in vitro fertilization
placenta previa management
no vag exam, c-section, if less than 34 weeks administer corticosteroid
recommended delivery for placenta previa
between 36-37 weeks to prevent risk of bleeding with prolonged pregnancy
placental abruption
premature separation of all or part of the placenta
- can occur after 20 weeks of gestation
S+S of placental abruption
- hemorrhage
- late decelerations
- DIC due to excess thromboplastin released bc of damage to uterine wall
most concerning S+S of placental abruprion
no bleeding with rigid/board-like abdomen
- late decels due to hypoxia
fetal issues for placental abruption
nearly 100% mortality, preterm labor, hypoxia
GBS
fetus can acquire at birth from mom (common and harmless bacteria) and then get disease
- get swab at 35-36 weeks regardless of if having vaginal or c-section delivery
dystocia
“failure to progress”
- dysfunctional uterine contractions causing abnormally slow labor and hinder cervical dilation
hypertonic uterine dysfunction
occurs before 5cm and is linked to fear/tension
- overactive uterus not allowing rest leading to inadequate contractions
- contractions are ineffective and painful
hypotonic uterine dysfunction
develops in the active phase
- less intense contractions
cause of hypotonic uterine dysfunction
cephalopelvic disproportion or occiput posterior
hypertonic uterine dysfunction management
rest, analgesics, bath, oxytocin to regulate contractions
hypotonic uterine dysfunction management
nipple stimulation, repositioning, oxytocin, ROM
shoulder dystocia
inability of fetal shoulders to deliver spontaneously
turtle sign
diagnostic of fetal shoulder dystocia
- head out with chin stuck inside (pushing will not move baby)
McRoberts maneuver
used for shoulder dystocia
- bring knees back
precipitous labor
any labor lasting 3 hours or less from onset of regular contractions to birth
post c-section nursing care
- don’t take ASA or aspirin bc it can interfere with clotting
- use football hold for breastfeeding
- make sure there is bowel movement at day 3/4 post op
uterine rupture definition
tear in the wall of the uterus that can expel the baby into the mother’s abdomen
mothers are at high risk of uterine rupture due to this..
trial of labor after cesarean (TOLAC)
- due to scarring
a uterine rupture can cause..
severe blood loss and hypoxic-ischemic encephalopathy (HIE)
cord prolapse
umbilical cord wants to come out before baby and is below baby’s head
cord prolapse management
getting on hands and knees and sticking bum in the air
S+S of cord prolapse
will feel heavy and like something needs to come out
amniotic fluid embolism
amniotic fluid in the bloodstream
- usually occurs 48 hours after birth and is very high mortality
2 causes of amniotic fluid embolism
- breach in placenta allows amniotic fluid to enter bloodstream and lodge in pulmonary arteries
- amniotic fluid in bloodstream activates immune response and causes an anaphylactic reaction
S+S of amniotic fluid embolism
pale, SOB, chest pain, low O2, heavy chest, hypotension, tachycardia, DIC, altered mental status
PPH
more than 500ml of blood loss after a vaginal birth or more than 1000 mlp of loss after a c-section
primary PPH
occurs within the first 24 hours
secondary PPH
occurs days later and is higher risk bc mom may not know what’s going on
- 4 T’s (causes) of PPH
- thrombin
- tone
- tissue
- trauma
- thrombin (4 T’s)
blood not clotting
- includes bleeding disorders, placental abruption, and preeclampsia
- tissue (4 T’s)
retained placenta or clot
- includes retained placenta, placenta accreta, and retained products of conception
- tone (4 T’s)
soft/boggy uterus
- includes placenta praevia, overdistention of the uterus, and previous PPH
- trauma (4 T’s)
laceration or uterine inversion
- includes c-section, episiotomy, macrosomic baby
PPH management
- fundal massage
- IV fluid replacement
- administer plasma
- administer misoprostol
hematoma
collection of blood in body outside of a vessel and commonly found in the vulva, or retroperitoneal space
- often associated with lacerations and episiotomies
common S+S of hematoma d/t labor
issues with voiding
- may need catheter
hypovolemic shock
caused by uncontrolled hemorrhage and is triggered when the volume of blood circulating decreases to point of O2 deprivation
body response to hypovolemia
adrenal glands sense it and release catecholamines to cue arterioles and venules to constrict in other organs so blood can be rerouted
hypovolemic shock treatment
restore blood volume with LR or NS and administer 10-12L of O2
thromboembolic disease
2nd most common cause of pregnant female death
- blood clot inside a vein
key sign of venous thromboembolism
swelling and inflammation below the blockage site
taking in phase
1-2 days after delivery
- dependent on support people
- indecisive
- anxious/uncertainty
taking hold phase
2-4 days after delivery
- initiates decision making
- starts to settle
- starts to focus more on newborn than self
postpartum blues
day 3 PP to 2 weeks
- sadness, irritability, sleeping problems
- usually due to hormones
postpartum depression
can occur anytime after 2 weeks PP to 1 year
- feelings of hopelessness, worthlessness, suicidality
IUGR stands for and possible causes are …
intrauterine growth restriction
- can be due to placental issues, infection, or maternal nutrition
SGA stands for…
small for gestational age
LGA stands for..
large for gestational age
- known as macrosomia
- caput succedaneum
edema of the scalp of presenting part of neonates head due to pressure against mothers cervix during labor
* crosses the suture lines
- dissipates within days
causes of caput succedaneum
mechanical trauma
- pushing, prolonged/difficult delivery, vacuum extraction
caput succedaneum puts the fetus at risk for ..
jaundice; due to bruising
cephalohematoma
accumulation of blood under the scalp
* does not cross suture lines
cold stress
excessive heat loss that results in compensatory mechanisms that can contribute to RDS and hypoglycemia
cold stress occurs through..
evaporation, convection, conduction, and radiation
thermoregulation of the newborn is closely related to…
metabolism rate and oxygen consumption
characteristics affecting thermal instability
- decreased subcutaneous fat/thin epidermis
- blood vessels closer to surface of skin
- un-flexed posture
neonatal sepsis
deadly systemic inflammatory response occurring in the first 4 weeks of life as a result of infection
S+S of neonatal sepsis
respirations higher than O2 sats, fever, poor feeding, grunting, nasal flaring, chest retractions
neonatal symptomatic hypoglycemia
blood levels less than 2.6
symptomatic hypoglycemia can result in…
neuronal injury
treatment of symptomatic hypoglycemia
IV 10% dextrose 80 ml/kg/day
neonatal asymptomatic hypoglycemia
blood levels of 1.8-2.5
treatment of asymptomatic hypoglycemia
dextrose gel (40%)
- absorbed into buccal membranes
S+S of neonatal hypoglycemia
poor feeding, sleepy, shakes,
hyperbilirubinemia
high load of bilirubin due to destruction of maternal RBC’s and shortened RBC lifespan of the newborn causing fat destruction leading to decreased ability to clear bilirubin
- peaks 4-5 days after birth
- greater than 95 percentile on scoring chart
risk factors for hyperbilirubinemia
- prematurity
- significant bruising
- blood type
- ineffective breastfeeding
physiologic jaundice
fetus does not have enterohepatic circulation in utero so it is normal to have some jaundice initially as there is an increase in bilirubin and moving it around is difficult
- first few days of life (2/3 until day 7)
- unconjugated
enterohepatic circulation
breakdown of used RBC’S and bilirubin excess is filtered through bloodstream by the liver then released to intestinal tract for disposal but the breakdown of the cells is yellow causing the physiologic jaundice
pathologic jaundice
present at birth or within first 24 hours of life
- usually related to blood incompatibility (hemolytic disease of the newborn)
- always conjugated
2 common causes of pathologic jaundice
- increased production of bilirubin due to blood incompatibility
- decreased clearance of bilirubin due to endocrine disorders or metabolic dysfunctions
breastfeeding jaundice
appears in first few days of life due to poor feeding and dehydration
- jaundice and sleepiness
- unconjugated
- common in mothers with little supply
treatment for breastfeeding jaundice
rehydration
breast milk jaundice
high level of free fatty acids in mothers breastmilk which competes with albumin sites inhibiting the conjugation process
- bilirubin levels increase after 5-7 days of life and last until 2-3 weeks of life
- unconjugated
high risk infants expected bilirubin levels
want total serum bilirubin to be 15 by day 5 (aka 257)
medium risk infants expected bilirubin levels
want total serum bilirubin to be 18 by day 5 (aka 320)
low risk infants expected bilirubin levels
want total serum bilirubin to be 21 by day 5 (aka 363)
key things for phototherapy
- eye mask/eye drops
- change fetal position every so often
- do US every 2-4 hours
- lights do not emit heat
neonatal jaundice
jaundice that occurs in newborns up to 28 days of age
bilirubin induced neurological dysfunction
happens when there is too much bilirubin buildup (which is a neurotoxin) and crosses the BBB
1st phase of acute bilirubin encephalopathy
- mild hypotonia
- sleepiness
- poor suck
intermediate phase of acute bilirubin encephalopathy
- high pitched cry
- difficult to console
- febrile
- hypertonic
advanced phase of acute bilirubin encephalopathy
- apnea
- inability to feed
- seizures
kernicterus
deposition of bilirubin in the brain causing necrosis
- chronic outcome of bilirubin induced neurological dysfunction
chronic bilirubin encephalopathy
occurs when necrosis of the brain occurs due to deposition of bilirubin
RDS
lack of surfactant to help keep alveoli from collapsing by reducing surface tension
- common in preterms
RDS can lead to…
expiratory atelectasis
S+S of RDS
grunting, tachypnea/apnea, nasal flaring, low O2, chest indrawing
treatment of RDS
betamethasone (corticosteroid) in 2 doses 12-24 hours apart
transient tachypnea of the newborn (TTN)
respiratory distress due to inability to clear lung fluid; most common cause of respiratory distress
- short term issue
- c-section babies are at greater risk
S+S of TTN
normal appearing respiratory transition but shortly after birth presents with
- expiratory grunting
- nasal flaring
- mild cyanosis
TTN can lead to …
persistent pulmonary hypertension and bradycardia
TTN management
CPAP, tube feeding, ABG, chest x-ray
meconium aspiration syndrome (MAS)
aspiration of meconium amniotic fluid in utero or first breaths of life causing mechanical airway obstruction
- more likely to occur in term babies
causes of MAS
stress during pregnancy, post dates
MAS can lead to…
pneumothorax, persistent pulmonary hypertension
S+S of MAS
chest retractions, rapid breathing, cyanosis, LOW APGAR
