Maternity 2 Flashcards
Describe developmental task of adolescents challenged by pregnancy
o Establish sense of self-worth/value system
• Maintain sense of self and schooling
o Emancipate from parents
• Often requires financial support / health
• Feelings of complete dependency
• Encourage practice responsibility/independence
• Maintain confidentially / privacy
o Adjust to body image
• Weight gain and fatigue
o Choose a vocation
Describe strategies to assess and engage with pregnant youth
o Considered high risk r/t HTN, anemia, premature labour, decreased pelvic size, intimate partner violence risks
o Health Hx, Family Hx, Physical (maybe without parent present)
o Propensity to avoid prenatal assessment and care
o Sell it as a “growth experience”, provide extra education
o Social and financial supports
o Consider limiting number of care providers ( INc trust)
o Peer support groups may be helpful
o Pregnant teens generally emancipated (make own decisions)
7 complications likely in adolescent pregnancy
Gestational HTN Iron deficient Anemia Preterm Labour Cephalopelvic disproportion, postpartum hemorrhage (uterus not fully developed) inability to adapt postpartally knowledge deficit of infants High risk of hemorrhoids high rate of intimate partner violence
What are the prominent risks of advanced maternal age
o Gestational HTN- blood vessel inelasticity
o Failure to progress in labour (cervical dilation not as spontaneous)
o Difficulty accepting the event
o Postpartum Hemorrhage (inelasticity and tears)
o Also in box 22.7 hemorrhoids, varicose veins, thrombophlebitis
What is substance dependance and what might the complications be
Inability to meet role obligations, legal problems, risk behavious d/t addictive substance. Withdrawal symptoms present
• May be less willing to seek prenatal care out of concern of judegment or baby been taken away
• May be under financial burden r/t addiction
• Fetus often has drug conc 50% that of mother, may have withdrawal symptoms at birth, preterm or variable heart rate
• Breastfeeding may be contraindicated if drug conc. remain high
Cocaine and pregnancy
vasoconstriction limits uterine circulation
o baby – intercranial hemorrhage, withdrawal, long term defecits
o During preg, vasoconstriction → severely compromised placental circ + premature separation of the placenta → preterm labour or fetal death
o abstinence syndrome of tremulousness, irritability, muscle rigidity
o Possible social + learning deficits in long term (not well documented)
o Signs- Can be detected in Urine for 1 week
Amphetamines and pregnancy
o Methanphetamine = neurostimulant + neurotoxin
o Cheap, made in home labs
o Effects similar to cocaine
o Baby- jittery, poor feeding, poor growth
o Signs- Blackened infected teeth (smoking), measurable in blood
• Phencyclidine (PCP) and pregnancy
• Phencyclidine (PCP)- IV anesthetic originally, now rave culture
o In circulation, concentrate in fetal cells, injurious to fetus
Narcotics and pregnancy
includes opioids like heroin
o Abstinence symptoms: NVD, abdm pain, shivering, insomnia, body aches, muscle jerks – can begin as soon as 6 hrs after last dose + continue for several days
o Babies small, inc fetal distress + meconium aspiration
o Baby- neonatal dependency, distress, withdrawal, low weight,
o SIGNS- Gestational HTN, Blood pathogen r/t IV use (HIV, Hep risk)
Inhalants and pregnancy
o Effects similar to ETOH but with respiratory and Cardiac irregulaties that can effect fetal circulation
o Glue, Gas, sprays, computer keyboard cleaner
Alcohol and risks in pregnancy
Fetal alcohol spectrum disorder (facial features, cognitive challenges, memory defecits. Any drinking isn’t safe, but binge drinking is major risk
the 4 P’s Labour
Power, Passenger, Passage, Psyche
Two PHASES of Labour
Latent- Last up to 2 days, regular contraction pattern established, 3-4 cm dilated cervix, nap when possible, eat a bit
Active- Contractions are strong and regular (~every 2-3mins for 60s), 3-10cm dilated. This is Labour.
Stages of Labour
• Stages are of Labor (active phase)
1) First contraction to complete dilation
2) Pushing, descent and delivery
3) placenta delivery
4) hemeostasis established after delivery
What is normal intrauterine pressure
50mmhg measured by IUP Catheter
Why is it important for uterus muscle to contract with the right force
Uterus is a muscle (overexertion may be traumatic, under exertion may be exhausting)
How might the bladder impact labour and what can we do?
Full bladder may make the labour sluggish (Pee every 2 hours)
What are common risks that effect the POWER of contractions
Advanced age, adolescents, Macrosomic infants (uterus has trouble contracting with too much bulk, too thin), grand multiparas (5 or more children), multiple gestation **full bladder or bowel, **Dehydration, exhaustion, low sugars, narcotics used too early in labour
Describe normal contraction time in active labour
3-4 contractions in 10 mins , Resting Tone 60S contractions and 60s resting tone (or else fetal distress or hypoxia) (Abd should be soft at rest)
Describe normal cervical dilation
Dilation of 1cm/hr (or 1cm/1.5hrs premature) after initial 3-4cm dilation
What are the risks of Cephalopelvic disproportion CPD
Head isn’t fitting in the pelvis
Risks- gestations Diabetes, overdue babies, adolescent pregnancies
What is Bandl’s ring?
the abnormal junction between the two segments of the human uterus, which is a late sign associated with obstructed labor. Visible and palpable, may lead to rupture
What is a prolapsed cord
o Rapid fluid evacuation can sweep umbilical cord out
o Considered part of passenger
o Cord cut off can result in hypoxia, acidosis, inc HR in Infant
o have ~5min before hypoxia
What are the two main Lie positions
Longitudinal/vertex OR Transverse (Shoulder)
What is a normal position
Normal – Occiput Anterior (Back of head Anterior of pelvis)
Describe some of the positions a baby
o Moderate Risk work (maybe deliverable)
• Occipital Posterior (Takes longer, causes back pain)
• Military
• Asynclitis (slight tilt to head, not deliverab
• Face
• Breech
o High risk /not deliverable
• Breech (Bum, C section advised) Complete (Bhudda/Unsafe), Incomplete (cord issues/unsafe), Frank (deliverable)
*NOTE Hands off the breech, Dangle/support and finger in mouth
What is it called when large babies (Macrosomia) are stuck with their head protruding?
What can be done?
oShoulder Dystocia- (shoulder stuck on pubis symphosis)
o HELPER (call for help, Episiotomy (Cut vagina to anus), legs into McRoberts (to ears), Pressure, Enter (clavicle braek), Rotate)
Describe Normal and Concerning fetal heart rate variability during labour
• HR Acceleration (during contraction) Heart Rate with 15-25 bpm variability = normal. Loss of variability is a concern. (More then 15bpm lasting >15s during contraction= happy baby)
• HR Decelerations (of HR during Contractions)-
o Early – head compression (normal)
o Late- Fetal Hypoxia (Concerned, Infant struggling)
o Variable- Cord compression (View on U/S)
What are the four bone structures of the pelvis in women and which is easiest for labour
Gynecoid = easiest, Android, Anthropoid, Platypelloid
What are the risks of using forceps
low risk but can cause cuts/pressure/tears on baby or mother. Nerve damage (baby) and Bladder damage (Mother)
What is the risk of vacuum extraction
Indicated if Infant showing signs of hypoxia/struggle. Subdural hematoma risk (do not use on premature)
How long should the “pushing” stage last
no more then 2 hours
What is Dystocia and what are the MAJOR risks
• Difficult Labour (MAJOR RISK infection and hemorrhage)
o Risk of rupture, fistula development, future incontinence, infant mortality, fetal anoxia
Describe hyper and hypotonic contractions
• Hypotonic uterine contractions- Weak utetine contraction (~2-3 in 10mins, resting at 10mmHg and contracting at 25mmHg)
Risk = exhaustion
• Hypertonic uterine contractions- Frequent, common in later stages of labour (Increase in resting tone 15mmHg)
Risk-= Trauma
What is primary and secondary dysfunctional labour
Dysfunctional labour – (AKA inertia) Sluggishness of labour or less then usual force of contractions.
Primary= occurring at onset, Secondary = later
Precipitate labour
Refers to a delivery which results after an unusually rapid Labor
What is Oxytocin
A posterior pituitary hormone, hyperstimulation causes contractions too long to allow rest and oxygenation of infant
• Always given IV , Half life of 3mins means very adjustable
Describe Uterine Rupture
- Uterus ripping r/t pressure and thinning of muscle during labour
- Risk factors- previous cesarean scar, abd presentation, prolonged labor, multiple gestation, use of oxytocin, obstructed labor, traumatic maneuvers
- Signs and Symptoms- severe pain, tearing sensation during contraction, swelling, hypovolemic shock,
- Interventions- IV fluids, oxytoxin (contract uterus), laparotomy (bleeding control), C section
What is Inversion of the Uterus
- Refers to uterus turning inside-out
- Cause- Traction applied (to remove cord/placenta) and pressure applied to fundus when uterus is not contracted
- Interventions- DO not attempt to replace inversion, replace fluids, blood, 02, primary care provider will replace manually
What is an Amniotic embolism and how does it happen
- Amniotic fluid forced into open maternal uterine blood sinus
- Associated with rupture or separation of placenta, induction of labour, multiple pregnancy, hydramnios
- Not predictable, so generally not completely preventable
- Sudden onset respiratory distress, chest pain, cyanotic (like pulm embolism)
Describe abnormalities of the placenta
• Placenta Succenturiata-
o extra accessory lobes of placenta may be present or left behind. No fetal abnormality
• Placenta Circumvallata
Chorion covering fetal side of placenta (no concerns)
- Battledore Placenta- cord is inserted marginally , not centrally (no concerns)
- Velamentous cord insertion- cord splits intop several vessel before placenta. May affect fetal blood supply, more common in twins
• Placenta accrete-
o unusually deep attachment to uterus, might not deliver naturally, may require Sx r/t hemm risk
• Vasa previa-
o vessels are across cervix and deliver before fetus
o Similar to placenta previa, likely need C section, fetal blood loss risk
Describe Abnormalities of the cord
• Two vessel cord-
o I vein, one artery (Norm is 1 vein, two arteries)
o May be r/t kidney/heart congenital abnormalities
• Unuasual cord length-
o Short can cause early placental separation
o Long can get tangled, knots cut off blood supply
• OTHER ISSUES- Cord Prolapse- loop of cord flips down in front of fetal presenting part (head/limb)Multiple Gestation- cords intertwine
