Medications Used in Labor, Complications of Labor and Methods of Delivery Flashcards
fentanyl dosage, route, onset and duration
25-100mcg IV, onset 3-10mins, with 1 hr duration
does fentanyl effect the fetus/newborn?
fetal depression, neonatal respiratory depression
butorphanol dosage and route
1-2mg IV or IM q4 hours
nalbuphine dosage and route, side effects
10-20mg IV or IM q3 hrs, excessive sedation if given repeatedly
promethazine use, dosage, and route
used along with narcotics, relief of anxiety and decrease narcotic use; promethazine 25-50mg IM, promethazine hydrochloride 20-40 IV or IM
timing to use nitrous oxide properly
30-60 secs prior to contraction since it a delayed effect
side effects of nitrous oxide on mother?
n/v, excessive sleepiness, HA
lumbar epidural explained
labor should be well established; mother is placed in sitting position; catheter placed at L3-L5; mixtures of local anesthetic and opioids
spinal analgesia explained
injection into the subarachnoid space with opioids and local anesthetics; sometimes used in the first stages of labor; single doses or given intermittently per catheter;
spinal anesthesia (saddle block) explained
usually given just be delivery to provide rapid perineal anesthesia; not given during labor because it interferes with motor function; prior to patient must be given a bonus of 500-1000ml of fluid; placed while patient is in sitting position, very small needle is placed in the subarachnoid space; medications (locals and opioids) are given between contractions for about 30 secs; patient remains sitting for 3 mins and then is placed in the lithotomy position with a L uterine displacement to prepare for delivery
pudendal nerve block
used in the 2nd stage of labor to help with somatic (constant) pain; used for episiotomy and relaxation of the pelvic floor during a forceps delivery; patient is in lithotomy position; transvaginal or transperineal injection of local anesthetic meds
general anesthesia/c-section process and side effects
-used for emgenency procedures or when mother are not good candidates for epidural or subarachnoid blocks. oral antacid is given prior if mother is not NPO; mother at risk for aspiration/aspiration PNA; wedge is placed under R hip to displace the uterus to the left prior to anesthesia.
-woman experience resp depression which affects the oxygenation of fetus; relaxation of uterine muscles = increase risk of PPH; anesthesia usually affects the fetus within 2 mins of onset, general anesthesia is contraindicated in high risk or preterm fetus due to the risk of fetal depression
what is the purpose of tocolytics?
suppress preterm labor and premature birth
list 4 tocolytics
indomethacin, nifedipine, terbutaline, and magnesium sulfate
indomethacine
NSAID that inhibit is prostaglandin production; first line therapy 24-32 week gestational; used up to 32 weeks; crosses the placenta and case reduction in amniotic fluid after 32 weeks; cause premature closure of the ductus arteriosus
nifedipine
calcium channel blocker; reduces muscle contractility, most commonly used because of its effectiveness and safety; may increase FHR; first line for 32-34 weeks, 2nd line for 24-32 weeks
terbutaline
beta adrenergic asthma drugs that relaxes the uterine muscle; may increase FHR; 2nd line therapy to nifedipine
magnesium sulfate
relaxes the uterine muscles; close monitoring required due to adverse effect such as fetal/neonate resp and motor depression
premature rupture of membranes (PROM)
ROM where labor fails to begin within 1 hour, about 80% of woman will go into labor within 24 hours, close monitoring required, may require induction or augmentation to prevent infection of fetus/neonate
preterm premature rupture of membranes (PPROM)
occurs less then 37 weeks and rigor to the onset of labor, one of the leading causes of premature births
prolonged rupture of membranes
ROM persists 18-24 hour prior to the onset or labor, associated with increase risk of infection to the neonate
precipitous delivery
labor to birth onset is less then 3 hours
cause of precipitous delivery’s
strong uterine contractions and low muscle resistance
affects of precipitous deliveries on neonate
low APGAR scores, increased risk of meconium aspiration, subdural/dural tears, unexpected outside the hospital delivery; strong uterine contractions may interfere with blood supply to fetus
hypertonic
ineffectual contractions in the latent phase of labor that become more frequent but do no result in dilation or effacement; resting tone of myometrium increases; may interfere with fetal oxygenation; may cause cephalohematoma, caput succedaneum, or excessive molding; treatment includes oxytocin or AROM
hypotonic
fewer then 3 contractions in 10 mins with less then 1 cm per hour progression - treatment AROM or oxytocin
post term delivery definition and risk for fetus?
greater then 42 weeks; LGA, aspiration of mec, and post maturity syndrome (related to IUGR)
military malpresentation
head is erect and neck not flexed - poses little problem because flex will occur as the head decends
brow malpresentation
the neck is extended so that the brow presents first; SGA, LGA, hydramnios, uterine/fetal anomalies; increased risk of brith trauma to fetus; c-section of episiotomy usually required
face malpresentation
neck is so severely extended that the face presents first; prolongs labor, increased edema to fetus w possible fetal trauma and facial bruising; c-section is generally required
frank breech
buttocks presentation with legs extended upwards
complete breech
buttocks and both feet presentation
incomplete breech
buttocks and x1 foot presentation
footling or double footling breech
one or two foot presentation
shoulder malpresentation
transverse lie - extreme risk of uterine rupture - must be delivered via c - section
compound malpresentation
two presenting parts such as a head and a head; increase risk of laceration
what does deep suction put neonate at risk of?
vagal response resulting in dangerous arrhythmias
walk through current NRP guidelines for when mec is present
-neonate is crying and showing no signs of resp distress = suction not recommended; visible drainage wiped cloth
-neonate shows sign of resp distress = bulb suction first (mouth before nose), deep suction only if no change
-resp distress continues after all non invasive efforts, intubate
stomach may need to be suctioned as well, mec can be aspirated into lungs*
vasa previa
one of the fetal vessels lies across the internal cervical os - high fetal mortality if vessel is damaged - planned c-section increased fetal survival rate to 97%
detective decides basalis and list the 3 types
abnormal adhenese of the placenta to the uterine wall - more common where previous c section or placenta previa is present - dx done at time of surgery - high risk for maternal hemorrhage and hysterectomy
1. placenta accrete
2. placenta increta
3. placenta percreta
placenta grows directly into the uterine wall is called?
placenta accreta
placenta increta
trophoblastic cells invaded the myometrium of the uterine wall
trophoblastic cells
thin layer of cells that help the developing embryo attach to the wall of the uterus, protect the embryo and forms a part of the placenta
placenta percreta
trophoblastic cells penetrate through the uterine wall and invade other organs such as the bladder
uterine dehiscence
uterine wall separates at the site of previous scar but fetal membranes and the fetus stay intake
signs of uterine rupture in mother
sharp, tearing uterine pain, FHR decelerations, n/v, fainting, vaginal bleeding, tachycardia, hypotension and shock
what is uterine inversion?
turning inside out of the uterus
what are causes of uterine inversion
spontaneously without cause, fundal pressure, traction of umbilical cord, large fetuses, short umbilical cords , adherent of placental tissues, and the use of oxytocin
prolapsed umbilical cord
the umbilical cord precedes the fetus and becomes entrapped by the descending fetus; management includes elevated the presenting part off the cord, having the mother elevate her knees to her head, preparing for a c-section
velamentous cord insertion
abnormality in which the cord is inserts into the membranes rather than the middle of the placenta - leaving exposed vessels unprotected by wharton’s jelly; more common with placental previa and multiple gestation; 25% are associated with spontaneous abortions; treatment is careful monitoring and c-section
what is a normal fluid index?
5-24cm depending on the weeks of gestation
oligohydramnios
AFI less then 5cm; linked with fetal urinary tract abnormalities
polyhydramnios
AFI over 24 cm; acute or chronic; associated with fetal anomalies of the CNS or GI; maternal diabetes or multiple gestation
amniotic fluid embolism
amniotic fluid enters the mothers circulatory system (c-section/labor/delivery); mother has a anaphylactic response
what is the normal time between placenta and delivery?
5-30 mins post delivery
explain how the placenta separates from the uterus?
change in size of the uterus post delivery, hematoma forms between the placenta and uterine wall, and the placenta is separated from the uterine wall
signs of placenta separation
sudden increase in vaginal bleeding, lengthening of the umbilical cord, and the rising of the uterus in the abdomen
perineal lacerations
the perineal skin and mucous membranes of the vagina are torn
second degree tear
perineal skin, vaginal mucous membranes as well as the fascia and muscle of the perineum
3 degree tear
perineal skin, vaginal mucous membranes, fascia and muscle of perineum and the tear extended to the rectal sphincter
fourth degree tear
perineal skin, vaginal mucous membranes, fascia and muscle of the perineum are torn, tear extends into the rectal sphincter and the inner lumen of the rectum is exposed
maternal risk of forcep delivery
infection, cervical and birth canal lacerations, extension of episiotomy, anal sphincter injury, weakening of pelvic floor muscles
neonate risks of forceps delivery
bruising/edema to face, caput succedaneum, cephalhematoma, low APGAR score, rental hemorrhage, ocular trauma, erb’s palsy, elevated bilirubin
erb’s palsy
paralysis of the arm cause by injury to the upper arms main group of nerves
pressured used in vaccum assisted deliveries
50-60 mmHg
suction limits for vacuum assisted deliveries
suction limited to 20-30 mins, scalp trauma is more likely after 10 mins, suction can only be dislodged 3 times and then vacuum is discontinued
success rates of VBAC
60-80%
benefits of delayed cord clamping
increased hemoglobin, improved iron status, lower rates of intraventricular hemorrhage and necrotizing enterocolitis
ml of blood related to mins in delayed cord clamping
80ml in the first min and 100ml in the first 3 mins
