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NURB 3230 > mgmt of L&D risks > Flashcards

mgmt of L&D risks Flashcards

1
Q

maternal risk factors for dystocia

A

-short stature
-overweight
-CPD
-pelvic obstructions/contracture
-40yo or greater
-uterine abnormalities
-fatigue, fear, dehydration
-hyper/hypotonic uterus
-inappropriate timing of analgesics/anesthesia

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2
Q

fetal risk factors for dystocia

A

-macrosomia
-malpresentation/malposition
->1 fetus

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3
Q

power problems

A

-protracted disorders
-arrest disorder
-precipitate labor

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4
Q

protracted disorders

A

-longer active phase dilation
-delayed fetal descent/failure to descend
-interventions: c-section

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5
Q

arrest disorder

A

-complete cessation of progress
-dilation stops
-interventions: c-section

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6
Q

precipitate labor

A

birth 3 hours or less from the start of ctx

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7
Q

risks to infant and mother during precipitate labor

A

infant
-head trauma
-nerve damage
-hypoxia
-intracranial hemorrhage

mother
-lacerations
-tissue trauma
-uterine rupture
-postpartum hemorrhage

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8
Q

interventions for precipitate labor

A

-don’t leave the client, call for help
-assist to lateral position, apply O2
-continuous monitoring, pain mgmt, provide reassurance
-dont attempt to stop delivery
-apply light pressure to perineum/fetal
-support the infant

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9
Q

shoulder dystocia

A

-fetal shoulder is stuck after the head is delivered
-call for help immediately
-place mother in McRobert’s position
-C/S if no success with position changes
-document total time from head to body delivery

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10
Q

risks for fetus and mother when removing baby with shoulder dystocia

A

fetus: hypoxia, clavicular fracture, brachial-plexus injury
mother: hemorrhage, uterine rupture

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11
Q

risks for baby with shoulder dystocia

A

-LGA
-maternal previous soldier dystocia
-post date babies

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12
Q

passenger/positon problems

A

-multiple gestation
-macrosomia
-malpresentation

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13
Q

multiple gestation

A

-infertility treatments: IVF, ovarian stimulating drugs
-risk for: PPH d/t uterine atony

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14
Q

macrosomia

A

-fetal weight >4000 g (8lb 13oz)
-risk for: PPH, shoulder dystocia, soft tissue lacerations, fetal injuries
-may require an elective c/s delivery

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15
Q

malpresentation

A

-OP, longer labor/pushing phase
-face/brow, may require c-section
-breech, c/s delivery

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16
Q

passageway problems

A

-pelvic shape: favorable?
-CPD: cephalopelvic disproportion
-maternal swelling: soft tissues, cervix

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17
Q

psyche problems

A

-dystocia caused by hormones released d/t anxiety
-increased fear, tension, pain… decreases contractility

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18
Q

external version

A

attempt to turn a malpositioned fetus

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19
Q

external version contraindications

A

-uterine anomalies
-previous c/s
-cpd
-placenta previa
-oligohydramnios
-multifetal gestation

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20
Q

external version risks

A

-prolapsed cord
-compression
-placental abruption

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21
Q

mgmt of external version

A

-assess fetal status prior and after procedures
-vitals, watch for hypotension
-assess for ROM, bleeding fetal mvmt
-IVF and tocolytics, if ordered
-rhogam if RH-

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22
Q

preterm labor (PTL)

A

early onset labor (20-37 weeks)

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23
Q

PTL risk factors

A

-anything that can cause harm to fetus
-risky behavior

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24
Q

PTL assessment findings

A

-persistent low backache
-UTI
-vaginal bleedings
-ctx
-ROM

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25
Q

testing for PTL

A

-cervical length measurement
-BPP
-NST
-early ID is key!!!!!!!!

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26
Q

PTL tx

A

-mg sulfate, stops hemorrhage and contractions
-monitor for pulmonary edema and toxicity

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27
Q

PTL mgmt

A

-continuous monitoring, initiate seizure precautions
-documentation q hr
-VS, I&O, FHM, DTRs, total IVF, neuro checks
-toxicity: stop infusion, stat lab, call dr., calcium gluconate

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28
Q

s/s of toxicity

A

-loss of DTR
-urine output <30mLs/hr
-resp. rate <12/min
-blurred vision
-chest pain
-lethargy
-slurred speech
-h/a
-n/v
-difficulty breathing

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29
Q

drugs used for PTL tx

A

-nifedipine (Procardia): inhibits calcium from smooth cells, monitor bp & hr, maternal tachycardia
-indomethacin (Indocin): NSAID blocks prostaglandin production, monitor for pulmonary edema & GI stress
-betamethasone (Celestone): promotes fetal lung development, 24-34 weeks, IMx2 24 hrs apart, monitor for pulmonary edema, hypoglycemia, and infection

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30
Q

intrauterine fetal demise (IUFD) assessment

A

-US, confirms absences of fetal movement and cardiac activity
-hx of decreased fetal movement
-requires induction of labor

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31
Q

IUFD mgmt

A

-provide support
-assist with grieving
-CLS
-prepare parents for appearance
-allow unlimited time with stillborn
-refer to support groups
-therapeutic communication

32
Q

post-term pregnancy

A

-pregnancy longer than 42 weeks
-placenta ages and decreases perfusion
-oligohydramnios, increases risk for cord compression, fetal hypoxia
-high risk for fetal distress!!!!!!!

33
Q

risks for post term pregnancy

A

-macrosomia, shoulder dystocia, CPD
-meconium aspiration-> fetal distress
-PPH d/t uterine atony

34
Q

mgmt of post term pregnancy

A

-fetal monitoring
-update nursery staff, prep for resuscitation
-support anxiety

35
Q

labor induction

A

medically initiation of labor

36
Q

labor augmentation

A

mother’s labor has stalled or needs to be sped up via oxytocin or AROM methods

37
Q

labor induction & augmentation contraindications

A

-placenta previa
-transverse fetal lie
-umbilical cord prolapse
-previous classical C/S incision
-active HSV
-previous myomectomy
-poor bishop score

38
Q

bishop score

A

-used to determine maternal readiness for labor at 39 weeks or greater
-evaluates through scoring: dilation, effacement, station, cervical consistency, position of the cervix

39
Q

cervical ripening

A

-increases cervical readiness for labor
-softens, effaces, and dilates the cervix
-performed in conjunction to labor induction or can be performed alone
-mechanical and chemical ripening

40
Q

mechanical ripening

A

-balloon dilation
-membrane stripping
-amniotomy
-hygroscopic dilators (seaweed)

41
Q

chemical ripening

A

-misoprostol (Cytotec)
-dinoprostone (Cervidil)
-oxytocin (Pitocin)
-can cause hyperstimulation which can lead to fetal distress

42
Q

oxytocin (pitocin)

A

-used for induction and augmentation of labor, stimulates ctx
-iv titration
-hospital policy and MD order

43
Q

mgmt of oxytocin (pitocin)

A

-obtain NST and SVE prior to starting infusion
-continuous FHM, VS q 15min
-document
-call MD for any fetal distress, d/c if fetal distress occurs or uterine hyperstimulation (<2min apart), and tetanic ctx (<90 seconds)
-educate on s/s to report

44
Q

amniotomy

A

-AROM
-deliberate puncture of the amniotic sac to release fluid
-MD only

45
Q

risks of amniotomy

A

-umbilical cord prolapse
-infection (maternal or fetal)
-fetal distress

46
Q

mgmt of amniotomy

A

-perform SVE prior, if ballotable can have cord relapse
-continuous FHM
-assess amniotic fluid, ongoing until delivery
-obtain temp q 2hr, risk of infection

47
Q

meconium staining

A

-amniotic fluid is black, brown, green, or yellow, can be thick or thin
-loss of sphincter control d//t umbilical cord compression, fetal hypoxia, or fetal distress

48
Q

meconium staining mgmt

A

-document findings
-notify: MD, RT, neonatal team
-suction mouth/nose when head is delivered
-assess RR, HR, tone

49
Q

fetal distress

A

-FHR <110 or >160
-decreased or absent variability
-recurrent decelerations
-fetal activity: hyperactive or inactive

50
Q

fetal distress interventions

A

-continuous monitoring, notify MD, call for help
-maternal position change, left or side lying
-IVF bolus LR
-d/c oxytocin
-O2 via facemask at 10L/min
-give terbutaline if ordered (hold if maternal hr >120, or for bleeding)
-prepare for c/s

51
Q

operative delivery

A

-assisted delivery of fetus head
-vacuum assisted
-ineffective pushing, fetal distress

52
Q

mgmt of operative delivery

A

-lithotomy position
-empty bladder
-FHM
-document pop offs, release of vacuum extraction

53
Q

infant monitoring with operative delivery

A

-lacerations
-cephalohematoma
-caput
-bruising
-facial nerve palsy
-subdural hematomas

54
Q

maternal monitoring with operative delivery

A

-vag/cervical lacerations
-hematoma
-urinary retention
-hemorrhage

55
Q

cesarean delivery risks

A

-infection
-hemorrhage
-UTI
-DVT
-paralytic ileus
-atelectasis

56
Q

indications of c/s

A

-high risk pregnancy
-malpresentation
-abnormalities (maternal or fetal)
-multiple gestation
-previous c/s
-OB emergencies

57
Q

preop care for c/s

A

-ensure consent
-document time of decision by provider if not planned
-IVF bolus to prevent hypotension
-IV abx if non emergent
-foley, scd, shave, baseline labs

58
Q

TOLAC

A

-trial of labor after cesarean
-attempt to deliver or be induced

59
Q

VBAC

A

-vaginal birth after cesarean

60
Q

ACOG guidelines for TOLAC and VBAC

A

-adequate pelvis
-1 previous c/s delivery with low transverse incision
-no other uterine scars or previous uterine rupture
-OBGYN and anesthesia must be immediately available through active labor

61
Q

contraindications to TOLAC/VBAC

A

-cervical ripening agents
-previous classical incision, myomectomy
-obesity, 40yo or greater, inadequate pelvis, inadequate staff/facility

62
Q

mgmt of TOLAC & VBAC

A

-consent
-educate on risks and benefits
-document all interventions
-continuous monitoring
-ensure anesthesia, neonatal, and medical staff are aware of current status and prepared for emergency c/s if needed
-advocate for pt

63
Q

uterine rupture

A

-uterus tears at previous scar into the abdominal cavity, obstetrical emergency

64
Q

uterine rupture risk factors

A

-uterine scars
-prior molar pregnancy
-placenta accreta/increta
-cocaine/crack use
-excessive uterine stimulation

65
Q

uterine rupture s/s

A

-abrupt fetal distress or complete loss of FHTs
-acute/continuous abdominal pain
-vaginal bleeding, hematuria
-irregular abdominal wall contour
-loss of station/presenting part!!!
-hypovolemic shock

66
Q

umbilical cord prolapse

A

-umbilical cord protrudes through the cervix before presenting part
-cord compression, compromised fetus

67
Q

umbilical cord prolapse risk factors

A

-ballotable fetus during ROM
-polyhydramnios
-fetal malpresentation
-prematurity

68
Q

mgmt of umbilical cord prolapse

A

-immediately relive pressure off the cord- SVE, maternal position
-call for help
-prep for immediate c/s delivery

69
Q

placental abruption

A

premature separation of the placenta, emergency

70
Q

placental abruption risk factors

A

-pre-eclampsia
-HTN
-AMA
-uterine rupture
-trauma
-smoking/drug use
-external cephalic version

71
Q

placental abruption assessment findings

A

-sudden vaginal bleeding (sometimes none)
-rigid abdomen on palpation, extremely painful!!!
-fetal distress
-no relaxation between ctxs!!!!!

72
Q

mgmt of placental abruption

A

-fetal monitoring
-maintain iv access, IVF bolus
-monitor maternal CV status, bleeding, pain, FHT
-immediate c/s delivery

73
Q

amniotic fluid embolism

A

-amniotic fluid particles of debris enters maternal circulation, obstructing pulmonary vessels
-causes rapids resp. distress and cardiovascular collapse
-obstetric emergency, rare but often fatal for mother and fetus

74
Q

amniotic fluid embolism s/s

A

sudden hypotension, hypoxia, dyspnea, restlessness, cyanosis, pulmonary edema, tachycardia, DIC bleeding, petechiae/ecchymosis, uterine atony, sense of impending doom

75
Q

mgmt of amniotic fluid embolism

A

-O2, IVF bolus LR
-Immediate C/S delivery!
-Maternal position change – side tilt
-Continuous monitoring of CV status (VS)
-CPR
-Mainly supportive to maintain resp/cardio function
-**Immediate recognition is key!

NURB 3230 (13 decks)

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