Module 10 (Exam 3) Intrapartal Considerations Objectives 1

Question 1

Dystocia

Answer 1

Difficult labor due to mechanical factors relating to the fetus, maternal pelvis, or inadequate uterine contractions

Question 2

Cephalopelvic Disproportion (CPD)

Answer 2

Condition in which shape, size, or position of the fetal head precludes passage through the pelvis

Question 3

Precipitous Labor/Precipitous Birth

Answer 3

Intense, unusually short labor or rapid birth

Question 4

Prolonged Labor

Answer 4

Labor lasting more than 24 hours

Question 5

Premature Rupture of Membranes (PROM)

Answer 5

Rupture of amniotic membranes greater than 24 hours prior to birth

Question 6

Preterm Premature Rupture of Membranes (PPROM)

Answer 6

Premature rupture of membranes occurring in a pregnancy less than 37 weeks’ gestation

Question 7

Preterm Labor

Answer 7

Labor occurring between 20 and completion of the 37th week of pregnancy

Question 8

Tocolysis

Answer 8

Use of medications to arrest preterm labor

Question 9

Chorioamnionitis

Answer 9

Inflammation/infection of the amniotic membranes and/or amniotic fluid

Question 10

Terbutaline (Brethine)

Answer 10

• IV: 0.01-0.05 mg/minute. Increase rate by 0.01mg/min at 10 to 30 minute intervals until contractions of the maximum dose of 0.08 mg/min is reached. Maintain dose for 1 hour and then reduce the rate at 20 minute intervals to reach the minimum maintence dose when contractiions stop.
• Should not be used beyond 48-72 hours for preterm labor
• SC (most common route): intermittent injections. 0.25mg q4h
• Oral: should not be used to either treat preterm labor or prevent reccurent preterm labor
• Not approved by FDA for inhibiting uterine activity
• Infusion rate is not increased or may be decreased if maternal HR exceeds 120 beats per minute or systolic BP falls below 80-90mm hg
• Maternal: tachycardia, palpitations, cardiac dysrhythmias, chest pain, wide pulse pressure, dyspnea, chest discomfort, tremors, restlessness, weakness, dizziness, headache, hypokalemia, hyperglycemia, nausea, vomiting, reduced bowel motility, flushing, diaphoresis
• Fetal: Tachycardia

Question 11

Magnesium Sulfate (High alert medication)

Answer 11

• Tocolytic Use:
• IV: Loading dose 4-6g over 30 minutes. Maintence dose 1-4g/hour. When contraction frequency is no higher than 1 per 10 minute (greater than or equal to 6 per hour), maintain infusion rate for 12 hours then discontinue the drug
• Oral: may be ordered to continue tocolysis after magnesium sulfate is stopped
• Side effects occur at higher maternal serum levels: depression of deep tendon reflexes, R or cardiac depression if serum levels are high, lethargy, weakness, visual blurring, headache, sensation of heat, nausea, vomiting, constipation
• Fetal: Reduced fetal heart rate variability, hypotonia

Question 12

Nifedipine (Procardia)

Answer 12

• Oral: Loading dose 10-20 mg. 10-20mg every 3-6 hours until contractions are rare followed by long-acting formulations of 30-60mg every 8-12 hours until antepartum steroids have been administered
• Flushing, dizziness, headache, nausea, transient maternal tachycarida, mild hypotension, modest increases in blood glucose levels

Question 13

Indomethacin (Indocin)

Answer 13

• Limit use to preterm labor before 32 weeks of gestation
• Use for no longer than 48-72 consecutive hours
• PO: Loading dose 50mg, maintenance dose 25mg every 6 hours for 48 hours
• Ultrasound examinations and fetal echocardiography help determine if maternal indomethacin has adverse effects on fetus
• Epigastric pain, nausea, gastrointestinal bleeding, asthma in aspirin sensitive women, increased BP in hypertensive women
• Fetus: constriction of ductus arteriosus, impairs fetal renal function, reduced volume of amniotic fluid, cord compression
• Not approved by FDA

Question 14

State the rationale for corticosteriod administration to women experiencing preterm premature rupture of membranes or preterm labor

Answer 14

Acceleration of fetal lung maturity to reduce the incidence and severity of respiratory distress syndrome. Antenatal steriods can reduce the incidence of intraventricular hemorrhage and neonatal death in the preterm infant. Greatest benefits accrue if at least 24 hours elapse between the initial dose and birth of the preterm infant but the drug is indicated if birth is not imminent

Contradindications:

• Infection such as chorioamnioitis

Drugs: Betamethasone, dexamethasone