NUR 102 Exam 1 Complications of L&D Flashcards
What are some of the MATERNAL risks for Multiple Gestation?
-Higher morbidity & mortality
- Increased preterm labor
- Increased PROM (Premature rupture of membranes)
-Increased risk of PIH and preeclampsia
-Increased risk of gestational diabetes
-Increased risk of postpartum hemorrhage
-Increased Anemia
Very high Cesarean section rate
What are some of the FETAL risks for Multiple Gestation?
- Increased morbidity and mortality
- Increased abnormal presentations
- Increased prematurity
- Low birth weight
- SGA
- IUGR
- Twin -to twin transfusion
- Increased long term disabilities
- First born usually has higher APGAR score
- Better outcome if conceived naturally
What is the criteria for PTL (Preterm Labor) Dx?
Gestation less than 37 weeks
Contractions q5-10 minuted x 30 seconds for more than one hour
Cervical dilation more than 2.5 cm and 75% effaced
This onset is 20-37 weeks gestation
Occurs in 8% of pregnancies
Accounts of most perinatal deaths not resulting from congenital anomalies..what does this describe?
Preterm Labor (PTL)
What are the 13 risks for Preterm Labor (PTL)?
- Poor prenatal care
- FEtal abnormality
- Hx of preterm labor
- Multiple gestation
- Bacterial vaginosis
- Substance abuse; tobacco, alcohol, cocaine
- Poly or oligo hydramnios
- Placental abruption
- Trauma of surgery during pregnancy
- PROM
- less than 17 or more than 35 yrs old
- Poverty
- Short cervix
What are the 7 S&S of PTL?
-Uterine Cramping
-Abdominal cramping (with or without nausea)
Any vaginal bleeding
-Change in vaginal discharge
-Vaginal or pelvic pressure
-Low back pain
Thigh pain (intermittent or persistent)
What is the role of Nurse regarding PTL?
Open communication between patient and nurse
Education, Education, Education
-Assess risk factors and determine if at risk!
-Teach signs and symptoms of PTL
-Report sign and symptoms promptly
What are the 5 ways to stop PTL (Preterm Labor)?
- Stop the contractions before dilation of 3 cms ( or point of no return)
- Identify and treat any infection
- Restrict activity:modified bed rest and on side
- Increase hydration
- Tocolytic Drugs
What are the tocolytic agents?
When should they not be used?
-Ritodrine
-Nifedipine
-Terbutaline
All should not be used if bleeding or fetal distress
Goal is to delay delivery until lungs mature
Betamethasone is for what?
Decrease RDS
What is the nursing care for PTL patient?
- Maintain lateral position, hydration
- Strict I&O
- Report all below
- pulse higher than 120, BP less than 90/40, pulse ox less than 96%
- fluid retention
- adventitious breath sounds
- c/o SOB or chest pain
What is PPROM?
& PROM?
Preterm premature rupture of membranes
Premature rupture of membranes
What are the 9 risk factors for PROM/PPROM?
- Induced Labor
- Vaginal and/or cervical infection
- Chorioamnionitis (PPROM)
- Short or incompetent cervix
- FEtal abnormalities, malpresentation
- Fragile amniotic sac structure
- H/O PROM
- Recent Intercourse
- Recent procedures
What is the nursing care for PROM?
- Induce within 24 hours if no spontaneous labor
- Risk for infection of mom and fetus
- Risk for prolapsed cord
- Chrioamniontis
What is the nursing care for PPROM?
BED rest: daily fetal kick counts
- Vital signs
- FHR monitoring
- Monitor contractions
- Assess discharge
- Give corticosteroids and antibiotic therapy as ordered
- Emotional support
What is KEY for for PREVENTION of Preterm labor and Birth?
Prenatal Care
What is involved in prenatal care that will decrease health disparities?
- Assessing for risk factors and consistency of prenatal visits
- Predict prematurity (diagnostic lab tests/measurements
- Promote adequate nutrition
- Teach signs and symptoms of preterm labor
- Empower women ( HOW, When to seek help promptly)
What is pregnancy that extends beyond end of 42 weeks gestation?
Post Term Pregnancy
What’s the percentage of post term pregnancy?
4-10%
How might someone have a post term pregnancy?
Possibly by a deficiency of placental estrogen and continued secretion of progesterone
What are the maternal risks post term pregnancy?
- prolonged labor
- CPD, arrest of fetal descent
- dysfunctional labor
- the need for assisted birth
What are the fetal risks for post term pregnancy?
- prolonged labor
- SHOULDER DYSTOCIA
- birth trauma
- AGING PLACENTA
- FETAL HYPOXIA
- OLIOHYDRAMNIOS, STARTS TO LOSE WEIGHT
What is it called when poor quality contractions that are painful out of proportion to their intensity and DO NOT CAUSE DILATION OR EFFACEMENT, are uncoordinated and frequent in the prolonged latent phase (primip)
Hypertonic Uterine Dysfunction
Ineffective, painful, uterus never relaxes, it causes maternal exhaustion; fetal distress w/DECREASED placental perfusion
HYPERTONIC Uterine Dysfunction
What is the treatment for HYPERTONIC Uterine Dysfunction?
Rest & Therapeutic Sleep
Infrequent Contractions more than 2-3 every 10 min and poor intensity with little discomfort after labor has been established…is what?
HYPOTONIC Uterine Dysfunction
What to look for and intervention with HYPOTONIC Uterine Dysfunction
Risk of Infection if PROM
Result from CPD, malpresentation, over stretched uterus
If none of the above, augment labor
When the rate of cervical dilation or fetal descent is not progressing normally or uterine contractions are ineffective this is considered what?
Dysfunctional Labor
How do four of the stages of labor below present within a "dysfunctional labor"? Power: Passageway: Passenger: Psyche:?
Power: Abnormal uterine activity
Passageway:Abnormal pelvic size and shape or obstructions
Passenger: Abnormal fetal size
Psyche: Past experiences, culture, preparation and support system; anxiety or fatigue
Labor of LESS Than 3 hours from first contraction to birth is called what?
Precipitous Labor
What are some increased risks for PT in Precipitous Labor?
- Uterine Rupture
- increased risk of maternal and fetal complications:
- uterine rupture
- increased risk of cervical, vaginal, and perineal lacerations/perineal trauma
- amniotic fluid embolism
- postpartum hemorrhage
- fetal hypoxia
- rapid massage of fetal head thru birth canal causes intracranial hemorrhage
What are some passageway complications?
Contractures of Pelvic diameters; inlet, midpelvis, outlet or combinations
What are passageway complications caused by?
Rickets
Malnutrition, congenital, tumors, injury
Obstruction:tumor of bladder
Cervical scarring
What are some Passenger Complications?
-CPD (Cephalopelvic disproportion)
-Abnormal presentation
>Breech (3-4%)
> Face
>Brow
>Shoulder
>Compund
-External Version
-Risk:prolapsed cord, placental abruption
Psyche complications have a Strong effect on labor progress in which ways?
- The PT’s Perceived fears of pain
- Lack of support
- Embarrassment
- Violation of religious rituals
In regards to Psyche Complications what causes the release of epinephrine which inhibits (STOPS) contractions and diverts blood AWAY from uterus TO skeletal muscles?
STRESS
What are some Maternal Reasons for Induction or Augmentation of Labor?
- Chrorioamnionitis
- PROM
- PIH
- DM
- CPD
- Malpresentation
- LAbor dystocia
What are some Fetal Indications for Induction or Augmentation of Labor?
- IGR
- Post term
- Fetal demise
What is it called when it’s a soft pliable cervix caused by biochemical events?
Cervical Ripening
What are some pharmacological agents used in Induction (Cervical Ripening)?
Prostaglandin PrePidil, Cervidil, Cytotec (misoprostol) Oxytocin
What are the mechanical/non pharmacological:stripping membranes, amniotomy mechanical dilators (laminaria)
Stripping membranes
Amniotomy mechanical dilators (laminaria)
You have to check for Labor status,
Assess for uterine hyperstimulation and decreased fetal oxygenation
-Hyperstimulation:lates, uterine rupture, rapid labor w/cervical tears before inducing labor with what?
Oxytocin
What is (AROM) Artifical Rupture of Membranes called?
Amniotomy
What is PAINLESS, used to induce labor (IF CERVIX is RIPE) OR AUGMENT LABOR if slow,
Often used in combination with oxytocin & Represents a commitment to giving birth?
AROM Artificial Rupture of Membranes
What are the precautions to take before Labor Induction?
- Cephalic presentation
- The Presenting part must be engaged and up against cervix (to prevent prolapsed cord)
- Must be free of active genital tract infection (i.e Herpes, HIV
What are the nursing interventions for an Amniotomy?
- Obtain Baseline info
- Assess FHR for 20-30 min BEFORE procedure
- Assist with procedure
- Pads, towels under buttocks
- Gather:sterile gloves, lubricant, amnihook
- Sterile technique to hand amnihook
What are the 5 Nursing Interventions POST-amniotomy?
- Assess FHR
- Assess amiotic fluid
- Take temp every 2hrs
- look for S&S of infection; chills, uterine tenderness, foul smelling drainage, tachycardia
- Promote comfort (esp. changing pads)
What are paired, curved blades used to assist with the delivery of head ..with INTERMITTENT traction applied called?
Forceps Assisted Birth
What is used to shorten SECOND Stage; turn and/or bring down presenting part
Help Exhausted mom
-If there is Sudden Fetal Distress?
Forceps
What are some complications that can occur with Forceps Assisted Vaginal Birth?
- Fetal Scalp bruising or laceration
- Lacerations of the birth canal and perineum with DECREASED blood loss!
What are the Nursing Interventions for Forceps or Vacuum Assisted births?
FHR PATTERNS ASSESS REPORT RECORD BEFORE AND AFTER forceps or vacuum Assess for fetal complications Assess for Maternal complications
What do you Nurses assess for re: fetal complications with use of Forceps or Vacuum Assisted births?
- Ecchymosis
- Facial/scalp lacerations or abrasions
- Cephalahematoma
- Intercranial Hemorrhage
What do Nurses assess for re: Maternal Complications with use of Forceps or Vacuum Assisted births?
- Vaginal/Cervical Lacerations
- Urine retention
- Hematomas/Perineal Trauma
What uses traction not torque, Brings head down..doesn’t rotate and proper placement is essential?
Vacuum Assisted Birth
What complications are associated with Vacuum assisted Birth?
- Edema and bruising to fetal scalp
- Cephalhematomas, scalp lacerations subdural hematoma
What are the 5 deviations from Normal Labor?
- Excessive vaginal bleeding
- Meconium stained amniotic fluid
- No FHR or fetal movement; GET ULTRASOUND
- Prolapsed umbilical cord
- Precipitous Birth (labor less than 3hrs from 1st contraction to birth)
Severe maternal bleeding and shock is what complication?
Uterine Rupture
It is rare
What are some reasons for Uterine Rupture?
- Previous C-Section
- Aggressive or poorly managed induction
- Prolonged labor w/CPD
What are the 3 S&S of Uterine Rupture?
- Persistent uterine contractions, no relaxation
- Sharps supra pubic pain
- Bleeding
What complication is:excessive amniotic fluid?
How much fluid?
Polyydramnios
More than 2 Liters
Polyydramnios may be related to what?
-Congential abnormalited esp, of the Gastrointestinal tract
Over distended uterus
What complication is :Decrease in amniotic fluid?
How much fluid?
Oligohydramnios
Less than 500ml
What complication is caused by fetal age or fetal stress (hypoxia)?
Meconium stained amniotic fluid
Infuse NS into the uterus is called what?
Amnioinfusion
When cord lies below the presenting part of the fetus..this is called what?
Prolapsed Umbilical cord
These are risk factors of what umbilical cord complication?
- Small fetus
- High station when ROM
- Breech presentation
- Transverse lie
- Polyhydramnios
- Multiple gestation
- High parity
Prolapsed Umbilical cord
What are S&S of Prolapse umbilical cord?
Variable Decels
Bradycardia
What are Nursing Interventions for prolapse umbilical cord?
- Knee chest position
- Hand relieving pressure on cord
Which umbilical cord complication is when the cord is around the neck or cord is removed BEFORE delivery of body?
Nuchal Cord
Cord Accidents
True Knot
** Nuchal cord
resulting in fetal death are all Umbilical Cord Complications**
NOTE!!
The head is delivered but the shoulders get stuck under maternal pubic bone is called what?
Shoulder Dystocia
What can’t be predicted; LGA, large weight gain in pregnancy
MRoberts Manuever
-Sharp flexion of thighs toward hips and abdomen
-Supra pubic pressure are all complications of what?
Shoulder Dystocia
**Shoulder Dystocia increases fetal/neonatal and maternal morbidity and mortality**
It is an OBSTETRICAL EMERGENCY
What are the fetal risks with Shoulder dystocia?
- Asphyxia (CNS injury)
- brachial plexus damage
- fracture of humerus or clavicle
What are the nursing interventions for Shoulder dystocia?
- REQUEST HELP IMMEDIATELY
- Alert the neonatal team
- Alert the surgical team
- Implement McRobert’s maneuver as indicated
- Document series of interventions and events with exact times (FOLLOW FACILITY POLICIES AND PROCEDURES)
- Provide support and explain situation
Occurs when the placenta attaches to the lower uterine segment of the uterus, near or over the internal cervical os, instead of in the body or fundus of the uterus..what is this called?
Placenta Previa
What placenta complications are painless vaginal bleeding; quiet and sneaky
Total Placenta Previa
What are the Nursing Interventions for Placenta Previa?
- NO VAGINAL EXAMS
- MONITOR FETAL WELL BEING
What are some risk factors for Placental Abruption?
- 15% perinatal mortality
- cause unknown for spontaneous abruption
- HTN (42%)
- Smoking, ETOH, Cocaine
- Trauma, domestic violence
- MVA
What are some S&S for Placental abruption?
Tender, painful and rigid abdomen
WITH OR WITHOUT bleeding
What are Nursing Interventions for Placenta Complications?
- Monitor fetal well being
- Provide support
- Explain situation
Which placenta complication is..Beyond normal boundaries?
Accreta
Which placenta complication is..INTO the myometrium?
Incerta
Which placenta complication is..Into uterine musculature and pelvic organs?
Perceta
What are the Nursing Interventions for Accreta, Incerta, and Perceta placenta complications?
- Provide support
- Prepare for surgical intervention
- Assess the blood loss
What are the 12 Indications for C-Sections?
- Previous C?S
- Failed trial of labor
- Non-reassuring fetal heart rate (fetal distress)
- Placenta previa
- Abruptio placentae
- CPD
- Fetal malpresentation
- Prolapsed cord
- Medical complications of pregnancy
- Failure of labor to progress (failure of descent
- Active herpes simplex
- Post maturity
What is VBAC? and what is the Criteria?
Vaginal Birth After Cesarean
- one previous transverse C/S
- Adequate pelvis
- Absence of CPD
- EFM
- IV access
- Team available for C/S in less than 30 minutes
What is the Nursing CAre for VBAC?
Monitor Closely the..
- Uterine contractions and FHR
- Signs & Symptoms of uterine rupture
What is a rare but often fatal complication that occurs during pregancy, labor and delivery and the 1st 24 hours post-birth?
Amniotic Fluid Embolism
This is rare :1 per 8,000-30,000 pregnancies,
60% are Often fatal in first hour
UNABLE to predict; prevent, or decrease mortality?
Amniotic Fluid Embolism
Fluid particles contain, hair (lanugo), skin, vernix, meconium..which enter the maternal vascular system and initiates a cascading process that leads to cardiorespiratory collapse and disseminated intravascular coagulation (DIC)..what is this called?
Amniotic Fluid Embolism
What are the 8 signs & symptoms of Amniotic Fluid Embolism?
- Difficulty breathing (dyspnea)
- Hypotension
- Cyanosis
- Seizures
- Tachycardia
- Coagulation failure (DIC)
- Pulmonary Edema
- Cardiac and pulmonary Arrest
What are the Nursing Interventions for Amniotic Fluid Embolism?
- Monitor for signs & symptoms
- Initiate supportive measures
- Give Oxygen at 100%
- IV FLUIDS
- Control hemorrhage
- Uterine Atony meds, DIC meds & blood products as ordered!
