Prelabor Complications and High Risk L&D (1) Flashcards
what are prelabor complications
- incompetent cervix
- PROM
- preterm
- placental probs
- multiple gestation
- amniotic fluid probs
what is dilation of the cervix without pain or contraction
cervical insufficiency (incompetent cervix)
what is incompetent cervix d/t?
congenital (structural), acquired (trauma), hormonal
what is a stitch placed in the cervix to help cervical incompetency?
cerclage
what is the goal of a cerclage?
to maintain pregnancy
what is the risk of a cerclage?
if membrane bulges, a needle could rupture
what should you watch for in a pateint with cerclage?
s/sx of labor (cramp/infection)
rupture of membranes prior to the onset of labor (after 38 wk)
premature ROM
rupture of membranes prior to onset of labor (before 37 wk)
preterm premature ROM
ROM for more than 24 hours prior to delivery
prolonged rupture of membranes
what causes a greater risk for PROM?
- lower econ status
- infection
- incomp cervix
- multiple gestation
- prior PPROM
- prior preterm
- smoking/substance
- fetal anomaly
maternal risks of PROM
- infection
- choioamnionitis (infection of pregnancy)
- endometritis
fetal risks of PROM
- preterm delivery
- infection
- cord prolapse
- oligohydramnios
what to do if ROM is suspected?
nitrozene test for amniotic fluid
management of PROM/PPROM
- monitor infection
- monitor contractions
- bedrest
- fetal assessment
- corticosteroids
- possible antibiotics
time to be considered preterm
after 20 wk, before 38 wk
what are causes of preterm labor?
- trauma
- poor PN care
- substances
- anemia/infection
- bleeding/cervix
how is preterm labor disgnosed?
- patient symptoms
- contractions
- cervical exam
- fetal fibronectin
what is a vaginal swab that tests for presence of fetal fibronectin?
fetal fibronectin (FFN)
what does -FFN and +FFN indicate
- -FFN= likely will not deliver within 14 days
- +FFN= doesn’t tell much, if theres vaginal manipulation it’ll be positive
what are maternal risks of preterm labor
- the underlying cause (bleeding, infection, etc)
- DVT (bedrest)
- emotional concerns
- s/e from meds used to treat PTL
what are fetal risks of preterm labor
- mortality
- immature body systems and lungs
what kind of meds are used to stop labor?
tocolysis
what are examples of drugs to stop labor?
- ritodrine (yutopar)
- mag sulfate
- calcium channel blockers
- prostaglandin synthetase inhibitors
what preterm labor med reduces calcium entering smooth muscle cells
calcium channel blockers
what preterm labor med prevents the action of prostaglandins> prevent calcium from entering the smooth muscle cells
prostaglandin inhibitors
management of preterm labor
- bedrest
- VS
- fetal monitoring
- contraction monitoring
- administration of tocolytics
what is the separation of the placenta from the uterine wall
placental abruption
what are some cuases of placental abruption
- substance use
- PROM
- infection
- HTN
how does placental abruption affect fetus
not enough blood, o2, and nutrients
how does placental abruption affect mother
blood/hemorrhage
what kind of placental abruption is when blood passes between fetal membrane and uterine wall, escapes vaginally (vaginal bleeding)
marginal
which placental abruption is where the placenta separates centrally, not on the edges, bleeding intract with no vaginal bleeding
central
which placental abruption is massive vaginal bleeding, almost total separation, lots of distress,a nd no o2
complete abruption
what is when the palcenta improperly implants over the lower portion of the uterus and may cover the cervix, not @ fundus
placenta previa
what is the mother at risk for with placental previa?
hemorrhage/fetal distress
what does the presence of placenta previa indicate?
c/s delivery
what are some considerations of palcenta previa?
no vag exam if bleeding, labs, pad count
which placental prob is painful
abruption
which placental prob results in more bleeding?
they both bleed, but previa is more
which thing makes a greater risk for GDM, HTN, HELLP, hydramnios, PROM, pulmonary edema, LBW??
multiple gestation
is there a coorelation of multiple gestation with preterm birth?
yes!! 50% chance with twins and increases with more multiples
less than the normal amount of amniotic fluid
oligohydramnios
what does oligohydramnios put the fetus at risk for?
lung compliance issues, decelerations (variable)
great amount of amniotic fluid?
hydramnios (polyhydramnios)
what does (poly)hydramnios put the pregnancy at risk for?
malpresentation (breech), ROM -> possible cord prolapse, lack of o2
abnormal labor pattern related to contractions, expulsion, fetal size, position, presentation, or the pelvis
dystocia
what are characteristics of hypotonic contractions?
- irregular contractions
- lack intensity
- less than 1cm/hr
interventions for hypotonic labor patterns
- pitocin augmentation
- amniotomy
- active management of labor
what does active management of labor include?
- 1:1 nurse:patient
- amniotomy
- cervical exams
- pitocin
management of tachysystole labor patterns
- fetal assessment
- pain amangement
- pitocin (break cycle)
- amniotomy (promote labor)
what is it called when the entire labor and birthing process occurs within 3 hours
precipitous labor and delivery
what are causes of precipitous L&D
- low resitance of maternal soft tissues
- abnormally strong contractions
what are maternal risks of precipitous l&d?
- fear
- lacerations
- bleeding
what are fetal risks of precipitous L&D
- hypoxia
- meconium (in fluid)
- injuries
- low APGAR
what is the classification for post dates pregnancy
pregnancy that lasts longer than 42 completed weeks, so the start of week 43
what are risks of post dates pregnancy
- induction
- LGA or macrosomic
- c/s
- oligohydramnios
- dysmaturity (IUGR)
what is the normal position of baby
occiput anterior
what can cause a baby tobe occiput posterior?
maternal pelvis
management of occiput posterior presentation
- position change, hands and knees
risks of occiput posterior
- c/s
- longer labir (1st and 2nd stages)
- pitocin augmentation
- laceration/episiotimy
- instrumental delivery
- manual rotation
- bleed/infection/pain
fetal weight of more than 4000gm (8.82 lbs)
macrosomia
risk factors of having a macrosomia baby
- maternal obesity
- diabetes
- post term
- multiparity
what are maternal/fetal risks of macrosomia
- dysfunctional labor
- laceration/episiotomy
- instrumental delivery
- bleed/infection
- shoulder dystocia (McRoberts)!!!
how to help McRoberts (shoulder delivery)
flex thighs to abdomen
what defines nonreassuring fetal status
inadequate fetal oxygenation leading to distress and acidosis
what are causes on nonreassuring fetal status
-uteroplacental insufficiency
-cord compressions
what are nonreassuring signs
- decelerations, absent variability
- meconium stained fluid
- acidosis (7.2pH or less)
what are the interventions for nonreassuring fetal status?
5Ps
* turn pitocin off, turn on left side, turn fluids on, turn on o2, turn call light on
what is when the unbilical cord falls into the vagina prior to delivery and becomes trapped between the pelvis and presenting part, interfering with blood flow
cord prolapse
what is the cause of prolapse?
when the presenting part is not well applied
what are risks associated with cord prolapse
- limit bloodflow
- hypoxemia
- bradycardia
what are emergent interventions for cord prolapse
- relieve cord compression
- knee/chest position
- prepare for c/s
what is a retained palcenta
placenta is not delivered 30 mins or more after delivery, manual removal or D&C
what is wehn placental chorionic villi attach to the myometrium
placenta accreta
what is when the placenta invades the myometrium
placenta increta
what is when the palcenta penetrates the myometrium
placenta percreta
what is the amternal risk of placenta problems?
bleeding!!
what is the manual movement of the fetus from breech or transverse to cephalic presentation
external version
when is an external version done
after 36 weeks
what must be present for an external version to be performed?
adequate amniotic fluid, reassuring FHR, no high risk situations
softening and effacing the cervix prior to induction of labor
cervical ripening
meds for cervical ripening?
- cytotec (inserted into vag/oral)
- cervidil/prepidil (vaginally)
what are mechanical methods of ripening the cervix
pressure from balloon
stimulation of contractions prior to spontaneous labor
labor induction
stimulation of contractions in addition to spontaneously occuring contractions
labor augmentation
what are common indications of induction or augmentation?
DM, HTN, PROM, infection, fetal demise, nonreassuring FHR, IUGR, oligohydramnios
describe bishop score
augmentation/induction scale
score of 9 is favorable
less than 9 is associated with long labor and higher c/s rates
manual separation of maniotic membranes. thought to release prostaglandins and initiate labor
membrane stripping
what is the goal of oxytocin/pitocin infusion
stimualte adequate contractions that lead to dialtion (slowly, small amnts)
what needs to be well applied for an amniotomy (AROM)
head of baby
nursing assessment following AROM
FHR pattern
amount
color of fluid
administration of warmed sterile fluid into uterus through an intrauterine pressure catheter
amnioinfusion
what is the goal of an amnioinfusion
increase fluid volume to decrease umbilical cord compression or dilute meconium
instrumental delivery to assist in delivery once head is on pelvic floor, used when fetus/mother is threatened
foreceps
risks of foreceps
trauma to mom/fetus
suction applied to head to aid in delivery, risk of trauma to mom/fetus
vacuum extraction
when is vacuum used for extraction
prolonged secind stage of labor or non reassuring FHR
viable and safe alternative for subsequent delivery if prior indication is not recurring
VBAC (vaginal birth after c/s)
what is the success rate of VBAC, and what are risks
60-80%
uterine rupture
contraindications of VBAC
previous classical incision or uterine rupture
