Preterm Labor Flashcards
Why is a pregnant women’s pulse rate increased during hypovolemic shock?
The heart is attempting to circulate decreased blood volume
Why is a pregnant women’s blood pressure decreased during hypovolemic shock?
There is less peripheral resistance because of decreased blood volume
Why is a pregnant women’s respiratory rate increased during hypovolemic shock?
It increases gas exchange to better oxygenate decreased RBC volume
Why is a pregnant women’s skin cold & clammy during hypovolemic shock?
Vasoconstriction occurs to maintain the blood volume in the central body core
Why is pregnant women’s urine output decreased during hypovolemic shock?
There is inadequate blood entering the kidneys because of decreased blood volume
Why is a pregnant women dizzy or have a decreased LOC during hypovolemic shock?
inadequate blood is reaching cerebrum because of decreased blood volume
Why does a pregnant women have decreased central venous pressure during hypovolemic shock?
There is decreased blood returning to the heart because of reduced blood volume
What things are associated with placenta previa? Whats the patient profile
past C-sections, advanced maternal age, multiple gestation, male fetus, uterine scars, short interval between pregnancies, smoker, residence at high altitude
What could happen to the baby if there is a low implantation of the placenta which does not allow optimal fetal nutrition or oxygenation?
Congenital fetal anomalies
When a women has placenta previa, what is she told to avoid & recommended to do?
avoid coitus (sexual intercourse), & get adequate rest & call Dr if she starts bleeding
3 primary causes of bleeding during 3rd trimester
Placenta Previa, Abruption of placentae, Preterm labor
When would we want to stop preterm labor?
If dilation of the cervix is 4 cm & the membranes are intact
What causes the placenta to attach low at the cervix
Its unknown but could be the result of the uterus being an odd shape, or she has scars which migrate the placenta downward
S/S of placenta previa
abrupt, painless bleeding, bright red
What do you NOT want to do to a women who has placenta previa?
NO vaginal, rectal, pelvic exams because any agitation of the cervix can initiate massive hemorrhage!
Preterm labor= how many weeks?
before the end of week 37
Is placenta previa an emergency?
Yes, because it places mom at risk for hemorrhage & places baby at risk because oxygen to baby may be compromised
What do you asses immediately when bleeding occurs in mom
how far along is she, time bleeding began, how much blood was lost, was there pain, color of blood, what did she do about the bleeding (did she insert a tampon?), Any prior cervical surgery for premature cervical dilation, any prior episodes of bleeding
Good method for determining vaginal blood loss
weigh perineal pads before & after use & calculating the difference
What are Kleihauer-Betke tests (test strip procedures)
These can be used to detect whether the blood is of fetal or maternal origin
When assessing a women with placenta previa, is it ok to put an internal monitor for either fetal or uterine assessment?
no. attach an EXTERNAL fetal monitor
If placenta previa is over 30%, & fetus is mature, what is safest way to deliver baby?
c-section
Where are vaginal exams to determine if placenta previa is present done?
Operating room or a fully equipped birthing room so that if hemorrhage does occur with the exam, an immediate C-section can be carried out & get oxygen equipment set up in case of fetal distress
With placenta previa, If the bleeding has stopped, the fetal HR is good & the moms vitals are good, & the fetus is not yet 36 weeks..what kind of care do we give?
This is managed by expectant watching. Mom will be in hospital for observation for 48 hrs. If bleeding stops she will be sent home on bedrest
Placenta previa lab tests
Hemoglobin, hematocrit, CBC, urinalysis, platelet, fibrogen, PT, PTT, group/type c possible x-match for 3-4 units blood products, Apt test (Kleinhaur-Betke), Lecithin/sphingomyelin (L/S) ratio to asses for fetal lung maturity, Ultrasound (U/S)
Betamethasone (Calestone)
a steroid that hastens fetal lung maturity. May be prescribed if fetus is less than 34 weeks gestation
Anti-inflammatory & immunosuppressive agent
Betamethasone (Calestone)
When is Betamethasone (Calestone) given?
It is given 12-24 hours before birth to hasten fetal lung maturity if fetus is less than 34 weeks
Cause of placenta previa
male fetus, prior previa, uterine scars, increased altitude, short interval between pregnancies, history of C-section or uterine curettage, multiple gestation
S/S of Abruption placentae
Sharp abdominal pain, uterine tenderness & vaginal bleeding. Uterine will feel hard when we palpate it
Biggest problem with abruption placenta
mom is going to go into internal shock
Causes of Preterm labor
Trama, Drug Abuse, PIH, twins, triplets, illness
S/S of Preterm labor
Bloody show & uterine contractions
Placenta previa & Abruptio placentae plan of care
inspect for bleeding, palpate mildly (it should be soft, relaxed non-tender), ask patient if she knows what position baby is in, assess BP q5-15 min, place IV c large-gauge catheter, monitor urine output, attach fetal monitor, anticipate orders
Lecithin/sphingomyelin (L/S)
asses fetal lung maturity
Transvaginal ultrasounds are given when?
if baby & pelvic bone are in the way. Make sure Dr does it
How do you assess bleeding?
counting pads, abdominal assessment, assess fundal height
How do you assess fetal status?
FHR
How do you assess fetal lie? (position)
Leopold’s maneuver
Causes of Abruptio Placentae
Chronic hypertension, PIH, Cigarette smoking, alcohol comsumption, multi-gravida, grand-multipara, direct tumor, short umbilical cord, cocaine & meth use, sudden decompression of uterus, folic acid deficit, vena cava compression
Types of abruption placentae
marginal, central, complete
Marginal abruptio
separation at peripheral margin of placenta, may or may not be severe
Central abruptio
Concealed central separation of placenta from uterus, blood trapped between placenta & uterine wall
Complete abruptio
Total separation of placenta from uterus; massive bleeding
S/S of Abruptio Placentae
Sudden onset of intense localized pain, heavy bleeding (may not be obvious at first), Board-like tender abdomen to the touch, Constant pain over & above contraction pain, unable to asses contractions on palpation, fetal distress, symptoms of hypovolemic shock
What are you going to asses differently with Abruptio Placentae
Asses repiratory & cardiac sounds, skin color & turgor, Cap refill, LOC/emotional status, urinary out put
Tocolytic medications are used for?
to halt labor
Terbutaline(brethine) & Ritodrine Hydrochloride (Yutopar) are used for?
To Halt labor, they are mild hypotensives with tachycardic efforts
Terbutaline(brethine) & Ritodrine Hydrochloride (Yutopar) side effects
they relax smooth muscle, shaking, anxiety, hyperglycemia, hypokalemia, pulmonary edema hypotension,
Before administering a tocolytic agent what do you have to do?
obtain baseline blood data, place an external FHR monitor on, and an electrocardiogram may be scheduled
When does DIC occur?
When there is so much bleeding & so many platelets & fibrin from the general circulation rush to the bleeding site that there isn’t enough for the rest of the body
How do you stop DIC?
Take out baby, administer Heparin. Give heparin cautiously close to birth or postpartum hemorrhage can occur
How does DIC develop?
premature separation of the placenta, PIH, amniotic fluid embolism, placental retention, septic abortion & retention of a dead fetus
Any women who have bleeding before birth are more likely to have _______ after birth than average women
infection
Early symptoms of DIC?
easy bruising or bleeding from IV site
What kind of position do you put a women with placental separation?
Lateral NOT supine
What can develop with placenta previa?
endometritis because the placental site is close to the cervix which is the portal of entry for pathogens
chorioamnionitis
an infection of the fetal membranes & fluid. This can cause abruption placenta
What do you give if you can halt labor besides tocolytic meds
betamethasone, antibiotics (prophylaxis group b streptococcus
requirements for management using tocolytic agents
contractions are 10 secs long & occurring q 10 mins for more than an hour, do not use with abruption placenta, chorioamnionitis, pre-viable gestation, (<25 wks), there should be no cervical change or bleeding
Tocolytic treatment IV
give with LR, administer the med piggyback so you can easily stop it, use infusion pump & microdrip tubing
Tocolytic treatment Oral
once started continue until 37 wk or establishment of fetal lung maturity, take around the clock to maintain blood level, no skipping med,
What is the problem with using magnesium sulfate to halt labor?
It can cause hypotension, its a CNS depressant
What is the problem with using calcium channel blockers to halt labor?
calcium is blocked from entering smooth muscle cells preventing contractions. This is bad because it cause uterine cramps, decreased fetal urine output
What is the problem with using Indomethacin to halt labor?
It impairs the ability to blood clot. We don’t want hemorrhaging.
The rupturing of membranes is a “point of no return” in stopping or delaying labor b/c of increased risk of _______ that beings at that point
infection
nucal cord
cord around baby’s neck at delivery
PPROM
Preterm premature rupture of the membranes
When giving Betamethasone what do you have to watch for?
it can worsen hypertension so BP should be monitored closely & it can worsen diabetes if patient has diabetes. Blood glucose should be monitored closely. *Remember this is a steroid
When is a C-section mandatory?
herpes, transverse presentation, cephalopelvic disroportion
cephalopelvic disroportion
Head cant fit thru pelvis
Emergent c-section
placenta previa, abruption placentae, fetal distress, failure to progress in labor
vaginal blood loss vs C-section blood loss
Vag= 300-500ml & C-section=500-1000ml
What problems can occur after a C-section?
uterus not contracting which could cause post partum hemorrhage, The bladder is displaced during surgery which can cause mom to no be able to sense when her bladder is full, Paralytic ileus can occur b/c of pressure on intestines. B/c of all of this you want to assess circulatory function on the lower extremities
Who is at greater risk after a C-section?
> 40 yrs old, Obese & women who have a vitamin & Protein deficiency ( protein & vit D & C are needed for new cell formation at the C-section incision site
When should teaching about how to prevent C-section complications take place?
preoperatively when she is free of pain & focused. This implies “ I’ll see you & your healthy baby back here” which will provide comfort
When should teaching about how to prevent C-section complications take place with an emergent C-section?
After surgery
C-section respiratory & circulation exercises
deep breathing (5-10 deep breaths qhour. Inhale as deeply as possible, holding breath for a sec or 2 then exhaling as deeply as possible, Incentive spirometer, Turning(she doesn’t have to practice this before, just postoperatively, Ambulation ( most effective way to stimulate lower-extremity circulation)
When should a mom get up and ambulate after a C-section?
4 hrs or when epidural anesthesia is worn off. Have her walk even if she is fatigued or in pain. Tell her that its important to walk b/c the edema of the lower pelvic surgery compresses circulation to the lower extremities which increases risk for lower-extremity circulation stasis.
Metoclopramide (Reglan), Ranitidine (Zantac) & Sodium Citrate (Bricitra) are given when?
In an immediate Preoperative care (for a c-section )situation. They are give before surgery to prevent esophageal reflux & aspiration during C-section. These drugs speed up stomach emptying, decrease stomach secretions, & neutralize acid stomach secretions
Duramorph is used when?
used in epidurals. It lasts up to 24 hrs. Continuous pulse oximetry is necessary b/c it lasts for 24 hrs & it can cause respiratory distress
What type of an incision would you do on a women with placenta previa?
classic, b/c you don’t want to cut placenta. This incision runs thru the contractile portion of the uterus so this scar could rupture-cant have a vag birth
Low transverse incision pros
decreased blood loss, decreased postpartal uterine infections, less likely to cause gastrointestinal complications, easier to suture, can have future vag births
s/s of hemorrhage
decreased BP, pulse >110 or <60, Rapid respirations, restlessness & thirst
First signs of peritonitis (Peritoneal infection) after c-section
guarded abdomen. Hard abdomen
After a c-ection how long before full peristaltic function is restored & oral intake is possible?
24-48 hrs, IV fluids are administered during this time. Its normal for a mom who isn’t receiving much food yet to not have bowel movement for 3-4 days
Asses bowel sounds after C-section q?
at least q 8 hrs. If you hear a pinging sounds, this indicates that air is being moved thru the intestines or if mom passes gas it is another indication that the bowels are working
