Problems with Labor and Delivery Flashcards
Premature rupture of the membranes
Spontaneous rupture of the membranes prior to the onset of labor. Infection risk.
Interventions for prolapsed umbilical cord
- Trendelenberg’s position
- Administer 02
- Monitor for fetal hypoxia
- Elevate presenting part if it is on top of cord
- Prepare for immediate birth
Placenta Previa
When the placenta adheres to the lower uterus - marginal, partial or total blockage of cervix.
Symptoms of placenta previa
- Bright red vaginal bleeding
- Painless
- Uterus is soft and relaxed
- Fundal height is larger than expected for gestational age
Interventions for placenta previa
- Ultrasound
- Avoid vaginal examinations
- Maintain side lying bedrest
- Monitor bleeidng
- Administer fluid and blood products as required
Abruptio placentae
Premature separation of the placenta from the uterine wall after 20 weeks gestation and before delivery.
Symptoms of abruptio placentae
- Abdo pain
- Dark red vaginal bleeding
- Uterine pain/tenderness
- Uterine rigidity
- Fetal distress
- Possible maternal shock
Interventions for abruptio placentae
- Assess for excessive bleeding, enlargement of fundal height and pain
- Bed rest
- Administer fluids/blood products
- Prepare for birth (vaginal if possible)
Supine hypotension (vena cava syndrome)
Occurs when venous return to the heart is impaired by the weight of the fetus on the vena cava.
Symptoms of supine hypotension
- Dizziness
- Hypotension
- Pale
- Tachycardia
- Sweating, cool damp skin
- Fetal distress
Placenta accreta
Abnormally adherent placenta
Placenta increta
Placenta penetrates the uterus
Placenta percreta
Placenta perforates the uterus. Intervention for hemorrhage and shock. Prepare for possible hysterectomy.
Preterm labor
Between 20 and 37 weeks gestation.
Precipitous Labor
Labor which lasts less than 3 hours
Dystocia
Difficult, prolonged or excessively painful labor. Occurs due to problems with contractions, fetus, bones or tissues of the maternal pelvis. Can result in maternal dehydration, infection, fetal injury or death.
Recognizing dystocia
- Excessive abdo pain
- Labor which does not progress
- Fetal distress
- Maternal and fetal tachycardia
- Abnormal contraction pattern.
Amniotic fluid embolism
Escape of the amniotic fluid into maternal circulation. Debris from the fluid can lodge in the maternal pulmonary arterioles and be fatal.
Recognition of amniotic fluid embolism
- Respiratory distress
- Cyanosis
- Fetal bradycardia
Intervention for amniotic fluid embolism
- A-E assess and treat
- Administer fluids & blood products
- Stabilize the patient
- Prepare for delivery after stabilized
Fetal distress
- FHR 160 bpm
- Meconium stained amniotic fluid
- Fetal hyperactivity
- Progressive decline in baseline FHR variability
- Severe, variable decelerations in FHR
Interventions for fetal distress
- Mothering lateral position
- Provide 02
- Discontinue pitocin
- Monitor vitals
Recognizing intrauterine fetal demise
- Loss of movement
- Undetectable FHR
- Lowered Hb, hematocrit and platelet levels
- Prolonged bleeding and clotting time
Ruptured uterus
Can be partial or complete tear due to the stress of labor.
- abdo pain
- contractions stop
- rigid abdome
- absent FHR
- signs of shock
Interventions for ruptured uterus
- Monitor and treat for shock
2. C-section & possible hysterectomy
Uterine inversion
Uterus which is partially or completely turned inside out.
Symptoms of uterine inversion
- Fundal depression
- Signs of shock
- Severe pain
- Hemorrhage evident
Interventions for uterine inversion
- Monitor for hemorrhage and signs of shock
2. Return uterus to correct position (may require laparotomy)
