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Maternal-Newborn (Josh) > T4 - Labor Birth at Risk (Josh) > Flashcards

T4 - Labor Birth at Risk (Josh) Flashcards

1
Q

What is preterm labor?

A

cervical change and UC after 20 wks and before 38 wks

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2
Q

What is preterm birth?

A

any birth occurring b/t 20 wks and 36.6 wks

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3
Q

Overdistention of Uterus can cause Preterm Labor.

What causes overdistention of uterus?

A

Multips

Hydramnios

Macrosomic fetus

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4
Q

Lifestyle conditions that contribute to Preterm Labor

A

Smoking > 10 cigs/day

Substance abuse (Cocaine)

Standing for long hrs

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5
Q

S/S of Preterm Labor

A

UC q 10 mins with or without pain

Abdominal cramping or Pelvic Pressure

Low Backache

Increased vaginal discharge (pink tinged)

Leaking AF

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6
Q

What is Fetal Fibronectin?

A

Flue that holds the cervix together

Sample can tell who is likely to go into labor early
***high negative predictive value

Increases before preterm birth

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7
Q

When would Fetal Fibronectin predict a preterm labor?

A

if it appears b/t 24-34 wks gestation

***tells who will NOT go into PTL, not who WILL go into PTL

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8
Q

Home mgmt of Preterm Labor

A

Bedrest w/ fetus off of cervix

Empty bladder frequently

Hydration

Left side-lying

Resume activity lightly if symptoms stop

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9
Q

Hospital mgmt of Preterm Labor

A

BR on LEFT side

Continuous EXTERNAL FM

IV fluids

Strict I’s and O’s

Tocolytic Therapy to inhibit UC

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10
Q

What Tocolytics are given to prevent UC in Preterm Labor?

A

Mag Sulfate

Terbutaline
***Hold if HR > 125

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11
Q

When would we stop using Tocolytics for preterm labor?

A

after 34 wks b/c fetus can survive past this point

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12
Q

What is the best reason to use tocolytics prior to 34 wks?

A

allows opportunity to administer glucocorticoids to accelerate fetal lung maturity

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13
Q

What are the Tocolytics we talked about?

A

Mag Sulfate (CNS depressant)

Terbutaline (raises BP)

Nifedipine (Calcium Channel Blocker)

NSAIDs

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14
Q

How do we help mature the lungs of fetus?

A

Glucocorticoids (Betamethasone)

  • **two doses 24-48 hrs before delivery
  • **used 24-34 wks
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15
Q

What is pPROM

A

Preterm Premature ROM

**done before 37 wks

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16
Q

AF looks like a — on a slide.

A

fern

***helps differentiate it from semen and urine

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17
Q

Regarding pPROM, what is the leading cause of death of fetus and mom?

A

sepsis

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18
Q

Management for pPROM

A

Temp q 2-4 hrs

Modified Bedrest

Kick counts (10 in 1 hr)

NO TUB BATHS

NST, BPP

Avoid vag exams if possible

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19
Q

After ROM, when can mom ambulate safely?

A

after fetal head is engaged

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20
Q

What do you test for after pPROM?

A

Beta Hemolytic Strep (risk to fetus)

21
Q

What is Chorioamnioitis?

A

bacterial infection of amniotic cavity

leads to:

  • maternal fever
  • maternal and fetal tachycardia
  • uterine tenderness
  • foul odor of AF
22
Q

— is a term used to describe any difficult labor or birth.

23
Q

What causes Dystocia?

A

Ineffectivity of any one of the 5 P’s of Labor:

  • Powers (UC)
  • Passengers (Fetus and Placenta)
  • Passage
  • Position
  • Psychologic
24
Q

What are the top two reasons that C/S are performed?

A

1: Repeat C/S

25
Hypotonic UC vs. Hypertonic UC: Which one results in poor labor prognosis if it persists?
BOTH ***need normal UC 2-3 mins apart for good labor
26
When are Dysfunctional Labor patterns classified?
according to Latent and Active phase of First Stage of Labor
27
When do Hypertonic UC usually occur?
Latent Phase of Stage 1
28
Interventions for Hypertonic UC
Therapeutic Rest Warm Shower/Bath Analgesics Mild Sedation
29
When do Hyotonic UC usually occur?
Active Phase of Stage 1
30
What classifies as Hypotonic UC?
31
Interventions for Hypotonic UC
Rule Out CPD (Cephalopelvic Disproportion) Ambulation Hydrotherapy Enema ROM Nipple Stimulation (oxytocin release) Pitocin Position Change
32
--- is active labor in which birth occurs within 3 hours of onset of UC.
Precipitate Labor ***abrupt increase in UC instead of gradual
33
Risk Factors associated w/ Precipitous Birth
Maternal Lacerations / Hematoma Fetus may become hypoxic r/t short relaxation period b/t UC Non reassuring EFM patterns (bradycardia and Late Decels) Intracranial Hemorrhage (fast passage through birth canal)
34
Interventions for Precipitous Labor
Side-Lying position to promote perfusion IV Fluids to maintain BV O2 per facemask
35
Why would pharmacological measures not usually be used with Precipitous Labor?
not enough time for them to take effect cause respiratory depression in neonate
36
Is meconium always a sign of distress?
non necessarily
37
Nulliparous client w/ fetus in breech position almost always has ---
C/S
38
What is McRoberts Maneuver?
thighs flexed sharply against abdomen opens pelvic curve if shoulder dystonia (shoulders stuck in canal)
39
Which clients at risk for Shoulder Presentation
Obesity Previous Macrosomic baby Chronic or Gestational DM Prolonged 2nd Stage of Labor
40
Which presenting position results in longer labor and back pain?
Occiput Posterior
41
Maternal Positions that promote head rotation to Occiput Anterior
``` Knee Chest (rocking pelvis) ***Best ``` Side Lying (on opposite side of occiput) Lunges Squatting Birth Ball
42
When would a version be attempted?
attempt to turn baby in utero ***After 37 wks
43
What do we use to chemically ripen the cervix?
Prostaglandin E
44
--- cannot be the primary IV fluid.
Pitocin ***piggyback it
45
When would we stop Pitocin?
UC frequency less than 2 mins UC duration greater than 240 secs Fetal destress (Late Decels)
46
What is Uterine Tachysystole?
more than 5 contractions in 10 mins over a 30 min window series of single contractions lasting longer than 2 mins
47
Amniotomy is ---, not ---
augmentation, not induction
48
Terms: VBAC TOLAC ASP C/S
VBAC = Vaginal Birth after Cesarean TOLAC = Trial of Labor after Cesarean ASP = Anaphylactoid Syndrome of Pregnancy (AF Embolism) C/S = Cesarean Section

Maternal-Newborn (Josh) (29 decks)

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