T4 - Labor Birth at Risk (Josh) Flashcards
What is preterm labor?
cervical change and UC after 20 wks and before 38 wks
What is preterm birth?
any birth occurring b/t 20 wks and 36.6 wks
Overdistention of Uterus can cause Preterm Labor.
What causes overdistention of uterus?
Multips
Hydramnios
Macrosomic fetus
Lifestyle conditions that contribute to Preterm Labor
Smoking > 10 cigs/day
Substance abuse (Cocaine)
Standing for long hrs
S/S of Preterm Labor
UC q 10 mins with or without pain
Abdominal cramping or Pelvic Pressure
Low Backache
Increased vaginal discharge (pink tinged)
Leaking AF
What is Fetal Fibronectin?
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
When would Fetal Fibronectin predict a preterm labor?
if it appears b/t 24-34 wks gestation
***tells who will NOT go into PTL, not who WILL go into PTL
Home mgmt of Preterm Labor
Bedrest w/ fetus off of cervix
Empty bladder frequently
Hydration
Left side-lying
Resume activity lightly if symptoms stop
Hospital mgmt of Preterm Labor
BR on LEFT side
Continuous EXTERNAL FM
IV fluids
Strict I’s and O’s
Tocolytic Therapy to inhibit UC
What Tocolytics are given to prevent UC in Preterm Labor?
Mag Sulfate
Terbutaline
***Hold if HR > 125
When would we stop using Tocolytics for preterm labor?
after 34 wks b/c fetus can survive past this point
What is the best reason to use tocolytics prior to 34 wks?
allows opportunity to administer glucocorticoids to accelerate fetal lung maturity
What are the Tocolytics we talked about?
Mag Sulfate (CNS depressant)
Terbutaline (raises BP)
Nifedipine (Calcium Channel Blocker)
NSAIDs
How do we help mature the lungs of fetus?
Glucocorticoids (Betamethasone)
- **two doses 24-48 hrs before delivery
- **used 24-34 wks
What is pPROM
Preterm Premature ROM
**done before 37 wks
AF looks like a — on a slide.
fern
***helps differentiate it from semen and urine
Regarding pPROM, what is the leading cause of death of fetus and mom?
sepsis
Management for pPROM
Temp q 2-4 hrs
Modified Bedrest
Kick counts (10 in 1 hr)
NO TUB BATHS
NST, BPP
Avoid vag exams if possible
After ROM, when can mom ambulate safely?
after fetal head is engaged
What do you test for after pPROM?
Beta Hemolytic Strep (risk to fetus)
What is Chorioamnioitis?
bacterial infection of amniotic cavity
leads to:
- maternal fever
- maternal and fetal tachycardia
- uterine tenderness
- foul odor of AF
— is a term used to describe any difficult labor or birth.
Dystocia
What causes Dystocia?
Ineffectivity of any one of the 5 P’s of Labor:
- Powers (UC)
- Passengers (Fetus and Placenta)
- Passage
- Position
- Psychologic
What are the top two reasons that C/S are performed?
1: Repeat C/S
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
When are Dysfunctional Labor patterns classified?
according to Latent and Active phase of First Stage of Labor
When do Hypertonic UC usually occur?
Latent Phase of Stage 1
Interventions for Hypertonic UC
Therapeutic Rest
Warm Shower/Bath
Analgesics
Mild Sedation
When do Hyotonic UC usually occur?
Active Phase of Stage 1
What classifies as Hypotonic UC?
Interventions for Hypotonic UC
Rule Out CPD (Cephalopelvic Disproportion)
Ambulation
Hydrotherapy
Enema
ROM
Nipple Stimulation (oxytocin release)
Pitocin
Position Change
— is active labor in which birth occurs within 3 hours of onset of UC.
Precipitate Labor
***abrupt increase in UC instead of gradual
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)
Interventions for Precipitous Labor
Side-Lying position to promote perfusion
IV Fluids to maintain BV
O2 per facemask
Why would pharmacological measures not usually be used with Precipitous Labor?
not enough time for them to take effect
cause respiratory depression in neonate
Is meconium always a sign of distress?
non necessarily
Nulliparous client w/ fetus in breech position almost always has —
C/S
What is McRoberts Maneuver?
thighs flexed sharply against abdomen
opens pelvic curve if shoulder dystonia (shoulders stuck in canal)
Which clients at risk for Shoulder Presentation
Obesity
Previous Macrosomic baby
Chronic or Gestational DM
Prolonged 2nd Stage of Labor
Which presenting position results in longer labor and back pain?
Occiput Posterior
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
When would a version be attempted?
attempt to turn baby in utero
***After 37 wks
What do we use to chemically ripen the cervix?
Prostaglandin E
— cannot be the primary IV fluid.
Pitocin
***piggyback it
When would we stop Pitocin?
UC frequency less than 2 mins
UC duration greater than 240 secs
Fetal destress (Late Decels)
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
Amniotomy is —, not —
augmentation, not induction
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
