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OB > Too slow, too fast, too soon, too late > Flashcards

Too slow, too fast, too soon, too late Flashcards

1
Q

What are 3 different types of too slow?

A

Dysfunctional—long difficult or abnormal
Protracted—slower than normal
Arrested—no progress

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2
Q

What is another word for too fast?

A

Precipitous

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3
Q

What is considered too soon for labor? Too late?

A

Pre-term - before 37 weeks

Post-dates - after 42 weeks

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4
Q

What are the causes for too slow of labor?

A

Dystocia—lack of progress in labor

Abnormal labor pattern due to any of the “Ps”: (Power, passenger, passageway, position, psyche/people)

Most common cause is a ‘dysfunctional’ contraction pattern (uncoordinated contractions)

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5
Q

What is the number 1 reason for a c-section?

A

Dysfunctional contraction pattern

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6
Q

What is latent phase disorder? When does it happen? What is it also called?

A

HYPERtonic Uterine Dysfunction– frequent and painful contractions that are not sufficient to cause the cervix to begin to change

Happens before the onset of active labor

AKA “prodromal” labor

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7
Q

What are two patho reasons for latent phase disorder?

A

Uncoordinated contractions in the midsection of the uterus instead of fundus—no downward pressure of fetus on cervix

Uterus may not relax completely between contractions

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8
Q

What is active phase disorder? When does it happen?

A

HYPOtonic uterine dysfunction–uterine contractions are not effective enough to continue making the cervix change (montevideo units <200)

Happens once enters active labor (≥ 6 cm with regular UCs)

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9
Q

What are two different outcomes of active phase disorder?

A

Protraction—slower than normal

Arrest– stop making progress

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10
Q

What are causes of active phase disorder? (7)

A

Contractions inadequate
Cephalopelvic disproportion (CPD)
Malpostioning (posterior or asynclitic)
Intraamniotic infection
Full bladder
Exhausted patient/unmanageable pain
Dehydrated

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11
Q

What are interventions if contractions are inadequate?

A

assess with IUPC (MVUs <200)?

Pitocin or rupture membranes (AROM)

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12
Q

What are interventions if CPD?

A

Use positions to maximize space

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13
Q

What are interventions if there is malposition??

A

Use frequent position changes

Normal cardinal movements of baby produces OA babies

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14
Q

What are s/s of intraamniotic infections? Interventions?

A

fever, tachycardia, fetal tachycardia

Treat the infection

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15
Q

How often should the patient void to avoid a full bladder?

A

Every 2 hours

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16
Q

What is the cause of latent phase? Risk factors?

A

Unknown cause

Fatigue, stress
Dehydration
Increased pain -uterine muscle anoxia and decreased coping
Infection

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17
Q

What is the treatment for latent phase disorder? Does this affect the rest of labor?

A

STOP it (“Therapeutic Rest”-Ambien, morphine sleep, Benadryl)

OR

START it (IOL/Augmentation – AROM, Pitocin, nipple stimulation)

Once they enter active labor often –> normal progress

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18
Q

What are the 3 things dystocia r/t powers causes?

A

Protracted– descent of fetus takes longer than expected

Arrested– fetus stops descending

Inadequate/ineffective pushing efforts (may be related to spinal/epidural nerve blocks or exhaustion)

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19
Q

How do you manage the alteration dystocia places on power in the second stage?

A

Coach on pushing, encourage rest between
Positioning—maximize space, utilize gravity
Anesthesia to reduce epidural infusion rate

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20
Q

What is dystocia r/t passenger? What does this cause?

A

“Hand Presentation”/compound presentation

Longer labor
Increased tears
Increased c/s

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21
Q

What are the risk factors for macrosomia?

A

Gestational diabetes (GDM)
BMI>30
Excessive weight gain
Maternal or FOB larger birth weight
Previous macrosomic baby

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22
Q

What effects does macrosomia cause for labor and delivery?

A

Slow progress
Infection
Shoulder dystocia,
Lacerations
PPH
Need for assisted birth (VAVD, FAVD, C/S)

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23
Q

A fetus greater than _____ is offered a c/s to decrease risk of ________

A

Fetus greater than 5000g (on US) is offered a c/s to reduce risks of shoulder dystocia (if GDM 4500 grams)

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24
Q

What type of fetal position would cause dystocia?

A

Occiput posterior
Asynclitic
Breech
Face, brow presentation

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25
Q

Can psyche/people cause dystocia?

A

Yes, stress

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26
Q

What is shoulder dystocia? What happens to the fetus with this?

A

After birth of head, the anterior shoulder remains lodged under the pubic bone and is unable to deliver

Fetal head fills with blood with no means for blood return –> hypoxia –> neuro damage –> death so prompt timing is critical (within minutes)

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27
Q

What complications does shoulder dystocia cause?

A

Entrapment of cord

Inability of child’s chest to expand properly

Severe brain damage or death if child is not delivered within minutes

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28
Q

Is shoulder dystocia an emergency? Can you just dislodge the shoulder?

A

Obstetrical emergency

No, attempts to dislodge shoulder can cause injury to fetus:
Brachial plexus injury (~10% are permanent)
Fractured clavicles

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29
Q

What are the risk factors for shoulder dystocia? Do risk factors need to be present for this to occur?

A

Macrosomia
Labor dystocia
Vacuum/forceps
GDM
Obesity
Postdates delivery
Previous shoulder dystocia

High percentage of cases occur with NO RISK FACTORS

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30
Q

How can you be prepared for shoulder dystocia before birth?

A

Recognize risk factors
Notify team members – MD, charge nurse, neonatal staff
Have stool positioned within reach
Have extra RN at delivery to help/keep track of time

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31
Q

What are 3 maneuvers to intervene with should dystocia?

A

McRoberts’ Maneuver
Suprapubic pressure
Gaskin maneuver

32
Q

What is McRoberts’ Maneuver? What is it r/t?

A

Changes maternal pelvis angle
Mom brings needs to chest

Should dystocia

33
Q

What is Suprapubic pressure? What is it r/t?

A

Pressure over suprapubic bone –if you know position, push shoulder toward chest
NO FUNDAL PRESSURE!!!!

Shoulder dystocia

34
Q

What are the interventions for should dystocia? (5)

A

Deliver posterior arm
Woods Screw maneuver
Episiotomy
Shoulder shrug maneuver/remove posterior shoulder with fingers
Zavanelli Maneuver-Pushing the head back into the uterus and rush to C/S!

35
Q

When preforming a newborn exam for a baby with should dystocia would should be examined?

A

tone, moving upper extremities bilaterally, crepitus over clavicles

36
Q

What is precipitous labor and birth? Cause?

A

Entire process of labor and birth < 3 hours long

Strong contractions and/or low resistance in soft tissues

37
Q

What are the risk factors for precipitous birth?

A

Abruption (history of drug use–cocaine, methamphetamines, stimulants; seizure/eclampsia, HTN)
Multiparity
Very small fetal size
Previous precipitous birth

38
Q

What are the maternal complications of precipitous birth?

A

Sudden (terrifying) birth and immediate postpartum/newborn period without provider
Abruption (cause or effect)
PPH

39
Q

What are the newborn complications of precipitous birth?

A

Hypoxia (diminished reserve)
Lower APGAR scores
Meconium-stained fluid
Trauma (facial bruising, cephalohematoma, fractured clavicle)

40
Q

What is the nursing care for precipitous birth?

A

Put on gloves
Call for help and DO NOT LEAVE THE ROOM
If provider is not able to make it in time, catch baby, place skin-to-skin on birthing person’s abdomen and then call for help

41
Q

What is the definition of pre-term labor and delivery?

A

Preterm labor (PTL): Labor that occurs between 20 and 36 6/7 weeks

Preterm delivery (PTD): preterm labor results in delivery

42
Q

What is the leading cause of neonatal mortality?

A

Prematurity

43
Q

What can be done r/t equity to improve birth outcomes and reduce M&M?

A

Eliminate racial disparities
Remove barriers to obtaining quality care in underserved and rural communities

44
Q

How can access improve birth outcomes and reduce M&M?

A

Protect comprehensive health care coverage
Provide affordable, quality public health programs pre-conception
Extend Medicaid coverage to at least 12 months postpartum
Access to midwifery/Doula care services
Group prenatal care and telehealth reimbursement

45
Q

How can M/M in birth be prevented?

A

Advance our understanding of why individuals/infants are dying during pregnancy, birth, and postpartum (up to 12 months after birth)
Support public health programs to improve health of birthing people and their babies
Create paid family leave systems
Support vaccinations and boost confidence in vaccines
Reduce primary c-section in low-risk individuals (>37 weeks, singleton, cephalic, primigravida)

46
Q

What are health problems r/t preterm birth in babies?

A

All organ systems immature, maturational deficiencies

Respiratory distress syndrome (RDS)
Intraventricular hemorrhage (IVH)
Patent ductus arteriosus
Necrotizing enterocolitis (NEC)
Retinopathy of prematurity (ROP)
Increased risk of long-term health problems and lifelong disabilities

47
Q

What are the symptoms of preterm labor?

A

Back pain
Pelvic pain
Abdominal pain (uterine or GI)
Menstrual like cramping
Pelvic pressure
Diarrhea
Increased vaginal discharge

48
Q

What are the risk factors for preterm labor? (14)

A

Previous preterm labor and delivery
Multiple gestation
H/O incompetent cervix: Cerclage in place
Stress
Age (<17 or > 35)
Substance abuse
Non-white race
Anemia
Infection
Intimate partner violence
Poor weight gain
Low maternal weight
Inadequate prenatal care
History of cervical cone or LEEP biopsy for treatment of pre-cervical cancer abnormalities

49
Q

How many contractions and how much does the cervix need to be dilated/effaced to be considered preterm labor?

A

≥ 6 contractions per hour with documented cervical change or
Cervical dilation ≥ 2 cm and 75% effaced with a history of contractions

50
Q

What screening tests can be used to predict preterm labor?

A

Sterile cervical exams

Cervical length via trans-vaginal US

Fetal fibronectin (fFN)

51
Q

How does cervical length via trans-vaginal US help predict risk for pre-term labor?

A

> 3 cm = decreased risk of preterm labor at this time
< 2 cm = increased risk of PTL that will progress to preterm birth

52
Q

How does fFN help to determine risk of preterm labor?

A

High negative predictive value: if NEG –> < 1% chance of giving birth in next 7 days
Low positive predictive value: if POS –> means nothing

53
Q

When is an fFN preformed? How is it collect? What can alter the results?

A

Use between 22-34 weeks GA when cervical length between 2-2.9 cm because most predictive

Collect via vaginal swab (before cervical exam/pelvic US)

Test is altered by blood, lubricant, sex

54
Q

What can be done to pr3event preterm labor?

A

Regular prenatal visit to identify and address risk factors
Avoid unnecessary IOL-iatrogenic prematurity!
Cerclage in women with history of incompetent cervix
History of previous preterm birth

55
Q

How does regular prenatal visits prevent preterm labor? (6)

A

Identify and treat maternal infections
Assess for and promote adequate nutrition and weight gain
Promote dental care
Smoking/drug/alcohol cessation
Decrease stress
Identify and address any risk factors

56
Q

What can be done if women have a history of pre-term labor?

A

Progesterone supplementation– from 16-36 6/7 weeks
Daily vaginal progesterone OR
Weekly IM progesterone injections

57
Q

When are tocolysis medications used? Which medications? How long are thy used for? Why?

A

use of medications in patients 24-33 6/7 gestation to delay birth to allow for administration of corticosteroids or transport to higher level care

Nifedipine, indomethacin, terbutaline

Used for no more than 48 hours; all have significant side effects

58
Q

Why is magnesium sulfate used in preterm labor? How long should it be used for?

A

fetal neuroprotection in patients < 32 weeks

Reduces severity/risk of CP in surviving infants

Limit treatment to no longer than 24 hours; discontinue with birth of baby

59
Q

What are maternal corticosteroids used for? When are they administered? When do they provide the greater benefit?

A

Administered at 24-33 6/7

Reduces risk of neonatal death, intraventricular hemorrhage, and RDS

Greatest benefit 48 hours -7 days post treatment

60
Q

When are antibiotics used in pre-term labor?

A

Preterm labor (<37 weeks; GBS status unknown)– to prevent early onset neonatal GBS sepsis

Intraamniotic infection

pPROM (24-33 6/7)–Infection is one cause of pPROM

Helps to delay an indicated preterm delivery due to intraamniotic infection

61
Q

What type of medication is Nifedipine? What are the side effects?

A

Ca++ channel blocker

Side effects: maternal tachycardia, palpitations, flushing, headaches, dizziness, and nausea

62
Q

What type of medication is indomethacin? Side effects?

A

NSAID

Side effects: maternal nausea, heartburn; fetal constriction of ductus arteriosus, oligo, NEC

63
Q

What type of medication is terbutaline? Side effects? When should it not be used?

A

beta-adrenergic

Side effects: tachycardia (both), hyperglycemia, palpitations , pulmonary edema, myocardial ischemia, and cardiac arrhythmia

No Terbutaline if HR > 120; FHR > 180

64
Q

What is the hospital care for preterm labor and delivery?

A

Evaluate pregnant person’s status
Evaluate fetal status
Administer meds & evaluate for side effects
Keep SVEs to minimum
Decrease anxiety
Anticipatory guidance for labor & birth and neonatal period following preterm birth such as have NICU team talk to family

65
Q

What is the home care for preterm labor and delivery?

A

Those at risk for PTD who are currently stable may be monitored at home for:
Infection- elevated temperature; abnormal discharge, pain, etc.
Increased contractions

66
Q

What situations would you not stop pre-term delivery? (8)

A

Fetal demise
Lethal fetal anomaly
Preeclampsia with severe features/eclampsia
Hemorrhage/severe abruption
Chorioamnionitis
Severe IUGR
Fetal lung maturity
Acute non-reassuring fetal status

67
Q

How is fetal lung maturity assessed?

A
68
Q

What is post-term pregnancy?

A

Pregnancy that extends > 42 0/7 weeks

69
Q

What are the risk factors for post-term pregnancy?

A

Primigravidas
Personal history of previous post-term delivery
Family history of post-term pregnancy (genetic predisposition)
Fetal anomalies
Often no risk factors
*Inaccurate dating

70
Q

What complications can post-term pregnancy have on a pregnant person?

A

Increased risk perineal damage due to increased incidence macrosomia, forceps/vacuum-assisted vaginal deliveries
Increased risk of Cesarean birth (rates double)
Anxiety, emotional fatigue!!!

71
Q

What are the fetal complications of post-term pregnancy?

A

Macrosomia: fetus continues to grow
Birth trauma R/T macrosomia
Eventual breakdown of the placenta: “limited shelf life”
Risk for Meconium Aspiration Syndrome (MAS) while in utero or with delivery (fetus aspirates meconium into pulmonary tree)

72
Q

What does breakdown of the placenta cause?

A

Uteroplacental insufficiency:
Intrauterine growth restriction (IUGR – SGA infant)
Late decelerations during labor

Oligohydramnios:
Increased chance of cord compression –> Variable decelerations

73
Q

What tests can be done to assess whether placental functioning remains adequate in post-term infants?

A

Biweekly Non-Stress Tests
Weekly Amniotic Fluid Check with MVP
PRN Biophysical Profile
Fetal Movement

74
Q

What should be done if a non-stress test is nonreactive?

A

Desire reactive NST

If nonreactive– BPP or IOL

75
Q

What should the MVP be?

A

Normal = 2 cm - < 8 cm

76
Q

What is considered an abnormal BPP?

A

Abnormal: < 8

77
Q

What is abnormal fetal movement?

A

< 10 movements in 2 hours
Or decreased fetal movement from normal

OB (16 decks)

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