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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
Can psyche/people cause dystocia?
Yes, stress
26
What is shoulder dystocia? What happens to the fetus with this?
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)
27
What complications does shoulder dystocia cause?
Entrapment of cord Inability of child's chest to expand properly Severe brain damage or death if child is not delivered within minutes
28
Is shoulder dystocia an emergency? Can you just dislodge the shoulder?
Obstetrical emergency No, attempts to dislodge shoulder can cause injury to fetus: Brachial plexus injury (~10% are permanent) Fractured clavicles
29
What are the risk factors for shoulder dystocia? Do risk factors need to be present for this to occur?
Macrosomia Labor dystocia Vacuum/forceps GDM Obesity Postdates delivery Previous shoulder dystocia High percentage of cases occur with NO RISK FACTORS
30
How can you be prepared for shoulder dystocia before birth?
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
31
What are 3 maneuvers to intervene with should dystocia?
McRoberts’ Maneuver Suprapubic pressure Gaskin maneuver
32
What is McRoberts’ Maneuver? What is it r/t?
Changes maternal pelvis angle Mom brings needs to chest Should dystocia
33
What is Suprapubic pressure? What is it r/t?
Pressure over suprapubic bone –if you know position, push shoulder toward chest NO FUNDAL PRESSURE!!!! Shoulder dystocia
34
What are the interventions for should dystocia? (5)
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
When preforming a newborn exam for a baby with should dystocia would should be examined?
tone, moving upper extremities bilaterally, crepitus over clavicles
36
What is precipitous labor and birth? Cause?
Entire process of labor and birth < 3 hours long Strong contractions and/or low resistance in soft tissues
37
What are the risk factors for precipitous birth?
Abruption (history of drug use--cocaine, methamphetamines, stimulants; seizure/eclampsia, HTN) Multiparity Very small fetal size Previous precipitous birth
38
What are the maternal complications of precipitous birth?
Sudden (terrifying) birth and immediate postpartum/newborn period without provider Abruption (cause or effect) PPH
39
What are the newborn complications of precipitous birth?
Hypoxia (diminished reserve) Lower APGAR scores Meconium-stained fluid Trauma (facial bruising, cephalohematoma, fractured clavicle)
40
What is the nursing care for precipitous birth?
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
What is the definition of pre-term labor and delivery?
Preterm labor (PTL): Labor that occurs between 20 and 36 6/7 weeks Preterm delivery (PTD): preterm labor results in delivery
42
What is the leading cause of neonatal mortality?
Prematurity
43
What can be done r/t equity to improve birth outcomes and reduce M&M?
Eliminate racial disparities Remove barriers to obtaining quality care in underserved and rural communities
44
How can access improve birth outcomes and reduce M&M?
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
How can M/M in birth be prevented?
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
What are health problems r/t preterm birth in babies?
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
What are the symptoms of preterm labor?
Back pain Pelvic pain Abdominal pain (uterine or GI) Menstrual like cramping Pelvic pressure Diarrhea Increased vaginal discharge
48
What are the risk factors for preterm labor? (14)
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
How many contractions and how much does the cervix need to be dilated/effaced to be considered preterm labor?
≥ 6 contractions per hour with documented cervical change or Cervical dilation ≥ 2 cm and 75% effaced with a history of contractions
50
What screening tests can be used to predict preterm labor?
Sterile cervical exams Cervical length via trans-vaginal US Fetal fibronectin (fFN)
51
How does cervical length via trans-vaginal US help predict risk for pre-term labor?
> 3 cm = decreased risk of preterm labor at this time < 2 cm = increased risk of PTL that will progress to preterm birth
52
How does fFN help to determine risk of preterm labor?
High negative predictive value: if NEG --> < 1% chance of giving birth in next 7 days Low positive predictive value: if POS --> means nothing
53
When is an fFN preformed? How is it collect? What can alter the results?
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
What can be done to pr3event preterm labor?
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
How does regular prenatal visits prevent preterm labor? (6)
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
What can be done if women have a history of pre-term labor?
Progesterone supplementation– from 16-36 6/7 weeks Daily vaginal progesterone OR Weekly IM progesterone injections
57
When are tocolysis medications used? Which medications? How long are thy used for? Why?
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
Why is magnesium sulfate used in preterm labor? How long should it be used for?
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
What are maternal corticosteroids used for? When are they administered? When do they provide the greater benefit?
Administered at 24-33 6/7 Reduces risk of neonatal death, intraventricular hemorrhage, and RDS Greatest benefit 48 hours -7 days post treatment
60
When are antibiotics used in pre-term labor?
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
What type of medication is Nifedipine? What are the side effects?
Ca++ channel blocker Side effects: maternal tachycardia, palpitations, flushing, headaches, dizziness, and nausea
62
What type of medication is indomethacin? Side effects?
NSAID Side effects: maternal nausea, heartburn; fetal constriction of ductus arteriosus, oligo, NEC
63
What type of medication is terbutaline? Side effects? When should it not be used?
beta-adrenergic Side effects: tachycardia (both), hyperglycemia, palpitations , pulmonary edema, myocardial ischemia, and cardiac arrhythmia No Terbutaline if HR > 120; FHR > 180
64
What is the hospital care for preterm labor and delivery?
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
What is the home care for preterm labor and delivery?
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
What situations would you not stop pre-term delivery? (8)
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
How is fetal lung maturity assessed?
68
What is post-term pregnancy?
Pregnancy that extends > 42 0/7 weeks
69
What are the risk factors for post-term pregnancy?
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
What complications can post-term pregnancy have on a pregnant person?
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
What are the fetal complications of post-term pregnancy?
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
What does breakdown of the placenta cause?
Uteroplacental insufficiency: Intrauterine growth restriction (IUGR – SGA infant) Late decelerations during labor Oligohydramnios: Increased chance of cord compression --> Variable decelerations
73
What tests can be done to assess whether placental functioning remains adequate in post-term infants?
Biweekly Non-Stress Tests Weekly Amniotic Fluid Check with MVP PRN Biophysical Profile Fetal Movement
74
What should be done if a non-stress test is nonreactive?
Desire reactive NST If nonreactive-- BPP or IOL
75
What should the MVP be?
Normal = 2 cm - < 8 cm
76
What is considered an abnormal BPP?
Abnormal: < 8
77
What is abnormal fetal movement?
< 10 movements in 2 hours Or decreased fetal movement from normal

OB (16 decks)

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