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SEM 1 > W5: Labor At Risk > Flashcards

W5: Labor At Risk Flashcards

1
Q

Caring for high risk clients requires:

A

understanding the normal birth process
prevent & detect deviations
implement nursing measures when complications arise

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2
Q

Preterm Labor

A

cervical changes + contractions
20-37w

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3
Q

Preterm birth

A

any birth occuring before 37w

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4
Q

Preterm Causes

A

infections
vaginal bleeding
hormone changes
stretching of uterus

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5
Q

S/S of Preterm Labor

A

UTERINE ACTIVITY:
uterine contractions more frequenct than q10m, for 1+hrs,

DISCOMFORT:
lower abd pain (~gas pain), diarrhea, dull back pain, cramps, suprapubic pressure, pain, heaviness

VAGINAL D/C:
change in character + amt, colour, odour

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6
Q

Preterm Labor Diagnositc criteria

A

20-37
regular uterine activity + cervical changes
regular contractions + 2cm+ dilation

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7
Q

NC: preterm labor

A

address risk factors (stress, nutrtion, diet)
administer prophylactic progesterone to decrease rate

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8
Q

Interdisciplinary care

A

tooclytics- suppression of uterine activity
bethamethasone- fetal lung maturity, surfactant
magnesium sulphate to prevent/reduce newborn neurological morbidity [inevitable birth]

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9
Q

Patient Teachinf Preterm Labor

A

stop what you’re doing
empty bladder
2-3 glasses of water/juice
lie down on the side for 1hr

symptoms continue: doctor
go away:
- resume light activity
- not what you were doing before

Immediate hospital:
- leakage of amniotic fluid
-vaginal bleeding
- uterine contractions q10mins for 1hr

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10
Q

PROM

A

rupture of amniotic sac and leakage of fluid before onset of labor

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11
Q

pPROM

A

rupture of membranes before 37w

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12
Q

Interdisciplinary Care: PROM

A

term pregnancy: induction of labor
34-36 weeks: mgt if low risk of infection
<32weeks: expectant mgt for fetal lunf maturity

betamethasone: 24-34w:
magnesium sulphate: <34w

  • NST, BPP
  • antibiotics (7days)
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13
Q

Nursing Care: PROM

A

teach fetal movement counting
keep vagina clear, and don’t introduce anything new
Signs of infection: foul d/c, tachy (m/f)

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13
Q

Maternal Complications: PROM

A

placental abruption
retained placenta –> hem. –> sepsis –> death
chorioamnionitis:

d/t :
pronlonged rupture
vaginale xaminations
internal monitors
young maternal age
low SES
nulliparity
pre-existing infections

mgt: broadspectrum antibiotics

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13
Q

Fetal Complications: PROM

A

intrauterine infection
cord prolapse, umbilical cord compression (assoc w/ oligohydramnios)

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14
Q

Post-term Pregnancy

A

beyond 42 weeks

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15
Q

Risk factors: Post-Term

A

hx of post-term
male fetus
obesity
genetic disposition

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16
Q

Maternal Risk: Post-term

A

labor dystocia
perineal injuries
chorioamnionitis
endomyometritis
PPH
c-section
anxeity

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17
Q

Fetal Risk: Post-term

A

macrosomia/SGA
birth trauma
asphyxia
oligohydramnios (cord compression, abnormal FHR)
aging placenta (still birth)
meconium stained fluid, meconium aspiration
low apgar scores
convulsions in newborn

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18
Q

NC: Post-term

A

41w: FMC, NST, AFV, BPP, CST

42+6w= birth recommended

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19
Q

Patient teaching: post-term

A

daily fetal movement counts
assess for signs of labor

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20
Q

Dystocia

A

slow progress of labor
4+ hrs w/ less than 0.5cm dilation
1+hr hour of pushing w/ no descent

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21
Q

Causes of Dystocia (5 P’s)

A

power: ineffectice contractions, pushing
passageway: structure, abnormalities
passenger: presentation, multiple babies, size
position: of pt
psychological: prep, hx

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22
Q

Interventions for Dystocia

A

external cephalic versin
cervical ripening
induction/augmentation of labor
operatice procedures (forcepts, vaccum)
c-section

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23
Q

Complications of Labor Dystocia

A

fetal distres
risk of infection
PPH
uterine rupture
trauma
uterine/organ prolapse
obsetrical fistula (vesico-vaginal, rectovaginal), incontinence
sacroiliac joint dislocation

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24
Q

Management of Cord Prolapse

A

goal- relieving pressure on cord

knee-chest position
manual decompression (hcp elevates head)
trendelenburg position
tocolytics - less pressure, better perfusion
cord: kept warm & moist [prevent vasospasm]
fetal monitoring
c-section: minimal dilation, fetal compromise risk

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25
Q

Recognizing Cord Prolapse

A

sudden gush of fluid followed by feeling of vaginal pressure/fullness
seek immediate care
assume knee-chest positon

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26
Q

Shoulder dystocia

A

head born but shoulder can’t pass

d/t:
fetopelvic disproportion (>4000g) - macrosomia
pelvic abnormalities
prolonged 2nd stage of labor
hx of shoulder dystocia

27
Q

Shoulder Dystocia

A

Interventions:
McRobert’s maneuver (legs to chest)
suprapubic rpessure over anterior shoulder
gaskin maneuver (hands & knees)

28
Q

Shoulder Dystocia: complications

A

brachial plexus
fracture of humerus/clavicle
asphyxia

29
Q

Amniotic Fluid Embolism (AFE)

A

introduction of amniotic fluid into circulation ot pt during birth or after birth

30
Q

Effects of AFE

A

respiratory distress:
restlessness
dyspnea
cyanosis
pulmonary edema
respiratory arrest

circulatory collapse:
hypotension
tachycardia
shock
cardic arrest

hemorrhage:
coagulation faliure
uterine atony

31
Q

Interventions of AFE

A

oxygenate:
administer 10L/min
tilt pt 30 degrees to the side

cardiac ouput
position on side
IV fluids
blood
catheter (measure output)

correct coagulation faliure

32
Q

induction of labour

A

chemical or mechnicals intiation of uterine contractions for birth

33
Q

high priority indications of induction

A

pre-eclampsia >37w
maternal dx not responding to tx
antepartum hemorrhage
chorioamninitis
suspected fetal compromise
PROM + group b streptococcus

34
Q

Contraindications of induction

A

suspected fetal macrosomia
absence of fetal or maternal indication
convinience

35
Q

Cervical ripening Agents Induction

A

ripens cervix, making it softer, dilation, contraction.
prostaglandins E2

cervidil insert
prepidil gel

36
Q

NC: Cervical Ripening Agents

A

bring prepidil to room temp before administration (no hot water/microwave)

keep cervidil frozen until before insertion, warm

pt void before insertion

pt maintain supine position w/ later tilt for 30 mins (gel), 2 hrs (insert)

pt to ambulate

pull string to remove insert if AE occur
- delay oxytocin for induction by 6hrs after last gel OR 30-60mins since removal of insert

37
Q

Mechanical Induction

A

balloon catheters, release prostaglandins, ripen cervix

38
Q

Balloon Catheters

A

inflated above os w/ 30-50ml
results in pressure = prostaglandins
balloon will fall out when 3cm dilation OR removed after 24 hrs

39
Q

Balloon Catheters Contraindications

A

low-lying placenta
antepartum hemorrhage
rupture of membranes
evidence of lower genital tract infection

40
Q

Hydrascopic Dialators

A

substance absorbs fluid from tissue and enlarges

laminaria tent (seaweed)
lamicel synthetic dialators w/ mag sulp

41
Q

Mechanical & Physical Methods of Induction

A

sexual intercourse (prostaglandins in semin, contractions w/ orgasm)
nipple stimulation (oxytocin released)
ambulation/walking (gravity applies pressure on cervix = oxytocin)

42
Q

Alternative Induction: Amniotomy

A

aritificial rupture of membranes
labor begins within 12 hrs
combined w/ oxytocin

43
Q

Amniotomy Indications

A

presenting part of fetus is engaged & well applied to cervix
no active infections of genital tract
HIV status is negative, viral load is low

44
Q

Alternative Induction methods

A

amniotomy
blue cohosh + castor oil (labor stimulation)
black cohosh + evening primrose (ripen cervix)

45
Q

Compolications of Amniotomy

A

chorioamnionitis d/t prolonged rupture w/o labor
variable FHR decelerations d/t cord compression d/t cord prolapse OR dec AFV

46
Q

Oxytocin

A

stimulates uterine contractions
induction/augmentation of labor
given via IV

47
Q

Oxytocin Contraindications

A

abnormal FHR
cephalopelvic disproportion
prolapsed cord
transverse lie
plaventa rpevia
hx of uterine surgery
herpes
cancer of cervix
uterine rupture

48
Q

Complications of Oxytocin

A

uterine tachysystole (~FHR changes)
abnormal FHR
suspected uterine rupture
inadequate uterine response

49
Q

NC: Oxytocin

A

monitor fetal status:
q15m w/ every dose change - 1st stage
q5m w/ active pushing - 2nd stage

monitor contraction pattern & uterine tone
q15m w/ every dose change - 1st stage
q5m - 2nd stage

BP, pulse , RR : q30-60m w/ every dose change

assess I/O
- iV intake 1000ml only / 8hrs
- output 120+ml / 4hr

50
Q

NC: AE Oxytocin

A

discontinue oxytocin
turn pt to later side
give IV bolus if pt is hypovolemic/hypotensive
oxygen (8-10L/m)- w/ hypoxia/hypovolemia
NO to decrease uterine activity

51
Q

Augmentation of Labor

A

stimulation of uterine contractions after labor has started spontaneously but progress is unsatisfactory

hypotonic uterine dysfunction

Common methods:
oxytocin infusion
amniotomy
non-invasiveness methods: empty bladder, ambulation, position changes, relaxation, nourishment, hydration, hydrotherapy

52
Q

External Cephalic Version (ECV)

A

manual turning of fetus from breech to transverse to vertex

53
Q

ECV Contraindications

A

multiple fetuses
non-assuring fetal status
placenta previa
placenta abruption

54
Q

ECV Required Assessment

A

determine fetal position
locate umbilical cord
rule out placenta previa
detect multiple gestation, oligohydramnios, or fetal abnormalities
measure fetal dimension

55
Q

Indications: Forceps-Assisted Birth

A

m: prolonged 2nd stage for maternal reasons
f: abnormal FHR, abnormal presenstation, arrest of rotation, delivery of head in breech

56
Q

Consideratins: Forceps-Asissted Birth

A

memrane ruptured
assess pelvic-head ratio
dully dilated cervix w/ engaged head
empty bladder

57
Q

Nursing Care: Forceps- Assisted Birth

A

bleedinf
urinary retention
f: abrasions, brusiing
facial palsy d/t pressure on facial nerve
subdural hematoma

58
Q

Vacuum Assissted Birth

A

attachment of vacuum cup to fetal head using negative pressure to assist birh of head

59
Q

vacuum assisted birth: fetal risks

A

cephalohematoma
scalp lacerations
subdural hematoma

60
Q

scheduled c-section

A

labor and vaginal birth are contraindicated

61
Q

unplanned c-section

A

changes in labouring pt & family’s expecatations

62
Q

forced c-section

A

to protect well being of pt and babty

63
Q

Maternal Indicatins of C-section

A

cardiac dx
respiraotry dx
intracranial pressure
mechanical obstruction
hx of c-sections
elective c-section

64
Q

fetal indications of c-section

A

abnormal FHR
malpresentation
mama herpes, hiv
congenital abnormalies

65
Q

maternal-fetal indications for c-section

A

dysfunctional labor (diproportion head)
placenta abruption
placenta previa

66
Q

Contraindications of TOLAC

A

classical uterine incision
inverted T or low uterine incision
uterine rupture
uterine surgery
pt requests c-section
inability to preform c-section if necessary

SEM 1 (11 decks)

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