Week 4 (Labour & Birth at Risk) Lecture Flashcards
Critical thinking:
Brim is G3T1P0A1L1 at 41 weeks
Presents to L&D with noticeable anxiety and indicates that her last labour was “unbearable”.
She describes her previous delivery as “traumatic” as forceps were used due to concerns with the fetal heart rate.
What effects of anxiety might impact Brim’s progress of labour?
What priorities for nursing care would be appropriate?
1) Anxiety about previous labour experience
2) Listen to experiences & acknowledge them; Ask what she wants; Post-traumatic counselling after birth
What are the causes of PPROM.
1) Weak amniotic membranes
- If multiple kids or lots of fluid -> water breaks quickly
2) Inflammation
3) Increased uterine pressure
4) Infection of the urogenital track
List the common complications of PPROM for both mom and fetus.
Maternal
- Chorioamnionitis
- Placental abruption
- Retained placenta
- PPH
- Sepsis
Fetal - Intrauterine infection - Cord compression • Fetal HR decr • Variable on fetal monitor • Deceleration
- Cord prolapse
• Baby hypoxic - Premature birth
Case study:
Kelly presents to L&D with signs of preterm labour and 275 weeks gestation. During the admission, Kelly receives betamethasone 12mg IM for two doses x 24 apart. Her contractions stop and no further cervical changes are noted, she is discharged home. Kelly was scheduled for her GTT at her appointment at 28 weeks. Results come back as 12.8mmol/L
Are these results accurate?
No b/c corticosteroids -> hyperglycemia (false-negative result)
What is chorioamnionitis? What are some signs and symptoms? What are the risks? What are the complications? What are the treatments?
It’s a bacterial infection of the amniotic cavity. Labour slows b/c contractions aren’t happening.
S&S: maternal fever, maternal and fetal tachycardia, uterine tenderness, and foul odour of amniotic fluid.
Increased risk associated with prolonged rupture, multiple vaginal examinations, internal FHR and IUCP.
Complications:
- If water breaks & labour occurs days/wks later -> infection
- Multiple vaginal exams (think about if it’ll help)
- Inserting instruments
Treated with IV broad-spectrum antibiotics
Increased likelihood to experience labour dystocia and operative birth (wound infection or pelvic abscess).
What is a prolapsed cord? What are some risks? What are the complications? What are the immediate interventions?
Cord lies below the presenting part of the fetus
Risk of fetal hypoxia (due to decr profusion) from prolonged cord compression
Immediate interventions:
- The examiner places the sterile gloved hand in the vagina and holds the presenting part off the umbilical cord
- Trendelenburg or knee-chest position
- If fully dilated, forceps or vacuum can be performed but often emergency caesarean birth.
- Have pt go on all 4s. Pressure will be put on the baby’s head to relieve pressure
- Emergency c-section (put them under general b/c no time for anything else)
• Loss of control results in strong grief (missing birth b/c under anesthesia) -> rebirth may be done after
What are the maternal and fetal risks of postdates?
Maternal risks:
- Perineal injury related to fetal macrosomia
- PPH
- Infection
Fetal risks:
- Birth injuries
- MEC aspiration
- Stillbirths
What is oxytocin?
Hormone produced from the posterior pituitary gland. It stimulates uterine contractions. This synthetic dose can induce or augment labour.
Discuss the process of oxytocin induction.
IV administration with rate controlled by pump for induction
- Dosage is increased per protocol until an adequate contraction pattern is established
What are the risks associated with oxytocin induction?
Maternal risks: Placental abruption, uterine rupture, c-section, PPH and infection
High alert: monitor for uterine tachysystole
- Over stimulated (no more than 6 contractions in 10 mins, shouldn’t last longer than 90 secs; should have adequate relaxation/break b/w contractions)
What is meconium stained amniotic fluid? What does it look like?What should you be prepared for? What is a complication?
Assess amniotic fluid for meconium after ROM.
The colour is brown/green.
Prepare for potential neonatal resuscitation
- After birth, assess respiratory efforts, HR and muscle tone
- Suctioning may be required of mouth, nose and trachea
Pneumonia is a complication.
True or false: routine suctioning of mouth and nose no longer recommended.
True
What are the risks of meconium aspiration syndrome?
- Often term or postdates
- Intrauterine process vs. aspiration immediately after birth
- Severe form of aspiration pneumonia
What is an amniotic fluid embolism (AFE)? What are the signs and symptoms? When can it occur? What are the maternal risk factors? List some interventions.
It’s amniotic fluid introduced into the maternal circulation.
It’s a rare but sudden, acute onset of maternal hypoxia, hypotension, cardiovascular collapse, and coagulation.
AFE occur during labour, birth or within 30 minutes after birth
Maternal risk factors: advanced age, meconium stained amniotic fluid, placenta previa, pre-eclampsia, forceps-assisted or c-section.
Interventions:
- O2 therapy
- Intubation and mechanical ventilation
- CPR
- IV fluids, blood products (PRBC, FFP)
- Prepare for emergency birth
- Emotional support
What is worse: a frank breech or a single footing breech?
Frank breech = most common & safest
Legs first = most dangerous
