week 5: labour and birth w risks Flashcards
spontaneous preterm birth
early initiation of labour process (PPROM, cervical insufficiency, etc)
diagnostic: gestational age 20-37 weeks, contractions, and progressive cervical changes
indicated preterm birth
a mean to resolve maternal mean to resolve maternal or fetal risks related to continuing the pregnancy (preeclampsia. GDM, seizures. IUGR)
what delays birth
tocolytics delay birth long enough for corticosteroids to reach max. benefit
what drug stim fetal lung maturity
antenatal glucocorticoids
administration of what can reduce or prevent neonatal neurological morbidity btwn 24-32 wks
MgSO4
PPROM (preterm premature rupture of membranes)
- rupture of membranes b4 completion of 37 weeks
- hospitalization for conservative management
- antenatal glucocorticoids
- broad-spectrum antibiotics
PROM
premature rupture of membrane-water ruptures before onset of contractions
PPROM
preterm rupture under 37 wks
Maternal PPROM complications
- chorioamnionitis: infection in amniotic fluid
- placental abruption
- retained placenta
- PPH
- sepsis
fetal PPROM complications
intrauterine infection
cord compression
cord prolapse
premature birth
what is chorioamnionitis
- bacterial infection of amniotic cavity
- S/S: maternal fever, maternal and fetal tachycardia, uterine tenderness, and foul odour of amniotic fluid
- increased risk associated with prolonged rupture, multiple vaginal exam, internal FHR and IUCP
- treated w IV broad-spectrum antibiotics
- increased likelihood to experience labour dystocia and operative
prolapsed umbilical cord
cord lies below presenting part of fetus
risk of fetal hypoxia from prolonged cord compression
immediate: interventions:
- examiner places sterile gloved hand in vagina and holds presenting part of umbilical cord
- trendelenburg or knee-chest position
- fully dilated - forceps or vacuum can be performed but often emergency caesarean birth
describe oxytocin induction
hormone produced by posterior pituitary gland
stim uterine contractions
synthetic version induces labour or augments labour
IV administration w rate controlled by pump for induction
dosage increased per protocol
high alert: monitor for uterine tachysystole
how many seconds rest in btwn contractions
30 seconds
what is meconium stained amniotic fluid
assess amniotic fluid for meconium after ROM
prepare for potential neonatal resuscitation
after birth assess resp efforts, HR, and muscle tone
routine suctioning of mouth and nose no longer recommended
meconium aspiration syndrome
often term or postdates
intrauterine process vs aspiration immediately after birth
severe form of aspiration pneumonia
shoulder dystocia
“turtling” where the baby comes in and out
If they’ve had it before at more risk to have it again
Positional change can be helpful
anterior shoulder cannot pass under pubic arch
shoulder dystocia signs
retraction of fetal head at the perineum
shoulder dystocia interventions
position changes (legs flexed apart w knees to abdomen, hands and knees position/squatting), apply suprapubic pressure
avoid fundal pressure as a method of relieving shoulder dystocia
what do u not do when someone is given birth
DO NOT put pressure on upper part of fundas, this is actually a issue and cause injury
newborn risks of operative vaginal births (forceps)
subdural hematoma, bruising, abrasions, facial palsy
indications of operative vaginal births
prolonged 2nd stage
maternal exhaustion
abnormal FHR
abnormal fetal presentation
arrest of rotation
extraction of the head in a breech
prereqs to vacuum assisted birth
fully dilated, ruptured membranes, engages head, vertex presentation, greater than 34 weeks gestation
caesarean birth
birth of fetus through a transabdominal incision of the uterus
maternal-fetal c-section indications
placenta previa
placenta abruption
dysfunctional labour
active herpes lesions
maternal c-section indications
2+ c-sections
specific med conditions
fetal c-section indicators
abnormal FHR pattern
malpresentation
congenital anomalies
maternal HIV w high viral load
success of vaginal birth after c-section
60-80%
strongest predictors are previous vaginal birth and spontaneous labour
benefits: decrease risk of hemorrhage, infection, and shorter recovery
risk: uterine rupture
describe UA patterns
contractions no more than q2mins (max 5 contractions in 10 min)
contractions lasting less than 90 sec
minimum 30 sec rest period btwn contractions
No closer than 2 min apart, so in 10 min 5 or less contractions, want them to be less than 90 seconds, and at least 30 secs in btwn contractions to rest
Monitor for hyperstimulation**
Also note the resting tone in btwn contractions, place hands on uterus and make sure that is it soft in btwn contractions
Make sure abdomen is resting in btwn, so blood flow can return to and reoxygenate fetus and placenta
Intrauterine pressure transducer (IUCP) = this measures strength of contractions, this is left in, used in situations where pt is being induced with oxytocin and we need to monitor it is doing the proper thing
FHR (ultrasound transducer) and tocotransducer are external, these do not measure the strength
nose-chin-forehead thingy
Duration (beginning to end of contraction), frequency, strength of contraction
If pt has external monitor in place the toco does not measure the strength of contraction, we need to palpate at the fundus to feel the strength of the fundas
If you feel tip of nose there’s some softness, mild contraction kind of feels like this
Now go to chin this is firmer but still softness this is like a moderate contraction
Now tip of forehead, this firmness is what a strong contraction feels like
As well ask how the pt is perceiving the contraction
best place to hear clearest and loudest FHR
back btwn shoulder blades
fetal tachycardia causes
early fetal hypoxia, maternal or fetal infection maternal hyperthyroidism, fetal anemia, maternal medications, or illicit drugs
greater than 160 bpm lasting longer than 10 min
fetal bradycardia potential causes
fetal hypoxia, viral infections, maternal hypotension, maternal hypoglycemia, maternal hypothyroidism, maternal position, medications, cardiac structural defects
less than 110 for longer than 10 min
Amplitude FHR Variability Types (4)
absent
minimal
moderate
marked
what is absent amplitude
range is undetectable (0-2bpm)
we don’t want to see this
what is minimal amplitude
range is detectable but equal or less than 5 bmp
fluctuation is less than 5 from beat to beat
what is moderate amplitude
6-25 bpm
this is ideal, this is reassuring
what is marked amplitude
> 25 bpm
abnormal
what are accelerations
- visually abrupt increase in FHR above baseline
- periodic or episodic
- indication of fetal well being
- term infant: peak is 15 bpm above baseline that lasts 15 sec or longer
- preterm infant under 32 wks: peak is 10 bpm above baseline that lasts 10 sec or longer
- prolonged accelerations lasting longer than 2 min but less than 10 min
what is early deceleration
- visually apparent gradual decrease in the FHR and return to baseline associated w a UC
- onset, nadir, recover of deceleration correspond WITH beginning, peak, and end of contraction
- described as a mirror image
When less blood flow to fetus = fetus HR goes down
Make sure fetus recovers when contraction is over
Described as mirroring contraction
biggest potential cause of early deceleration
head compression!!
late deceleration
- visual apparent gradual decrease in FHR and return to baseline associated w UC
- onset, nadir, recovery of deceleration occur AFTER beginning, peak, ending of contraction
- decel begins after contraction and the lowest point of deceleration occurs after peak of contraction
Does not mirror
associated w fetal hypoxemia, acidemia, low apgar scores
if persistent and uncorrectable, especially w fetal tachycardia and decreased variability
potential cause of late deceleration
uteroplacental insuffiency!
a client recieved an epidural and the BP decreased to 80/50. a late deceleration to 80 bpm x 50 seconds was noted. upon notifying the healthcare provider, which nursing intervention would be most appropriate?
a) increase oxytocin infusion
b) place the client in supine position
c) increase IV fluids
d) apply supplemental oxygen
C
intrauterine resuscitation
stop or decrease oxytocin
change maternal position
improve maternal hydration w IV bolus
vag exam to assess progress or relieve pressure of presenting part on cord
consider amnioinfusion
reduce maternal anxiety
coach or modify pushing technique
variable decelerations
- visually abrupt rapid decrease in FHR below baseline by at least 15bpm for 15 seconds or longer but less than 2 min
- shape commonly resembles U, V, W
- most common type of deceleration seen in labour and usually correctable
- can occur during or between contractions
- potential cause: cord compression
prolonged deceleration
- visually apparent decrease (gradually or abrupt) of at least 15 bpm below baseline and lasting more than 2 min but less than 10 min
- deceleration lasting longer than 10 min is considered baseline change
- potential cause: interrupted fetal oxygen
- call HCP, initiate appropriate intrauterine resuscitation
NEED TO KNOW THIS MF PNEUMONIC
VEAL CHOP!!
Variable Deceleration -> cord compression
Early -> head compression
Accelerations -> okay!
late -> placental insufficiency
