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NURS 372 > Week 5 - Labour, Birth at Risk, Fetal Health Surveillance > Flashcards

Week 5 - Labour, Birth at Risk, Fetal Health Surveillance Flashcards

1
Q

Preterm labour

A

cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy

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2
Q

Preterm birth

A

any birth that occurs before completion of 37 weeks of pregnancy

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3
Q

Low birth weight

A

2500 g or less

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4
Q

What is more dangerous?
a) low birth weight
b) preterm

A

b) preterm

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5
Q

T or F: Signs of preterm labour tend to be less obvious than term labour.

A

TRUE

menstrual like cramps, diarrhea, back labour, pressure in pelvis

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6
Q

Spontaneous preterm birth

A

early initiation of the labour process (PPROM, cervical insufficiency etc.)

gestational age 20-37 weeks, contractions, and progressive cervical changes

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7
Q

Indicated preterm birth

A

A mean to resolve maternal or fetal risks related to continuing the pregnancy (preeclampsia, GDM, seizures, IUGR etc.)

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8
Q

Management

A

preventive strategies that address risk factors

modified activity restrictions (not bed rest though, DVTs)

meds
-tocolytics
-glycocorticoids
-mag sulf

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9
Q

Purpose of tocolytic meds

A

delay birth long enough for corticosteroids to reach max. benefit

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10
Q

Purpose of glucocorticoids

A

stimulate fetal lung maturity

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11
Q

Purpose of magnesium sulfate

A

can reduce or prevent neonatal neurological morbidity (between 24-32 weeks gestation)

neuroprotective

situations when birth is inevitable

also for pre-eclampsia

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12
Q

PPROM

A

preterm premature ruptures of membranes

rupture of membranes before completion of 37 weeks

hospitalization for conservative management

kick counts, BPP, NST

antenatal glucocorticoids

broad-spectrum antibiotics

signs of infection

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13
Q

Complications of PPROM - Maternal

A

chorioamnionitis

placental abruption

retained placenta

PPH

sepsis

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14
Q

Complications of PPROM - Fetal

A

intrauterine infection

cord compression

cord prolapse

premature birth

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15
Q

Chorioamnionistis

A

bacterial infection of the amniotic cavity

can overwhelm uterus, preventing it from contracting effectively

S&S: maternal fever, maternal and fetal tachycardia, uterine tenderness, and foul odour of amniotic fluid

associated with prolonged rupture, multiple vaginal examinations, internal FHR and IUCP.

IV broad-spectrum antibiotics

increased chance or labour dystocia and operative birth (wound infection or pelvic abscess)

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16
Q

Prolapsed Umbilical Cord

A

BIG EMERGENCY

blood flow severely compromised

cord lies below the presenting part of the fetus

risk of fetal hypoxia from prolonged cord compression

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17
Q

Prolapsed Umbilical Cord - immediate interventions

A

want to lift baby’s head off cord to reduce pressure

examiner places sterile gloved hand in 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

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18
Q

Postdate labour

A

beyond the end of 42 weeks gestation

placenta begins to age, enlarging areas of infarctions and calcium deposits

oligohydramnios

maternal risks: Perineal injury related to fetal macrosomia, PPH, infection

fetal risks: Birth injuries, MEC aspiration, stillbirths

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19
Q

What to do for postdate

A

daily kick counts

NST, BPP

AFV assessments

Cervical assessment Bishops Score (assess favourability of the cervix)

Cervical ripening
-Mechanical: Balloon catheter
-Pharmacological: Vaginal or Cervical Prostagladin E (cervidal), Misoprostol PO
-Amniotomy (ARM)
-Induction

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20
Q

Education for postdate patient

A

breast stimulation, pumping - oxytocin

positional change

upright movement, walking

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21
Q

Oxytocin Induction

A

stimulates uterine contractions

IV (High risk! 2 RNs)

High alert: monitor for uterine tachysystole

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22
Q

Uterine tachysystole

A

hyperstimulate the uterus

contractions may be too close together - more than 6 contractions in 10 minutes OR longer than 90 seconds

fetal distress - lack of perfusion

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23
Q

Meconium Stained Amniotic Fluid

A

prepare for potential neonatal resuscitation

routine suctioning no longer recommended, but may have no

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24
Q

Meconium Aspiration Syndrome

A

severe form of aspiration pneumonia

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25
External Cephalic Version
trying to flip breech baby done through ultrasound manually rotate the baby in to a cephalic position hospital - due to risk of rupture of membranes, cord prolapse, fetal distress rate of effectiveness - 30-40% success rate may use meds to relax uterus, analgesics
26
Shoulder Dystocia
anterior shoulder cannot pass under the pubic arch. sign: retraction of the fetal head at the perineum "turtling", baby going in and out
27
Interventions for shoulder dystocia
position changes (legs flexed apart with knees to abdomen, hands and knees position/squatting), apply suprapubic pressure DON'T APPLY PRESSURE TO FUNDUS
28
McRoberts Manoeuvre
supine, legs up helps when shoulder stuck
29
Operative Vaginal Births (Forceps)
WITH pushing effort from patient use decreasing, risks
30
Vacuum Assisted Birth
less risk than forceps attachment of a vacuum cup to the fetal head using negative pressure
31
Prereqs for vacumn assisted birth
fully dilated, ruptured membranes***
32
C-section
birth of a fetus through a transabdominal incision of the uterus suprapubic region lots of reasons -placenta previa, active herpes lesions, Breech birth risks to baby are minimal
33
Automatic C-section for
placenta previa not automatic for placental abruption
34
strongest predictors of Vaginal Birth after Caesarean (VBAC) (2)
1) previous vaginal birth 2) spontaneous labour
35
Fetal Health Surveillance goal
identify potential fetal decompensation to allow for timely and effective interventions to prevent perinatal morbidity or mortality
36
What is always assessed in associated with FHR?
uterine activity
37
Uterine Activity
assessed by palpitation, external tocotransducer or internal intrauterine pressure catheter (IUCP)
38
Uterine Activity (4)
1) frequency 2) duration 3) intensity 4) resting tone
39
Frequency
beginning of one contraction to the beginning of the next contraction (minutes)
40
Duration
beginning to the end of the contraction (seconds)
41
Intensity
determined by palpitation (mild, moderate, strong) or by IUCP (mmHg)
42
Resting tone
degree of muscular tension between contractions by palpitation (soft, relaxed) or IUCP (10mmHg)
43
Uterine Activity Patterns
contractions no more than q2mins (max. 5 contractions in 10 minutes) contractions lasting less than 90 seconds minimum 30 seconds rest period between contractions
44
When to listen to FHR
for 60 seconds immediately AFTER contractions Baseline FHR Rhythm (regular or irregular) Presence of acceleration of deceleration Categorization of FHR as normal or abnormal
45
Frequency of IA in 1st Stage of Labour - Latent
Hourly
46
Frequency of IA in 1st Stage of Labour - Active
q15-30mins
47
Frequency of IA in 2nd Stage of Labour
q5mins while pushing
48
Electronic Fetal Monitoring
continuous assessment of fetal oxygenation tracing are analyzed for patterns that suggest fetal hypoxic events and metabolic acidosis allows practitioners to intervene in a timely manner external: -Toco - uterine contractions -ultrasound - FHR internal: -intrauterine monitor - contractions
49
Baseline FHR must be present for ________________
2 minutes in any 10 minute period.
50
Fetal Tachycardia
over 160 bpm lasting 10 minutes hypoxia, infection, drugs
51
Fetal Bradycardia
under 110 bpm lasting 10 minutes hypoxia, viral infections, hypoglycemia, hypotension, hypothyroidism
52
FHR Variability
fluctuation in the baseline in a 10 minute segment, excluding accelerations or decelerations irregular amplitude that are visually determined absent minimal moderate = good! marked
53
Absent variability
amplitude range is undetectable (0-2bpm)
54
Minimal variability
amplitude range is detectable but equal or less than 5 bmp
55
Moderate variability
amplitude 6-25bpm
56
Marked variability
amplitude >25bpm
57
VEAL CHOP
V - variable deceleration -resembles letter V -associated with cord compression -repositioning to reduce pressure on the cord E - early deceleration -slow onset and recovery -associated with head compression A - acceleration -spontaneous increase in fetal HR above the baseline for longer than 15 seconds -more than 15 seconds, with increase -good, want to see them L - late declaration -deceleration occurs after the peak of a contraction -concerning - regarding placenta sufficiency C - cord compression H - head compression O - ok P - placental insufficiency D - deceleration -15 beats below baseline for at least 15 seconds
58
Accelerations
visually abrupt increase in FHR above the baseline periodic or episodic indication of fetal well-being 15 seconds or longer 2 - 10 minutes
59
Early Deceleration
visually apparent gradual decrease in the FHR and return to baseline associated with a UC correspond with contraction "mirror image" head compression often benign
60
Late Deceleration
visual apparent gradual decrease in FHR and return to baseline associated with a UC AFTER contraction uteroplacental insufficiency tell mom to change position
61
Variable Decelerations
visually abrupt (rapid) decrease in the FHR below the baseline by at least 15bpm for 15 seconds or longer but less than 2 minutes  U, V, W most common cord compression
62
Intrauterine Resuscitation
stop or decrease oxytocin change maternal position improve maternal hydration with IV bolus vaginal examination to assess progress or relieve pressure of presenting part on the cord consider amnioinfusion reduce maternal anxiety coach or modify pushing technique (open glottis, push only with contraction, shorter efforts)
63
Prolonged Deceleration
visually apparent decrease (gradually or abrupt) of at least 15bpm below the baseline and lasting more than 2 minutes but less than 10 minutes interrupted fetal oxygen notify HCP** intrauterine resuscitation

NURS 372 (12 decks)

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