Week 5: Pre-Birth complications Flashcards
What is low birth weight?
2500g or less
What is more dangerous, low birth weight or premature birth?
Premature birth because gestation impacts the development of the fetus
Describe spontaneous pre-term birth
Early initiation of the labour process (PPROM, cervical insufficiency)
If a patient presents with GA 20-37 weeks, contractions, and progressive cervical changes what is the Dx? What could be causing this?
Dx: Spontaneous pre-term birth
Causes: PROM
Describe indicated pre-term birth?
A mean to resolve the maternal or fetal risks related to continuing the pregnancy
What are some possible reasons for indicated preterm birth?
Pre-eclampsia, GDM, seizures, IUGR, a pt would be induced because of the risk.
A pt presents with menstrual cramps, diarrhea, back pain what should you do and what does this indicate?
Symptoms of preterm labour, check the dilation
What are some risk factors for preterm birth?
-Hx spontaneous PB
-Genital track infection
-Multifetal gestation
-Racism
-Low pre-pregnancy weight
-Low SES
-Lack of access to prenatal care
-Maternal age (under 18, over 35)
-Smoking
What happens when there is an increase in an inflammatory response in the genital tract of a mother
Increase in histamine which weakens the amniotic fluid, to increase the risk of preterm birth
How can nurses manage patients who are at risk for preterm birth?
Use preventative strategies which address risk factors and modify
Tocolytics
Delay birth long enough for corticosteroids to reach the maximum benefit
Antenatal gluccorticoids
Stimulate fetal lung maturity
MgSO4 administration
can reduce or prevent neonatal neurological morbidity- Neuroprotection
Describe PROM (premature rupture of membranes)
Not the dance- rupture of membranes before the completion of week 37
What is the ethology of PROM
Weak amniotic membranes, inflammation, increased uterine pressure, and infection of urogenital tract
How would you manage PROM ?
Hospitalization
Monitor fetal movement
BPP (Biophysical profile)
NST (non-stress test)
Pharmacological measures for PROM
Antenatal glucocorticoids, broad spectrum antibiotics
How would you engage in health teaching in a patient who is at risk for PROM?
How to look for signs of infection
(i.e. changes in amniotic fluid, fever, feeling unwell, odour, uterine pain)
List the maternal PROM complications
Chrorioamnionitis, placental abruption, retained placenta, PPH which can lead to sepsis
List the fetal PROM complications
Intrauterine infection, cord compression, cord prolapse, premature birth
What is chorioamnionistis?
Bacterial infection go the amniotic cavity
Signs and symptoms of chorionamnionistis
Maternal fever, both tachycardia, uterine tenderness, foul odour of amniotic fluid
When is the an increase risk in PROM?
With a prolonger rupture, multiple vaginal exams, internal FHR and IUCP
How do we treat chorioamnionistis?
IV broad spectrum antibiotics
What does chorionamnionistis increase your risk of?
Chances of experiencing labour dystocia, and operative birth (wound infection or pelvic abscesses)
What happens when the umbilical cord prolapses?
Cord occlusion and the leads to inadequate blood flow for the fetus. There will be an abrupt deceleration in fetal heart rate.
What increases the risks of umbilical cord prolapse?
Lung cord, low-lying placenta, fetus unengaged with pelvis as there is extra space below
Describe a prolapsed umbilical cord
Cord lies below the presenting part of the fetus. Increasing risk for fetal hypoxia if this becomes prolonged.
Cord is popping out to say hello, this is bad :(
As a nurse, how would you intervene if a patient presented with a prolapsed umbilical cord?
sterile gloved hand in vagina, hold presenting part off the umbilical cord to relieve pressure, trendelenburg or knee-chest position
WWYD: A patient presents with a prolapsed umbilical cord and they are fully dilated
Forceps or vacuum can be performed BUT often emergency caesarean birth-done very quickly
How is a mother anesthetized if they need a caesarean because of a prolapsed umbilical cord but they have not had an epidural yet?
GA because there is no blood flow to the baby
What is a postdates labour ?
Beyond end of 42 weeks
What happens if a pregnancy is postdated?
Beyond the 42 weeks, the placenta begins to age (ew) and there are enlarging areas of infarctions and calcium deposits. Also concerned about oligohydroamninos
What are the maternal risks for postdates labour?
Perineal injury related to fetal marcosomia, PPH, infection (meconium)
Marcosomia: Big Baby
What are some risks that the baby faces if there is a post-dated birth beyond the end of 42 weeks?
Birth injuries, MEC aspirations, still births
When is induction offered in a post-dated labour?
After 4 weeks because of increased rates of stillbirth, it reaches 0.19 at 42 weeks
As a nurse, how would you assess a patient with post-dated pregnancy?
Daily fetal movement counts (6 move in 2h)
NST
BPP
AFV
Cervical assessment/bishops score
What interventions would you use with a patient who has a post-dated labour?
Aim to ripen the cervix with balloon catheter or pharmacological interventions, amniotomy (manually rupture membrane), induction
What pharmacological interventions would you use to ripen the cervix?
Vaginal or cervical prostaglandin E, misoprostol PO
