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Mother Baby > WEEK 8 > Flashcards

WEEK 8 Flashcards

Complications of Birth and Labor ATI

1
Q

define preterm labor

A

onset of reg uterine contractions THAT CAUSES CERVICAL change prior to 37 weeks

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2
Q

why might preterm birth occur without manifestations of labor

A

cause could be cervical insufficiency (dilation without contractions)

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3
Q

common contributing factors to preterm contractions

A

UTIs
trauma
acute illness

all can cause dehydration leading to preterm labor

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4
Q

HIGHEST risk factors for preterm labor include

A

maternal history of preterm labor in prior pregnancy

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5
Q

what are risk factors (besides history) for preterm labor?

A

multis
low BMI
AMA
young age
reproductive assistance
Irish twins
low socioeconomic status
partner violence
smoking!

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6
Q

significant comorbidities that increase risk for preterm labor and birth

A

maternal depression
gestational diabetes
preeclampsia/HTN
UTIs

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7
Q

age of viability

A

22-26 weeks

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8
Q

clinical presentation of preterm labor

A

contractions at reg rate
back pain
pelvic pressure
changes in cervix
mucous plug-bloody show
evidence of PPROM

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9
Q

Dx and labs for preterm labor

A

NST/BPP
nitrazine swab
fFN
measure cervical length (cervical insuffiency)

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10
Q

fFN (fetal fibronectin)

A

test of maternal vag secretions

negative: 2 weeks until giving birth

positive: isn’t always accurate; can pick up on protein if client recently has sex

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11
Q

primary treatment for preterm labor

A

tocolytic medications

slow contractions and delay cervical change

Terbutaline and Nifedipine
also Mag sulfate

short term: first 48 hours of labor

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12
Q

what can be given secondary and with tocolytic medications for preterm labor?

A

neonatal steroids

Betamethasone

to increase lung maturity

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13
Q

what is the greatest benefit in using tocolytic medications for preterm labor?

A

doesn’t stop labor BUT prolongs it and gives the chance to admin neonatal steroids

Betamethasone

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14
Q

what is another treatment for preterm labor if client is having preterm labor due to cervical insufficiency?

A

cerclage

helps support weight of baby

placed 12-16 wks but can be placed UP TO 24 weeks gestation

removed PRIOR to labor

prevents dilation AND effacement of cervix

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15
Q

findings of mag sulfate toxicity

A

0 to +1 deep tendon reflexes

respiratory depression (less than 12/min, low O2 sat)

oliguria (less than 30 mL/hr)

high magnesium in blood (higher than 8 mEq/L)

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16
Q

define PROM

A

prelabor rupture of membranes

typically, contractions are what rupture your membranes, so have a ruptured membrane BEFORE having contractions/cervical change would be PRElabor

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17
Q

define PPROM

A

preterm prelabor rupture of membranes

rupture of membranes without signs of labor BEFORE 37 weeks

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18
Q

why does PPRROM place risk to mom and baby

A

infection
prematurity issues with baby
chorioamnionitis
risk for C section

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19
Q

risk factors that increase the possibility of the occurrence of PPROM

A

low BMI
low economic status
infection (UTI or vaginal)
cervical insuff.
amniocentesis
vag bleeding
multis
polyhydramnios
substance use

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20
Q

sign comorbidities that increase risk for PPROM

A

gest DM
HTN
cardiac/kidney/sickle cell diseases

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21
Q

why do you think polyhydramnios would cause PPROM

A

so much fluid just causes membranes to rupture

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22
Q

manifestations of infection related to PPROM

A

foul-smelling AF
weird color AF
100.4 or higher temp
uterine tenderness
elevated WBC
fetal tachycardia

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23
Q

expected WBC during pregnancy

A

5,000-15,000

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24
Q

treatment of PPROM for clients peri viable (so near term)

A

expected mang (wait and see)

or induction of labor

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25
Q

meds for PPROM

A

antibiotics to prevent chorioamnionitis and decrease infection to baby too

common ones:

penicillin and vancomycin (if allergic to penicillins)

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26
Q

EARLY preterm Tx for PPROM (7 things)

A

(24-33 6/7 weeks)

Hospitalization

Expectant management (monitor for infection)

Tocolysis (if indicated)

Corticosteroids for fetal lung maturity

Magnesium sulfate for fetal neuroprotection

If infection present, antibiotics then proceed toward birth

GBS screening and treatment (if positive)

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27
Q

LATE preterm Tx for PPROM

A

(34-36 6/7 weeks)

Hospitalization

Expectant management (monitor for infection)

Corticosteroids (if birth anticipated within 7 days)

If infection present, antibiotics then proceed toward birth

GBS screening and treatment (if positive)

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28
Q

when do you not give tocolytics for PPROM

A

late preterm: 34-36 6/7

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29
Q

what color on nitrazine paper shows ROM

A

blue

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30
Q

what helps prevent CP in premature babies

A

mag sulfate

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31
Q

define chorioamnionitis

A

infection that results in inflammation of the (any combo of the) uterus, amniotic fluid, or placenta

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32
Q

what is chorioamnionitis most common in

A

clients who have preterm labor, PPROM, or prolonged rupture of membranes

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33
Q

common infectious organisms with chorioamnionitis

A

E coli or fungal candida

STI like trichomoniasis

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34
Q

risk factors for chorioamnionitis

A

in-vitro preg
maternal smoking/substance use
cervical ballon or labor with meconium AF
many vag exams during labor

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35
Q

initial manifestation of chorioamnionitis

A

fever (100.4 or higher on 2 occasions at least 30 mins apart)

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36
Q

other manifestations of chorioamnionitis

A

uterine tenderness
purulent AF
mom/baby tachycardia
high WBC (above 15,000)

same as infection

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37
Q

Dx of chorioamnionitis

A

AF culture:
high C-reactive protein
leukocytosis (high leukocytes)

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38
Q

treatment for chorioamnionitis

A

antibiotics

Ampicillin
Gentamycin
Clindamycin
Cefazolin

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39
Q

why to continue antibiotics with chorioamnionitis after birth?

A

at least 1 more dose to lower risk for endometriosis

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40
Q

induction versus augmentation

A

Induction: meds TO HELP LABOR begin

Augmentation: meds to HELP LABOR progress when labor spontaneously occurs

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41
Q

labor dystocia

A

prolonged labor with minimal cervical change

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42
Q

risk factors for dysfunctional labor

A

intra-amniotic infection
previous preg with labor dystocia
admin of epidural prior to an onset of effective labor pattern
unsuccessful positioning of mom

43
Q

clinical presentation of dysfunctional labor

A

ineffective contractions or mom/fetal anatomical disporportion

44
Q

when is augmentation of labor prescribed?

A

with client is having dysfunctional labor

45
Q

interventions to AUGMENT labor

A

amniotomy
IUPC
neuraxial anesthesia

46
Q

amniotomy

A

artificial rupture of membranes

47
Q

noninvasive interventions to augment labor

A

the nurse can encourage emptying of the bladder, ambulation, position changes, and relaxation methods such as hydrotherapy, focused breathing techniques, nourishment, and hydration

48
Q

second part (invasive) way to help augment labor

A

IV oxytocin

set contractions every 2-3 minutes

49
Q

what may be done to help treat labor dystocia (long labor with little cervical change)

A

amniotomy

50
Q

ideal fetal presentation

A

vertex (head first) cephalic

51
Q

risk factors for breech presentation

A

Hx of breech
placenta previa
bicornuate uterus
uterine leiomyoma
first pregnancy
multis

52
Q

comorbidities with breech presentation

A

caused by uterine malformation (risk factors in the other flash card)

53
Q

clinical presentation of breech

A

Leopold’s maneuvers

will be able to head HB loudest ABOVE umbilicus

54
Q

Tx: breech (at or near term)

A

EVC (abdominal palp to get baby into cephalic presentation)

55
Q

contraindications for EVC

A

premature rupture of membranes
non-reassuring FHR
vaginal bleeding
multis
placenta previa or abruption
uncontrolled preeclampsia, HTN, cardiac disease

56
Q

complications of EVC

A

placental abruption, cord prolapse, or uterine rupture, so it should take place in a facility with the capacity to perform an emergency cesarean birth if indicated

57
Q

what does unexpected FHR patterns consist of?

A

bradycardia
tachycardia
decreased or absent variability
late/variable decelerations

58
Q

risk factors for non-reassuring FHR patterns

A

preg past 41 weeks OR complications of labor (VEAL CHOP)

interventions for augmentation of labor (oxytocin, amniotomy, etc)

59
Q

maternal conditions that can impact FHR

A

diabetes
preeclampsia
HTN
infection
placental abruption

60
Q

non-reassuring FHR tx

A

intrauterine resuscitation

61
Q

what does it mean for baby if meconium is found in AF

A

hypoxia and aspiration

62
Q

greatest risk for meconium in the AF

A

post-term!!!

63
Q

other conditions that can increase risk for meconium in AF

A

breech
chorioamnionitis
preeclampsia
vag misoprostol

64
Q

factors associated higher risk for meconium-stained AF (mom)

A

mom:

Obesity

Nulliparity

Smoking

Drug use

Diabetes

Chronic cardiac or respiratory disease

Hypertension

65
Q

factors associated higher risk for meconium-stained AF (baby)

A

Post-term pregnancy

Oligohydramnios

Intrauterine growth anomalies (SGA or LGA)

66
Q

meconium-stained AF presentation

A

brown, green, yellow

after ROM or during amniocentesis

67
Q

tx for MSAF

A

amnioinfusion to decrease risk of meconium aspiration syndrome (MAS)

68
Q

contraindications for amnioinfusion

A

placenta previa
vag bleeding
polyhydramnios
active herpes/HIV
uterine anomalies

69
Q

what is mom at risk for with MSAF

A

infection

monitor for clinical signs of infection in maternal clients

70
Q

why would an operative birth need to be required?

A

non-reassuring FHR pattern
maternal exhaustion
prolonged second stage of labor
mom neuro/cardio condition

71
Q

is operative vaginal birth a complication or intervention?

A

intervention to aid in fetal descent` during SECOND stage of labor

72
Q

two devices used in operative vaginal birth

A

vacuum extractor

forceps

73
Q

vacuum extractor

A

Suction applied to the fetal head to aid in descent

Traction applied during contractions with maternal pushing efforts

Most common type of operative vaginal birth

Contraindicated prior to 34 weeks of gestation

74
Q

forceps

A

Spoon-like devices that must be placed securely around the fetal head

May aid in fetal rotation and descent

May be used when maternal pushing efforts are contraindicated or ineffective

75
Q

maternal risks from having an operative vaginal birth

A

Tissue trauma

Increased pain

Hemorrhage

Postpartum incontinence

76
Q

fetal risks from vacuum extraction

A

Cephalohematoma

Intracranial hemorrhage*

Scalp laceration

Brachial plexus injury (Erb-Duchenne palsy)

77
Q

fetal risks from forceps

A

Facial lacerations

Facial nerve palsy

Ocular trauma

Skull fracture

Intracranial hemorrhage*

78
Q

cephalohematoma

A

Collection of blood that accumulates under the scalp caused by shearing forces to the scalp and skull.

can happen from vacuum extraction

79
Q

how many times to do vacuum extractor

A

no more than 2-3 as it can increase risk for fetal trauma

80
Q

define prolapsed cord

A

EMERGENCY

cord goes through the vaginal opening and is visible upon examination

81
Q

risk factors for cord prolapse

A

growth restriction
SGA
fetal malpresentation
male sex
PPROM
polyhydramnios
preterm
multis
PROM
cord and fetal anomalies
amnioinfusion
anmiotomy
EVC
IUPC
cerv ballon

82
Q

comorbidities with prolapsed cord

A

diabetes and infection
polyhydramnios or PROM

83
Q

clinical presentation of prolapsed cord

A

fetal bradycardia
variable decelerations
prolonged decelerations
change in FHR

84
Q

tx for prolapsed cord

A

emergent cesarean birth

85
Q

What positions should the nurse assist the client into for umbilical cord prolapse?

A

Trendelenburg
knee-chest
left lateral semi-prone recumbent

86
Q

placenta abruption

A

placenta separates from the uterine wall either partially or totally before or during birth

87
Q

what can placenta abruption cause

A

hypovolemia
fetal hypoxia
preterm birth

88
Q

risk factors for placental abruption

A

amniotic infection
short umbilical cord
HTN!
preeclampsia/eclampsia!
pregest DM!
polyhydramnios
AMA
smoking
cocaine
previous abruption
alc

89
Q

comorbidities (mom) that can lead to placental abruption

A

HTN
DM
anemia
depression

90
Q

clinical presentation of placenta abruption

A

sharp abdominal pain
vaginal bleeding
board-like abdomen
late decels/bradycardia for FHR

91
Q

what to monitor for placental abruption

A

vitals
Hgbl + Hct
newborn assessment
FHR

92
Q

define uterine rupture

A

EMERGENCY

all three layers of uterus tear
baby floats in abdominal cavity

93
Q

biggest risk factor for uterine rupture

A

previous C-section!!!!

94
Q

other risk factors for uterine rupture include

A

fetal malpresentation
macrosomia
polyhydramnios
partner violence
use of oxytocin
uterine fibroids
multis

95
Q

clients findings in uterine rupture

A

uterine atony
acute onset abdominal pain
acute bleeding
N/V, dizziness
loss of fetal station
hypotension/tachycardia
hematuria
sudden change in shape of uterus

96
Q

Tx of uterine rupture

A

EMERGENCY

immediate C-section!!

97
Q

shoulder dystocia

A

EMERGENCY

should is impacted behind maternal pubic bone after birth of the head

98
Q

greatest risk for shoulder dystocia

A

macrosomia due to diabetes

99
Q

what are some other risks for shoulder dystocia

A

male
epidural
prolonged second stage on birth
operative vag birth

100
Q

turtle sign!!!

A

SHOULDER DYSTOCIA

head emerges and then retracts

101
Q

comorbidities for shoulder dystocia

A

maternal obesity
gestational diabetes
fetal macrosomia

102
Q

McRobert’s position

A

legs up

Hyperflexion of client’s thighs toward the abdomen to increase pelvic circumference.

shoulder dystocia

103
Q

suprapubic pressure

A

pressing hard on baby on abdomen

Mother Baby (9 decks)

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