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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
meds for PPROM
antibiotics to prevent chorioamnionitis and decrease infection to baby too common ones: penicillin and vancomycin (if allergic to penicillins)
26
EARLY preterm Tx for PPROM (7 things)
(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)
27
LATE preterm Tx for PPROM
(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)
28
when do you not give tocolytics for PPROM
late preterm: 34-36 6/7
29
what color on nitrazine paper shows ROM
blue
30
what helps prevent CP in premature babies
mag sulfate
31
define chorioamnionitis
infection that results in inflammation of the (any combo of the) uterus, amniotic fluid, or placenta
32
what is chorioamnionitis most common in
clients who have preterm labor, PPROM, or prolonged rupture of membranes
33
common infectious organisms with chorioamnionitis
E coli or fungal candida STI like trichomoniasis
34
risk factors for chorioamnionitis
in-vitro preg maternal smoking/substance use cervical ballon or labor with meconium AF many vag exams during labor
35
initial manifestation of chorioamnionitis
fever (100.4 or higher on 2 occasions at least 30 mins apart)
36
other manifestations of chorioamnionitis
uterine tenderness purulent AF mom/baby tachycardia high WBC (above 15,000) same as infection
37
Dx of chorioamnionitis
AF culture: high C-reactive protein leukocytosis (high leukocytes)
38
treatment for chorioamnionitis
antibiotics Ampicillin Gentamycin Clindamycin Cefazolin
39
why to continue antibiotics with chorioamnionitis after birth?
at least 1 more dose to lower risk for endometriosis
40
induction versus augmentation
Induction: meds TO HELP LABOR begin Augmentation: meds to HELP LABOR progress when labor spontaneously occurs
41
labor dystocia
prolonged labor with minimal cervical change
42
risk factors for dysfunctional labor
intra-amniotic infection previous preg with labor dystocia admin of epidural prior to an onset of effective labor pattern unsuccessful positioning of mom
43
clinical presentation of dysfunctional labor
ineffective contractions or mom/fetal anatomical disporportion
44
when is augmentation of labor prescribed?
with client is having dysfunctional labor
45
interventions to AUGMENT labor
amniotomy IUPC neuraxial anesthesia
46
amniotomy
artificial rupture of membranes
47
noninvasive interventions to augment labor
the nurse can encourage emptying of the bladder, ambulation, position changes, and relaxation methods such as hydrotherapy, focused breathing techniques, nourishment, and hydration
48
second part (invasive) way to help augment labor
IV oxytocin set contractions every 2-3 minutes
49
what may be done to help treat labor dystocia (long labor with little cervical change)
amniotomy
50
ideal fetal presentation
vertex (head first) cephalic
51
risk factors for breech presentation
Hx of breech placenta previa bicornuate uterus uterine leiomyoma first pregnancy multis
52
comorbidities with breech presentation
caused by uterine malformation (risk factors in the other flash card)
53
clinical presentation of breech
Leopold's maneuvers will be able to head HB loudest ABOVE umbilicus
54
Tx: breech (at or near term)
EVC (abdominal palp to get baby into cephalic presentation)
55
contraindications for EVC
premature rupture of membranes non-reassuring FHR vaginal bleeding multis placenta previa or abruption uncontrolled preeclampsia, HTN, cardiac disease
56
complications of EVC
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
what does unexpected FHR patterns consist of?
bradycardia tachycardia decreased or absent variability late/variable decelerations
58
risk factors for non-reassuring FHR patterns
preg past 41 weeks OR complications of labor (VEAL CHOP) interventions for augmentation of labor (oxytocin, amniotomy, etc)
59
maternal conditions that can impact FHR
diabetes preeclampsia HTN infection placental abruption
60
non-reassuring FHR tx
intrauterine resuscitation
61
what does it mean for baby if meconium is found in AF
hypoxia and aspiration
62
greatest risk for meconium in the AF
post-term!!!
63
other conditions that can increase risk for meconium in AF
breech chorioamnionitis preeclampsia vag misoprostol
64
factors associated higher risk for meconium-stained AF (mom)
mom: Obesity Nulliparity Smoking Drug use Diabetes Chronic cardiac or respiratory disease Hypertension
65
factors associated higher risk for meconium-stained AF (baby)
Post-term pregnancy Oligohydramnios Intrauterine growth anomalies (SGA or LGA)
66
meconium-stained AF presentation
brown, green, yellow after ROM or during amniocentesis
67
tx for MSAF
amnioinfusion to decrease risk of meconium aspiration syndrome (MAS)
68
contraindications for amnioinfusion
placenta previa vag bleeding polyhydramnios active herpes/HIV uterine anomalies
69
what is mom at risk for with MSAF
infection monitor for clinical signs of infection in maternal clients
70
why would an operative birth need to be required?
non-reassuring FHR pattern maternal exhaustion prolonged second stage of labor mom neuro/cardio condition
71
is operative vaginal birth a complication or intervention?
intervention to aid in fetal descent` during SECOND stage of labor
72
two devices used in operative vaginal birth
vacuum extractor forceps
73
vacuum extractor
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
forceps
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
maternal risks from having an operative vaginal birth
Tissue trauma Increased pain Hemorrhage Postpartum incontinence
76
fetal risks from vacuum extraction
Cephalohematoma Intracranial hemorrhage* Scalp laceration Brachial plexus injury (Erb-Duchenne palsy)
77
fetal risks from forceps
Facial lacerations Facial nerve palsy Ocular trauma Skull fracture Intracranial hemorrhage*
78
cephalohematoma
Collection of blood that accumulates under the scalp caused by shearing forces to the scalp and skull. can happen from vacuum extraction
79
how many times to do vacuum extractor
no more than 2-3 as it can increase risk for fetal trauma
80
define prolapsed cord
EMERGENCY cord goes through the vaginal opening and is visible upon examination
81
risk factors for cord prolapse
growth restriction SGA fetal malpresentation male sex PPROM polyhydramnios preterm multis PROM cord and fetal anomalies amnioinfusion anmiotomy EVC IUPC cerv ballon
82
comorbidities with prolapsed cord
diabetes and infection polyhydramnios or PROM
83
clinical presentation of prolapsed cord
fetal bradycardia variable decelerations prolonged decelerations change in FHR
84
tx for prolapsed cord
emergent cesarean birth
85
What positions should the nurse assist the client into for umbilical cord prolapse?
Trendelenburg knee-chest left lateral semi-prone recumbent
86
placenta abruption
placenta separates from the uterine wall either partially or totally before or during birth
87
what can placenta abruption cause
hypovolemia fetal hypoxia preterm birth
88
risk factors for placental abruption
amniotic infection short umbilical cord HTN! preeclampsia/eclampsia! pregest DM! polyhydramnios AMA smoking cocaine previous abruption alc
89
comorbidities (mom) that can lead to placental abruption
HTN DM anemia depression
90
clinical presentation of placenta abruption
sharp abdominal pain vaginal bleeding board-like abdomen late decels/bradycardia for FHR
91
what to monitor for placental abruption
vitals Hgbl + Hct newborn assessment FHR
92
define uterine rupture
EMERGENCY all three layers of uterus tear baby floats in abdominal cavity
93
biggest risk factor for uterine rupture
previous C-section!!!!
94
other risk factors for uterine rupture include
fetal malpresentation macrosomia polyhydramnios partner violence use of oxytocin uterine fibroids multis
95
clients findings in uterine rupture
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
Tx of uterine rupture
EMERGENCY immediate C-section!!
97
shoulder dystocia
EMERGENCY should is impacted behind maternal pubic bone after birth of the head
98
greatest risk for shoulder dystocia
macrosomia due to diabetes
99
what are some other risks for shoulder dystocia
male epidural prolonged second stage on birth operative vag birth
100
turtle sign!!!
SHOULDER DYSTOCIA head emerges and then retracts
101
comorbidities for shoulder dystocia
maternal obesity gestational diabetes fetal macrosomia
102
McRobert's position
legs up Hyperflexion of client’s thighs toward the abdomen to increase pelvic circumference. shoulder dystocia
103
suprapubic pressure
pressing hard on baby on abdomen

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