Complications of Labor and Delivery
Terms
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- Premature Rupture of Membraness
- Spontaneous rupture of membranes before the onset of labor
- Diagnostic tests for Rupture of Membrane
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Nitazine pater - turns blue
Ferning test - looks like fern under microscope if positive - Management of premature rupture of membranes if < 37 wks gestation with no signs of infection
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Hospitalization on bed rest
Monitor fetal well being
Administration of betamethasone 24 hrs prior to immanent labor to aid fetal lung development - Preterm Labor
- Labor that occus between 20 and 36 completed weeks of pregnancy
- Fetal Risks with Preterm Labor
-
Respiratory distress syndrome
Risk of trauma during birth
Maturational deficiencies inc.:
decreased fat storage
decreased thermoregulation
immaturity of organ systems - Early signs of preterm labor
-
Backache
Tightening in abdomen
Bloody show - Conditions that can initiate preterm labor
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UTIs
Vaginal discharge caused by bacterial vaginosis - Predictors of preterm labor
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Cervicovaginal fibronectin
Abnormal cervical length
History of previous preterm
birth
Presence of infection
(acute pyleonephritis,bacterial
vaginosis) - Incompetent Cervux
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Premature cilatation of cervix
Occurs in the 4th-5th month - Medical diagnosis and management of Incompetent cervix
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History of spontaneous abortions
Sterile Speculum Exam revealing
Effacement and dilitation of
cervix
Bulging membranes
Vaginal ultrasounds to detect
cervical length
TX: Cerclage - Cerclage
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Puse string suture inserted in the cervix to prevent preterm cervical dilatiation
After placement the string is tightened and secured - Delivery options with a cerclage
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C-section: sutures left in place
Vaginal: sutures removed before term - Nursing care management of preterm labor
-
Position pt on left side to maintain good uterine blood flow
Electronic fetal monitoring to detect uterine contractions
Prevent dehydration with IV infusion
Administer tocolytic medication
- Tocolytics
-
Magnesium sulfate IV
Terbutaline sulfate PO
Nifedipine PO -
Indications for use of
Magnesium Sulfate IV during pregnancy -
Used to treat preeclampsia and eclampsia
Used rarely to suppress uterine contraction - Therpeutic range of Magnesium Sulfate
- 4-8 mg/dL
- Required monitoring with use of Magnesium Sulfate
-
Respiratory rate
Maternal pulmonary edema - Side effect of magnesium sulfate
-
lethargy and weakness
sweating
flushing - Signs of magnesium sulfate toxicity
-
Depression or absence of
reflexes (occurs at levels
>9 mg/dL)
Oliguia
Confusion
Respiratory depression - Fetal side effects with magnesium sulfate
-
respiratoru depression
muscle weakness - Nursing interventions for magnesium sulfate use
-
Monitor maternal VS q 15 min
Monitor maternal serum magnesium
levels
Check levels
Check reflexes
Have calcium gluconate at
bedside - Tocolytic most often given to stop uterine contractions
- Nifedipine PO
- Side effects of Terbualine sulfate PO
-
Palpatations
Tremor
Dizziness
Nervousness - Side effects of Nifedipine PO
-
Hypotension
Tachycardia
Facial flushing
Headache - Placenta Previa
- The placenta is improperly implanted in the lower uterine segment
- Signs and symptoms of placenta previa
- Painless bright red vaginal bleeding occurring when placental villi are torn from uterine wall during uterine contractions
- Risk factors for placenta previa
-
Multiparity
Advanced maternal age
Previous C-section - Diagnostic method for diagnosing placenta previa
- Ultrasound
- Treatment for placenta previa if < 37 wks gestation
-
Bed rest with BRP as long as
not bleeding
No rectal or vaginal exams
Monitoring of blood loss, pain
and uterine contractibility
Evaluation of FHTs and VS
Evaluation of H&H
IV fluids
2 units of cross-match blood
available for transfusion - Treatment for placenta previa if >37 wks gestation
-
Deliver vaginally if bleeding stops or C-sec if still bleeding
- Abruptio Placenta
- Premature separation of a normally implanted placenta from the uterine wall
- Clinical manifestations of multiple gestation
-
SOB
Backaches
Pedal edema
Abnormal fetal presentation
Uterine dysfunction
Prolapsed cord
Hemorrhage at birth - Dietary considerations with multiple gestation
- Increased protein intake and increased total caloric intake
- Effect of multiple gestation on fetus
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Higher mortality
Decreased intrauterine growth rate
Increased incidence of fetal anomalies
Increased risk of prematurity
Twin to twin transfusion syndrome - Factors that may result in hydramnios
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Congenital anomalies
Increase of fetal urine caused by maternal diabetes, Fh sensitizatin, multiple gestation - Fetal/Neonatal risks with oligohydramnios
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Pulonary hypoplaia (less fluid availabe for fetus to use during fetal breathing movements)
Fetal skin and skeletal abnormalities
Umbilical cord compression during labor - Medical treatment for oliohydromnios
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Fetal assessment (biophysical profile, NST, US)
During labor - continuous FHT
After ROM - Amnioinfusion (transcervical instillation of 250 mL of warmed sterile saline via catheter to provide additional cushioning - Dystocia
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Difficult labor
Labor not progressing due to hypertonic uterine dysfunction or hypotonic uterine dysfunction - Hypertonic uterine dysfunction
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Contractions are painful but ineffective in dilating and effacing the cervix - may lead to prolonged latent phase
Increased resting tone
Most commonly afflicted - very anxious nulliparas at term or post term - Medical treatment for hypertonic uterine dysfunction
-
Rule out CPD and fetal malpresentation
Bed rest
Sedation (seconal)
C-sec if signs of fetal distress - Hypotonic uterine dysfunction
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Labor patterns begin normally then p rogress to infrequent, less intense contractions and a marked slowing or arrest of cervical dilatiation
Ususally during active phasse - Causes of Hypotonic Uterine Dysfunction
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Overdistension of uterus due to twins, large singleton, hydraminios, grandmultiparity
Inappropriate analgesic
Pelvic contraction(CPD)
Fetal malposition - Medical treatment for hypotonic uterine dysfunction
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Oxytocin (if no contraindications such as prematurity, CPD, fetal malpresentation)
Amniotomy (of GBS positive, give antibiotics first)
IV fluids - Nursing care for hypotonic uterine dysfunction
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Assess contractions, maternal VS, FHR
Assess amniotic fluid
Monitor for s/s of infection and dehydration
Have pt void q 2 hrs
Provide psych support - Postterm pregnancy
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One that extends past 42 weeks gestation
Incidence 7%
More frequent in premigravidas and >35 yrs - Postterm Pregnancy maternal resk
-
Increased incidence of operative birth (C/S, forceps)
Labor induction
LGA infant
Infection - Postterm Pregnancy - Fetal/Neonatal Risks
-
Meconium aspiration
Oligohydramnios (umbilical cord compression) variable decels
Macrosomia (birth trauma or shoulder dystocia)- >4000gm
Decreased placental perfusion
Fetal demise - Medical treatment for postterm pregnancy
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Antenatal testing (NST, US exams (biophysical profile)
Kick count - hydromnios
-
occurs when there is over 2000 mL of amniotic fluid
Diagnosed by ultrasound