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EXAM #3 - FAMILY
Labor Complications/Infections
| Question | Answer |
|---|---|
| Toxoplasmosis | Transferred by hand to mouth after touching cat feces, while changing their litter box or through gardening contaminated soil. Avoid eating raw or undercooked meat (especially lamb or pork). Clean cutting boards. Peel or wash all raw fruits and veggies before eating, wear gloves when gardening. Keep cat indoors to prevent them from hunting and eating birds/rodents with the disease |
| Cytomegalovirus | Transmitted via sexual contact, blood transfusions, kissing, contact with children in daycare centers. Permanent disability can occur (especially when infected during the first trimester) |
| Parvovirus | Common, self-limiting benign childhood virus that causes fifth disease. Pregnant women may carry the virus and transmit it to the fetus. BLOOD OR ORAL PHARYNGEAL TEST. Slap Cheek appearance, rash, fever, malaise |
| Rubella | Type of virus, often called GERMAN or THREE-DAY-MEASLES Droplet spread. Tested for at first prenatal visit, if not immune, we give a vaccine |
| Systemic Lupus Erythmatosus | Recommended to postpone conception until the disease has been stable or in remission for at least 6 months. Active disease at the time of conception and history of renal disease increase the likelihood of poor pregnancy outcomes. Possible to have first every flare up and be diagnosed during pregnancy |
| Herpes Simplex | Highly contagious, recurrent infection, caused by HSV1 or HSV2. Possibility for spontaneous abortion, birth anomalies, or preterm birth. Treatment of antiviral agents (acyclovir) are needed. C-Section is preferred, but vaginal births are possible if there are no active lesions |
| Hepatitis B | A mother can receive a vaccination for Hep. B during pregnancy. If the mother tests positive for HBV during pregnancy, the baby will receive the HBV vaccine within 12 hours of birth – and then a second dose at 1 month --- and then a third dose at 6 months |
| Varicella Zoster Virus | Part of the herpes family, causes shingles or chicken pox. Passed from the mom through the placenta. If the patient is not immune VACCINE SHOULD BE GIVEN BEFORE PREGNANCY OCCURS |
| HIV | Provide counseling about the risk of perinatal transmission and potential obstetric complications. Should be treated with antiretroviral therapy (ART) regardless of CD4 count or viral load throughout pregnancy. IV administration during birth and oral zidovudine for the newborn within 6-12 hours of birth is preferred. Patient should be educated to avoid breast feeding |
| Group B Streptococcus | Prophylaxis antibiotics will be used during childbirth. CDC guidelines are that all pregnant women are screened for GBS at 25-37 weeks gestation and be treated. Vaginal and rectal specimens are cultured for the presence of the bacterium. Penicillin G is the drug of choice. The drug is usually administered IV at least 4 hours before birth so that it can reach adequate levels in the serum and amniotic sac. |
| Blood Incompatibility | Incompatibility can be prevented with the use of Rho(D) immune globulin to Rh negative Women. Suppresses immune response of non-sensitized Rh-negative clients exposed to Rh-positive blood after abortions, miscarriages, and pregnancies. Administer IM. Educate woman that she will need this after subsequent deliveries if fetuses are Rh-positive. Also check lab study results prior to administering the drug |
| Dystocia | Difficult or prolonged labor |
| Shoulder Dystocia | OBSTRUCTION OF FETAL DESCENT OFTEN DUE TO THE AXIS OF THE FETAL SHOULDERS AFTER THE HEAD HAS BEEN DELIVERED. Increased risk of brachial plexus palsy, postpartum hemorrhage. |
| Brachial Plexus Palsy | Transient Erb or Duchenne Brachial Plexus Palsies, Clavicular or Humeral Fractures are the most common |
| McRoberts Manuever | Can reduce severity of injuries to both mother and newborn. Mother's thighs are flexed and abducted as much as possible to straighten pelvic curve |
| Suprapubic Pressure | Light pressure is applied just above the pubic bone, pushing the fetal anterior shoulder downward to displace it from the symphysis pubis |
| Umbilical Cord Prolapse | A rare, obstetric emergency that occurs when the cord precedes the fetus out. Leading to a total or partial occlusion, and fetal oxygen deprivation. Possible visualized cord outside of the vagina, or abnormal, non-reassuring fetal heart rate is often the first indication |
| Umbilical Cord Prolapse Risk Factors | AMNIOTOMY, multiparity, multigestations, low birth weight, long length of umbilical cord, noncephalic presentations, preterm labor, hydramnios. |
| Umbilical Cord Prolapse Interventions | Raise presenting part off the umbilical cord with gloved hand. Call for help. Administer oxygen 8-10 L/min via face mask. Place patient in Trendelenburg or Knee chest position. Monitor Vital Signs. Monitor FHR. Prepare for Birth (c-section) |
| Preterm Infant | Born before 37 weeks |
| Late Preterm Infant | Born between 34 0/7 to 36 6/7 weeks |
| Full term infant | Born between 38 and 41 weeks |
| Postterm Infant | Born after 42 weeks |
| Tests and Diagnostics for Preterm Labor Risks | CBC. Urinalysis. Amniotic Fluid Analysis. Fetal Fibronectin Testing. Cervical Length Evaluation by Transvaginal Ultrasound. Salivary Estriol. Home Monitoring of Uterine Activity |
| Signs and Symptoms of Preterm Labor | Change/Increase in Vaginal Discharge. Pelvic Pressure, or Low, Dull Backache. Menstrual Like Cramps. Feeling of Pressure or Fullness. GI Upset. General Sense of Discomfort. Heaviness or Achiness in Thighs. Persistent Uterine Contractions with or without Pain. More than 6 contractions per hour. Intestinal Cramping with or without Diarrhea |
| Treatment of Preterm Labor | Tocolytic Drugs such as Magnesium Sulfate, Indomethacin (Indocin), Nifedipine (Procardia) & Corticosteroids such as Betamethasone (Celestone) |
| Complications of the Preterm Infant | Leading cause of death within the first month of life. Second leading cause of death of all infants. Newborn is at risk for complications due to organ system immaturity. More likely to be affected by hypothermia, hypoglycemia, respiratory distress, apnea, jaundice, feeding difficulties. Often have neurodevelopment delays in the first years of life. |
| Tocolytic Drugs MOA | Promote uterine relaxation by interfering with uterine contractions to manage preterm labor. May prolong gestation from 2-7 days (typically does not stop – but prolongs labor). During this time periods, steroids can be given to improve fetal lung maturity and the woman can be transported to a tertiary care center |
| Corticosteroids MOA | A single course is recommended for all pregnancy women between 24-35 weeks gestation, who are at risk of preterm labor within 7 days. Prenatal corticosteroids significantly reduce the incidence and severity of neonatal respiratory distress syndrome |
| Magnesium Sulfate | Relaxes uterine muscles, stops contractions. Also used in seizure prophylaxis and treatment of seizures in preeclamptic and eclamptic seizures. oONLY GIVEN IV, MONITOR FOR WATER INTOXIFICATION. Monitor FHR, I&Os, respiratory rate. Report urine output less than 30 mL per hour, respiratory rate less than 12 per minute, and pulmonary edema in the lungs |
| Indomethacin (Indocin) | used to inhibit contractions in preterm labor. DO NOT GIVE TO WOMEN WITH PEPTIC ULCER DISEASE. Schedule an ultrasound to assess amniotic fluid volume and function of ductus arteriosus BEFORE THERAPY. Monitor for maternal hemorrhage. CONTRADICTED IN THOSE OVER 32 WEEKS GESTATION, FETAL GROWTH RESTRICTION, HISTORY OF ASTHMA, URTICARIA, OR ALLERGIC REACTIONS TO ASPIRIN OR NSAIDS |
| Nifedipine (Procardia) | Blocks calcium movement into muscle cells, to stop contractions in preterm labor. Use with caution if given with magnesium sulfate as there is an increased risk of hypotension. Also monitor BP hours and report a pulse of less than 110 bpm. MONITOR FOR DECREASED UTEROPLACENTAL BLOOD FLOW, MANIFESTED BY FETAL BRADYCARDIA. CONTRADICTED IN WOMEN WITH CARDIOVASCULAR DISEASE OR HEMODYNAMIC INSTABILITY |
| Betamethasone (Celestone) | Promotes fetal lung maturity by stimulating surfactant production. Prevents or reduces the risk of respiratory distress syndrome and intraventricular hemorrhage in the preterm neonate less than 34 weeks gestation. Administer 2 doses IM 24 hours apart. MONITOR FOR MATERNAL INFECTION AND PULMONARY EDEMA. Educate on the benefits of drug to the preterm infant. ASSESS LUNG SOUNDS AND MONITOR FOR SIGNS OF INFECTION |
| Magnesium Sulfate Side Effects | Flushing, nausea, vomiting, dry mouth, blurred vision, headache, transient hypotension |
| Magnesium Sulfate Toxicity | Decreased LOC, depressed respirations and DTR, slurred speech, weakness, and respiratory or cardiac arrest. CALCIUM GLUCONATE should be available at the bedside to reverse toxicity. |
| Indomethacine (Indocin) Side Effects | Nausea, vomiting, heartburn, rash, prolonged bleeding time, oligohydramnios, and hypertension |
| Nifedipine (Procardia) Side Effects | Flushing of the skin, transient tachycardia, palpitations, headache, postural hypertension, peripheral edema, and trasient fetal tachycardia. |
| Labor Induction | Can increase the risk for C-Section births, longer birth times, increased risk of the need for instrumental delivery, epidural use, and NICU admission. Includes IV therapy, bed rest, continuous fetal monitoring, increase dlabor discomfort, and prolonged hospital stays |
| Amniotomy | Surgical Stripping of membranes with an amnihook. Promotes pressure of the presenting part on the cervix and stimulates and increases the activity of prostaglandins locally. Monitor the amount, color, odor, and consistency of amniotic fluid. RISKS include umbilical cord prolapse, cord compression, maternal/neonatal infection, FHR deceleration, bleeding, and client discomfort |
| Prostaglandins | Dinoprostone Gel (Prepidil), Dinoprostone Inserts (Cervidil), and Misoprostol (Cytotec). Meds used to attain cervical ripening Some women require no additional stimulants and go into labor on their own. RISKS include their ability to induce excessive uterine contractions, which can increase maternal and perinatal morbidity. Contraindicated in women with prior uterine scars |
| Oxytocin | Potent endogenous uterotonic agent used both for artificial induction and augmentation of labor. Woman may receive prostaglandins the night before, and then receive this medication if they do not go into labor on their own. CONTRADICTED IN A DISTENDED UTERUS. |
| Oxytocin Adverse Effects | Can cause uterine hyperstimulation which leads to fetal compromised and impaired oxygenation. Also can cause water intoxification due to its antidiuretic effects. Monitor mothers for headache and vomiting |
| Bishop Score | Is used to evaluate the predicted success of labor induction |
| Misoprostol (Cytotec) | Stimulates uterine contractions to terminate pregnancy and evacuate the uterus. Ensures passage of all products. Monitor for side effects such as diarrhea, nausea, vomiting, and dyspepsia. Assess for vaginal bleeding, and report any increased bleeding, pain or fever. Monitor signs and symptoms of shock, such as tachycardia, hypotension, and anxiety |
| Mifepristone (PU-486) | Acts as a progesterone antagonists allowing prostaglandins to stimulate uterine contractions. Endometrium will slough. May be followed by misoprostol within 48 hours. Monitor for headache, vomiting, and heavy bleeding. Anticipate administration of antiemetic prior to use to reduce nausea & vomiting. Encourage the client to use acetaminophen to reduce discomfort from cramping |
| PGE2, Dinoprostone (Cervidil) | Stimulates uterine contractions, expels uterine contents in fetal death or missed abortion during second trimester. Effaces and dilates the cervix. Bring gel to room temperature before administering. Avoid contact with skin, using a sterile technique to administer. Keep client supine for 30 minutes after administration. Document time of insertion, and dosing intervals Remove insert with retrieval system after 12 hours or at the onset of labor. Explain the purpose and expected response to the client |
| VBAC | Vaginal birth after cesarean. It is a women who is giving birth vaginally after having at least one previous c section RISK INCLUDES POSSIBLE UTERINE RUPTURE. |
| TOLAC | Trial of labor after cesarean. A planned attempt to give birth vaginally after a previous surgical birth. |
| Contraindications in VBAC | Classic uterine scar that is vertical. Obesity, short-maternal stature, macrosomia, maternal age over 40, gestational diabetes, inadequate staff |
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