Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
NCTC Maternity 2
Unit 2 Maternity NCTC
| Question | Answer |
|---|---|
| Danger signs in pregnancy | Sudden gush of fluid from vagina Vaginal bleeding Abdominal pain Persistent vomiting Epigastric pain Edema of face and hands Severe, persistent headaches Blurred vision or dizziness Chills with fever over 100.4° F Painful or reduced urine output |
| Ultrasound | visualizes and allows measurement of fetal structures |
| Amniotic fluid volume | measurement of fluid in pockets surrounding fetus |
| Estimation of gestational age by ultrasound | measures crown-rump length or biparietal and thigh measurements |
| MRI | used with high suspicion of anomaly |
| Kick count | 3 kicks/hr is desired |
| Doppler ultrasound blood flow | determines adequacy of blood through placenta and cord |
| Alpha-fetoprotein test | test of maternal blood sample to determines risk for neural tube defects, done around 15-19 weeks. Can find anencephaly, gastroschisis and Down syndrome |
| Chorionic villus sampling | collection of placental part for chromosomal studies, neural tube , (help detects anichephly- no head) |
| Amniocentesis | collection of amniotic fluid using US guidance for chromosomal studies, biochemical disorders, neural tube defects, anencephaly, and Down syndrome |
| Non-stress test | tests for fetal compromise in conditions such as gestational diabetes, hypertension, and posterm gestation; positive result desired. we want baby heart rate to go up 15 beats for 15 sec. |
| Vibroacoustic stimulation test | used with NST to stimulate fetal movement Contraction stress test – tests for likelihood of fetus to withstand labor; negative results desired |
| Percutaneous umbilical blood sampling | tests fetal blood for anemia caused by blood incompatibility, placenta previa, and abruption placenta. check for different enemia's!!! |
| Lecithin-to-sphingomyelin (L/S) ratio | 2:1 required for sufficient surfactant production. (by amnio, to check lung function/ development) |
| Hyperemesis gravidarum | N/V which severely hinders nutritional status, usually self-limiting May result in low-birth-weight baby Dehydration impairs perfusion of the placenta |
| Hyperemesis gravidarum Treatment: | Correct dehydration and electrolyte imbalances: oral &/or IV fluids, TPN Antiemetic drugs: Phenergan usually suppository form if hospitalized IV Zofran. TPN in severe cases FLUID AND ELECTROLYTE IMBALANCE IS PARAMOUNT |
| Hyperemesis gravidarum Nursing care: | Accurate I&O including Daily Weight Emotional support |
| Spontaneous abortion | Intentional or non-intentional termination of pregnancy before 20 weeks gestation - all will have bleeding and cramping |
| Threatened abortion | usually before 12 weeks of gestation *Closed cervix *No tissue is passed |
| Inevitable abortion: | *Cervix dilates Membranes may rupture *No tissue is passed- yet |
| Incomplete abortion | Same as Inevitable, but *some tissue is passed - but not all of it...still bleeding and cramping. |
| Complete abortion | *All POC are passed *Bleeding and cramping decrease *Cervix closes |
| Missed abortion - past 8 weeks | Fetus dies within the uterus but is not expelled for many weeks Changes of early pregnancy cease |
| Recurrent abortion (habitual abortion) | 3 or more consecutive abortions Structural abnormalities such as incompetent cervix |
| Induced abortion | Therapeutic – intentional to preserve the health of the mother Elective – intentional for reasons other than the health of the mother (such as fetal anomaly) |
| Threatened abortion: Treatment | Ultrasound to see if fetus is living No intercourse, douching, tampons, lifting until bleeding stops for at least 2 weeks Bed rest for at least 48 hours after each bleeding episode |
| Ectopic pregnancy | Zygote implants outside the uterus (95% are in the tube) |
| Ectopic pregnancy Manifestations: | Low (vague )abdominal pain Light vaginal bleeding Sometimes signs of shock if the tube ruptures Shoulder pain – referred pain from bleeding into the abdomen tachycardia |
| Hydatiform mole (gestational trophoblastic disease): | Occurs when the chorionic villi develop vesicles (sacs) that resemble grape-like clusters |
| Hydatiform mole (gestational trophoblastic disease): Manifestations: | Uterus larger than expected for gestational age; rapid uterine growth Signs of hyperemesis gravidarum Unusually high levels of hCG US shows "snowstorm" pattern but no developing fetus within the uterus |
| Hydatiform mole (gestational trophoblastic disease) Treatment: | Vacuum aspiration and D&E hCG monitoring q week X 6 months, then q 6 mo X 1 year or longer if at risk for carcinoma Persistently high hCG indicates retained vesicle or malignant changes delay pregnancy attempts until follow-up care is completed |
| Placenta previa | - Occurs when the placenta develops in the lower part of the uterus rather than the upper part of the uterus |
| Manifestations/Treatment:Placenta previa | Painless vaginal bleeding/ Depends on gestational age and amount of bleeding Bedrest C-sect if previa is partial or total |
| Abruptio placentae | Is the premature separation of a normally implanted placenta |
| Abruptio Placentae Manifestations | Bleeding accompanied by abd or low back pain Bleeding may be concealed behind the placenta Firm, board-like abd because blood leaks into muscle fiber May be complicated by DIC (disseminated intravascular coagulation) |
| Abruptio Placentae Treatment | Immediate C/S Blood and clotting factor replacement to tx DIC Close observation shock and bleeding Observe gums, nose, and other sites for signs of bleeding Close monitoring of fetal well-being Support for the family if fetus and/or mother dies |
| Hypertension during pregnancy | May exist before pregnancy, can complicate pregnancy, and may worsen with pregnancy if mom has chronic hypertension Old term is "toxemia"; may be called preeclampsia which progresses to eclampsia when accompanied by convulsions |
| Hypertension | Defined as 140/90+ Increases over baseline should be seriously considered |
| Edema | Occurs because fluid leaves the vessels for the tissue and decreases blood flow to the maternal organs and placenta Characterized by sudden excessive weight gain Edema above the waist suggests PIH |
| Proteinuria | Develops later as reduced blood flow damages the kidneys that allows protein to leak into the urine Must use clean catch or cath specimen due to false positives from vaginal secretions |
| Hypertension Manifestations: | CNS: Severe, unrelenting headache due to brain edema and small cerebral hemorrhages Eyes: Blurred, double vision, spots due to arterial spasm and edema Epigastric pain and nausea due to liver edema; Often precede seizures |
| HELLP syndrome | (Hemolysis, Elevated Liver enzymes, Low Platelets) Low platelets cause clotting problems |
| Eclampsia | An eclamptic seizure may result in cerebral hemorrhage, abruptio placenta, fetal compromise, or death of the mother or fetus. |
| Hypertension / preeclapsmia Management focuses on: | Maintaining blood flow to the woman's vital organs and the placenta Preventing convulsions Activity restriction is essential – bedrest, side-lying allows blood to be diverted from skeletal muscles to vital organs |
| Mag sulfate: | CNS depressant used as anticonvulsant Given per infusion pump Continued 12-24 hrs postpartum for continued risk of seizures |
| Mag sulfate: Antidote | Antidote is calcium gluconate |
| Mag sulfate: Excreted by the kidneys, so reduced kidney function can cause toxicity: | Absence of DTRs Respiratory depression Circulatory collapse Death |
| Antihypertensive drugs | Used if BP is higher than 160/100 Usual drugs of choice: hydralazine (Apresoline) or labetalol (Normodyne) New drugs like nifedipine (Procardia) or verapamil (Calan) now being used but do not have FDA approval for hypertensive control |
| Administering medications (common protocols) for hypertension pt | VS q 1 with T Q 4 DTRs q 1-4 I&O q 1 (may have indwelling cath for accuracy) Protein dip with q void Mag levels q 4 hrs |
| Hypertension/preeclampsia Deteriorating condition noted by: | Increasing BP Signs of CNS irritation: facial twitching, hyperactive DTRs Decreased urinary output Abnormal FHR Symptoms which commonly precede seizures: severe headache, visual disturbances, epigastric pain |
| Recognizing mag toxicity signs, report to charge nurse, administer calcium gluconate: | Absent DTRs Respirations under 12 Urine output < 30 ml/hr Serum mag > 8 mg/dl |
| Postpartum care Hypertension/preeclampsia | Must be monitored at least 48 hours during postpartum time Mom is still at risk for seizures for 72 hours after the birth of the baby Antihypertensive drugs may adversely affect milk production for breastfeeding |
| Rh incompatibility | Blood incompatible between the pregnant woman and fetus mom is RH- and baby is RH+ usually not a problem with the first RH+ baby but is for subsequent pregnancies |
| RH Incompatibility - testing | *New maternal plasma test available to determine fetal Rh status |
| RH Incompatibility - treatment | Primary treatment is prevention of antibody formation by RhoGam IM injection at 28 weeks and within 72 hrs postpartum Given after amniocentesis, placental previa, abruption, and abortion |
| If mom already has antibodies from prior sensitization: | Frequent Testing Amniocentesis detects fetal well-being Percutaneous umbilical blood sampling May require intrauterine transfusion O- RBCs injected into fetal umbilical vessels by US guidance May be required q 2 weeks from week 28 -term |
| Nursing care for pregnancy-related blood incompatibilities | Administer RhoGam every time it is indicated Careful observation and assessment of fetus especially during first 24 hrs |
| Effect of pregnancy on glucose metabolism | Increase resistance of cells to insulin Increase speed of insulin breakdown Most women respond to these changes by secreting more insulin |
| Gestational diabetes | Screening 24-28 weeks gestation >140 is indication for 3 hr GTT Diabetic dietician is recommended Usually self-testing is done keeping records at least qid |
| Insulin | Insulin preferred because it does not cross the placenta |
| Heart disease | Vaginal birth is preferred due to less risk of infection Forceps or vacuum extraction decrease need for maternal pushing (valsava ) |
| Folic acid-deficiency anemia | 1 mg or more qd for women with previous deliveries of babies with NTD |
| Torch infections: Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex | Do not adversely effect mom, but is devastating to fetus |
| Cytomegalovirus | Babe may present with: petechiae, deafness, blindness, mental retardation,seizures, dental abnormalities |
| Rubella | Mom presents with low-grade fever and rash Effects on developing fetus are devastating: microcephaly, mental retardation, cardiac defects, deafness, congenital cataracts, IUGR, malformation of major body systems |
| Herpesvirus | Disseminated infection of the fetus results in high mortality rate (60%) Survivors may have neurologic complications Treatment and nursing care Avoid neonatal contact with lesions If mom has active lesions, do cesarean section |
| HIV - the causative organism of AIDS | AZT given PO to reduce transmission to fetus baby may be born positive but will seroconvert to negative. |
| Toxoplasmosis | Protozoal infection from cat feces, raw meat, or transplacental infection Wash fruits and vegetables well |
| Group B Strep | Most common cause of neonatal sepsis in the US with high neonatal mortality rate Screening during prenatal care and between 35-37 weeks gestation If positive screening or presence of following risk factors, give IV antibiotics |
| STI - Infections include: syphilis, gonorrhea, chlamydia, trichomoniasis, condylomata acuminata | Genital herpes results in 50-60% mortality rate for infants!!!!!! Screening and treatment according to the causative organism is required |
| Candidiasis | Most common cause of "Yeast" infection Causes: itching and occasional painful urination and intercourse, and cottage cheese discharge Neonate may be infected during delivery; presents as thrush Treated with miconazole (Monistat) |
| UTI | Can cause maternal septic shock and preterm labor High fever can decrease O2 supply to fetus |
| Smoking | Causes IUGR, abruptio placenta, preterm labor, stillbirth, increases neonatal death, and SIDS |
| Alcohol | Most commonly abused drug available Causes FAS: prenatal and postnatal growth retardation, facial abnormalities (flat, thin upper lip border, and downslant eyes) |
| Heroin | Neonatal absence syndrome presents within 24 hours: prolonged high-pitch crying,high need for sucking, tremulousness, seizures, hyperactivity, disturbed sleep- wake cycles |
| Anticonvulsants | For women with history of seizures and on anticonvulsants,MD will prescribe drug that is least teratogenic Phenobarb has lowest risk than other anticonvulsants |
| Anticoagulants | Heparin is the only anticoagulant that does not cross the placenta |
| Acne meds | isotretinoin (Accutane) causes serious fetal defects |
| TRAUMA IN PREGNANCY Three leading causes of death: | Automobile accidents Use care when performing ordinary tasks Use seat belts in automobiles Homicide Suicide Most common cause of fetal death is maternal death |
| The powers | the forces that cause cervix to open and propel fetus downward through the birth canal |
| Uterine contractions | Effects if cntx on the cervix Effacement (thinning) When 100% effaced, cervix feels like thin, slick membrane over the fetus mom doesn't push until she is 100% effaced Dilation (opening) Described in cm (fully dilated is 10 cm) |
| Frequency: | Elapsed time form the beginning of one cntx to beginning of the next cntx Described in minutes Cntx occurring more frequently than q 2 min may reduce fetal O2 and should be reported |
| Duration: | Elapsed time from the beginning of one cntx to the end of the same cntx Described in seconds Cntx longer than 90 sec reduce fetal O2 supply because the placenta is unable to refill with blood and should be reported |
| Intensity: | Approximate strength of the cntx Describes uterus as: Mild - nose Moderate - chin strong - forehead |
| Interval | The amount of time the uterus relaxes between cntx Persistent cntx with intervals shorter than 60 sec can reduce fetal O2 supply and should be reported |
| Maternal pushing | Voluntary pushing is begun only when the cervix is fully dilated Most women feel need to push before cervix is fully dilated due to fetus pressing on rectum - if so they need to blow with an open mouth. |
| Anterior fontanel | Diamond-shaped |
| Posterior fontanel | Triangular-shaped |
| Lie | Describes how the fetal body is oriented to the mother's spine Most common lie is longitudinal (>99%) - fetus is parallel to the spine |
| Attitude | Normal is flexion with head flexed forward and limbs flexed |
| Presentation | Refers to the fetal part that enters the pelvis first Cephalic is most common (95%) |
| Vertex | head is completely flexed with chin on chest (most desirable because the smallest possible diameter of the head enters the pelvis) |
| Breech presentation (3-4%) | Frank - buttocks are visible with legs flexed at the hips toward the shoulders Complete - buttocks visible with legs flexed at the knees and arms crossed Transverse (shoulder enters pelvis first) Requires c/s for delivery |
| Bloody show | Mucus plug that has sealed the cervix is dislodged, and tears small capillaries Bloody show is thick mucus mixed with pink or dark-brown blood May occur after vaginal exam or intercourse May begin a few days before labor, or when labor begins |
| False labor | Cntx without cervical changes Cntx are irregular and do not increase in frequency, intensity, or duration Walking relieves discomfort Discomfort is in abdomen and groin |
| True labor | Cntx that efface and dilate cervix Cntx become regular and develop a pattern with increased frequency, duration, intensity Cntx become stronger and more effective with walking Discomfort felt in lower back and low abdomen |
| Station describes the level of the presenting part (head) in the pelvis | Measured from the level of the ischial spines (0 station) Minus stations are above the ischial spines Plus stations are below the ischial spines |
| Engagement | Occurs when the fetal presenting part is at 0 station or lower Often occurs before labor's onset in the nullipara May not occur until after labor begins in multipara |
| When to go to the hospital or birthing center | Cntx - have developed a pattern and 5 min apart for primigravida or 10 min apart for 1 hour in multigravidas ROM - anytime membranes rupture or she thinks they have ruptured Bleeding other than bloody show Decreased fetal movement Concerned mom |
| FHR (110-160) | Is irregular and fluctuates 5-15 bpm Preterm fetus has faster HR; mature fetus has slower HR FHR may slow during cntx and returns to baseline by end of each cntx |
| When BOW ruptures | our first action is to check the baby heart rate listen for one full minute. When BOW ruptures, check color, odor, and amount of fluid WNL is clear with flecks of white vernix |
| Abnormal Amniotic fluid: | Green - passed some meconium and may indicate some fetal distress or newborn respiratory problems after birth Cloudy or yellow indicates infection Amount is variable from intermittent trickle to gush Foul or strong-smelling indicates infection |
| Impending birth - Behaviors to observe for: | Sitting on one buttock Making grunting sounds Bearing down with cntx Stating "the baby's coming" Bulging of the perineum Don gloves and call for help on the call bell |
| Nursing care of the woman in false labor (prodromal labor) | If BOW is ruptured, mom is kept due to risk of infection or prolapsed cord |
| Accelerations | Increases in FHR of 15 bpm for at least 15 min Indicate well-oxygenated fetus Only require reassurance of mother |
| Early decelerations | FHR drops during cntx but return to baseline by end of cntx Caused by fetal head compression and are normal Only require continued observation |
| Variable decelerations | Begin and end abruptly and look like a V, W, or U Suggest cord compression, cord around fetal neck, or inadequate fluid to cushion it well Inconsistent with cntx pattern Requires positioning mom on side and administering O2 may need amnioinfusion |
| Late decelerations - FHR drops below baseline but does not return to baseline until after cntx ends | reposition mom IV fluid increase, stop Pit O2 notify MD administer tocolytic drugs know baseline and what it is dipping too Suggest placental insufficiency and requires close monitoring |
| Reassuring FHR Patterns | Stable rate between 110-160 Variability present Accelerations present Frequency >2 minutes Duration <90 seconds Interval >60 seconds |
| Non-reassuring FHR Patterns | Tachycardia ≥ 10 minutes Bradycardia ≥ 10 minutes Decreased or absent variability Late decelerations Variable decelerations |
| First stage | Stage of dilation form onset of labor to complete dilation Usually the longest stage (6-10 hours) |
| Latent | Usually complete before mom enters hospital Extends from labor onset to 4 cm Cervix effaces almost completely in nullipara Often remains thick in multiparas Cntx increase in strength and intensity and become » 5 min apart relatively comfortable,excited |
| Active | Cervix dilates from 4-7 cm Effacement is completed Cntx become 3 min apart, last 45 sec, moderate to firm Woman becomes less sociable but still cooperative |
| Transition | Intense, short phase of labor Cervix completes dilating from 8-10 cm Cntx are firm and 2-3 min apart, with duration of 90 sec Woman feels loss of control and thinks it will never be over Becomes uncooperative and hostile |
| Second stage | Stage of expulsion Lasts from complete dilation to birth of baby (1 1/2-2 hr-nullipara & 20-45 min-multipara) |
| Third stage | Expulsion of placenta is the shortest stage (5-30 min) Lasts from birth of babe to expulsion of placenta Expelled as: Schultze mechanism - shiny, fetal side exits first Duncan mechanism - rough maternal side exits first |
| Fourth stage | Recovery stage for first few hours after birth Uterus should be felt as firm round grapefruit-sized ball Felt halfway between umbilicus and symphysis pubis then swells to umbilicus Chill for 20-30 min that stops spontaneously is normal |
| NURSING CARE IMMEDIATELY AFTER BIRTH :Care of the mother | Observe for hemorrhage with VS Skin color Location and firmness of fundus Lochia rubra (dark red) No more than 1 pad q hour - Ice pack to perineum to reduce swelling for at least first 12 hours |
| Care of the infant Care of the newborn immediately after delivery | Dry infant to prevent heat loss from evaporation Bulb suction of mouth (mouth first because that is where the initial breath is taken) and nose Perform APGAR scoring at 1 and 5 minutes after birth |
| Perform APGAR scoring at 1 and 5 minutes after birth is to identify need for respiratory resuscitation and consists of: | Heart rate Respiratory effort Muscle tone Reflex response to suction or gentle stimulation Skin color |
| Sources of pain during labor | Dilation and stretching of the cervix Reduced uterine blood supply during contractions Pressure of the fetus on pelvic structures Stretching of the vagina and perineum |
| Nonpharmacological pain management techniques | Progressive relaxation – contract-release different muscle groups Differential relaxation – contract one muscle group while relaxing all others Effleurage – woman strokes abdomen in circular motion during contraction |
| How to recognize hyperventilation | Dizziness Tingling of hands and feet Cramps and muscle spasms of hands Numbness around nose and mouth Blurring of vision |
| How to correct hyperventilation | Breathe slowly, especially in exhalation Breathe into cupped hands or paper bag Place moist washcloth over mouth and nose while breathing Hold breath for a few seconds before exhaling |
| Narcotics: butorphanol (Stadol), nalbuphine (Nubain), meperidine (Demerol), fentanyl (Sublimaze) | Primary risk is newborn respiratory depression due to opioids crossing placenta Usually given in small amts IVP Avoided if birth is expected within the hour |
| Narcotic antagonist: naloxone (Narcan) | Used to reverse respiratory depression in the neonate May be given IV or through endotracheal tube in resuscitation Has a shorter duration than the drugs it reverses |
| Adjunctive drugs: | promethazine (Phenergan), hydroxizine (Vistaril only given z-track IM)Enhance pain-relief and reduce nausea |
| Epidural block | Give a bolus of fluid to prevent hypotension to which is the most common side effect of the epidural Adverse effects: Maternal hypotension which compromises fetal oxygenation Prevented by IV bolus before procedure |
| Subarachnoid (spinal) block | Postspinal headache (lie flat for at least 4 hours) Blood patch done to form gelatinous seal to prevent spinal fluid loss for postspinal headache |
| General anesthesia used in: Emergency C/S when there is no time for spinal or epidural C/S for contraindications or refusal of epidural | Adverse effects in neonate Respiratory depression Time of induction of anesthesia to clamping cord is kept as short as possible All is ready before anesthesia is begun |
| The nurse's role in pharmacologic techniques | Observe for respiratory depression and hypotension Have Narcan for use after delivery of fetus prn Observe for late respiratory depression if she had an epidural Reinforce instructions for procedures |
| Amnioinfusion | Injection of warmed saline solution or lactacted Ringer’s solution into the uterus during labor after the membranes have ruptured |
| Amniotomy (AROM)-Performed to stimulate or enhance cntx Technique: vag exam to determine effacement, station, and effacement Snagging of membrane with disposable plastic hook Performed to permit internal fetal monitoring | Complications: Prolapse of the umbilical cord - look for variable decelerations ...move mom's position to try to move the baby off the cord. Infection Abruptio placenta |
| Induction (initiation) or augmentation (stimulation) of labor Indications (if continuing pregnancy is more hazardous than delivery) | Gestational hypertension ROM without onset of labor Uterine infection Medical problems: diabetes, kidney disease, heart or pulmonary disease Fetal problems: IUGR, prolonged pregnancy, maternal/fetal incompatibility Placental insufficiency Fetal death |
| Cervical ripening | Prostaglandin gel or vaginal insert softens cervix Cytotec (misoprostol) under study – is not labeled use of drug Laminaria insertion into the cervix (narrow cone of substance that absorbs water and swells to expand the cervix) |
| Nonpharmacological methods to stimulate uterine contractions | Walking Nipple stimulation |
| Oxytocin induction and augmentation | oxytocin (Pitocin) given in IVPB solution per pump Amount adjusted per cntx pattern |
| Excessive cntx (can progress to uterine tetany) Frequency less than 2 minutes Durations longer than 90 seconds Resting intervals less than 60 seconds | Treatment Stop oxytocin (Pitocin) infusion Increasing nonmedicated IV solution Change position, avoiding supine administer O2 by facemask at 8-10 L/min |
| Forceps and vacuum extraction births Used to aid pushing efforts | Risks: Trauma to maternal (hematoma)/fetal tissues; lacerations, cephalohematoma, or intracranial hemorrhage, chignon where vacuum applied |
| Cesarean birth Indications | Abnormal labor CPD (inability of fetus to pass through the mom's pelvis) Maternal conditions (Gestational hypertension, diabetes, etc) Active maternal herpes lesions Previous uterine surgery or C/S Fetal compromise Placenta previa or abruption |
| Low transverse | Preferred due to less likely to rupture during another birth Less blood loss Easier to repair Makes VBACs possible |
| Low vertical | Minimal blood loss Allows delivery of large fetus More likely to rupture during another birth |
| Classic | Rarely used due to more blood loss Most likely to rupture with subsequent birth May be only choice for transverse lie, scarring,or placenta previa |
| c-section Nursing care | Emotional support Post-op care Postpartum assessments VS IVF check Fundal check Dressing check Lochia check Urinary output Respiratory status of mother Pain relief |
| Hypertonic labor dysfunction | Frequent, cramplike, poorly coordinated cntx Painful and nonproductive Usually occur during latent phase (before 4 cm) Less common than hypotonic |
| Hypotonic labor dysfunction | Cntx are too weak to be effective, usually after 4 cm dilation in active phase of labor More likely to occur if uterus is overdistended Medical treatment Amniotomy Augmentation Force fluids (oral or IV) |
| Ineffective maternal pushing | Coaching effective techniques Instruction during pushing stage if anesthetized |
| Macrosomia (>4000 gm) | May not fit through passage Contributes to hypotonic labor due to overdistention Shoulder dystocia is common |
| Abnormal fetal presentation | Breech or face Prevent smooth dilation of the cervix and interfere with mechanisms of labor Most require C/S If breech is vaginal delivery, head must be delivered quickly so babe can breathe |
| Soft tissue obstructions | Full bladder is biggest obstruction Tumors and fibroids |
| Stress initiates "fight or flight" mechanism that interferes with labor by: | Using glucose the uterus needs for energy Diverting blood flow from the uterus Increasing tension of pelvic muscles which impede fetal descent Increasing perception of pain which worsens the cycle |
| Prolonged labor | Maternal or newborn infection, especially if membranes are ruptured Maternal exhaustion Postpartum hemorrhage Anxious about subsequent pregnancies Nursing care Observe for signs of infection |
| Precipitate labor (less than 3 hours) | Frequent and intense cntx May be prone to: Uterine rupture Cervical lacerations Hematomas Birth injuries of fetus |
| PREMATURE RUPTURE OF MEMBRANES (PROM) Membranes rupture at term more than one hour before cntx begin Preterm PPROM occurs when membranes rupture before 37 weeks, with or without cntx | Vaginal or cervical infection Nutritional deficiency association Risks: Chorioamnionitis Sepsis in the newborn Confirm presence of amniotic fluid with nitrazine paper or ferning test |
| PRETERM LABOR Characteristics Occurs after 20 weeks and before 37 weeks Main risk is immaturity of fetus Signs of impending labor: | Cntx that are uncomfortable or painless Feeling that baby is "balling up" frequently Menstrual-like cramps Constant backache "Feeling bad" or "coming down with something |
| Tocolytic therapy | Magnesium sulfate Drug of choice to stop labor IV followed by oral therapy Baby may experience respiratory depression if born during therapy Calcium gluconate is antidote |
| Beta-adrenergic :terbutaline (Brethine) | May be given orally or subcutaneously through a pump Has tachycardia as side-effect Propranolol overcomes side effects |
| Prostaglandin synthesis inhibitor | indomethacin Given orally or rectally Can cause ductus arteriosus to close prematurely, causing fetal demise |
| Calcium channel blockers like nifedipine (Procardia) | Causes vasodilation, so flushing and hypotension could be side effect |
| Speeding fetal lung maturation | Steroids increase lung maturation and may be repeated in one week Betamethasone IM given to mother q 24 hr X 2 Thyroid-releasing hormone enhance pulmonary maturation in fetuses < 28 weeks |
| Nursing care preterm labor | Teach symptoms of preterm labor, especially in moms at risk Help maintain bedrest and reduce complications of prolonged inactivity Have pt set up two rooms to facilitate rest Keep telephone nearby and pack picnic basket so she does not have to get up |
| PROLONGED PREGNANCY | Placenta aging decreases nutrients and O2 to fetus Fetus does not tolerate labor well Places additional stress on fetus Meconium passage is greater |
| Prolapsed umbilical cord | Interrupts blood flow to placenta and fetus Medical treatment Position mom knee-chest or Trendelenberg to use gravity assistance in displacing fetus Manually push fetus up off cord Administer O2 and tocolytic druts Deliver babe, usually C/S |
| Uterine rupture | Nursing care Monitor VS Monitor bleeding Emotional support |
| Uterine inversion | Uterus turns inside out after babe is born Characteristics Minor depression in top of uterus Uterus protrudes from vagina Rapid onset of shock More likely to occur if uterus is boggy |
| Amniotic fluid embolism | Fluid and particulate enters blood stream and obstructs blood vessels of lungs Shows abrupt and severe respiratory distress and circulatory collapse DIC may develop Cardiac and respiratory support is required May occur before or after babe is born |
| Prenatal vitamins | Supplement with extra Iron and Folic acid prn |
| Oxytocin | used to induce or augment labor, immediate postpartum to contract uterus and control bleeding |
| Methergine | used to control postoperative bleeding |
| Prostaglandins | used to control postoperative bleeding |
| Tocolytics | Terbutaline (Brethine) – used to stop preterm labor Magnesium sulfate – suppresses uterine activity Nifedipine (Procardia) – relaxes smooth muscle of the uterus |
| Pregnancy-induced hypertension | Magnesium sulfate – CNS depressant to prevent seizures Hydralazine – lowers blood pressure Labetalol – lowers blood pressure Nifedipine( Procardia) – lowers blood pressure |
| Ectopic pregnancy | Methotrexate – stops cells from rapidly dividing |
| Cervical ripening | Prostaglandins: dinoprostone (Prepidil) – gel inserted into cervical os prostaglandin E2 (cervidil) – absorbs water and swells in the cervical os |
| Uterine stimulants | Oxytocin - used to induce or augment labor, immediate postpartum to contract uterus and control bleeding Methergine - used to control postoperative bleeding Prostaglandins - used to control postoperative bleeding |
| First Visit | CBC, H&H, Type, Antibody screen, Rubella, Hep B, HIV, RPR C/G, Pap, Ultrasound (May also have chorionic villus sampling if genetic problems are suspected) |
| 14-19 weeks | MS-AFP (HCG and estradiole if Down syndrome is concern; level II sono if neural tube defects suspected) Amniocentesis if indicated |
| 28 weeks | CBC, H&H, 1-hr glucose challenge, type and screen (administer RhoGam to Rh- moms) Amniocentesis for L/S ratio PTL; administer steroids IM to mom if labor continues to speed production of surfactant in the infant; administer surfactant ET to infant prn) |
| 35 weeks | Group B strep culture Herpes culture and serology for HSV antibodies prn |
Created by:
736699267