Labor and Birth at Risk
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| what is preterm labor | preterm labor: 20-37wks
preterm birth: up to 37 wks, length of gestation, not wt
term: 38-42
postterm: past 42
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| what is considered low birth wt | <2500g or less
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| What are two main predictors for preterm birth | Fetal fibronectins - b/n 24-34wks
salivary estriol
Endocervical length
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| Causes of preterm labor | infections (oral hygiene), turning(version), demographic factors
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| what is most important nursing prevention for preterm birth | education about early symptoms
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| what are main early signs for preterm labor | gestational age b/n 20-37wks
uterine activity
cervical changes: 80%/>2cm dilation
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| what are tocolytics used for and examples of common ones | stop contractions
Terbutaline(Brethine)
Mg Sulfate(most common)
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| what do you give to mature young preterm lungs in preterm labor | glucorticoids, not good for cord prolapse, chorioamnionitis, abruptio placentae
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| what is difference b/n PROM and PPROM | PROM: premature rupture of membranes before 1 hr of labor
PPROM: before 37 wks, can be inf.
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| what is dystocia | long difficult, abnormal labor from dilation, effacement, descent
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| what is dysfunctional labor | abnormal uterine contracitons prevent progress.
Those at incr risk: body build,malposition (op), malpresentation(breech), CPD(diabetic), over on oxytocin, mom tired, epidural b4 time, hyper/hypotonic uterine tone
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| what is precipitous labor | lasts less than 3 hrs from onset
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| what is version | turn baby in utero to head down.
Risks: labor, abrupt placentae(have C-section ready)
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| what is a prostaglandin do | ripens cervix, Cytotec
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| what is an amniotomy | artificial breaking of H2O
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| How should pitocin be given or never given | always on pump, PB, never primary adn always with NS or LR
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| what are prerequisites for vacuum assisted birth | vertex presentation, ruptured membranes, absence of CPD(diabetic big baby)
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| Which incision for c-section can't do a VBAC | vertical thru uterus - classical
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| what are risks for postterm birth | dysfx labor, birth canal trauma, more interventions, lg infant(macrosomia), shoulder dystocia, aging placenta
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| what is normal blood loss for vag/C-section? If more, what is that called | vag: 500ml
C-section: 1000ml
PPH: postpartem hemorrhage: leading cause of mom death, VS q15min, fundal massage
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| what is the McRobert's maneuver | open pelvis for shoulder dystocia
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| what are two kinds of prolapse cord | occult(hidden): compressed up high, complete
Cause variable compressions
TX: Trendelenberg/knee-chest pos
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| Some OB emergencies | Amniotic fluid embolism, rupture of uterus
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| Risk Factors for hemorrhage | uterine atony: boggy soft uterus, hypotenia
lacerations of genital, hematomas, retained placenta, inversion/subinvolution of uterus
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| What drug helps uterus to contract if oxytocin doesn't | Methergine by IM only, not for HTN
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| what is tx for hemorrhaging | replace fluids
S/S: not show til 30-40% loss of blood, tachy then brady, clammy
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| What is idiopathic thrombocytopenic purpura | low platelets, leads to DIC (disseminated intravascular coagulation) clotting then bleed out
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| what is puerperal sepsis and other infections postpartum | infection in canal in 28 days of abortion or birth, endometritis, wound inf, UTI, mastitis
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| What are things that happen after childbirth | incontinence
cystocele: bladder goes into vag
rectocele: rectum goes into vag wall..Tx: Pessary
Fistulas: vesicovag, urethrovag, rectovag
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| Psychological postpartum complications | baby blues, depression, psychosis(emergency)
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