Labor and Birth Complications: Chapter 17

Warning signs of preterm labor

Dull low backache Menstrual-like cramps Pelvic pressure Increased vaginal discharge Vaginal spotting ROM

What is considered tachysystole of the uterus?

> 5 contractions in 10 minutes

What Bishop score is a favorable score for induction?

8 or higher

A pregnant patient has been administered magnesium sulfate as prescribed. Following the assessment, the nurse reports to the primary health care provider (PHP) that the patient's respiratory rate is 11 breaths/min. Which medication administration can the nurse expect from the PHP? Dextrose solution intravenously to the patient Calcium gluconate intravenously to the patient Ringer's lactate solution intravenously to the patient Increased doses of magnesium sulfate to the patient

A respiratory rate of 11 breaths/min in the patient who is administered magnesium sulfate indicates magnesium toxicity. Administering calcium gluconate can counteract this. Ringer's lactate solution would help in reduced amniotic fluid levels, but it does not reduce the effect of magnesium sulfate. Dextrose solution is given for the treatment of maternal ketoacidosis. Magnesium sulfate should be discontinued when the respiratory levels are lowered in the pregnant patient.

The nurse is assessing a pregnant patient and finds that the patient has inflammation around the teeth and bleeding of the gums. What should the nurse tell the patient after the assessment? "You might be at risk for preterm labor." "Your baby might have spina bifida." "You may be at risk of having a miscarriage." "Your baby might have delayed tooth eruption."

According to research, the patients who have periodontal diseases like gingivitis, inflammation around the teeth, and bleeding of gums may have an increased risk of preterm labor. Down syndrome and hypothyroidism would cause a delay in tooth eruption in the infant. Periodontal diseases would not cause miscarriage, because it does not affect fetal development. Spina bifida results from a deficiency of folate, not from maternal periodontal diseases.

A nurse is caring for a woman whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of what? Uterine contractions occurring every 8 to 10 minutes A fetal heart rate (FHR) of 180 beats/min with absence of variability The woman needing to void Rupture of the woman's amniotic membranes

An FHR of 180 beats/min with absence of variability is nonreassuring. The oxytocin should be discontinued immediately and the health care provider should be notified. The oxytocin should be discontinued if uterine hyperstimulation occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. The woman needing to void is not an indication to discontinue the oxytocin induction immediately or to call the health care provider. Unless a change occurs in the FHR pattern that is nonreassuring or the woman experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The health care provider should be notified that the woman's membranes have ruptured.

Which factor should alert the nurse to the potential for a prolapsed umbilical cord? Oligohydramnios Pregnancy at 38 weeks of gestation Presenting part at a station of -3 Meconium-stained amniotic fluid

Because the fetal presenting part is positioned high in the pelvis and is not well applied to the cervix, a prolapsed cord could occur if the membranes rupture. Hydramnios puts the woman at risk for a prolapsed umbilical cord. A very small fetus, normally preterm, puts the woman at risk for a prolapsed umbilical cord. Meconium-stained amniotic fluid shows that the fetus already has been compromised, but it does not increase the chance of a prolapsed cord.

The ultrasound scanning reports of a pregnant patient confirmed the presence of a fetus in single footling breech position. Upon reviewing the medical records, the nurse finds that the patient has previously undergone uterine surgery. Which method should be planned for the safe birth of the infant? Internal version Vaginal delivery Cesarean section External cephalic version

Because the fetus is present in a single footling breech and the mother has a history of uterine surgery, a cesarean section would be the safest method of delivery. This helps prevent fetal distress. The external cephalic version should not be performed in the patients who have undergone uterine surgery, because it may cause uterine injury. The internal version is usually performed for patients with multifetal gestation. This is usually preferred for the delivery of the second fetus and may also cause maternal and fetal injury. Vaginal delivery is not advisable in this type of fetal presentation, because it may result in a prolapsed umbilical cord.

What do you need to teach about nifedipine?

Because using a calcium channel blocker can result in orthostatic hypotension and dizziness, it is essential to instruct women to slowly change position from supine to upright and then sit until any dizziness disappears before standing. In addition, it is important to maintain adequate fluid balance to reduce the drop in bp that can occur with drug-related vasodilation

What do you teach to help prevent cord prolapse?

EFM bedrest limit activities

Measures used to help prevent infection after PPROM

EFM vitals & temp q4h No SVEs until labor is imminent Prophylactic antibiotics Limit activities *bedside commode bc they are on magnesium, which relaxes muscles*

The nurse is teaching about the use of primrose oil to a pregnant patient. Which statement would the nurse include in the teaching? "Primrose oil helps ripen the cervix." "Primrose oil helps prevent vaginal infections." "Primrose oil helps reduce the risk of preterm labor." "Primrose oil helps improve uterine contractions (UCs)."

Evening primrose oil is an alternative method used to ripen the cervix of a pregnant patient before labor. Maintaining good hygiene conditions and cleaning the vaginal region regularly prevent vaginal infections. Premature labor risk is not reduced by primrose oil, because it usually occurs as a result of the rupturing of membranes prematurely. UCs or labor stimulations are improved by using castor oil.

After AROM from an amniotomy, what should you assess for?

FHR time color, odor, consistency, check temp q2h for chorionitis

What is the diagnostic test used for preterm labor? What does it mean when the test is negative? Positive?

Fetal fibronectin (fFN) fFN is the protein found in fetal membranes before 20 weeks gestation and *again at term* Negative Test: indicates very low risk of birth in next 7-14 days Positive Test: could mean preterm labor

What is done for a neonate with an immature GI system?

Food and hydration given TPN bc they can't handle formula/breast milk

Teach self-assessment of uterine contraction

INstruct to lie on left side, place fingers on top of uterus teach to note a painful, periodic hardening or tightening Teach that more than 5 contractions in an hour should be reported immediately to health care provider or clinic

What are two things you need to do before giving cytotec, cervidil, and prepidil

NST (most be reactive) have to void

During the first stage of labor, a pregnant patient complains of having severe back pain. What would the nurse infer about the patient's clinical condition from the observation? Oligohydramnios Chorioamnionitis Frank breech presentation Occipitoposterior position of the fetus

If a pregnant patient has severe back pain during the first stage of labor, it indicates that the fetus is in occipitoposterior position. In this position, the fetal head (occiput) exerts pressure and presses against the sacrum of the patient. Oligohydramnios, chorioamnionitis, and frank breech presentation are not associated with typical backache in pregnant women. Oligohydramnios is the presence of low amniotic fluid volume in the pregnant woman. Chorioamnionitis is a bacterial infection of the amniotic cavity, which results in high maternal fever and a foul amniotic fluid odor. If flexed hips and extended knees of fetus are observed, then it is called frank breech presentation (malpresentation).

What would define whether the patient needs to be in the hospital or managed at home?

If you have a *compliant* patient, then we can send them home If she's too far dilated and the baby is less than 30 weeks, then we are going to keep her for monitoring

What do you need to do if a mother who had a previous c section is trying to give birth vaginally?

Know where their incision is. *Vertical incision is contraindicated for a vaginal delivery.*

The nurse is caring for a pregnant patient who is administered magnesium sulfate to prevent preterm labor. Which parameters should the nurse assess in the patient to determine drug toxicity? Select all that apply. Fluid intake Respiratory status Body temperature Level of consciousness Deep tendon reflexes

Magnesium sulfate, when used as a tocolytic agent, depresses the central nervous system (CNS). The CNS depressive effect would be enhanced if the drug reaches toxic levels. CNS activity can be determined by assessing the respiratory status, level of consciousness, and deep tendon reflexes. A low respiratory rate, decreased level of consciousness, and slow reflexes indicate magnesium sulfate toxicity. Fluid intake and body temperature are not affected by CNS depression.

A pregnant patient experienced preterm labor at 30 weeks of gestation. Upon assessing the patient, the nurse finds that the newborn is at risk for having cerebral palsy. Which medication administration should the nurse perform to prevent cerebral palsy in a newborn? Calcium gluconate to the pregnant patient Magnesium sulfate to the pregnant patient Glucocorticoid drugs to the pregnant patient Antibiotic medications to the pregnant patient

Newborns who are born before 32 weeks of gestation may be at risk for cerebral palsy. Administering magnesium sulfate to the patient can prevent this risk as it would delay delivery. Calcium gluconate is administered when the preterm child has magnesium toxicity. This intervention would not help to prevent cerebral palsy. Also, the newborn would not have a fully developed respiratory system. Therefore administering glucocorticoids to the pregnant patient would help to prevent the risk for respiratory depression in the baby. However, it does not help in preventing cerebral palsy. Administering antibiotics during labor would help prevent neonatal group B streptococci infection.

The nurse is caring for a pregnant patient who is receiving terbutaline (Brethine) treatment. The primary health care provider (PHP) adds nifedipine (Adalat) to the patient's prescription. How does the nurse administer nifedipine (Adalat) to the patient? Infuse nifedipine (Adalat) along with terbutaline (Brethine). Infuse nifedipine (Adalat) only after terbutaline (Brethine) is stopped. Provide a glass full of orange juice before administering nifedipine (Adalat). Provide the patient with calcium supplements before administering nifedipine (Adalat).

Nifedipine (Adalat) is a calcium channel blocker that is used to relax the uterine muscles during pregnancy. Therefore the nurse should avoid administering nifedipine (Adalat) along with terbutaline (Brethine), because it causes adverse effects and may alter the heart rate and blood pressure of the patient. Infusing nifedipine (Adalat) along with terbutaline (Brethine) may impair cardiovascular functioning in the patient. Therefore the nurse should avoid infusing the drugs simultaneously. Orange juice is administered to relax the patient during labor. However, it is not necessary to administer it with nifedipine (Adalat). Nifedipine (Adalat) is administered to reduce the calcium activity; no additional calcium supplementation is required.

What two tocolytics should not be used at the same time? Why?

Nifedipine (Procardia) and Magnesium *Administering nifedipine and magnesium sulfate simultaneously can cause skeletal muscle blockade. In addition, nifedipine should not be given along with or immediately following beta adrenergic agonist (terbutaline) because of effects on maternal hr and bp*

What are the tests done to see if ROM has occurred?

Nitrazine testing Ferning: take sample of vaginal fluid and put it under a microscope AmniSure: read just like a pregnancy test (one line positive, two lines negative for amniotic fluid)

Which patient situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor? A primigravida who is 17 years old A 22-year-old multiparous patient with ruptured membranes A primigravida who has requested no analgesia during her labor A multiparous patient at 39 weeks of gestation who is expecting twins

Overdistention of the uterus in a multiple pregnancy is associated with hypotonic dysfunction because the stretched uterine muscle contracts poorly. A young primigravida usually will have good muscle tone in the uterus. This prevents hypotonic dysfunction. There is no indication that the 22-year-old patient's uterus is overdistended, which is the main cause of hypotonic dysfunction. A primigravida usually will have good uterine muscle tone, and there is no indication of an overdistended uterus.

Causes of indicated preterm birth (Box 17.2)

Preexisting or gestational diabetes Chronic htn Pre-eclampsia previous c section via a vertical or t shaped uterine incision Cholestasis (involves liver) Placental abruption or previa Advanced maternal age Medical disorders such as: -seizures -thromboembolism -connective tissue disorders -asthma/chronic bronchitis -maternal HIV or active herpes -obesity -smoking Fetal disorders such as: -fetal compromise -poor fetal growth -abnormal resulty on a NST or BPP -Polyhydramnios or oligohydramnios -fetal hydrops, ascites, blood group allimmunization -birth defects -fetal complication of multifetal gestations

What do you do to help manage prolonged descent?

Rule out CPD and malpresentation AROM oxytocin high fowler's position

During the second phase of labor in a pregnant patient, the nurse finds that the shoulders of the baby are not able to be delivered. The nurse informs the primary health care provider (PHP) who advises to perform the McRoberts maneuver to deliver the shoulders of the baby. What intervention should the nurse perform during the McRoberts maneuver? Apply fundal pressure to relieve the baby's shoulders. Instruct the patient to acquire a hands-and-knees position. Apply suprapubic pressure to the baby's anterior shoulder. Keep the patient's legs flexed apart with the knees on the abdomen.

Shoulder dystocia is a condition where the head of the baby is born but the anterior shoulder is unable to pass down the pubic arch of the mother. Certain positions and maneuvers can help in delivery of the shoulders. McRoberts maneuver involves keeping the patient's legs flexed apart with the knees on the abdomen. This position decreases the pelvic inclination, allowing more space for the shoulders to be delivered. McRoberts maneuver does not involve applying suprapubic pressure to the baby's anterior shoulder. A hands-and-knees position is also helpful in shoulder dystocia, but it depends on the mother's mobility and is not a part of McRoberts maneuver. McRoberts maneuver does not involve applying fundal pressure.

The nurse finds that the amniotic membranes in a pregnant patient who is in labor have ruptured and that the amniotic fluid is meconium-stained. The nurse should infer from the findings that the baby has a high risk of presenting with what? Shoulder dystocia Umbilical cord prolapse Aspiration pneumonia Brachial plexus injury

Some babies may pass meconium even before birth, thus staining the amniotic fluid green. This meconium-stained amniotic fluid can be aspirated in the fetal lungs, increasing the risk for meconium aspiration syndrome, which may cause respiratory depression and aspiration pneumonia. Meconium-stained amniotic fluid does not increase the risk for shoulder dystocia. Shoulder dystocia is common when there is fetopelvic disproportion as a result of excessive fetal size or maternal pelvic abnormalities. Umbilical cord prolapse is an obstetric emergency where the umbilical cord lies below the presenting part of the fetus. Brachial plexus injury is common in babies when the vaginal delivery takes place despite shoulder dystocia.

spontaneous vs indicated preterm labor

Spontaneous: an early initiation of the labor process (75%) Indicated: a means to resolve maternal or fetal risk (25%)

Home management/teaching for preterm labor

Teach SSx Activity restriction: limited work hours Restriction of sexual activity Modified bed rest with fetus off the cervix (no sitting or kneeling) suppression of uterine activity: hydration sedation tocolytics

The fetal fibronectin test of a pregnant patient is positive, and her cervical length is found to be 32 mm. What will the nurse interpret from these observations regarding the patient's pregnancy status? Normal gestational labor Indicated preterm labor Spontaneous preterm labor Miscarriage in the next week

The cervical length and fibronectin test help to identify the risk of preterm delivery in the patient. If the cervical length of the patient is greater than 30 mm, the patient would not have preterm labor, irrespective of having the symptoms of preterm labor. As the cervical length of the patient is 32 mm, the patient may have normal gestational labor. Cervical length and the fibronectin test do not indicate whether the patient would have a miscarriage. If the cervical length is less than 30 mm, the patient may have indicated or spontaneous preterm labor.

During the assessment of a pregnant patient, the nurse finds that the patient has a compressed umbilical cord. What instruction does the nurse expect to receive from the obstetrician? Provide a glass of orange juice to the patient. Suggest that the patient lie in the lateral position. Administer Ringer's lactate solution into the uterus. Infuse magnesium sulfate (Epsom salt) into the patient's uterus.

The compression of the umbilical cord occurs in pregnant women during labor due to inadequate amniotic fluid that results in fetal hypoxia. So, amnioinfusion would resolve the problem of low amniotic fluid (oligohydramnios). Therefore, the obstetrician would instruct the nurse to administer Ringer's lactate solution or normal saline to the patient to maintain the cushioning of the umbilical cord. The intake of a glass of orange juice may not be helpful in restoring the amniotic fluid volume in the patient. The patient is asked to lie in the lateral position to enhance placental perfusion but not to maintain the amniotic fluid volume. Magnesium sulfate (Epsom salt) is a tocolytic used to reduce uterine contractions (UCs) during labor. It is not used to maintain cushioning of the umbilical cord.

The nurse is preparing to perform a fetal fibronectin test for a pregnant patient. Which intervention should the nurse perform to collect the sample for the test? Take a blood sample from the forearm. Take a sample of the patient's amniotic fluid. Ask the patient to provide a urine sample. Collect the vaginal secretions using a swab.

The fetal fibronectin test is conducted to assess whether a patient is at risk for preterm labor. Fetal fibronectin is a glycoprotein found in the vaginal secretions during early and late pregnancy. To conduct the test, the nurse should collect the vaginal secretions using a swab and send it for analysis. Urine, blood, and amniotic fluid are not collected for a fetal fibronectin test, as they may not contain adequate glycoprotein levels.

A pregnant patient is suspected to have preterm labor. The nurse is preparing to collect the vaginal discharge for conducting the fetal fibronectin test. What interventions are necessary before collecting the sample to ensure accuracy of the test? Select all that apply. Instruct the patient to drink two glasses of water. Check for the presence of vaginal bleeding in the patient. Ask about history of sexual intercourse in the past 24 hours. Ask the patient to empty the bladder before collecting the sample. Assess the patient to see if the amniotic membranes have ruptured.

The fetal fibronectin test is performed to determine whether the patient has preterm labor. Amniotic fluid can affect the accuracy of the test. Therefore the nurse should check to see if the amniotic membranes are intact before collecting the vaginal secretions. Vaginal bleeding can also result in negative results and should be identified before collecting the sample. The nurse should also check whether the patient has had sexual intercourse in the past 24 hours, because it may reduce the accuracy of the results and cause a false-negative result. Drinking water and emptying the bladder have no effect on the test results. Therefore these interventions are not necessary before conducting the test.

A laboring patient's amniotic membranes have just ruptured. What is the immediate action of the nurse? To assess the fetal heart rate (FHR) pattern To perform a vaginal examination To inspect the characteristics of the fluid To assess maternal temperature

The first nursing action after the membranes are ruptured is to check the FHR. Compression of the cord could occur after rupture leading to fetal hypoxia as reflected in an alteration in FHR pattern, characteristically variable decelerations. The same initial action should follow artificial rupture of the membranes ( amniotomy). Performing a vaginal examination, inspecting fluid characteristics, and assessing maternal temperature should be done after the FHR pattern is assessed.

A pregnant patient is administered misoprostol (Cytotec) to induce labor. After 8 hours of drug administration, the patient develops diarrhea and vomiting. What does the nurse do to alleviate the symptoms? Administer terbutaline (Brethine). Administer oxytocin (Pitocin) infusion. Give a magnesium-containing antacid. Increase the time between doses.

The patient is taking misoprostol (Cytotec) medication for labor induction. Vomiting and diarrhea are the adverse effects of the drug. These effects can be reversed by the administration of terbutaline (Brethine) by the subcutaneous route. To prevent the adverse effects, dosing intervals must be increased before the administration. However, increasing the dosing intervals will not be helpful in alleviating these symptoms. Oxytocin (Pitocin) can be given 4 hours after administering the last dose of misoprostol (Cytotec). This is usually given if the labor has not occurred, and it does not prevent the adverse effects of misoprostol (Cytotec). Magnesium-containing antacids should not be given to the patients who are taking misoprostol (Cytotec) medication because they interact with each other.

The nurse is caring for an obese patient who gave birth to a child through a cesarean delivery. Which nursing intervention should be performed for providing effective postpartum care? Cleaning the stitches once a day with soapy water Drying the wound by using a hair dryer at low setting Removing the sutures as soon as the wound starts healing Keeping the wound covered at all times for better healing

The surgical wound should be kept dry at all times to prevent infections. This can be achieved by drying the wound with the help of a hair dryer at a low setting. The wound should be washed several times a day with soapy water to prevent infection and promote healing. The sutures should not be removed for some time to prevent wound disruption, which is a common problem in an obese patient. The wound should be left open for some time to prevent the formation of moisture and promote better healing.

The nurse observes that a pregnant patient at 36 weeks of gestation who is in labor has a cervical dilation of 5 cm with membranes intact. Which nursing intervention is the most appropriate in this situation? Monitor the blood glucose levels in the patient on a regular basis. Ensure that the propranolol (Inderal) is available for administration. Prepare to administer intravenous magnesium sulfate (Epsom salt). Assess fetal ductus arteriosus and neonatal pulmonary hypertension.

This patient at 36 weeks of gestation is considered preterm based on a cervical dilation of 5 cm. With membranes intact, the therapeutic plan of care would include stopping the labor process. Magnesium sulfate (Epsom salt) may be administered to the patient to prevent cerebral palsy of the fetus that may occur due to preterm birth. Therefore the nurse has to prepare for the administration of magnesium sulfate intravenously to the patient. Assessment of blood glucose levels is not useful to prevent preterm birth. Propranolol (Inderal) is used to reverse the adverse effects of terbutaline (Brethine), and it is not useful to prevent preterm birth. Assessment of fetal ductus arteriosus and neonatal pulmonary hypertension is useful when indomethacin (Indocin) is administered to the patient but not before administering magnesium sulfate (Epsom salt) to the patient.

The nurse is assessing a pregnant patient with multifetal gestation. Upon reviewing the medical history, the nurse finds that the patient had preterm delivery during the first pregnancy. What will the nurse do to prevent preterm delivery in the patient during the second pregnancy? Suggest that the patient avoids smoking and consuming alcohol. Suggest that the patient increases physical activity to prevent risk. Administer progesterone (Prometrium) suppositories to the patient. Administer a 17-alpha hydroxyprogesterone injection to the patient.

To prevent preterm labor, the nurse can suggest health promotion activities to the patient, such as avoiding smoking and alcohol consumption. This helps to promote intrauterine growth and fetal development. The nurse should suggest that the patient get proper rest and care at home. The nurse should not suggest that the patient increase physical activity, which could worsen the condition. Progesterone supplements, such as progesterone (Prometrium) suppositories and 17-alpha hydroxyprogesterone injections, are ineffective in preventing preterm birth in patients with multifetal gestation.

alternative methods to pitocin (non pharmacalogical)

blue cohash caster oil black cohash red raspberry leaf tea evening primrose oil

What do you need to remember about pitocin and uterine scarring?

Women with previous uterine scars are prone to uterine rupture, especially if oxytocin or forceps are used. If a woman complains of a sharp pain accompanied by the abrupt cessation of contractions, suspect uterine rupture, which is a *medical emergency.* Immediate surgical delivery is indicated to save the fetus and the mother! (Hesi hint)

2 main signs of shoulder dystocia

baby's head does not emerge with standard moderate traction and maternal pushing after delivery of baby's head "turtle sign"- head suddenly retracts back against mother's perineum after it emerges from vagina

Post term pregnancy defined

a pregnancy that extend beyond the end of 42 weeks gestation

What are some risks for a post-term fetus?

aging placenta oligohydramnios macrosomia increased risk for birth injuries abnormal fetal growth

Examples of dystocia of fetal origin

anomalies CPD Malposition Malpresentation Multifetal pregnancy

What do you administer if there is magnesium toxicity?

calcium gluconate/chloride

Preterm labor defined

cervical changes and uterine contractions occurring between 20 to 37 6/7 completed weeks of pregnancy *If they deliver before midnight on their 36 and 6th day, then they are considered preterm. If they are delivered after midnight, then they are not considered preterm*

Low bishop scores increase the risk of what?

chances of c section

prereqs of vaccuum-assisted birth

completely dilated cervix engaged head ruptured membranes *vertex presentation* no CPD

What would be considered a prolonged deceleration (transition) phase?

nulliparous >3 hours multiparous >1 hour abnormal head position c section

Patients with short stature are less likely to what?

deliver vaginally; especially if overweight

What is dystocia?

difficult birth resulting from any cause defined as long, difficult, or abnormal labor *dystocia, dysfunctional labor, and uterine inertia are terms used interchangeably*

How do you strip membranes?

do a vaginal exam; go through the opening of cervix and strip membranes from top of the cervix; insert gloved finger into internal cervix rotate finger 360 degrees, twice typically labor begins within 24 to 48 hours

What should you not do during Mc Roberts

do not pull forcefully on baby's head absolutely no fundal pressure (you're just pushing that shoulder harder into the pelvic bone)

What are some risks for the mother if her baby is post term?

dysfunctional labor perineal injury due to macrosomia hemorrhage/infection interventions more likely to be necessary fatigue and psychologic reactions

What could compromise the accuracy of an fFN?

false positives can occur if: recent sexual intercourse recent vaginal exam bacterial vaginosis vaginal bleeding (any blood on q tip indicates an automatic positive)

potential neonatal probs after preterm birth

fat storage (Not as much. Have trouble regulating temp) heat regulation Immature Respiratory system -have to be intubated initially, then they step down to C pap Immature immune system Immature GI system

What symptoms would lead you to suspect prolapsed cord?

fetal bradycardia variable/prolonged decels

What would cause a protracted active phase?

fetal malposition CPD primipara >12 hours or <1 cm/hr multiparous >6 hours or <1.5 cm/hr hypotonic contractions *do oxytocin or c section*

What type of mother usually doesn't get progesterone?

first time mothers because you don't know if they're at risk for PTL because they've never had a baby and mothers pregnant with multiple babies

3 major criteria for diagnosis of preterm labor

gestational age contractions >5 per hour cervical change 2cm or more dilated

What is magnesium given for for preterm birth? (2)

helps slow contractions helps reduce/prevent neonatal neurologic sequelae (like cerebral palsy) *helps baby's brain*

Hypertonic vs hypotonic contractions

hypertonic: really strong contractions; just really frequent, uncoordinated contractions pattern hypotonic: slow and not as high of a wave

Induction vs. Augmentation

induction: contracting but ctx aren't causing cervical change augmentation: mother comes in contracting; about 5 cm stays this way for about 24 hours then start on Pitocin

What is the greatest risk for PROM?

infection SOOOOOO antibiotics bitch labor will likely be induced

What device is used for an amnioinfusion?

intrauterine pressure catheter

What position should you be in if you have a prolapsed cord

knee-chest trendelenburg

Define precipitous labor

labor that lasts less than 3 hours hypertonic uterine contractions (really strong) Complications: -placental abruption -uterine tachsystole -recent cocaine use

What do you do if the cord is protruding?

loosely wrap cord in a sterile towel saturated with warm sterile normal saline

maternal and fetal indications of forceps assisted birth

maternal: prolonged 2nd stage of labor fetal: abnormal FHR certain abnormal presentations arrest of rotation delivery of head in breath position

indication of amnioinfusion

meconium fluid variable decels *ensure fluid is being expelled bc if not then there's a risk for uterine rupture*

What mothers on glucocorticoids need to be closely monitored?

mothers with gestational diabetes bc glucocorticoids increase blood glucose

Contraindications for version

multiple gestation Oligo Nuchal cord Unexplained bleeding CPD

Which preterm neonates have the best chance of survival?

neonates over 2000 g (4.5 lb) or 32 weeks gestation have best chance of survival

When would the latent phase of labor be considered prolonged?

nulliparous >20 hours multiparous >14 hours unripe cervix excessive analgesics hypertonic contractions

What conditions would potentially be the reason behind an elective birth <39 weeks gestation?

oligo preeclampsia diabetes IUGR *all of these increase risk for fetal demise*

Increased risk for uterine dystocia

overweight or short stature advanced maternal age *infertility: mothers who has IVF, IVI, or anything to help them get pregnant have harder time delivering vaginally* Uterine abnormalities malpresentations and position of fetus CPD uterine overstimulation with pitocin

pelvic dystocia and soft tissue dystocia

pelvic: contractures of pelvic diameters that reduce capacity of bony pelvis, inlet, midpelvis, or outlet soft tissue: results from obstruction of birth passage by an anatomic abnormality other than bony pelvis -ex. Can be cause by uterine fibroid

Cytotec things to remember

pill or vaginal nst void q4h until 3 cm or srom *do not start pitocin within 4 hours of last cytotec dose* once you put it in you can't take it out

Most common ways to induce/augment labor

pitocin stripping membranes/arom

Examples of dysfuctional labor

position of the woman Her psychologic response -hormones/neurotransmitters released in response to stress can cause dystocia *encourage her to continue!*

Obesity of mother has increased risk of?

postdate pregnancy and complications likely to begin pregnancy with HTN or diabetes Nursing care such as vaginal exams or giving an epidural becomes harder

Forceps prerequisites and management

prereqs: cervix completely dilated head at 0 or +1 station amniotic membranes ruptured no CPD management: assess for lacerations/bladder function monitor FHR and ctx

Which is more dangerous: preterm labor or LBW

preterm labor fo sure

PROM management.

prevent cord prolapse prevent infection prolong pregnancy gestational age? (34-36 is encourage to labor) (PROM before 32 weeks you dont want them to do labor bc preterm birth risks outweigh infection risks) induction for SSx of chorioamnionitis

What drug other than tocolytics is given to help prevent a woman from going into preterm labor? When is it initiated and discontinued?

progesterone initiated 16-24 weeks discontinued 36 weeks IM or vaginal suppository *not effective after PTL started not effective with mutiple gestation/twins, triplets*

PROM implications: fetal risks

pulmonary hypoplasia (lungs don't develop without fluid) facial anomalies limb position defects IUGR respiratory distress neonatal infection fetal hypoxia cord prolapse

How often should you monitor VS postpartum after c section?

q15m for 1 hour q30m for 1 hour q4h

What do tocolytics do?

relax the muscle of the uterus to help slow contractions

prepidil gel how often do you give

repeat every 6 hours

Most frequent cause of rupture of uterus?

scarred uterus as a result of previous c sections

Maternal Risk factors for preterm labor

short pregnancy intervals PROM polyhydramnios anemia smoking indadequate prenatal care age extremes hx of PTL low pre-pregnancy weight (90-100 lbs at first prenatal visit. <19.6 BMI) grand multiparous multiple gestation infection (UTI, STI, flu) African American

Mc Roberts maneuver is used for? What do you do?

shoulder dystocia pull knees up and out to side to rotate and open pelvis use *suprapubic pressure* to un-trap the anterior shoulder from behind pelvis

Criteria for Version

single pregnancy presenting part NOT engaged *intact membranes* don't do with ruptured bc there's not enough fluid to turn baby Adequate AFI Reactive NST

Teaching of what to do if symptoms of preterm labor occur

stop what you are doing lie down on your side drink two to three glasses of water or juice lie down on your side wait 1 hour if symptoms get worse, call your health care provider if symptoms go way, tell your health care provider what happened at your next prenatal visit if symptoms come back, call your health care provider *Call HCP if: symptoms persist leakage of fluid or vaginal bleeding Decreased fetal movement*

When should you take out cervidil?

that's the tampon looking one after 12 hours remove

If a PPROM occurs, what happens?

the mom is usually hospitalized. We want to try to get them as far along as they can before we have to deliver

Why may you delay labor for 48 hours in a preterm birth?

to administer corticosteroids for lung maturity and treat unknown GBS infections

What FHR is normal during/after an amniotomy

transient tachycardia variable decels

Care of the woman during version

use Leopold's maneuver to determine how the baby is positioned Try to turn the baby, NOT GENTLE, painful Give epidural, shot of brethine to relax uterus; then HCP comes to turn

Biggest risk in mothers who've had a c section and now are trying to deliver vaginally

uterine rupture

How do you relieve pressure off the prolapsed cord?

vaginal exam and exert upward pressure against the presenting part to relieve compression of the cord

What is external cephalic version?

when you turn the baby from the outside