Day 3 Meconium + Operative Vaginal births + Chorioamnionitis + Labor Augmentation + heart tones

Risk factors for meconium in utero:

• post term

• Breech

• Chorioamnionitis (infection of fetal membrane)

• Preeclampsia - baby in distress

• Maternal comorbidities like HTN or smoking or diabetes

What are the 3 grades of meconium staining severity?

Grade 1: lightly stained or thin fluid

Grade 2: Green or yellow, may have flecks

Grade 3: Dense or thick fluid ‘pea soup’ consistency

What do we do for meconium stained fluid?

Monitor

Amnioinfusion: Give NS with a pump into amniotic cavity with tube up vagina.

Antibiotics: meconium is sterile but it does attract bacteria.

Contraindications / possible effects of amnioinfusion: MEMORIZE

Placenta previa, vaginal bleeding, polyhydramnios, HIV infection, active herpes.

Placenta previa

Placenta covers cervix. C-section

What is an operative vaginal birth. What tools would be used? Why would we do this?

Intervention to assist baby come down in 2nd stage of labor.

Forceps and vacuum when necessary.

Done for non-reassuring FHR, maternal exhaustion, prolonged second stage (over 3 hours).

Maternal complications for vacuum:

• tissue trauma

• Increased pain

• hemorrhage

• Postpartum incontinence

Fetal complications for vacuum:

• Intracranial hemorrhage: very bad

• Lacerations on scalp

• Brachial plexus injury from being sucked out

• Cephalohematoma - collection of blood on baby’s head.

Maternal forceps complications:

Tissue trauma

pain

hemorrhage

postpartum incontinence

Fetal forceps complications:

Facial lacerations

Facial nerve palsy

Ocular trauma

Skull fracture

Intracranial hemorrhage

What is chorioamnionitis

Infection of amniotic sac, fluid, uterus and placenta.

Chorioamnionitis: what causes it? What is it most common with?

Bacterial, viral or fungal infection

Common with preterm labor, PROM, or prolonged ROM or poor hygiene

Risk factors for chorioamnionitis:

Assistive tech

Maternal smoking or alcohol use

Induction with a cervical balloon

Meconium

Multiple vaginal exams

How common is chorioamnionitis?

3-5%

70% of PROM

S/S of chorioamnionitis:

Fever over 38 C or 100.4 F on 2 occasions more than 30 mins apart

Uterine tenderness

Purulent (pus) amniotic fluid

Maternal tachycardia (over 100) or fetal (over 160)

Lab tests for chorioamnionitis

• Amniotic fluid culture

• Elevated c-reactive protein

• Leukocytosis (are there white blood cells present)

Chorioamnionitis treatments:

IV antibiotics

Transfer to better unit

May keep the person pregnant or not

What 3 things may indicate dysfunctional labor

Ineffective contractions

Maternal/fetal anatomical disproportion

Friedman curve (depicts first stage of labor)

Induction v aumnentation

Induce: start

Augment: propell

Amniotomy

Rupture of amniotic sac

What is the purpose of the bishop score chart? What 5 categories are included? What scores mean favorable, borderline or ripen/balloon.

To determine how ‘inducible’ a person is.

5 categories:

• dilation

• position of cervix

• effacement

• consistency of cervix

• fetal position/station

8 is favorable

6-7 is borderline

<5 need to ripen/balloon

Amniocentesis

Needle injected into belly. Sample sent to lab. Determines genetic abnormalities.

List the fetal conditions that are a result of each of the following:

tachycardia:

bradycardia:

minimal variability:

early decelerations:

variable decelerations:

late decelerations:

tachycardia: maternal fever

bradycardia: cord compression

minimal variability: sleep cycle

early decelerations: head compression

variable decelerations: cord compression

late decelerations: encephalopathy, hypoxia

Ways to resuscitate a baby with non-reassuring FHT?

Get on left side

Increase fluids

O2

Birth

What are reassuring FHT?

variability

Occasional accelerations

HR: 110-160