Complications of Labor and Birth Flashcards

This set of flashcards covers vocabulary and key concepts from the lecture on Complications of Labor and Birth, including preterm labor, PPROM, chorioamnionitis, fetal heart patterns, and obstetric emergencies like cord prolapse, abruption, and shoulder dystocia.

Viability

The point in fetal development at which the fetus is capable of surviving outside the uterus.

Periviable

Refers to the period of pregnancy just before viability.

Pelvic shape

A maternal anatomical factor that influences the progress of labor and birth.

Cervical/perineal resistance

Maternal anatomical factors that can affect the transition and descent of the fetus during labor.

Amniotic membranes

The maternal/fetal structure that holds the amniotic fluid and usually ruptures during or shortly before labor.

Disenfranchised grief

Grief that is not acknowledged or supported by social rituals or the community, often seen in cases of fetal loss.

Support for fetal loss

Nursing interventions include individualized support, facilitating grieving, and caring for support person(s).

Preterm Labor

Regular contractions that cause cervical change prior to the $37^{th}$ week of pregnancy.

Early preterm labor

Preterm labor occurring up to $34$ weeks of gestation.

Late preterm labor

Preterm labor occurring between $34$ to $37$ weeks of gestation.

Maternal history of preterm birth

A significant risk factor for experiencing preterm labor and birth in subsequent pregnancies.

Multiples

A pregnancy involving more than one fetus, which is a risk factor for preterm labor.

Low Pre-pregnancy BMI

A maternal risk factor for both preterm labor and Preterm/Prelabor Rupture of Membranes.

Adolescent pregnancy

Pregnancy occurring in early adolescence is considered a risk factor for preterm labor.

Assistive reproductive technology

Used to achieve pregnancy; it is a risk factor for preterm labor and chorioamnionitis.

Pregnancies < 18 months apart

A short interval between pregnancies that increases the risk for preterm birth.

Substance abuse

A maternal risk factor for preterm labor and birth.

Gestational DM

A comorbidity of pregnancy that can increase the risk of preterm labor and PPROM.

Hypertensive disorders

Maternal conditions such as preeclampsia that are comorbidities for preterm labor and birth.

GU Tract Infections / STIs

Infections of the genitourinary tract that can trigger preterm labor.

Global Preterm Birth Rate

Approximately $10\%$ of births annually worldwide are preterm.

Preterm Labor Diagnostics

Includes the Non-stress test (NST), Biophysical profile (BPP) / US, and fetal fibronectin (fFN).

fetal fibronectin (fFN)

A diagnostic test used to assess the likelihood of preterm labor.

Tocolysis

The use of medications to inhibit uterine contractions and delay preterm labor.

Terbutaline

A tocolytic medication often administered subQ to treat preterm labor.

Oral nifedipine

An oral medication used as a tocolytic to manage preterm labor.

Mag Sulfate (IV)

Administered intravenously to provide neuroprotection for the fetus or as a tocolytic during preterm labor.

Corticosteroids

Medications administered in the event of preterm birth to accelerate fetal lung development while tocolysis is used to delay delivery.

Cerclage

A surgical procedure to close the cervix, typically performed between $12$ to $16$ weeks.

Emergency Cerclage

A cerclage performed in emergency situations up to $24$ weeks of gestation.

Maternal activity restriction

A consideration for clients in preterm labor to reduce stress on the pregnancy.

Facilitation of adequate perfusion

A nursing intervention for preterm labor to ensure the fetus receives sufficient oxygen.

PPROM

Preterm Prelabor Rupture of Membranes, which increases the risk of infection and respiratory distress for the infant.

Fetal lung development

A process that can be negatively impacted by Preterm Prelabor Rupture of Membranes (PPROM).

Short cervical length

A clinical risk factor for Preterm Prelabor Rupture of Membranes.

PPROM Statistics

Accounts for $2\%$ to $3\%$ of all pregnancies and $40\%$ of spontaneous preterm births.

Fern test

A diagnostic test used to confirm the rupture of membranes by looking for a characteristic pattern under a microscope.

Nitrazine test

A test that uses pH paper to check for the presence of amniotic fluid to confirm ROM.

Expectant management

A treatment strategy for PPROM near term where the provider waits for labor to begin naturally while monitoring for complications.

Maternal sepsis

A potential complication for the mother following Preterm Prelabor Rupture of Membranes.

Fetal sepsis

A life-threatening complication for the neonate associated with PPROM and chorioamnionitis.

Frequent pad changes

A nursing intervention for comfort and hygiene in clients with ruptured membranes.

Avoidance of vaginal exam

A nursing priority in cases of PPROM to prevent the introduction of infection into the uterine environment.

Chorioamnionitis

An infection resulting in inflammation of the amniotic fluid, placenta, uterus, or fetus.

Intraamniotic infection

Another term for chorioamnionitis, involving the infection of the fetus, amniotic membranes, and placenta.

Ascending infection

The primary mechanism of chorioamnionitis, where bacteria move from the vagina into the uterus.

Induction with cervical balloon

A risk factor for developing chorioamnionitis during labor.

Uterine tenderness

A clinical manifestation indicating the presence of chorioamnionitis.

Purulent amniotic fluid

A sign of chorioamnionitis characterized by foul-smelling or cloudy fluid.

Maternal Fever in Chorioamnionitis

Defined as a temperature > $38^\circ\text{C}$ ($100.4^\circ\text{F}$) on two occasions $30$ minutes apart.

Maternal tachycardia

Often seen as an early sign of maternal infection or chorioamnionitis.

Leukocytosis

An elevated white blood cell count found in lab testing for chorioamnionitis.

Postpartum endometritis

A maternal complication that chorioamnionitis treatment with antibiotics aims to prevent.

GBS screening

A health promotion activity to screen for Group B Streptococcus to prevent infections like chorioamnionitis.

Augmentation

The use of medications or interventions to help labor progress once it has already begun spontaneously.

Induction

The use of medications or mechanical techniques to help labor begin.

Pitocin

An IV medication (oxytocin) used for both the induction and augmentation of labor.

Amniotomy

An intervention to help labor progress by artificially rupturing the amniotic membranes.

Friedman Curve

A tool used to evaluate the progress of labor and identify dysfunctional labor patterns.

Dysfunctional labor

Labor characterized by ineffective contractions or anatomical disproportion between mother and fetus.

Uterine atony

A risk following dysfunctional labor that can lead to postpartum hemorrhage.

Fetal Demise

Intrauterine fetal death, which may require augmentation or induction of labor.

Breech Presentation

A situation where the fetus enters the birth canal with the buttocks or feet first instead of the head.

Frank breech

A type of breech where the fetus's hips are flexed and knees are extended with feet near the head.

Complete breech

A breech presentation where both hips and knees are flexed.

Footling breech

An incomplete breech where one or both feet are the presenting part.

External cephalic version

A procedure where a provider attempts to manually turn the fetus from breech to a cephalic position through the maternal abdomen.

Placenta previa

A cause of breech presentation where the placenta covers the cervix.

Cord prolapse risk

A major risk associated with external cephalic version or breech vaginal birth.

Reassuring FHR range

Excepted fetal heart rate range between $110$ to $160$ beats/min.

FHR Variability

Fluctuations in the fetal heart rate baseline that indicate a healthy neurological system.

Non-reassuring FHR patterns

Patterns suggesting fetal hypoxia or neurological dysfunction, such as bradycardia or absent variability.

Fetal Tachycardia

A baseline FHR above $160$ beats/min, potentially caused by maternal fever or chronic hypoxia.

Fetal Bradycardia

A baseline FHR below $110$ beats/min, often associated with cord compression or hypoxia.

Category I FHR Classification

Includes a baseline of $110$ to $160$ per minute, moderate variability, and no late or variable decelerations.

Category II FHR Classification

Includes patterns such as moderate variability with recurrent late decels or minimal variability with recurrent variable decels.

Category III FHR Classification

Characterized by absent variability combined with recurrent late/variable decels, bradycardia, or a sinusoidal pattern.

Sinusoidal pattern

A regular, smooth, undulating FHR pattern classified as Category III, indicating severe fetal distress.

IUGR

Intrauterine growth restriction, a fetal risk factor for non-reassuring heart patterns.

SGA

Small for gestational age, a fetal condition associated with increased risk during labor.

Modifiable factor for Tachycardia

Maternal Fever.

Modifiable factor for Bradycardia

Cord compression.

Early Decelerations

Caused by fetal head compression during labor, usually considered a benign finding.

Late Decelerations

Caused by uteroplacental insufficiency, indicating fetal hypoxia, acidosis, or encephalopathy.

Variable Decelerations

Caused by umbilical cord compression.

Fetal scalp electrode

An internal monitoring device used for direct and accurate fetal heart rate measurement.

IUPC

Intrauterine pressure catheter, used to measure the exact strength of uterine contractions.

Intrauterine resuscitation

Interventions like repositioning the mother, administering oxygen, and increasing IV fluids to improve fetal oxygenation.

VBAC

Vaginal birth after cesarean, a consideration for future pregnancies after a non-reassuring FHR event leading to surgery.

Meconium Staining

When the fetus passes stool into the amniotic fluid, often indicating fetal hypoxia.

Meconium Aspiration Syndrome (MAS)

A serious condition that occurs when an infant inhales meconium-stained fluid into the lungs around the time of birth.

Post-term pregnancy

Pregnancy greater than $41$ weeks, which is a risk factor for meconium staining.

Meconium Grade 1

Lightly stained or thin amniotic fluid.

Meconium Grade 2

Green or yellow stained fluid, may contain flecks.

Meconium Grade 3

Dense or thick fluid with a 'pea soup' consistency.

Amnioinfusion

The infusion of sterile fluid into the uterine cavity to dilute meconium or relieve cord compression.

Newborn resuscitation

A prioritized intervention for infants born with meconium-stained fluid.

Operative Vaginal Birth

An intervention using a vacuum extractor or forceps to aid fetal descent or expedite birth.

Vacuum extractor complications

Includes cephalohematoma, intracranial hemorrhage, scalp laceration, and Erb-Duchenne Palsy.

Forceps complications

Includes facial lacerations, facial nerve palsy, ocular trauma, and skull fractures.