NURS 2866 - Chapter 17 - Labor and Birth Complications

What defines preterm labor in terms of contractions and cervical change?

Regular uterine contractions with cervical change (effacement and/or dilation) OR contractions with cervical dilation ≥ 2 cm

Between what gestational ages is preterm labor defined?

20 weeks to 36 weeks + 6 days

What is the definition of preterm birth?

Birth occurring between 20 weeks and 36 weeks + 6 days gestation

What is the difference between preterm birth and low birth weight?

Preterm refers to gestational age, while low birth weight refers to ≤ 2500 grams at birth

What are all risk factors for preterm labor and birth?

Infection, African American race, history of preterm birth, multifetal gestation, substance abuse, BMI < 19.6 or ≥ 30, periodontal disease, cervical length changes

What is fetal fibronectin (fFN)?

A glycoprotein found in plasma and cervical/vaginal secretions during early and late pregnancy

When is fetal fibronectin testing clinically significant?

Late 2nd trimester or early 3rd trimester

What does a positive fetal fibronectin indicate?

Possible placental inflammation and increased risk of preterm labor

What is fetal fibronectin most useful for clinically?

Ruling OUT preterm labor

What does a negative fetal fibronectin result mean?

Patient is unlikely to go into preterm labor soon

What are nursing assessment and prevention strategies for preterm labor?

Identify risk factors, encourage dental care, consider progesterone therapy

What forms of progesterone therapy are used to prevent preterm labor?

Daily vaginal suppository/cream or weekly IM injection

When is progesterone therapy used?

Before 24 weeks gestation in high-risk patients

What early interventions reduce preterm infant morbidity and mortality?

Transfer to NICU-capable facility, antibiotics for GBS, antenatal glucocorticoids, magnesium sulfate

What are the signs of preterm labor?

Change in vaginal discharge, pelvic pressure, constant low back pain, mild cramping, abdominal tightening, ruptured membranes

What patient education should be given for suspected preterm labor at home?

Lie on side, drink 2–3 glasses of water, wait 1 hour

What should the patient do if symptoms continue after 1 hour?

Call provider

What are possible provider instructions after calling?

Wait another hour OR come in for evaluation

What are ongoing care interventions for preterm labor?

Activity restriction, hydration, tocolytics

What is the key point about tocolytics?

No FDA-approved drugs prevent preterm birth; they only delay labor

Why are tocolytics used?

To buy time for fetal lung maturity

What are the main tocolytic medications and their actions?

Magnesium sulfate (CNS depressant, relaxes uterus), Terbutaline (smooth muscle relaxation, bronchodilation), Indomethacin (inhibits prostaglandins), Nifedipine (blocks calcium, relaxes uterus)

How is fetal lung maturity promoted in preterm labor?

Betamethasone IM

What does betamethasone do?

Increases surfactant production and decreases respiratory distress syndrome

What is the most effective intervention for preterm newborn survival?

Antenatal glucocorticoids PROM (PREMATURE RUPTURE OF MEMBRANES)

What is PROM?

Rupture of amniotic sac before labor begins

At what gestational age can PROM occur?

Any gestational age

What is the major risk factor for PROM?

Infection

What are maternal complications of PROM?

Chorioamnionitis

What are fetal complications of PROM?

Infection, cord prolapse, cord compression

How is PROM managed at term?

Induce labor

How is PROM managed if preterm?

Hospitalize and monitor to delay delivery

When must delivery occur with PROM?

Infection, vaginal bleeding, labor onset, or non-reassuring fetal status

What is chorioamnionitis?

Bacterial infection of the amniotic cavity

What causes chorioamnionitis?

Ascending vaginal flora

What are risk factors for chorioamnionitis?

Prolonged labor, prolonged ROM, multiple vaginal exams, internal monitoring

What maternal complications result from chorioamnionitis?

Dysfunctional labor leading to C-section

What neonatal complications result from chorioamnionitis?

Pneumonia, meningitis

What is the treatment for chorioamnionitis?

IV broad-spectrum antibiotics (ampicillin/penicillin + gentamicin) and delivery

What defines post-term pregnancy?

≥ 42 weeks gestation

What clinical findings occur in post-term pregnancy?

Decreased amniotic fluid, maternal weight loss, meconium, advanced fetal bone maturity

What are maternal risks of post-term pregnancy?

Labor dystocia, perineal injury, infection, postpartum hemorrhage, C-section, fatigue, anxiety, depression

What are fetal risks of post-term pregnancy?

Cord compression, hypoxia, meconium aspiration

How is post-term pregnancy managed?

NST, CST, BPP, kick counts, induction around 41 weeks, continuous monitoring

What is dystocia?

Lack of labor progress

What is dysfunctional labor?

Long, difficult, abnormal labor

What uterine factors cause dysfunctional labor?

Weak, too frequent, or ineffective contractions

What are secondary power causes of dysfunctional labor?

Epidural, pain, fear, exhaustion causing ineffective pushing

What defines precipitous labor?

Labor lasting < 3 hours

What are maternal complications of precipitous labor?

Uterine rupture, lacerations, amniotic fluid embolism, postpartum hemorrhage

What is the fetal complication of precipitous labor?

Hypoxia

What pelvic factors contribute to dystocia?

Narrow pelvis or soft tissue obstruction

What fetal factors cause dystocia?

Macrosomia, malpresentation, malposition, multiple fetuses, anomalies

What is cephalopelvic disproportion (CPD)?

Fetus too large OR pelvis too small

How does maternal position affect labor?

Lack of movement slows labor

What psychological factors affect labor?

Fear, stress, exhaustion

What BMI defines overweight, obese, and morbidly obese?

≥25 overweight, ≥30 obese, ≥40 morbidly obese

What risks does obesity pose in labor?

Difficult monitoring, need for internal monitors, BP cuff issues, blood clots

What postpartum risks are associated with obesity?

Infection, poor wound healing, moisture in abdominal folds

What nursing interventions are needed for obese patients?

Correct BP cuff, ambulation, SCDs, incision care, dry folds, longer sutures

What is external cephalic version (ECV)?

Manual turning of fetus through abdomen

When is ECV performed?

36–37 weeks

What must be done before ECV?

NST, consent, tocolytic administration

What are contraindications for ECV?

Placenta previa, multiple gestation, previous C-section, ROM, cord around neck, CPD

What must be monitored after ECV?

Vital signs, FHR ≥1 hour, vaginal bleeding

What medication is given if patient is Rh negative after ECV?

Rh immune globulin

What is internal version?

Provider inserts hand into uterus to turn fetus, usually for second twin

What is induction of labor?

Artificial initiation of labor

What methods are used for induction?

Pitocin and amniotomy

What does the Bishop score assess?

Dilation, effacement, station, consistency, position

What Bishop score indicates successful induction?

≥ 8

What are indications for induction?

Hypertension, preeclampsia, fetal death

What additional conditions require induction?

Infection, diabetes, IUGR

What are contraindications to induction?

Fetal distress, malpresentation, placenta previa, prior uterine incision

What is the purpose of cervical ripening?

Soften and dilate cervix before Pitocin

What medications are used for cervical ripening?

Cytotec and Cervidil

What is the mechanical method of cervical ripening?

Foley balloon catheter

How much fluid is used in the balloon?

30–50 mL

When does the balloon fall out?

Around 3 cm dilation

How long does it take?

About 12 hours

What is the typical cervical ripening schedule?

Night insertion, monitor overnight, start Pitocin in morning

What is membrane stripping?

Separating amniotic sac from cervix to release prostaglandins

When is membrane stripping used?

Post-term patients

When can labor begin after stripping?

Same day or within days

What is amniotomy?

Artificial rupture of membranes

What must be true before amniotomy?

Fetal head engaged and applied to cervix

Why is engagement required before amniotomy?

Prevent cord prolapse

What must be assessed after amniotomy?

Fluid color, odor, consistency, time, FHR

What is Pitocin used for?

Induction and augmentation

What are maternal risks of Pitocin?

Abruption, rupture, C-section, hemorrhage, infection

What is the fetal risk of Pitocin?

Hypoxia from frequent contractions

How is Pitocin administered?

Secondary IV line

What is the starting dose of Pitocin?

1 milliunit/min

How is Pitocin increased?

1–2 milliunits every 30–40 minutes

What monitoring is required with Pitocin?

Continuous FHR, contractions q15 min, VS q30 min

What is uterine tachysystole?

5 contractions in 10 minutes

What interventions are done for tachysystole?

Reposition, IV fluids, stop Pitocin, oxygen

What is augmentation of labor?

Increasing contractions after labor begins

What is it used for?

Dysfunctional labor

What methods are used?

Pitocin and amniotomy