OB Exam 3: Complications of labor

Define preterm labor:

how do healthcare providers diagnose preterm labor? (3)

regular uterine contractions that cause cervical changes b4 37 weeks

1. Fetal Fibronectin Test (fFN): looks for presence of the protein which acts like “glue” bw fetal membranes and uterine lining (vaginal swab)

2. NST

3. BPP/USN

How to manage preterm labor: (2)

1. Tocolysis (makes contractions go away and delay labor)

2. Cerclage (sew cervix shut)

What are the tocolytics used: (4)

1. terbutaline SubQ

• give to stop contractions

2. oral nifedipine

• relaxes smooth muscle ⬇contractions

3. mag sulfate IV

• preeclampsia/neuroprotection

• relaxes smooth muscle

4. betamethasone

• lung maturity

What is Prelabor/ Preterm rupture of membranes (PROM)

Prelabor-ROM: rupture of membrane b4 labor begins @ term (> 37 weeks)

PPROM: b4 labor and b4 37 weeks (< 37 weeks)

What should u monitor for when mom’s water breaks?

1. Sepsis!!

• check temperature frequently!!

• q1-2 hrs

2. FHR!!

PROM/PPROM diagnostic tests (4)

1. visual (color, odor, amt, time)

2. Fern test

3. Nitrazine test (turns blue)

4. Fetal Fibrinectin Test

• Fetal fibronectin (fFN) is a protein that acts like a “glue” b/w fetal membrane and the uterine lining.

  • vaginal swab is taken

  • u want negative

Tx for PROM/PPROM (2)

1. tocolytics to make contractions go away

2. corticosteroids (speed up fetal lung maturity)

Terbutaline education: (7)

1. hold if mom HR >120 bpm

2. monitor signs of pulmonary edema

3. SOB

4. HA

5. palpitations/tachycardic

6. tremors

7. hyperglycemia

Mag Sulfate education: (4)

1. monitor for ⬇DTR

2. respiratory depression

3. oliguria

4. calcium gluconate antidote

Chorioamnionitis clinical manifestations: (4)

• due to prolonged rupture of membrane

1. maternal fever > 100.4F x2, 30 mins apart

2. mom and baby tachycardia

3. uterine tenderness

4. foul smelling amniotic fluid

What is the difference between augmentation and induction of labor?

Induction:

• starting labor ARTIFICIALLY b4 it begins (Pitocin or mechanical techniques)

Augmentation:

• help labor progress AFTER it starts

What are the contraindications for using oxytocin (Pitocin) during labor? (5)

1. placenta previa

2. umbilical cord prolapse

3. prior cesarean

4. cephalopelvic disproportion(baby’s head too big to fit through pelvis)

5. fetal distress (breech)

Types of breech presentations (3):

1. frank breech: butt first, legs up

2. complete breech: butt first, knees flexed

3. footling breech: one or both feet first

How do providers respond to non-reassuring fetal heart patterns? (5)

• ex: late or prolonged decels, minimal or absent variability, bradycardia

1. Reposition LEFT side!!!

2. STOP oxytocin

3. give O2

4. IV fluids

5. emergent delivery if needed

Category I-III FHR patterns:

• baseline

• variability?

• decels?

I: good

• baseline 110-160 bpm

• moderate variability

• no late or variable decels

• has accelerations

II: needs monitoring

• recurrent late/variable decels

• minimal variability

• prolonged decels

III: bad

• absent variability w/ recurrent late decels

• absent variability w/ recurrent variable decels

• bradycardia

• sinusoidal pattern!!!

Describe the s/s of uterine rupture (5)

1. uterine atony (loss of contractions on palpation)

2. loss of fetal station

3. change in shape of uterus

4. referred shoulder/CP

5. abnormal contraction patterns

What factors contribute to these findings:

1. tachycardia

2. bradycardia

3. minimal variability

4. variable decels

5. early decels

6. late decels

1. tachycardia: mom has fever

2. bradycardia: cord compression

3. minimal variability: baby sleeping

4. variable decels: cord compression

5. early decels: head compression

6. late decels: placental insufficiency, fetal hypoxia

Hallmark Placental Abruption signs: (2)

1. painful, dark red bleeding (hypovolemia)

2. rigid/board-like abdomen

• start tocolytics (stop contractions)

signs of uterine rupture: (4)

1. loss of uterine contractions on palpation/monitor (uterine atony)

2. loss of fetal station/ cant feel presenting part (where’d baby go?")

3. referred shoulder/CP

4. sudden change in shape of uterus

Emergent nursing actions for uterine rupture: (6)

1. move on left side

2. stop Pitocin

3. non rebreather @ 10L/min

4. 2 #20 gauge IV lines

5. indwelling cath

6. prep for hysterectomy

7. emergent c-section

Explain prolapse cord and know the nursing responses: (5)

• umbilical cord slips through cervix b4 baby

• response:

1. lift presenting baby off cord w/ sterile hand (prevent kinks)

2. pt in knee to chest

3. Trendelenburg

4. stop Pitocin

5. emergent c-section

What is Shoulder Dystocia: (2)

• complications: (3)

• baby’s shoulder stuck behind moms pubic bone

• “turtle sign”- head goes out, in, out…etc)

→ can cause

1. Erb Duchenne palsy (disabled arm)

2. uterine rupture

3. hemorrhage etc

Tx shoulder dystocia: (6)

1. Apply suprapubic pressure (avoid fundus to attempt to free shoulder)

2. Mvmt of babys arm across head to dislodge shoulder

3. Pt on hands and knees

4. Prep for Episiotomy

5. McRoberts maneuver: push mom legs to chest

6. Rotate fetus manually

Define amniotic fluid embolism and s/s (3):

• amniotic fluid enters moms bloodstream post birth → clotting

s/s:

1. sudden SOB

2. hypotension

3. altered LOC