maternity final pt2

prolapse cord emergency interventions

immediate recognition

-cord compression can cause fetal hypoxia and CNS damage or death in just over 5min

relieving cord compression

-mother position in knee-chest, trendelenburg, or side-lying to use gravity to shift fetal presenting part away from cord

-nurse holds presenting part of fetus until emergency c

normal interventions to add to emergency interventions for prolapsed cord

-prepare for emergency c section

-oxygen administration

-IV access

-tocolytics

-cord handling (keep moist and warm with sterile saline towels)

-fill bladder with saline to elevate presenting part

conditions that would prevent woman from having vaginal birth

-previous uterine surgery

-placental abnormalities (placenta previa, placenta accreta, vasa previa)

-active genital herpes @ time of labor

-umbilical cord prolapse (cord presents before fetus)

-complete placental abruption

-failed trial of labor

-breech presentation

-dangerous fetal distress

-severe macrosomia

-pelvic structural blockages

-severe high bp conditions

preterm labor

-labor occurring before 37 weeks gestation

-prevented with progesterone supplementation

-treatment is tocolytics, steriods, or mag sulfate

oxytocin (pitocin) class and indication

-uterine stimulant

-labor induction

-labor augmentation

-prevention/control of postpartum hemorrhage

-induction of incomplete abortion

-promotion of milk ejection reflex

oxytocin side effects

maternal

-painful/intense uterine contractions

-n/v

-hypertension or cardiac arrhythmias

-fluid retention and hyponatremia

-placental abruption

-uterine rupture

-infection

fetal

-hypoxia and acidemia from decreased placental perfusion

-late decels

-minimal or absent variability

oxytocin patient teaching

-expect strong, frequent, and increasingly painful contractions

-report any side effects

-continuous fetal monitoring is necessary

-fluid intake and output will be closely monitored

postpartum depression

-more serious and persistent than blues

-requires professional interventions

-lasts more than 2 weeks

-intense sadness with severe mood swings

-feelings of detachment from newborn

-guilt and shame

-obsessive thoughts about harming the infant but does NOT act

-fatigue, sleep disturbance, appetite disturbance, irritability

postpartum blues

-peaks around day 5 and subsides by day 10

-"blue period" following initial postpartum joy

-crying for no reason

-let-down feeling

-mood swings

-fatigue and restlessness

-anxiety, sadness, anger

postpartum psychosis

-most often in first 2-4weeks after birth

-likely to act on thoughts

-bizarre behavior

-auditory or visual hallucinations

-disoriented and confused

-extreme judgement deficits with high impulsivity

-may believe infant is possessed or destined for harm

-command hallucinations to kill infant or self (psych emergency)

interventions for vaginal bleeding during pregnancy

-rest and activity limits

-hospital monitoring

-fluid and blood replacement if heavy blood loss

-medications like steroids

-delivery if severe distress

intervetnions for vaginal bleeding during labor

-continuous fetal monitoring

-obtain IV access (large bore)

-possible emergency delivery or use of forceps and vacuum

interventions for vaginal bleeding postpartum

-fundal massage

-empty bladder

-uterotonic meds (methergine, hemabate)

-antifibrinolytic drugs (TXA)

-fluid resuscitation (large bore IV with blood and fluids)

-assess for causes besides hemorrhage

uterotonic drugs

*all help stimulate contractions (induction of labor) or increase uterine tone (prevent/treat PPH)

oxytocin (pitocin)

-stimulates uterine contractions

-first line intervention for uterine atony

misoprostol

-used for cervical ripening

methergine

-enhances myometrial tone and increases force and frequency of uterine contractions

-helps prevent uterine atony and hemorrhage

hemabate

-used for excessive bleeding after miscarriage or PPH

engorgement

-usually 3-5days after birth as milk transitions from colostrum to mature milk

-d/t rapid increase in milk volume and tissue swelling

-both breasts affected

-breasts are firm, tender, and hot

-appear shiny and taut

-NO fever

-NO infection present

mastitis

-usually during 2-4weeks postpartum

-caused by infection (pathogens enter cracked nipples)

-localized area that is red, painful, and tender

-mostly upper outer quadrant of breast

-usually ONE breast affected

-body aches and headache

-n/v

treatment of engorgement

-cold therapy (cold packs or cabbage)

-warmth before feeding (warm shower)

-breast massage

-frequent feeding

-antiinflammatory meds

treatment of mastitis

-antibiotics

-bed rest

-antiinflammatory meds

-cold compresses

-continue frequent breastfeeding

-make sure to completely empty breasts

respiratory distress syndrome

-caused by surfactant deficiency in lungs

^^causes the alveoli to collapse

-responsible for more infant deaths than any other disease

-almost exclusively in preterm infants (2x more in males)

respiratory distress syndrome s/sx

-tachypnea

-grunting when exhaling

-nasal flaring

-retraction

-cyanosis

respiratory distress syndrome treatments

-exogenous surfactant administration within 15-30min of birth

-oxygen therapy (usually mechanical ventilation)

-steroids given before birth --> will increase surfactant

rupture of membranes

-rupture of amniotic sac wtih release of amniotic fluid

PROM --> prelabor rupture of membranes (before labor/contractions begin)

PPROM --> preterm prelabor rupture of membranes (before 37wk)

prolonged rupture of membranes

gap of 18-24hours between the time the water breaks and the baby is born

kangaroo care

-aka skin to skin contact

-place undressed infant (with diaper) in vertical position directly on parents bare chest

benefits

-increases bonding

-improved cardiorespiratory stability

-reduces stress and mortality risk

-strong analgesic effect

-increased movement and feeding

-fewer hospital acquired infections and decreased hospital stay

macrosomia

-birth weight more than 4000-4500g (>8.8lbs)

-most common fetal effect of gestational diabetes

-causes increased risk for shoulder dystocia, c section, or forcep birth

incomplete abortion

-loss of part of the products of conception BUT retention of some tissue in the uterus

-often heavy vaginal bleeding with excessive cramping

-cervix may be dilated

treatment for incomplete abortion

-less invasive: allowing resolution on own but lower success rates

-medical: misoprostol (more success than ^^ but less than surgical)

-surgical: dilation and curettage (uterine content remove by suction)

cervidil

-used to riper the cervix for labor induction

-^^when the uterus is 'unfavorable' (not soft or thin enough)

-the cervix must be ripe before oxytocin is able to be administered

-can also be used for termination of pregnancy 12-20wk or evacuation of uterine contents in missed abortion