Complications L&D

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  1. What are these abbreviations:
    G2/P1
    IUP
    BOW
    FM
    • G = Gravida or # of pregnancy; P  = Parity or # of deliveries
    • IUP = intrauterine pregnancy
    • BOW = bag of waters
    • FM = fetal movement
  2. What are the 4 P's for dysfunctional labor?
    • Power
    • Passenger
    • Passage
    • Psyche
  3. This P of dysfunctional labor refers to ineffective contractions or ineffective maternal pushing

    A. Power
    B. Passage
    C. Psyche
    D. Passenger
    A.
    (this multiple choice question has been scrambled)
  4. Is Hypertonic dysfunction a latent phase of dysfunctional labor or an active phase?
    Latent
  5. Is this hypertonic or hypotonic dysfunction:

     - UC's uncoordinated and erratic, painful but ineffective
     - Loss of downward pressure
     - Increased uterine resting tone
    Hypertonic
  6. T or F: Hypertonic dysfunction is when UC's are coordinated but too weak for labor
    False: Hypotonic
  7. List nursing management of Hypertonic contractions
    • Promote rest
    • ID contributing factors: CPD, fetal malpresentation
    • Hydrate
    • Tocolytics to decrease uterine irritability
    • Sedation
  8. List nursing management of HYPOtonic contractions
    • Hydrate
    • Change positions, ambulate
    • Pain management 
    • Amniotomy (amniotic sac is deliberately ruptured)
    • Augment labor (Pitocin)
    • Consider C-sec
  9. This is characterized by labor that can last as little as 3 hours and is typically less than 5 hours. How do you manage it?
    • Precipitous Labor:
    • Monitor closely for fetal distress
    • DC pitocin
    • Optimize uteroplacental profusion by positioning on left side
    • Guard perineum and prevent rapid decent
  10. This term refers to when a baby's head or body is too large to fit through a mother's pelvis
    Cephalopelvic Disproportion (CPD)
  11. How can these hormones complicate delivery: Catecholamines, cortisol, Epinephrine, Beta-endorphrine?
    Release of these stress hormones interfere with uterine contractility and lower placental perfusion.
  12. Fill in:
    For normal labor, dilation should be __a__ cm/hr for nullip and __b__ cm/hr in multip
    • a. 1.2 cm/hr
    • b. 1.5 cm/hr
  13. Fill in:
    For normal labor, normal descent is _a__ cm/hr for nullip and __b__ cm/hr in multip
    • a. 1
    • b. 2
  14. This med can inserted directly into the vagina or cervix to induce Labor, where the action is to produce cervical changes
    Prostaglandin
  15. What are implications of induced labor from prostaglandin?
    • Might cause abnormal or execssive contractions which diminish baby's O2 and HR
    • Increased risk that uterine muscles won't properly contract after birth, causing serious bleeding
  16. What is Terbutaline used for during complicated deliveries?
    For induced labor complications that ause achysystole of the uterus resulting in fetal bradycardia and possible hypoxia
  17. Is this augmentation or induction:

    This intervention is intended to increase the intensity of labor, usually when labor is not progressing or progressing too slowly
    Augmentation
  18. What are indications of Augmentation? What is its intended goal?
    If contractions have become weak, not coordinated (or irregular), far apart, not lasting long enough or have ceased.

    It is aimed at strengthening, coordinating and/or increasing frequency of contractions until cervix is fully dilated and baby is born
  19. Is this augmentation or induction:

    When labor does not naturally start on its and and delivery needs to happen soon.
    Induction
  20. What are some indications for induced labor?
    • Pregnancy has gone 1-2 weeks past due date
    • A condition that may threaten your or your baby's health if pregnancy continues
    • Amniotic sac has broken but no active labor contractions starte
    • Baby has a condition that needs treatment
  21. State if augmentation or induction

    1. Stimulates uterine contractions before the onset of spontaneous labor
    2. Enhances ineffective contractions after labor has begun
    • 1. Induction
    • 2. Augmentation
  22. What is a sufficient Bishop score for fetal readiness?
    7 or higher
  23. Fill in: 
    Amniotomy (AROM) is indicated if dilation is only __a__ and there is a bulging BOW.
    2-4cm
  24. What are the risks of AROM?
    • Prolapse of the ubilical cord
    • Prolonged rupture leading to risk of infection
    • Need for augmentation
  25. What are some near-term tests for fetal well being?
    • Sonograms (placenta, cervix, fetus and fluid)
    • Fetal movement (10 kick counts over 3hr period)
    • FHR patterns (NST, CST, BST (breast stimulation test))
    • AFI (amniotic fluid index)
  26. What is the normal range of the AFI (amniotic fluid index)?
    Normal = >5cm  and <20cm of fluid
  27. What are the components of the Biophysical profile (5)
    • 1. fetal breathing movements
    • 2. fetal muscle tone
    • 3. gross body movement
    • 4. amniotic fluid volume
    • 5. reactive FHR NST
  28. What could these findings mean:

    FHR = persistent fetal tachycardia
    Maternal temp >100.4
    Maternal pulse high
    Mom tachypnea
    foul smelling amniotic fluid
    Intrauterine infection
  29. What are some causes of PROM?
    • infection of vagina or cervix
    • Chorioamnionitis - intraamniotic infection
    • Hydramnios - excess of amniotic fluid
    • Poor nutrition
    • Overdistention of uterus
    • Trauma
  30. Define these infection complication risks for PROM:
    1. Chorioamnionitis
    2. Endometritis
    • 1. Also known as intra-amniotic infection, it is an inflammation of the fetal memranes due to a bacterial infection. 
    • 2. an inflammatory condition of the lining of the uterus, usually d/t an infection.
  31. What two ways to dx if there is a PROM?
    • Nitrazine paper
    • Ferning test
  32. What do you look for during a fern test?
    A detection of a "fern" like pattern of cervical mucus when viewed under a microscope
  33. List the therapeutic management of PROM (5)
    • 1. avoid digital cervical exam
    • 2. assess gestational age and fetal well being
    • 3. Assess s/s of infection
    • 4. Hospitalized and put on bed rest
    • 5. Induction if signs of sepsis develop
  34. T or F: If someone with PROM shows signs of sepsis, you would use induction
    True
  35. What does the Fetal Fibronectin test? When is it taken?
    20-34 weeks: This is something that leaks into the vagina if a preterm delivery is likely to occur. 

    If a fFN test is positive, it is an inconclusive test.
  36. T or F: If an fFN test is positive, it means that she is about to go into labor.
    False: It can indicate that she will go into preterm labor soon, but may or may not go into labor for weeks.
  37. List three medications that an help stop preterm labor
    • 1. Mag Sulfate
    • 2. Terbutaline
    • 3. Nifedipine
  38. This corticosteroid therapy drug can accelerate Preterm Fetal Lung Maturity. When should it be used?
    Betamethasone: If gestational age is >24 weeks and <34 weeks to reduce risk of RDS and IVH
  39. T or F: You would delay delivery of a preterm labor if giving Betamethasone
    True
  40. What is the dose of Betamethasone? What is it for?
    Given in two doses of 12mg, 24 hours apart.

    Given for preterm labor: accelerates fetal lung maturity and prevent respiratory distress syndrome
  41. List interventions for Preterm Labor
    • 1. avoid pelvic exams 
    • 2. Monitor temp and labs if PROM
    • 3. Bedrest
    • 4. Hydration
  42. Why do you want to avoid pelvic exams during preterm labor?
    It stimulates UC
  43. T or F: You do not want to restrict liquids if a mom is on MagSulfate
    False
  44. What are complications of a prolonged pregnancy?
    • Insufficient placental function
    • Decreased amniotic fluid
    • Meconium
    • Large fetus
    • Harder labor or birth injury
  45. What is Velamentous Insertion?
    When the umbilical cord inserts into the fetal membranes, then travels within the membranes to the placenta. 

    This means that the blood vessels of the umbiliccal cord are unprotected by the Wharton's jelly and may rupture during anytime of the pregnancy.
  46. Fill in: When cord prolapse is diagnosed, goal is __a__ off of cord and __b__ in __c__ position
    Fill in: When cord prolapse is diagnosed, goal is elevation of presenting off of cord and emergent delivery in knee chest position

    • a. Elevation of presenting
    • b. emergent delivery
    • c. knee chest position
  47. What is amniotomy?
    Artificial rupture of membanes
  48. T or F: an Amniotomy is performed during a prolapsed cord delivery
    True
  49. How much pressure do you use with a vacuum extractor?
    How long do you use it for? When should u d/c it?
    • 50-60 mmHg of pressure
    • No more than 10 minutes
    • after , should be d/c3 pop-offs
  50. T or F: If placenta isn't delivered after 10 minutes the baby is born, it should be manually removed.
    False: if it is longer than 30 minutes

Card Set Information

Author:
edeleon
ID:
333973
Filename:
Complications L&D
Updated:
2017-09-09 04:26:27
Tags:
complications nursing
Folders:
MCN Exam 2
Description:
Lecture notes
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