Risks of Labor and Birth Ch. 19
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A pregnancy ending before 20 weeks is termed as a _________
Cervical changes and uterine contractiosn occurring between 20-37 weeks of pregnancy is termed as ______ labor
A low birth weight baby weighs less than ________
What is more dangerous, preterm or low birth weight?
Preterm birth is highest among:
Social economic status
- Under 15y/o or over 45y/o
What biochemical marker most accurately predicts preterm labor? How?
- Their glycoproteins are found in plasma and are produced during fetal life
- **94% accurate
How is endocervial length a predicter for preterm birth?
- A shortened cervix less than 3.5cm is a high risk
- **Nurse should avoid checking cervix if mom's in preterm labor
What are the signs and symptoms of preterm labor with uterine activity?
- Contractions every 10minutes or less for more than 1 hour
- Painful or painless
What are the signs and symptoms of preterm labor with discomfort?
- Lower abdominal cramping or lower back pain
What are the signs and symptoms of preterm labor with vaginal discharge?
- Increasing amounts and odorous
- Rupture of amniotic membranes
What is the most important nursing intervention in preventing preterm birth?
What are the 3 main diagnostic criteria for preterm labor?
- 1. Gestational age between 20-37weeks
- 2. Uterine activity
- 3. Progressive cervical changes (80% effacement or 2cm dilated)
Why are glucocorticoids given as an early intervention?
- To accelerate fetal lung maturity
- Lowers the risk of respiratory distress syndrome
What are some lifestyle modifications that should be avoided when feeling the symptoms of preterm labor?
- Riding long distances in a vehicle
- Carrying heavy loads
- Standing more than 50% of the time
- Climbing stairs
- Heavy housework
What is the point of tocolytic therapy?
Name a few medications
To suppress uterine activty
- Magnesium sulfate
At what gestational age are tocolytics NOT to be used?
- After 34 weeks.
What are example medications of antenatal glucocorticoids?
How is it given?
What is the difference between PROM vs PPROM?
PROM - rupture of membranes at least 1 hour before onset of labor during any gestational age
PPROM - rupture of membranes before 37 weeks
What is the point of a fern test?
To test vaginal fluid and decipher if it is urine or amniotic fluid
How is dystocia defined?
Long, difficult or abnormal labor
What is the primary cause for cesarean births?
What are the 5 P's the affect labor?
- Psychologica responses
What is going on with dysfunctional uterine contractions in primary vs secondary powers?
How do you treat both?
- Primary - HYPERtonic uterine dysfunction
- Painful, frequent contractions cause cervical dilation/effacement to no progress
- Tx: Rest
- Secondary - HYPOtonic uterine dysfunction
- Weaking or cessation of uterine contractions
- Tx: Ambulation or oxytocin
What is the difference between pelvic dystocia vs soft-tissue dystocia?
- Pelvic - contractures of pelvic diameters reducing the capacity of the pelvis
- EX: inlet, midpelvis, outlet
- Soft-tissue - obstruction of the passageway by an anatomic abnormality besides the bony pelvis
- EX: placenta, fibroids, cervix
What is the most common cause of pelvic dystocia?
What are fetal causes of dystocia?
- Cephalopelvic disproportion
- Multifetal pregnancy
What is the most common fetal malposition of pelvic dystocia?
What is the most common form of malpresentation?
What are the types of breech birth
Frank - thighs are flexed on hips, knees extended (piked up)
Complete - thighs and knees are flexed (sitting indian style)
Incomplete - foot or knee extends below the butt
What nursing intervention can help move the baby from a breech to a vertex presentation?
What are the two most common methods to induce labor?
Prolonging the rupture of membranes can lead to ___________
Oxytocin is normally produced by what gland of the body?
What does it do?
Posterior pituitary gland
Stimulates uterine contractions
What is augmentation of labor?
Stimulation of uterine contractions after labor has started spontaneously but progress have been poor
When should these forceps be used:
Outlet - when baby is crowning
Low - Head is 2+
Mid - Head is at 0
What are the different incision types for cesearean births?
Classic - vertical through the skin and uterus
- Low Cervical(a) - horizontal through the skin, vertical through lower part of uterus
- Low Cervical(b) - horizontal through the skin, horizontal through the lower part of the uterus
If an opioid is used for pain, what is usually prescribed with it?
What is the main risk for VBAC's?
What are the 4 requirements to attempt a VBAC?
- Low transverse incision
- Adequate pelvis
- No other uterine scars
- No history of uterine rupture
Shoulder dystocia is when the head is born but the should cannot pass through the ________
What nursing interventions can be done for shoulder dystocia?
What is contraindicated?
- McRoberts Maneuver
- Suprapubic pressure
NOT Fundal pressure
What are the types of prolapsed cords:
Occult - hidden or can't see it
Complete - Visible if membranes are intact or not
Frank - breech birth and cord is out first
What is the main risk from a prolapsed cord?
What should the nurse do right away when noting a prolapsed cord?
Sterile glove and hold presenting part off of the umbilical cord
What positions are encouraged when coming across a prolapsed cord for the mom?
- Modified Sim's
- Trendelenburg (Knee-Chest)
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