Chp 19 Labor And Birth Complications

Front 1

pre-term labor

Back 1

uterine contractions and cervical changes between 20-37 weeks
cause most neontal deaths

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preterm birth

Back 2

before 37 weeks gestation

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low birth weight

Back 3

2500 grams or less

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risks for pre-term labor

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minorities
low socioeconomic status
unmarried
low levels of education
late/no prenatal care
age
multifetal pregnancy
* at least 50% of women who experience pre-term birth have no identifiable risk factors

Front 5

fetal fibronectin

Back 5

glucoproteins in plasma and cervical canal
appearance between 24-34 weeks predicts labor

Front 6

salivary estriol

Back 6

form of estrogen
levels increase with pre-term birth

Front 7

endocervical length

Back 7

shortened cervix - 30 mm or less at 34 weeks

Front 8

symptoms of PTL

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uterine activity
discomfort
vaginal discharge

Front 9

dx of PTL

Back 9

20-37 weeks
contractions
progressive cervical change (dilation of greater than 4 cm)

Front 10

tocolytics

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suppress uterine activity - relaxes smooth uterine muscles
brethine/terbutaline, MgSO4, ritodrine, indocin, procardia

Front 11

antenatal gluccocorticoids

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accelerate fetal lung maturity
24-34 weeks if preterm birth is a threat
bethamethasone, dexamethasone
24 hours to be effective

Front 12

premature rupture of membranes

Back 12

at least 1 hr before onset of labor
any gestational age
sudden gush or slow leakage

Front 13

preterm premature rupture of membranes

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before 37 weeks
25% of all PTL cases
infection often precedes

Front 14

test for ROM

Back 14

nitrazine, ferning tests
sterile vaginal exam only when necessary

Front 15

complications of ROM

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cord compression and prolapse
monitor for signs of infection/fetal distress

Front 16

dystocia

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long, difficult, abnormal labor
primary cause of c-section

Front 17

factors leading to dystocia

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dysfunctional labor
alterations in pelvic structure
fetal causes
maternal positioning
psychologic response

Front 18

primary powers (Uterine contractions) - dystocia

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abnormal UC
hypertonic uterine dysfunction(frequent, painful, ineffective UC)
hypotonic uterine dysfunction (weak and ineffective UC)

Front 19

secondary powers - dystocia

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abnormal pushing efforts
decreased effectiveness of bearing down

Front 20

abnormal labor patterns

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prolonged latent phase
protracted active phase dilation
secondary arrest/no change
protracted descent
arrest of descent
failure of descent

Front 21

causes of abnormal labor patterns

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ineffective UC, pelvic contractions, cephalopelvic disproprotion, abnormal fetal presentation or position, early use of analgesics, nerve block, anxiety, stress

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risks of abnormal labor patterns

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maternal - morbidity and death from uterine rupture, infection, severe dehydration, postpartum hemorrhage
fetal - increased risk of hypoxia

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precipitous labor

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rapid or sudden labor - less than 3 hours

Front 24

complications of precipitous labor

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maternal - uterine rupture, lacerations of the birth canal, amniotic fluid embolism, postpartum hemorrhage
fetal - hypoxia, intercranial trauma

Front 25

pelvic dystocia

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decreased capacity of bony pelvis

Front 26

soft tissue dystocia

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obstruction of birth passage with anatomic abnormality, other than pelivs (placenta previa, tumor, full bladder/rectum)

Front 27

fetal causes -dystocia

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anomalies
cephalopelvic disproportion
malposition (occiput posterior)
malpresentation (breech)
multifetal pregnancy
complications

Front 28

maternal position

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alter functional relationship of UC, fetus, pelvis
"effects of gravity" - find a position that facilitates fetal descent (sit, stand, squat)

Front 29

psychologic response

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fear, anxiety, stress can have negative impact
hormones and nuerotransmitters released with stress and anxiety can negativity impact labor

Front 30

external version

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after 37 weeks - can cause pre-term labor
tocolytics to relax uterus
US and NST

Front 31

induction of labor

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any condition putting mother/baby at risk
sucess rate is better when cervix is favorable
bishop score - 9 if multipara, 5 if nullipara

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cervical ripening

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prostagladins
mechanical dilators

Front 33

amniotomy

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when cervix is ripe and infant engaged
must deliver afterward

Front 34

oxytocin

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hormone to stimulate UC - risk of hyperstimulation

Front 35

augmentation of labor

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stimulating UC that are weak or ineffective
common management for hypotonic uterine dysfunction (protracted active phase)

Front 36

methods of augmenting labor

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noninvasive - empty bladder, ambulation, relaxation, hydrotherapy
invasive - oxytocin, amniotomy, nipple stimulation

Front 37

operative delivery

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forceps
vacuum assisted
both to aid in descent and shorten 2nd stage of labor

Front 38

higher rate of c-section due to

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repeat c-section
EFM
epidurals
first time labor + advanced maternal age
decline VBAC rates

Front 39

uterine incisions

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classic, vertical
low-uterine transverse

Front 40

VBAC

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depends on reason for first c-section
contraindications- fundal scar, scar from uterine surgery, evidence of CPD

Front 41

post-term pregnancy

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beyond 42 weeks
risks - large baby, induction, aging placenta, hypoxia, decreased AFV, meconium

Front 42

shoulder dystocia - what and risks

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emergency
related to macrosomia , pelvic abnormalities
risks - asphyxia, brachial plexus damage, fracture + maternal blood loss, uterine rupture, laceration

Front 43

shoulder dystocia interventions

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suprapubic (not fundal) pressure
maternal position change (hands/knees, squat)
mcroberts maneuver - legs flexed apart with knees on abdomen

Front 44

umbilical cord prolapse

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occult (visible), frank (not visible)
occlusion of blood flow for +5 minutes = fetal CNS damage, death
causes - AROM, small baby, polyhdramnion

Front 45

umbilical cord prolapse interventions

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manually hold presenting part off cord
modified sims, trendelenberg, knee chest
c-birth

Front 46

uterine rupture causes

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scar seperation of classic c-birth incision, uterine trauma, congenital uterine anomaly, hypertonic stimulation, multiple gestation, malpresentation, external/internal version
complete or incomplete

Front 47

uterine rupture complications

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loss of FHR, internal bleeding = shock

Front 48

amniotic fluid embolism

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amniotic fluid + debris enter maternal circulation, obstruct pulmonary vessels
respiratory distress/circulatory collapse
clotting and DIC