Ch.32 L and D Complications

• Causes of Spontaneous Pre-term Labor and Birth:

  • H_
  • I_
  • P_ C_
  • S_ A_ of Uterus
  • S_
  • L_ P_
  • O_ of the uterus
  • A_ R_?

  history, infection, placental causes, structural abnormalities, stress, low progesterone, overdistention, allergic reaction
• Fetal Fibronectin (fFn) Test :

  • Used to predict who will N_ go into L_
  • (-) = L_ C_ within _ wks
  • (+) = H_ C_ in a couple of wks?

  not, labor, low chance, 2, high chance
• Preterm Management:

  • Symptoms of Preterm Labor
  • L_ A_ pain
  • A_ D_
  • C_ and P_
  • Contracting
  • S_ and R_ on S_
  • Drink _ to _ glasses of water
  • L_ A_
  • F_ L_ M_ - _ to _ wks?

  lower ab, abnormal discharge, cramping, pressure, stop, rest, side, 2, 3, limit activity, fetal lung maturity, 24, 34
• Preterm Management:

  • Meds
  • T_ that R_ the U_ and S_ C_
  • M_ S_
  • T_
  • I_
  • N_
  • B_ at less than _ wks but not at _ wks?
  • tocolytics, relax, uterus, stop contractions, mag sulfate, terbutaline, indomethacin, nifedipine, betamethasone, 36, 18
• PPROM

  • Before _ wks
  • C_ can occur
  • A_ to H_?

  37, chorio, admin, hospital
• PROM Care Management:

  • I_ and F_ T_ B_ best option
  • PPROM
  • < _ wks managed
  • Steroids
  • _ and _ wks
  • A_ for _ days
  • M_ S_ for fetal N_?

  individual, full-term birth, 32, 24, 37, antibiotics, 7, mag sulfate, neuroprotection
• Chorioamnionitis:

  • P_ or P_ term when ruptured
  • R_ for R_ for L_ T_
  • I_
  • M_ F_
  • T_
  • U_ T_
  • F_ O_
  • A_?

  pre, post, risk, ruptured, long time, infection, maternal fever, tachycardia, uterine tenderness, foul odor, antibiotics
• Post-term:

  • Risks
  • D_ L_
  • P_ I_
  • P_
  • M_
  • P_ M_
  • F_ A_ G_
  • C_ C_
  • S_ D_
  • F_ I_
  • P_
  • M_?
  • dysfunctional labor, perineal injury, pph, morbidity, post maturity, fetal abnormal growth, cord compression, shoulder dystocia, fetal injury, placenta, meconium
• Post-term Care:

  • N_, C_, B_, U_
  • F_ A_ D_
  • K_ A_?

  nst, cst, bpp, ultrasound, fetal activity daily, keep appointments
• Obesity Risk for Complications:

  • S_ A_ or S_
  • B_
  • G_ D_
  • B_ C_
  • F_ C_ A_
  • C_
  • V_ T_
  • P_ and L_ L_?

  spontaneous abortion, stillbirth, bp, gest diabetes, blood clots, fetal congenital abnormalities, c-section, venous thrombo, post-term, long labor
• External Cephalic Version (ECV)

  • _ to _ wks
  • U_ before
  • N_ and C_ before
  • T_ used
  • Can't be E_ or R_?

  36, 37, ultrasound, nst, consent, terbutaline, engaged, ruptured
• ECV Contraindications:

  • T_
  • L_ A_
  • P_ C_
  • P_ P_ and R_
  • V_ B_
  • U_ A_?

  twins, low amino, prev c-section, placenta previa, rupture, vag bleeding, uterus abnormal
• Induction Agents/Strategies:

  • Elective not done until _ wks
  • Cervical Ripening
  • C_, C_, and P_
  • Bishop's Score used to E_ I_ and R_ because C_ is N_ C_
  • _cm take out C_
  • E_ B_ B_ and S_ on S_ for suppository?

  39, cytotec, cervidil, prepidil, evaluate induction, ripeness, cervix, not changed, 3, catheter, empty bladder before, stay, side
• Induction Agents/Strategies

  • Contradictions
  • P_ P_
  • P_ C_
  • U_ R_ in S_ area
  • U_ S_?
  • placenta previa, prev c-section, uterine rupture, scal, uterine scar
• Induction Agents/Strategies

  • Oxytocin (Pitocin)
  • Wait _ to _ hrs
  • No D_ A_ to prevent U_ T_
  • for more R_ C_
  • Needs T_
  • Stop when contracting q _ to _ mins?
  • 4, 6, double agents, uterine tachy, rupture cervix, titrated, 2, 3
• Uterine Tachysystole:

  • _ contractions in _ mins
  • R_, IV B_ of L_
  • D_ or turn off P_
  • T_ Sub q?

  5, 10, reposition, bolus, lr, decrease, pitocin, terbutaline
• Forceps and Vaccum Delivery:

  • Forceps - Worried about L_
  • Vacuum- Worried about B_ and R_?

  laceration, bruising, redness
• C-Section:

  • P_ W_ B_ of mom and fetus
  • P_ D_ with scheduled, elective, unplanned
  • Pre-op
  • B_ W_, I_, F_
  • Intra
  • B_ E_, N_, I_ B_
  • Post-op
  • S_ S_ I_
  • TOLAC
  • T_ of L_ after C_
  • VBAC
  • V_ after C_
  • Only if S_?
  • preserve well-being, prolonged decels, blood work, IV, fhr, bladder empty, nst, iv bolus, surgical site infection, trial, labor, c-section, vaginal, c-section, successful
• Meconium Stained Fluid:

  • Possible Causes
  • N_ F_
  • B_
  • H_
  • C_ C_
  • May need to D_ S_?

  normal function, breech, hypoxia, cord compression, deep suction
• Shoulder Dystocia:

  • B_ B_ or G_ and P_ D_
  • T_ S_
  • S_ P_
  • M_?

  big baby, gest, pre-diabetes, turtle sign, suprapubic pressure, mcroberts
• Shoulder Dystocia:

  • Newborn Risks
  • F_ and B_ P_ I_
  • Check C_
  • Look for L_ M_?

  fracture, brachial plexus, clavicle, limited movement
• Shoulder Dystocia:

  • Mother risks
  • U_ R_
  • H_
  • E_
  • D_
  • P_
  • D_ T_
  • High I_ and W_?
  • uterine rupture, hysterectomy, endometritis, death, pph, degree tears, infection, weight
• Prolapsed Cord:

  • V_ or P_ decels
  • Risks
  • L_ C_ more than _ cm
  • B_
  • T_ L_
  • U_?
  • variable, prolonged, long cord, 10, breech, transverse lie, unengaged
• Prolapsed Cord:

  • Make sure H_ is E_ when P_
  • Reposition
  • H_ and K_
  • S_
  • T_
  • S_ G_ to put U_ P_ on head until delivered
  • S_ C_
  • S_ G if cord is out of cervix?

  head, engaged, prom, head, knee, side, trendelenberg, sterile glove, upward pressure, stat csection, sterile gauze