Intrapartum Complications

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Intrapartum Complications by Mind Map: Intrapartum Complications

1. Dystocia

1.1. General term that describes any difficult labor or birth process

2. Shoulder Dystocia

2.1. Urgent situation

2.2. Umbilical cord compressed between fetal body part and maternal pelvis

2.3. High risk of cord prolapse

2.4. Therapuetic Managment

2.4.1. Continuously monitor fetal heart tones

2.4.2. Avoid fundal pressure!

2.4.3. Mc Roberts maneuver

2.4.4. Women flexes thighs sharply against her abdomen

2.4.5. Suprapubic pressure by assistant

2.4.6. Pushes the fetal anterior downward to displace it from above the mother’s symphysis

3. Precipitous Delivery

3.1. Fast birth process

3.2. 3 hours of onset

3.3. Risk factors: hypertonic uterus, oxytocin, multiparous

3.4. Complications

3.5. Higher risk for pph

3.5.1. Continue to monitor the patient postpartum

3.6. Lacerations

3.7. Amniotic fluid embolism

3.8. Fetal hypoxia

4. Premature Rupture of Membranes (PROM)

4.1. Increased risk of cord prolapse

4.2. Increased risk for infection when greater than 12 hours

4.2.1. Group B strep, gonorrhea, vaginosis, for example

4.2.2. Maternal fever/baby tachycardia

4.2.3. Uterine tenderness

4.2.4. Neonatal sepsis and respiratory distress syndrome

4.2.5. Adminster IV antibiotics

4.2.6. GIVE MOM STEROIDS FOR LUNG MATURITY

4.2.7. May need to delivery baby

4.2.8. Testing for PROM

4.2.8.1. PH test: Normal Vaginal fluid is 4.6-6.0, greater than 7.1 may indicate amniotic fluid

4.2.8.2. Nitrazine test: The strips change color depending on the pH of the fluid. The strips will turn blue if the pH is greater than 6.0. A blue strip means it's more likely the membranes have ruptured

4.2.8.3. Ferning: a “fern-like” pattern under a microscope due to salt crystallization

5. CHORIOAMNIONITIS

5.1. A bacterial infection of the amniotic cavity

5.2. Causes: IUCP, cervical exams, amniocentesis, PROM

5.3. Can result in endometritis and sepsis

5.4. Manifestations: fever (100.4 or greater), leukocytosis, tachycardia, malodorous amniotic fluid, fetal tachycardia

5.5. Therapeutic Management: Blood cultures(before antibiotic), antibiotics will be started(will change later if needed based on organism)

5.5.1. Ampicillin/gentamycin/clindamycin

5.6. May need to deliver the baby

5.7. Baby may require cultures and antibiotic treatment based on status

6. CERVICAL INSUFFICIENCY, INCOMPETENT CERVIX, PREMATURE CERVICAL DILATION

6.1. Weak cervical tissue causes or contributes to premature birth or spontaneous abortion

6.2. Sometimes when the cervix begins to shorten, the internal os begins to dilate and the cervix changes from a "v" to a "u" shape. This is called cervical funneling. An insufficient cervix, or incompetent cervix, can cause cervix shortening and therefore premature birth

6.2.1. Treatment

6.2.1.1. Bedrest, activity restriction, avoid sexual intercourse

6.2.1.2. Hydration(dehydration stimulates uterine contractions)

6.2.1.3. Cerclage: suture encircling the cervix

6.2.1.4. Placed early in pregnancy(about 12 weeks) to prevent premature cervical dilation

6.2.1.5. Monitor for infection

6.2.1.6. Cerclage removed before delivery: around 37 weeks gestation

7. Meconium Stained Amniotic Fluid

7.1. Greater risk 38 weeks and greater

7.2. Fetus has a bowel movement in -utero

7.3. Amniotic fluid will have a green, thick, “pea soup”, like appearance

7.4. May indicate fetal hypoxia

7.5. Fetal distress can be present

7.6. FHR below 110, or above 160

7.7. Variability: decreased, minimal, or absent

7.8. Variable decelerations, late decelerations, or prolonged decelerations occurring

7.9. Fetal hyperactivity or no fetal activity

7.10. Arrange resuscitation equipment/resources(NICU)

7.11. If respirations are depressed, Muscle tone decreased, heart rate below 100 bpm suction below infants vocal cords with et tube before spontaneous breath occurs

7.12. Neonate may develop Respiratory Distress Syndrome (RDS)

8. Women with Heart Disease

8.1. Limit physical activity

8.2. Avoid excess weight gain

8.3. Prevent anemia

8.4. Prevent infection: Immunizations/antibiotics for prevention

8.5. Assess for S&S of CHF

8.6. Mitral valve stenosis and atrial fibrillation may require anticoagulant therapy, However no Warfarin(Coumadin)= fetal malformations.

8.7. Heparin/Lovenox are approved for use

8.8. During labor position client on side, with head and shoulders elevated

8.9. Monitor for signs of cardiac decomposing

8.10. May use vacuum/forceps to minimize exhaustion from pushing

9. Hyperemesis Gravidarium

9.1. Persistent, uncontrollable vomiting

9.2. Labratory Tests

9.2.1. Urinalysis for ketones and acetones (breakdown of protein and fat) is the most important initial

9.2.2. CBC (elevated HCT)

9.2.3. Electrolyte panels

9.2.3.1. Elevated urine specific gravity

9.2.4. Thyroid test- indicating hypothyroidism

9.3. Therapeutic Management

9.3.1. Monitor the client’s I&O

9.3.2. IV fluids

9.3.2.1. May need lipids/TPN/vitamin replacement

9.3.2.2. Antiemetic medications

9.3.2.3. Assess the client’s skin turgor and mucous membranes

9.3.2.4. Monitor the client’s vital signs

9.3.2.5. Monitor the client’s weight

9.3.2.6. Have the client remain NPO for 24 to 48 hr.

9.3.3. Clear liquid diet, bland foods, advance diet as tolerated

9.3.4. Small meals every 2-3 hours

9.3.5. Easily digested carbs

9.3.6. Sit upright after meals

9.3.7. Relief from ptyalism (excessive salivation)

9.3.7.1. Gum/mints

9.3.7.1.1. Mouth care

9.3.8. Emotional support

10. INTRAHEPATIC CHOLESTASIS

10.1. Cholestasis occurring in pregnancy in the second or third trimester

10.2. Group of liver disorders specific to pregnancy that interfere with the flow of bile

10.3. Results in a buildup of bile

10.4. Recurrence with subsequent pregnancies common

10.5. Maybe be dangerous to the fetus

10.5.1. Elevated bilirubin levels Preterm birth Fetal distress Fetal hypoxia Meconium in the amniotic fluid Fetal demise

10.6. Maternal Manifestations

10.6.1. Itching, dark urine, pale stool, jaundice, nausea, loss of appetite(same signs of cholestasis)

10.7. Labratory

10.7.1. Elevated ALT Elevated AST Bile acids may be elevated or normal

10.8. Therapeutic Managment

10.8.1. Assess for fetal distress: Fetal monitoring, BPP, NST

10.8.2. Anti-itch cream(calamine lotion)

10.8.3. Avoid hot showers/prolonged sun exposure

10.8.4. Stay hydrated

10.8.5. Consume a low fat, healthy diet

10.8.5.1. Lean(low fat) protein

10.8.5.1.1. Fresh vegetables and fruit

10.8.5.1.2. Chicken breast

11. Gestational Diabetes(GDM)

11.1. Impaired glucose tolerance

11.2. Ideal blood glucose 60-99 mg/dl before meals, and less than or equal to 120 mg/dl 2 hours after meals

11.3. Urinary/vaginal infections- increased glucose in urine

11.4. Hydramnios(excess amniotic fluid)- overdistention of uterus can cause placental abruption, preterm labor, and PPH

11.5. Ketoacidosis

11.6. Hypoglycemia/hyperglycemia

11.7. *Increased risk to fetus: macrosomia, birth trauma, electrolyte imbalances, hypoglycemia

11.8. Labratory Tests

11.8.1. Glucose screening test/ 1-hour glucose tolerance test

11.8.2. 24-28 weeks gestation

11.8.3. Not necessary to fast

11.8.4. Client ingests 50 g or oral glucose solution

11.8.5. Blood sample one hour later

11.8.6. Oral glucose tolerance test(OGTT) for results over 130-140

11.8.6.1. Fast at midnight

11.8.6.2. Avoid caffeine and smoking 12 hours prior

11.8.6.3. Client drinks 100 g of oral glucose solution

11.8.6.4. Plasma levels are determined at: fasting, 1 hours, 2 hours, 3 hours

11.8.6.5. Diagnosis of GDM: 3 hours, greater than 130-140 mg/dl

11.8.7. Therapeutic Managment

11.8.7.1. Insulin is the preferred treatment for glucose management

11.8.7.2. Glyberide is the only FDA approved at this time

11.8.7.3. Diet/exercise

11.8.7.4. Glucose monitoring

11.8.7.4.1. Fasting

11.8.7.4.2. 2 hours postprandial(meal) insulin typically on a sliding scale level

11.8.7.4.3. Remember, when mom glucose is high, fetus’s glucose is low

11.8.7.4.4. Bedtime

11.8.7.4.5. Monitor fetal well being

11.8.7.4.6. Pateint education