NARM study: MIA module 11, labor complications
Terms in this set (56)
What is the dividing line between early- and late-preterm?
What are the 5 root causes of preterm labor?
Premature HPA-axis activation, inflamation or infection, decidual bleeding, uterine distendion, genetic factors
What common asymptomatic condition is a significant contributor to preterm labor?
What are the two pathological changes in FHR baseline?
bradycardia and tachycardia
How long must an acceleration or deceleration last to be considered a change in baseline?
What is the term for an FHR baseline change to >160 beats per minute?
What is fetal tachycardia most likely due to?
What labor emergency can tachycardia indicate?
When preceded by or accompanied by recurrent decelerations, what is indicated?
The baby is losing its ability to compensate for recurrent hypoxic episodes. Terminal bradycardia may follow.
What is the term for an FHR baseline change to <110 beats per minute?
During what stage of labor is fetal bradycardia most likely to be noted, and why?
second stage/pushing, due to descent which compresses the fetal head and can trigger the vagal response
When fetal bradycardia is due to the vagal response, is it associated with acidosis?
At what point does fetal bradycardia threaten brain circulation?
At what point does fetal bradycardia threaten cardiovascular circulation?
What labor emergencies might fetal bradycardia indicate?
cord prolapse, abruption, uterine rupture, or vasa previa
What is the common cause of early decels?
benign head compression
What do late decelerations usually indicate?
What are variable decelerations usually due to?
When is a decel prolonged?
When it lasts for longer than 2 minutes, but less than 10 minutes
What are the three signs of fetal hypoxia?
late decelarations, absent FHR variability, and meconium
What neonatal conditions are associated with meconium?
Meconium Aspiration Syndrome and bacterial infection
What are contraindications to AROM?
GBS-positive status, breech presentation, unengaged head, malposition, or signs of fetal compromise
What risks are associated with AROM?
cord prolapse, cord compression, ruptured vasa previa, infection
What should be done following AROM?
checking for cord prolapse and checking the fetal heart rate
What is a common underlying cause of hypotonic labor?
What should be tried first with a hypotonic labor?
position correction, rest, sleep, nourishment, hydration
When does hypotonic labor occur?
during the active phase of labor
When does hypertonic labor occur?
during the latent phase of labor
Who most often experiences hypertonic labor?
What are possible underlying causes of hypertonic labor?
malposition, UTI, or uterine infection
What labor emergencies can cause hypertonic labor?
abruption or uterine rupture
What is the major risk factor for cord prolapse?
an unengaged fetal head
What condition involving the amniotic fluid level is a risk factor for cord prolapse?
What fetal presentations are associated with cord prolapse?
breech, transverse, compound
At what point in dilation is cord prolapse most common?
What are two early signs of infection during labor?
Maternal fever and fetal tachycardia
What are two symptoms of infection during labor involving the uterus?
uterine tenderness and dysfunctional labor
Besides fetal, neonatal, and maternal postpartum infection, what are some emergencies associated with chorioamnionitis?
placental abruption and pelvic vessel thrombosis
What are four possible causes of intrapartum hemorrhage?
placenta previa, placental abruption, uterine rupture, and vasa previa
If painless bleeding immediately follows rupture of membranes, consider possibility of:
ruptured vasa previa
What assessment should be made immediately if intrapartum bleeding is noted?
auscultate the FHR
What pattern of FHT are likely to be heard in the case of ruptured vasa previa?
decelerations or bradycardia
What pattern of maternal vitals are likely to be noticed with maternal hemorrhage?
dropping BP, rising pulse, pale clammy skin, and altered mental status
If birth cannot be hastened (and/or mother is unstable), what should management be?
apply O2, monitor FHR and maternal vitals, start 2 large-bore IVs, and transport
If baby is born following hemorrhage, what should you be prepared for?
full resuscitation and maternal PP hemorrhage
What are possible causes of an intrapartum seizure?
eclampsia, seizure disorder, head trauma, or stroke
Why are maternal grand mal seizures dangerous for the fetus?
They involve an extended period of maternal hypoxia.
What may follow a focal seizure?
progression to a grand mal seizure- therefore emergent transport is appropriate
When a grand-mal seizure ends, what should be done immediately?
Ensure the airway is clear, check for a pulse and chest rise.
What should be done following a seizure?
Place mother on her left side, apply O2, check vitals, continuously monitor the FHR
What segment of the uterus is most likely to rupture, and why?
the lower uterine segment, because it thins during labor
What are major risk factors for uterine rupture?
previous c-section, obstructed labor, uterine over-distension
What are the signs and symptoms of a "quiet" rupture?
gradual-onset of rising pulse, pallor, slight bleeding, ambiguous pain, and significantly, a stall in dilation
What are the common signs and symptoms of uterine rupture which develop over hours?
FHR decelerations or bradycardia, abdominal pain, vomiting, faintness, bleeding, maternal tachycardia, pallor, uterine tenderness, abnormal shape of uterus
What are the signs and symptoms of a violent, sudden uterine rupture?
hard contraction followed by feeling of something tearing, sharp lower abdominal pain, cessation of contractions, anxiety, palpation of free-floating fetal outline, floating presenting part, cessation of fetal movement and heartbeat, shock, collapse
Rupture into which anatomical part can conceal the rupture and hemorrhage?
into a round ligament