rupture of sac/water before the onset of true labor
r/t infections (chlamydia, gonorrhea, trichomonas, group b strep), weak amniotic sac, hx of preterm birth, fetal abnormalities/malpresentation, incompetent/short cervix, multifetal, recent intercourse, stress/low socioeconomic status, poor nutrition
risk of infections mom/baby, chorioamnionitis, maternal antibiotics uterine contractions and cervical changes between 20-37 weeks gestation
r/f: infection, HISTORY preterm, multifetal, hydramnios, maternal age 17-35, partner violence, drugs, smoking, substance abuse, DM/HTN/preeclampsia
s/s: contractions (painful or not, regular q10min or greater, lasting 1hr or longer w/ cervical dilation), PROM, cramping, low back pain, vag discharge, GI, malaise
*educate women & partner, provide access to care, identify risk factors, promote good nutrition can be incomplete or complete
r/f: uterine abnormality, trauma, macrosomia, multifetal, polyhydramnios, hyperstimulated uterus, external/internal version, forceps delivery, multigravida
s/s: reports sensation of "ripping" or sharp pain, abdominal pain/uterine tenderness, chest pain/shoulder pain, nonreassuring FHR, change in shape & palpable fetal parts, contractions stop, fetal station los, s/s hypovolemic shock
-adm IV fluids, o2, blood products, prepare for immediate c-section amniotic fluid is drawn into maternal circulation and carried to woman's lungs
-can occur during labor, birth or within 30mins PP
r/f: multiparity, advanced age, placenta previa/abruptio, preeclampsia/eclampsia, pit admin, DM, c-section, forceps, uterine rupture, cervix laceration, meconium
s/s: resp distress, coagulation failure, circulatory collapse
-give o2 via mask 8-10L/min
-assist w/ intubation & mechanical ventilation
-CPR
-Adm IV fluids & blood products
-position pt on side w/ pelvis tilted 30 angle displace uterus
-monitor baby & mom status
-prepare pt for emergency surgery -can ↑ ICP & risk of intraventricular hemorrhage
-risk of hypoxia, metabolic rate changes, effects on growth & healing
**stress/pain can alter pain thresholds & cause permanent change in neural pathways
interv: contaiment, KC, BF, rest, sucrose pacifier, opioids, acetaminophen, topicals, sedatives for agitation, regional/general anesthesia -caused by insufficient surfactant in lungs
-may occur w/ asphyxia, c-section, multiple births, male infant, cold stress, and maternal diabetes (interfere w/surfactant)
-occurs less often with chronic fetal stress (heroin, mom HTN, prolong ROM, antenatal corticosteroids: cause lungs to mature quickly)
s/s: tachypnea, nasal flaring, retractions, cyanosis first few hours post delivery, grunting on expiration (attempt to maintain lung expansion), crackles
acisosis develops, increase co2 bleeding around & into the ventricles of the brain; associated with ↑ or ↓ bp, resp distress & ↑/fluctuating cerebral blood flow
-also caused by rapid volume expansion, hypercarbia, acidosis and hypoglycemia
DX W/ CRANIAL U/S
s/s: depends on severity, can be none or lethargy, poor muscle tone, deterioration of resp status w/ cyanosis, apnea, drop in Hct, acidosis, hyperglycemia, ↓ reflexes, tense fontanel, seizures, abnormal eye positions
-supprtive tx w/ focus on maintaining resp function Blood loss >500mL during vag or >1,000 during C/S
s/s: tachycardia, hypotension, atony, blood clots >quarter, saturated pad <15mins, continuous trickle/oozing of frank blood, pallor of skin/mm, oliguria
-massage the fundus
atony, laceration, hematoma, retained placenta ↑ risk
labs: H&H, coagulation profile collection of clotted blood w/in tissues resulting from trauma or inadequate blood flow to laceration/incision repair
s/s: bulging mass, INTENSE PERINEAL PAIN, UTERUS REMAINS FIRM, URGE TO DEFICATE, sensitive to touch, difficulty voiding, pallor/tachycardia/hypotension
r/f: nulliparous, FORCEPS/VACCUUM, anesthesia, precipitous, macrosomia baby, prolonged pushing, light skin w/red hair
*DO NOT ADM RECTAL SUPPOSITORIES/ENEMAS
tx: ice packs or I&D localized infection of the lining of the uterus; usually beginning at placental site
s/s: temp >100.4, chills, maliase, anorexia, P >100, abd pain, cramping, uterine tenderness, delayed involtion, PURULENT, FOUL SMELLING LOCHIA, locha returns to rubra from serosa, WBC double
-bed rest in SEMI-FOWLERS to promote drainage, palpate fundus/abd q8hrs to assess pain, antibiotics