Childbirth at Risk: Pre-Labor Complications

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Childbirth at Risk Pre-Labor Complications

• Chapter 21

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Premature Rupture of Membranes

• Before 37 weeks gestation
• Maternal risks- infection, poly, multiple
  gestation,previa, abruptio, hx
• Fetal risks-sepsis, prolapsed cord, cord
  compression, oligo
• Earlier the rupture (32 wks) greater risk for
  complications

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Nursing Management

• Evaluate for infection-fluid,temp,FHTs, WBC
• Steroids before 34 weeks
• Minimize vaginal exams
• Educate, support

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Preterm Labor

• Between 20 weeks and completion of 36 weeks
• DX- 4 contractions in 20 min. or cervical change
• Teach to recognize symptoms.
• fFN- if negative low risk for 7-14 days
• Will allow delivery if risk factors

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Risk Factors for Preterm Labor
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Nursing Management of PTL

• Evaluate fetus, left lateral, hydration, uterine
  contractions.
• Administer tocolytics per MD orders
• Nifedipine (Procardia)-Prevent calcium form
  entering cell- decrease contractility
• Less side effects with similar outcomes

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Magnesium Sulfate

• Decreases acetylcholine- blocks neuromuscular
  transmission
• Side effects-lethargy, flushing, N/V
• Toxicity- Decreased reflexes, resp, depression
• Monitor-Levels, resp,reflexes,IO, fetus
• Have antidote available

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Placenta Previa

• Placenta in lower uterine segment
• Placenta villi torn away from uterine wall
• Expose sinuses that result in bleeding
• Determine if fetus is tolerating blood loss
• PAINLESS bleeding

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Types of Previa
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Nursing Management

• Expectant management until 37 weeks
• Assess for blood loss and fetal tolerance
• IV, labs, team prepared
• Evaluate newborn for blood loss

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Management of Previa
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Abruptio Placentae

• Placental separation from uterine wall
• Related to vasoconstriction, trauma
• Marginal, Central, Complete
• Dark old blood, increase uterine tone and PAIN

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Abruptio
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Nursing Management

• Complications are related to blood loss and DIC
• Placental clotting lead to decrease in
  thromboplastin
• Evaluate fibrinogen and platelets
• Birth plan, type and cross, fluids, labs
• Prepare for hysterectomy if poor contractility

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Previa vs. Abruptio
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Multiple Gestation

• Di-two ovums- fraternal
• Mono- one ovum-paternal
• Twins are high risk!
• Maternal and fetal risk increase with number of
  fetuses
• Maternal risk for PTL, Abruptio, PIH
• Bed rest and increase fetal surveillance

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Polyhydramnios

• AFI of 2000mls
• Related to diabetes and RH sensitization and
  infections
• Maternal risks -abruption, hemorrhage, prolapsed
  cord

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Oligohydramnios

• Less than 500mls
• Related to postmaturity, placental insufficiency,
  kidney disorders
• If occurs early can effect fetal lung development
  and skeletal structure
• Can cause variable deceleration during labor
• May use amioinfusion