Childbirth at Risk: Pre-Labor Complications

Chapter 21

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

Nursing Management
• Evaluate for infection-fluid,temp,FHT’s, WBC • Steroids before 34 weeks • Minimize vaginal exams • Educate, support

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

Risk Factors for Preterm Labor

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

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

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

Types of Previa

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

Management of Previa

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

Abruptio

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

Previa vs. Abruptio

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

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

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