Other predisposing factors include poor outcomes in a previous pregnancy such as placental abruption, fetal death, and intrauterine growth restriction (IUGR) in previous pregnancies. This. Boston, 2012, Pearson Prentice Hall, pp. 1. High risk pregnancy: Management options. B. b. c. Control of severe hypertension with an antihypertensive (labetalol) to maintain the systolic BP between 140 and 160 mm Hg and the diastolic BP between 90 and 105 mm Hg. Avoid administration of analgesics close to birth if possible. Evidence of fetal compromise. High risk pregnancy: Management options. Primary goals of management include prevention of seizures (via limitation of stimuli and drug therapy), prevention of complications (via frequent systems assessments and laboratory studies), and birth of a live infant. Good monitoring of the mother and fetus throughout labor ensures that prompt action can be take to prevent conditions from evolving to a life-threatening state. Examine the effect of obstetric analgesia/anesthesia and cesarean birth on the newborn infant. Preeclampsia and eclampsia are associated with nulliparity, extremes of maternal age (teenagers and age >40 years), family history of preeclampsia, preeclampsia in a previous pregnancy, obesity, maternal low birth weight, chronic inflammatory conditions (lupus, rheumatologic disease), a history of gestational diabetes or type 1 diabetes mellitus, chronic hypertensive or renal disease, thrombophilias (factor V Leiden mutation, antiphospholipid syndrome), multifetal gestation, or large fetus. Toxic reaction from overdose or intravascular injection. 2. h. Timing and mode of delivery are based upon the clinical picture of both the woman and the fetus, and some evidence suggests delivery at 38 weeks of gestation. 2. Functions of the placenta include fetal nutrition, respiration and excretion. Have naloxone (Narcan), oxygen, and ventilatory equipment available to manage potential newborn respiratory depression. Cord is protruding from vagina or is palpable on vaginal examination. Decreased variability of the fetal heart rate, sinusoidal pattern (Stadol). 504. Steer PJ, Danielian P. Fetal distress in labor. c. The outcome of decreased functional placental area can include a decrease in fetal growth, fetal or neonatal distress, and even fetal or neonatal death. Births: Final data for 2010. Obstetrics: Normal and problem pregnancies. a. -elective abortion... -multiple gestations... -multiparity... -advanced…. 1. Place wedge under woman’s right hip to displace the uterus to the left to avoid supine hypotension and fetal hypoxia. Failure of presenting part of fetus to become engaged. Primary goals of management include prevention of seizures (via limitation of stimuli and drug therapy), prevention of complications (via frequent systems assessments and laboratory studies), and birth of a live infant. a. Fetal bradycardia, in the absence of congenital heart disease, represents an acute decrease in oxygen. Pelvic pressure. Diethylstilbestrol (DES) exposure Antibiotic therapy should be instituted to prevent neonatal group B streptococcal infection, or to treat specific conditions such as urinary tract infections. Bleeding in late pregnancy. Home > Issues > Complications during childbirth. 3. Steer PJ, Danielian P. Fetal distress in labor. Fetal factors. A blood pressure (BP) of 140/90 mm Hg or above after 20 weeks of gestation. Signs of hypovolemic shock as bleeding increases. High risk pregnancy: Management options. In: Gabbe SG, Niebyl JR, Simpson JL, eds. The use of the fetal fibronectin test, performed on vaginal secretions in symptomatic women, may help prevent a false-positive diagnosis of preterm labor and prevent unnecessary and potentially harmful pharmacologic treatment. (8) Degenerative placental changes near term. Monitor fetal heart rate for changes as indicated above. 1. The American College of Obstetricians and Gynecologists recommends that all pregnant women be screened for gestational diabetes either by patient history, clinical risk factors, or a 50-g 1-hour glucose challenge test at 24 to 28 weeks of gestation. However, at this gestational age, the lower uterine segment is not yet fully developed and this is not diagnostic of a placenta previa. 4th ed. b. Fetal anoxia leading to long-range neurologic complications. Insertion of large-gauge IV catheters (16- to 18-gauge) for possible administration of fluids and blood products. Maternal Implications In addition: Frequent assessment of vaginal bleeding, with pad counts and/or weighing of pads. Low birth weightPrematurityIntrauterine growth restriction (IUGR)/small for gestational age (SGA) The placenta is the connection between the maternal and embryonic circulatory systems, facilitating metabolic and nutrient exchange. Intrapartum asphyxia is defined as metabolic acidemia measured at birth with pH less than 7.00 and base deficit greater or equal to 12 mmol/l. b. Nausea and vomiting. Cardiac disease 4th ed. Narcotic analgesics such as butorphanol tartrate (Stadol) and nalbuphine hydrochloride (Nubain) are commonly used for pain relief. Describe the effect on the fetus/neonate of select intrapartum crises: placental abruption, placenta previa, cord prolapse, and shoulder dystocia. b. 5. : occurring or provided during the act of birth intrapartum fetal monitoring intrapartum complications — compare intranatal. Philadelphia: Elsevier Saunders; 2012:3–22. e. Abnormal placental implantation (placenta accreta, percreta, and increta). 3. Threatened and actual preterm labor including mode of delivery. Women with average risk for GDM should be screened with a 1-hour glucose challenge test at 24 to 28 weeks of gestation, with further testing if values are abnormal. ↑ Risk preterm birth↑ Risk respiratory distress The exact cause of preterm labor is unknown, although chorioamnionitis and other infections such as periodontitis and bacterial vaginosis have been implicated. h. The expulsive efforts of the mother, as opposed to traction by the provider, are of the utmost importance. Burton GJ, Sibley CP, Jauniaux ERM. Fraser R, Farrell T. Diabetes. Observe the fetal heart rate for transient bradycardia. Other predisposing factors include poor outcomes in a previous pregnancy such as placental abruption, fetal death, and intrauterine growth restriction (IUGR) in previous pregnancies. c. Respiratory distress syndrome caused by retained fluid in the lungs. 3. 1. e. Gestational hypertension and preeclampsia. CURRENT PREGNANCY If risks factors are present and/or the provider anticipates a possible shoulder dystocia, the neonatal team should be present for delivery. Placental. Landon MB, Catalano PM, Gabbe SG. Woman feels fetus kicking in the lower abdomen. In: James D, Steer P, Weiner C, Gonik B, eds. Observe the neonate for side effects of maternal analgesia. d. With significant bleeding, placement of IV lines with 16- to 18-gauge catheters for blood administration. f. Avoidance of intercourse and orgasm, which can cause uterine contractions. b. Glycosylated hemoglobin tests may be performed before conception and during the pregnancy to assess glucose control during the previous 1 to 2 months, with an acceptable hemoglobin A1c goal of 5% to 6%. Fetal/neonatal: Outcomes can be improved via careful attention to prepregnancy and pregnancy glycemic control. With maternal hypotension, turn the woman onto her left side, increase IV infusion of fluids, and closely monitor the fetal heart rate and maternal BP. 3. The physician may attempt external cephalic version (after 36 weeks in nulliparas; after 37 weeks in parous women) with or without the use of a uterine relaxant and if the fetus remains in a cephalic presentation, vaginal birth. Toxic reaction from overdose or intravascular injection. Risk factors for GDM include maternal obesity, previous history of gestational diabetes, a family history of diabetes, age greater than 25 years, member of an ethnic group at risk for diabetes (Native North American, Hispanic, African American, Pacific Islanders, and South or East Asian Americans), and prior obstetric history (infant weighing >4500 g, congenital anomaly, stillbirth, hydramnios). Cervical dilatation at or near term is accompanied by bleeding from the placenta. In: 3rd ed. However, this change also facilitates the passage of drugs in pregnancy and the intrapartum period. In: Gabbe SG, Niebyl JR, Simpson JL, eds. 1. (a) Metallic taste. ↑ Risk congenital anomalies↑ Risk low birth weightNeonatal withdrawalLower serum bilirubin Ultrasonography may be ordered to confirm breech presentation, determine degree of flexion of fetal head, evaluate size of fetal head, estimate fetal weight, diagnose fetal anomalies, and locate placenta. Obstetrics: Normal and problem pregnancies. C. The placenta. Due to the increased risk of maternal morbidity and mortality, and the inherent risks to the fetus, there is a general consensus to deliver the baby if severe preeclampsia presents after 34 weeks of gestation. Large for gestational age (LGA) c. Causes of decreased uteroplacental blood flow include: ACOG recommends that the mode of delivery be based on the experience level of the provider, and the majority will choose elective cesarean delivery. h. Enlargement of the uterus as blood accumulates, with increasing abdominal girth. a. Make sure the woman’s bladder is empty before birth occurs. Decreased blood flow to the uterus or within the intervillous spaces will decrease the transport of substances to and from the fetus. Manually rotate the shoulders from the anteroposterior to the oblique diameter. 3. If general anesthesia is used for surgery, may result in uterine atony with subsequent postpartum bleeding. Postnatal care provision is as important as the antenatal and intrapartum care for these women to reduce the risk of relatively common complications, including infection and VTE. Continuous maternal assessment, including assessment for uterine contractions and signs of placental abruption. A. Etiology and predisposing factors in gestational diabetes. Birth should take place in a facility with a neonatal intensive care unit (NICU). Management: use of IV antihistamine such as diphenhydramine (Benadryl). Medical Definition of intrapartum: occurring or provided during the act of birth intrapartum fetal monitoring intrapartum complications — compare intranatal.. what are intrapartum complications? c. Concentration gradients are maintained when dissolved substances are removed from the plasma by metabolism, cellular uptake, or excretion. a. Preconception counseling is recommended, with optimal control of blood glucose levels. Women with insulin-dependent diabetes who become pregnant, and pregnant women in whom gestational diabetes mellitus (GDM) or type 1 diabetes develops, are at risk during the antepartum period due to altered carbohydrate metabolism. 3. Aspiration of amniotic fluid with potential for meconium aspiration syndrome. Increased viscosity of blood Murray SS, McKinney ES. ↑ Possibility repeat cesarean birth↑ Risk of uterine rupture (b) Hydralazine (Apresoline). Fetus may lie transversely or be in a breech position. 3. Threatened and actual preterm labor including mode of delivery. St. Louis: Elsevier Saunders; 2011:1191–1210. The placenta is the connection between the maternal and embryonic circulatory systems, facilitating metabolic and nutrient exchange. a. A number of maternal factors have been associated with an increased incidence of preterm labor: maternal age (<15 or >35 years), socioeconomic effects (lower socioeconomic status or educational level, African American race, poor nutrition, inadequate prenatal care), medical/obstetric history (use of assisted reproductive technologies, anemia, preexisting or gestational hypertension or diabetes, previous preterm birth, prior stillbirth, grand multiparity, one or more midtrimester pregnancy losses, pregnancy termination, short interpregnancy interval, uterine anomalies and cervical insufficiency, systemic and genitourinary tract infections, hydramnios, immunologic factors, placental abruption, and placenta previa), and lifestyle factors (use of alcohol, cigarettes, and illicit drugs such as cocaine, and domestic violence or other stressors) (Perry et al., 2010). 1. Washington, DC: American College of Obstetricians and Gynecologists; November 2008. Labor is a natural process, but one faced with many uncontrollable variables. e. Bladder atony. 2. a. Presenting part and its station. C. Clinical presentation. a. B. d. Drowsiness and dizziness. If the measures noted above are not successful, and the cervix continues to efface and dilate, the following measures are important: a. BP measurements must be on at least two occasions, 6 hours apart with the patient on bed rest. St. Louis: Elsevier Saunders; 2011:1075–1090. Although the cause of placental abruption has not been definitively established, there is a high correlation with hypertensive disorders during pregnancy, history of previous abruption, cocaine use, trauma, and placental abnormalities (circumvallate). c. Fetal death. Uterine contractions occur in 10% to 20% of cases, but otherwise the uterus is usually soft and nontender. Retrieved April 10, 2013, from www.marchofdimes.com/pregnancy/complications_abruption.html. Support of respirations with airway, oxygen, and suctioning, and the correction of hypoxemia and/or acidemia. c. Edema of villi may occur in: Ending dangerous practices, like augmenting labor with oxytocin under unsafe conditions or applying pressure on the mother’s belly during labor, can prevent fetal deaths.
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