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Childbearing Family (NURS 3250 ) Week 11 Intrapartum Complications

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John Marsh
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University of North Carolina at Charlotte

Nursing Care of the Childbearing Family (NURS 3250 )

Week 11 Intrapartum Complications

Intrapartum Complications
Complications and emergencies which occur during the intrapartum time which place mother
and fetus at risk are associated with an increase in perinatal morbidity and mortality
Preterm Labor (PTL)
– The onset of regular UC’s which cause cervical changes between 20 and 37 weeks of
gestation
– 10% of all pregnancies
– 83% of all infant deaths are related to preterm labor
– Etiology of 50% unknown; 1/3 occur after PROM
– Signs
o Potential ROM, bleeding, contractions that increase in frequency and intensity
that must change the cervix
Factors Related to Preterm Labor
– Low socioeconomic status, less than
high school education
– Teen pregnancy
– Lack of, or late prenatal care
– Previous preterm labor* – highest
instance/risk factor
– Altered nutrition resulting in low
maternal weight gain
– Substance abuse; legal or illegal
– Smoking
– Illicit drug use, especially cocaine
– Stress (long commutes, emotional, 2
or more children at home, heavy
work)
– Decreased uterine blood flow –
abruptio, previa, renal ds.,
cardiovascular ds.
– Over distention of the uterus –
multiple gestation*, polyhydramnios
– Abdominal trauma – previa related
– Abdominal surgery*
– Incompetent cervix
o Will not carry the pregnancy
and will often cause
spontaneous abortion
– Uterine anomalies*
– Urinary tract infections*
o Increase fluids because of
stasis and to increase
restroom use
– Infections of the vagina, uterus, or
fetus*
– Febrile illness of mother*
Preterm Labor
– Maternal effects
o Psychological and emotional stress
o Consequences related to treatment (BR, drugs and medication)
– Fetal and neonatal effects
o Respiratory distress syndrome (RDS)
o Intraventricular or pulmonary hemorrhage
o Hyperbilirubinemia (don’t have a mature liver), anemia
o Increased susceptibility to infections – they are already susceptible as full term
infants
 The older a baby gets gestationally, the better outcomes they have
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o Neurologic disorders, metabolic disturbances
o Ineffective temperature regulatory mechanism
 They don’t have subcutaneous fat to regulate temperature – put them skin
to skin (kangaroo care), put them in warmers, maintain oxygen levels
Nursing Care
– Assess for related factors at each prenatal visit
– Teach mom signs of PTL and how to palpate and assess UC’s, home monitoring
o Abdominal pain with or without diarrhea
o Teach difference between true contractions and false
o TOCO’s to monitor contractions that can be sent to provider’s office
– Weight and vital signs
o Fluid status and nutritional balance
o Vital signs show infection or changes in BP clue into pending preeclampsia
– Lab data
o CBC
o U/A
o Cervical cultures
o Fetal lung maturity – L/S ratio of 2:1
o Fetal fibronectin – found in the cervix, swap it and sent it to the lab
 Produced by the fetus during pregnancy and tells us the likelihood of PTL
– Fetal surveillance
o The younger the baby the less you would expect for variability
o The older the baby the lower the baseline tends to be
Home Management
– Teach mom to observe for and report all uterine activity or other signs of PTL
– Encourage fluids, well balanced diet with fiber
– Maintain an empty bladder
– Restrict activity – bedrest with bathroom privileges
– Encourage relaxation exercises
– Monitor prescribed medications and report side effects to primary caretaker
– Include family in planning
– Assess for and garner support resources
– Assess for negative physiological and psychological effects and intercede appropriately
Hospital management
– Tocolyic therapy: the use of pharmacologic agents to inhibit uterine activity (p. 767 –
768)
o Magnesium Sulfate (MgSO5) – depressed CNS and pulmonary
 Calcium gluconate is antidote
 Causes relaxation of the uterine muscle (Pitocin gets it to contract)
 Will increase glucose levels
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Childbearing Family (NURS 3250 ) Week 11 Intrapartum Complications

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