Postpartum Hemorrhage and Fetal Complications

Risk Factors for Postpartum Hemorrhage

• Prolapse of umbilical cord: Maternal implication - fear for baby, cesarean birth, and emergent risk; Fetal implication - acute fetal hypoxia
• Fetal heart deceleration: Fetal implication - tachycardia, chronic asphyxic insult, and bradycardia; Maternal implication - fear for baby, and risk of cesarean birth, forceps, and vacuum
• Uterine rupture: Maternal implication - hemorrhage, cesarean birth, and hysterectomy; Fetal implication - fetal anoxia, fetal hemorrhage, and neonatal morbidity and mortality

Postdates (Greater than 42 Weeks)

• Maternal implication - anxiety, incidence of induction of labor, and cesarean birth; Fetal implication - post-maturity syndrome, risk of fetal-neonatal mortality, and risk of antepartum fetal death

Diabetes

• Maternal implication - risk of hydramnios, hypoglycemia or hyperglycemia, and preeclampsia; Fetal implication - risk of malpresentation, macrosomia, IUGR, RDS, hypoglycemia, polycythemia, and congenital anomalies

Preeclampsia

• Maternal implication - abruptio placenta, risk of seizures, and risk of stroke; Fetal implication - risk of small for gestational age baby, preterm birth, and mortality

Maternal Fetal Triage Index (MFTI)

• A five-level standardized method for assigning an acuity score to pregnant women presenting to the hospital for care
• Level 1 - stat; Level 2 - urgent; Level 3 - prompt; Level 4 - no urgent; Level 5 - scheduled or requesting a service

Premature Rupture of Membranes

• Maternal implication - risk of infection, preterm labor, and prolonged hospitalization; Fetal implication - perinatal morbidity, prematurity, and risk of respiratory distress syndrome

Induction of Labor

• Maternal implication - risk of uterine rupture, and length of labor if cervix not ready; Fetal implication - prematurity if gestational age not assessed correctly, and risk of hypoxia

AIDS/STIs

• Maternal implication - risk of additional infections; Fetal implication - risk of transplacental transmission

Abruptio Placenta/Placenta Previa

• Maternal implication - hemorrhage, uterine atony, and incidence of cesarean birth; Fetal implication - fetal hypoxia, acidosis, and perinatal mortality

Failure to Progress in Labor

• Maternal implication - maternal exhaustion, incidence of augmentation of labor, and incidence of cesarean birth; Fetal implication - fetal hypoxia, acidosis, and intracranial birth injury

Precipitous Labor (Less than 3 Hours)

• Maternal implication - perineal, vaginal, cervical laceration; Fetal implication - neonatal tentorial (brain) tears, trauma – neural or tissue, and cephalohematoma

Initial Assessment

• Abnormal symptoms or signs of potential problems; FHR status of uterine contractions

Subsequent Assessment

• Determining if there is any change from the most recently documented prenatal care visit or other evaluation; and determining any ongoing or newly developed risk factors that could impact medical decision making during the present admission

Factors that would Place a Woman in a High-Risk Category

• Physical conditions, mental health, psychosocial, cultural, and intimate partner violence; The nurse's ability to provide support and care

Abnormal Presentation

• Maternal implication - incidence of cesarean birth, incidence of prolonged labor, and incidence of fibroids; Fetal implication - incidence of placenta previa, prematurity, and risk of congenital abnormality

Multiple Gestation

• Maternal implication - uterine distention, risk of postpartum hemorrhage, risk of cesarean birth, and risk of preterm labor; Fetal implication - low birth weight, prematurity, and risk of congenital anomalies

Hydramnios

• Maternal implication - discomfort, dyspnea, and risk of preterm labor; Fetal implication - risk of esophageal or other high alimentary tract atresia, and risk of CNS anomalies

Oligohydramnios

• Maternal implication - maternal fear of "dry birth"; Fetal implication - incidence of congenital anomalies, incidence of renal lesions, and risk of IUGR

Meconium Staining of Amniotic Fluid

• Maternal implication - psychologic stress due to fear for baby; Fetal implication - risk of fetal asphyxia, and risk of meconium aspiration