Labor Complications PDF

LABOR AND BIRTH Risk and complications Assessment of Risk Factors ◦ A comprehensive approach to high-risk pregnancy is used now ◦ Requires the efforts of an interprofessional health care team ◦ The factors associated with high-risk childbearing are grouped into broad categories based on threat...

LABOR AND BIRTH Risk and complications Assessment of Risk Factors ◦ A comprehensive approach to high-risk pregnancy is used now ◦ Requires the efforts of an interprofessional health care team ◦ The factors associated with high-risk childbearing are grouped into broad categories based on threats to health and pregnancy outcomes Assessment of Risk Factors Biophysical Originates with the pregnant woman or the fetus May affect development and functioning of either one or both Genetic disorders, nutritional and general health status, and medical or obstetric-related illnesses Assessment of Risk Factors Psychosocial ◦ Maternal behaviors and adverse lifestyles that have a negative effect on health of mother or fetus ◦ Risks may include emotional distress, history of depression or other mental health problems, disturbed interpersonal relationships such as intimate partner violence, substance use or misuse, inadequate social support, and unsafe cultural practices Assessment of Risk Factors Sociodemographic ◦ Arise from the context in which the pregnant woman and family live ◦ Lack of prenatal care, low income, single marital status, and ethnicity Environmental ◦ Hazards in workplace and woman’s general environment ◦ May include environmental chemicals (e.g. lead, mercury), anesthetic gases, and radiation  Antepartum Testing ◦ Ultrasonography o Abdominal versus Transvaginal o Levels of Ultrasonography o Standard (basic) o Limited o Specialized (also called detailed or targeted) o Indications for use o Fetal heart activity o Gestational age o Fetal growth o Fetal anatomy Major Uses of Ultrasonography During Pregnancy First Trimester Second Trimester Third Trimester Confirm pregnancy Establish or confirm dates Confirm gestational age Confirm viability Confirm viability Confirm viability Determine gestational age Detect polyhydramnios, Detect macrosomia Rule out ectopic pregnancy oligohydramnios Detect congenital anomalies Detect multiple gestation Detect congenital anomalies Detect IUGR Determine cause of vaginal Detect IUGR Determine fetal position bleeding Assess placental location Detect placenta previa or Visualization during Visualization during placental abruption chorionic villus sampling amniocentesis Visualization during Detect maternal Evaluate for preterm labor amniocentesis, external abnormalities such as version bicornuate uterus, ovarian Biophysical profile cysts, fibroids Amniotic fluid volume assessment Doppler flow studies Detect placental maturity Evaluate for preterm labor ANTEPARTUM ASSESSMENT USING ELECTRONIC FETAL MONITORING Antepartum Assessment Using Electronic Fetal Monitoring ◦ Indications o The goal of third trimester testing is to determine whether the intrauterine environment continues to support the fetus ◦ Nonstress Test (NST) o Interpretation: Reactive (normal) or nonreactive (requires further evaluation) ◦ Vibroacoustic Stimulation (VAS) ◦ Contraction Stress Test (CST) o Nipple-stimulated contraction test o Oxytocin-stimulated contraction test o Interpretation: Negative (desired result) or Positive (late FHR decelerations are present) Biophysical Score 2 Score 0 Variable Fetal breathing At least one episode of fetal breathing Absent fetal breathing movements or 2 cm Deepest vertical pocket ≤2 cm Nonstress test Reactive Nonreactive Score Interpretation Management 10 Normal; low risk for chronic asphyxia Repeat testing at weekly to twice-weekly intervals 8 Normal; low risk for chronic asphyxia Repeat testing at weekly to twice-weekly intervals 6 Suspect chronic asphyxia asphyxia If ≥36–37 weeks of gestation or