ATI/ OB | Labor Complications
STAT Stitch Deep Dive Podcast Beyond The Bedside · Regular Guy
April 6, 202655m 52s
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Show Notes
Prematurity & Membrane Rupture
- Preterm Labor: Regular contractions causing cervical change before 37 weeks. The primary goal is delaying birth 48 hours using tocolytics to administer corticosteroids for fetal lung maturity.
- PPROM: Amniotic sac rupture before 37 weeks. The greatest risk is infection; nurses must monitor temperature, avoid digital exams, and administer antibiotics.
Infection & Intrapartum Interventions
- Chorioamnionitis: Intra-amniotic infection presenting with maternal fever, uterine tenderness, and fetal tachycardia. Treatment requires IV antibiotics and prompt birth.
- Labor Augmentation: Used for dystocia via oxytocin or amniotomy. Oxytocin requires 1:1 nursing to monitor for tachysystole and fetal distress.
- Operative Vaginal Birth: Vacuums/forceps expedite the second stage. The cervix must be fully dilated, membranes ruptured, and the fetal head engaged.
Fetal Distress & Malpresentation
- Nonreassuring FHR: Indicates hypoxia (bradycardia, late decelerations). Nurses must perform intrauterine resuscitation: stop oxytocin, reposition laterally, increase IV fluids, and apply oxygen.
- Breech Presentation: Fetus presents buttocks/feet first. Managed via External Cephalic Version (ECV) or Cesarean, requiring continuous FHR monitoring.
- Meconium-Stained Fluid: Indicates hypoxia, risking aspiration. Nurses assist with amnioinfusion and prepare for neonatal resuscitation.
Obstetrical Emergencies (Require Rapid Response)
- Umbilical Cord Prolapse: Cord exits cervix before the fetus. The nurse must immediately use a sterile gloved hand to elevate the fetal presenting part off the cord and prepare for emergent Cesarean.
- Placental Abruption: Premature separation of the placenta. Identified by sharp abdominal pain, a board-like abdomen, and fetal bradycardia. Requires immediate Cesarean and fluid resuscitation.
- Uterine Rupture: Tearing of the uterine wall, highest risk during Trial of Labor After Cesarean. Signs include sudden pain, loss of fetal station, and ominous FHR patterns, necessitating immediate Cesarean.
- Shoulder Dystocia: Head emerges but retracts ("turtle sign"). Nurses must immediately implement the McRoberts maneuver (elevating legs) and apply suprapubic pressure.
Psychosocial Support Emergencies disrupt birth plans and can lead to fetal loss. Nurses must provide a supportive presence, actively listen, and facilitate healthy grieving.