2INTRAPARTAL COMPLICATIONS Interference with normal processes & patterns of labor/birth resulting in maternal or fetal jeopardy.Preterm labor; dysfunctional labor patterns; prolonged labor; hemorrhage – uterine ruputure/inversion; amniotic-fluid embolus.
3Dysfunctional Labor: Possible Causes: Catecholamines (response to anxiety/fear), increase physical/psychological stress, leads to myometrial dysfunction; painful & ineffective labor.Premature or excessive analgesia, particularly during latent phase.Maternal factors.Fetal factors.Placental factors.Physical restrictions (position in bed).Maternal Factors:Pelvic ctxUterine tumors (myomas, carcinoma)Congenital uterine anomalies (bicornnate uterus)Pathological contraction ring (Bandl’s ring)Rigid cervix, cervical stenosis/stricture.Hypertonic/hypotonic ctx.Prolonged ROM (intrauterine infection may have caused ROM or may follow rupture).Prolonged 1st or 2nd stage.Medical conditions: diabetes, hypertension.FETAL FACTORS:MacrosomiaMalposition/malpresentationCongenital anomaly (hydrocephalus, anencephaly)Multifetal gestation (ex-interlocking twins)Prolapsed cordPostermPLACENTAL FACTORS:Placenta previa; inadequate placental function with ctx.;abruptio placentae; placenta accreta.
4ASSESSMENT: Antepartal history. Emotional status. Vital signs, FHR. Contraction pattern (frequency, duration, intensity).Vaginal discharge.GOAL = to minimize physical/ psychological stress during labor/birth. Emotional support.Reinforce relaxation techniques.Support couple’s effective coping techniques / mechanisms.Encourage verbalization of anxiety / fear / concerns.Explain all procedures – to minimize anxiety / fear, encourage cooperation / participation in care.Provide quiet environment conducive to rest.CONTINUOUS MONITORING OF MATERNAL / FETAL STATUS & PROGRESS THROUGH LABOR:To identify early signs of dysfunctional labor, fetal distress.To facilitate prompt, effective treatment of emerging complications.MINIMIZE EFFECTS OF COMPLICATED LABOR ON MOTHER, FETUS:Position change: lateral Sims’ to reduce compression of inferior vena cava.Oxygen per mask, as indicated.Institute interventions appropriate to emerging problems.
5Preterm Labor: Occurs after 20 weeks gestation and before 38 weeks. Causes may be from maternal, fetal, or placental factors.Prevention:Primary: close observation and eduction in S&S of labor.Secondary: prompt, effective Rx of associated disorders.Tertiary: suppression of preterm labor.COEXISTING DISORDERS:Infections that may cause PROM.Hypertension (preeclampsia, eclampsia)Uterine overdistention (hydramnios, multifetal gestation)Maternal diabetes, renal or cardiovascular disorder, UTI.Severe maternal illness (ex-pneumonia, acute pylenephritis)Placental abnormalities (previa, abruption)Iatrogenic: miscalculated EDC for repeat C/S.Fetal death.Incompetent cervical os (small percentage).Uterine anomalies (rare): intrauterine septum, bicornate uterus.Positive fetal fibronectin assay (protein found in fetal tissue, membranes, amniotic fluid & decidua) found in cervical / vaginal fluid 1st half of pregnancy & normally absent through mid to late pregnancy).
6Tertiary: suppression of preterm labor Bedrest.Position: side-lying – to promote placental perfusion.Hydration.Pharmacological: betaadrenergic agents to reduce sensitivity of uterine myometrium to oxytocic & prostaglandin stimulation; increase bld flow to uterus.Pt may be maintained at home with adequate follow-up & health teaching.
7CONTRAINDICATIONS: for suppression of labor Placenta previa or abruptio placenta.Chorioamnionitis.Erythroblastosis fetalis.Severe preeclampsia.Severe diabetes (brittle).Increasing placental insufficiency.Cervical dilation of 4 cm or more.ROM (depends on cause & if sepsis exists).
8Nursing Assessment: PTL Maternal VS. Response to medication:HypotensionTachycardia, arrhythmiaDyspnea, chest painNausea & vomitingSigns of infection:Increased temperatureTachycardiaDiaphoresisMalaise
9Emotional status: denial, guilt, anxiety, exhaustion. Signs of continuing & progressing labor:EffacementDilationStation(vaginal exam ONLY if indicated by other signs of continuing labor progress)Status of membranes.FHR, activity (continuous monitoring).Ctx: frequency, duration, strength.
10Report PROMPTLY to MD: Maternal pulse of 110 or more. Diastolic pressure of 60 mmHg or less.Increase in maternal temperature.Respirations of 24 or more; crackles (rales).Complaint of dyspnes.Contractions: increasing frequency, strength, duration, or cessation of ctx.
11Intermittent back and thigh pain. Rupture of membranes. Vaginal bleeding.Fetal distress.IF LABOR CONTINUES:GOAL = facilitate infant survival; emotional support; support comfort measures; health teaching.NOTE: Analgesics contraindicated – to prevent depression of fetus / neonate.HEALTH TEACHING:Discuss the need for an episiotomy, possibility of outlet forceps-assisted birth (to reduce stress on fetal head).Prepare for c/s: to reduce possibility of fetal intraventricular hemorrhage (usually under 34 weeks).Rationale for avoiding use of medications to reduce contraction pain.
13HYPERTONIC DYSFUNCTION: Increased resting tone of uterine myometrium; diminished refractory period; prolonged latent phase.Nullipara: more than 20 hours.Multipara: more than 14 hours.Etiology: unknown. Theory – ectopic initiation of incoordiante uterine ctx.Assessment:Onset (early labor)
14Signs of fetal distress: Contractions:Continuous fundal tension, incomplete relaxation.Painful.Ineffectual – no effacement or dilation.Signs of fetal distress:Meconium-stained fluid.FHR irregularities.Maternal VS.Emotional status.Medical evaluation: to rule out CPD.Vaginal examination, x-ray pelvimetry, ultrasonography.
16HYPOTONIC DYSFUNCTION: After normal labor at onset, ctx diminish in frequency, duration, & strength.Lowered uterine resting tone; cervical effacement & dilation slow / cease.Etiology:Premature or excessive analgesia / anesthesia (epidural, spinal block).CPD.Overdistention (hydramnios, fetal macrosomia, multifetal pregnancy).Fetal malposition / malpresentation.Maternal fear / anxiety.
17Assessment: Onset (latent phase & most common in active phase). Contractions - normal previously, will demonstrate:Decreased frequency.Shorter duration.Diminished intensity (mild to moderate).Less uncomfortable.Cervical changes – slow or cease.Signs of fetal distress – rare.Usually late in labor d/t infection secondary to prolonged ROM.Tachycardia.
18Maternal VS (elevated temperature) – may indicate infection. Medical diagnosis – procedures: vaginal examination, x-ray pelvimetry, ultrasonography. To rule out CPD (most common cause).Management:Amniotomy (artificial ROM).Oxytocin augmentation of labor.If CPD, prepare for c/s.Emotional support, comfort measures, prevent infection.
19Precipitate LaborLabor that progresses rapidly and ends with the delivery occurring less than 3 hours after the onset of uterine activity.Rapid labor and delivery.
20Fetal Malpresentation and Malposition Breech presentationShoulder presentationFace presentationMalpositionsChapter 26
21Breech PresentationsFetal descent in which the fetal buttocks, legs, feet, or combination of these parts is found first in the maternal pelvis.Labor tends to be longer and more difficult due to a softer presenting part, that does not fill the birth canal completely.Increase risks for fetal outcome.
22Shoulder Presentation Fetal descent in which the shoulder precedes the fetal head in the maternal pelvis alone or along with the ftal arm and hand.Vaginally undeliverable.
23Face PresentationFetal descent in which hyperextension of the fetal head and neck allows the fetal face to descend into the maternal pelvis, as opposed to flexion that results in fetal vertex presentation.Brow presentation = occurs when the area between the anterior fontanelle and the fetal eyes descends first.
24Malpositions Persistent occipitoposterior position. Persistent occipitotransverse position.Result from fetal rotation as the fetus descends through the pelvis.Possible precipitating factors are macrosomia and pelvic abnormalities.Results in increased discomfort (particularly back labor), prolonged, abnormal labor, soft tissue injury, lacerations, or an extensive episiotomy incision.
25Maternal and Fetal Structural Abnormalities Cephalopelvic disproportion (CPD)MacrosomiaChapter 26
26DYSTOCIA: Difficult labor. Causes: “3 Ps” for mother: Psych, Placenta, Position.“3Ps” for fetus: Power, Passageway, Passenger.POWER: forces of labor (uterine contractions, use of abdominal muscles).Premature analgesia / anesthesia.Uterine overdistension (multifetal pregnancy, fetal macrosomia)Uterine myomas.
27PASSAGEWAY: Resistance of cervix, pelvic structures. Rigid cervix.Distended bladder.Distended rectum.Dimensions of the bony pelvis: oelvic contractures.PASSENGER: accommodation of the presenting part to pelvic diameters.Fetal malposition / malpresentation.Fetal anomalies.Fetal size.MALPOSITION / MALPRESENTATION:Transverse lie.Face,brow presentation.Breech presentation.CPD.FETAL ANOMALIES:Hydrocephalus.Conjoined (Siamese) twins.Meningomyelocele.
28Hazards with Dystocia: MATERNAL:1. Fatigue, exhaustion, dehydration.2. Lowered pain threshold, loss of control.3. Intrauterine infection.Uterine rupture.Cervical, vaginal, perineal lacerations.Postpartum hemorrhage.FETAL:Hypoxia, anoxia, demise.Intracranial hemorrhage.MATERNAL:d/t prolonged labor.2. d/t prolonged labor, continued uterine ctx, anxiety, fatigue, lack of sleep.d/t prolonged ROM and frequent vaginal examination.d/t obstructed labor.d/t obstetric interventions.d/t uterine atony or trauma.FETAL:d/t decreased O2 concentration in cord blood.d/t changing intracranial pressure.
30PLACENTA PREVIAAbnormal placement of placenta so that it partially covers the cervix; dilatation results in bleeding, which can be of hemorrhagic proportions.The placenta is located over or very near the internal cervical os.Severe hemorrhage can result from digital palpation of the internal os.Previa is a serious but uncommon complication, occurring in .3-.5% of pregnancies.
31Advanced maternal age and multiparity increase the risk. Painless hemorrhage is symptomatic of previa, often around the end of the 2nd trimester.Clinical diagnosis is reached through ultrasound examination in which the placenta is localized in relationship to the cervix.Manual examination is contraindicated!Management of pregnancy depends on gestational age.If the gestational age is early, an attempt is made to prolong the pregnancy with the intention of optimizing the neonatal outcome. The woman is usually hospitalized to try and avoid preterm labor or hemorrhage, and her mobility is restricted, usually to bed rest at first. Activity will be gradually increased as pregnancy progresses to term.Hemoglobin and hematocrit values are closely monitored, and blood replacement or iron therapy is instituted if anemia is present.Unless an emergency situation arises, delivery is planned for some point after the fetus has reached 36 weeks, and lung maturity.Vaginal delivery would be considered ONLY if the placenta previa were very marginal, the fetal head had descended low enough to act as a tamponade placing pressure against the placenta, active labor had begun, and no other complications were evident. Vag delivery would also be considered if the fetus were dead or had major malformations.In most cases, surgical intervention (C/S) is the delivery method of choice.
32PLACENTAL ABRUPTIONPremature separation of the placenta from the uterine wall; usually results in maternal hemorrhage and fetal compromise.Classified as “partial” or “total”.“Total Abruption” – fetal death is inevitable.“Partial Abruption” – the fetus has a chance of survival.Separation of >50% is incompatible with fetal survival.With an ABRUPTION:There is a hemorrhage into the decidua basalis, which divides, leading to separation of th3e part of the palcenta adjacent to the split.A hematoma may form between the placenta and the uterus.The bleeding then progresses to the edge of the placenta.If the placenta does NOT fully separate from the uterine wall, bleeding can remain concealed.
33Grading of Placental Abruptions: Grade I: Slight vag.bleeding & some uterine irritability. Maternal BP is unaffected & there are normal fibrinogen levels. FHR has a normal pattern.Grade II: External bleeding is mild to moderate. The uterus is irritable. Tetanic ctx may be present. Maternal BP is maintained. FHR shows signs of distress. Maternal fibrinogen level is decreased.
34Grade III: The bleeding may be severe & may be concealed in some instances. Uterine ctx are tetanic and painful. Maternal hypotension may be present. The fibrinogen level is greatly decreased & there are coagulation problems.Diagnosis: may be made by ultrasound, but frequently the diagnosis is made and confirmed at delivery, by inspection of the placenta.
35Umbilical Cord Abnormalities Velamentous insertion of the cordUmbilical cord compressionUmbilical cord prolapseChapter 26
36Velamentous Insertion of the Cord Condition where the umbilical cord joins the placenta at the edge, rather than the typical insertion in the center.Can result in chronic altered fetal perfusion. Can lead to trauma and compression during L&D, resulting in rupture and hemorrhage.
37PROLAPSED UMBILICAL CORD: Cord descent in advance of presenting part; compression interrupts blood flow, exchange of fetal / maternal gases. Leads to fetal hypoxia, anoxia, death (if unrelieved).Etiology:SROM or AROM.Excessive force of escaping fluid (hydramnios).Malposition (breech, compound presentation, transverse lie).Preterm or SGA fetus – allows space for cord descent.
38Nursing interventions: Assessment:Visualization of cord outside (or inside) vagina.Palpation of pulsating mass on vaginal exam.Fetal distress – variable deceleration and persistent bradycardia.Nursing interventions:Reduce pressure on cord.Increase maternal / fetal oxygenation (O2 per 8-10 liters).Protect exposed cord (continuous pressure on presenting part to keep pressure off cord).REDUCE PRESSURE ON CORD:Position = knee to chest; lateral modified Sims’ with hips elevated; modified Trendelenburg.With gloved hand, support fetal presenting part.
39Identify fetal response to these measures, reduce threat to fetal survival: moniotr FHR continuously.Expedite termination of threat to fetus (prepare for immediate vaginal or c/s).Support mother and significant other (try to explain things while mobilizing delivery team).
41Summary of Danger Signs During Labor: Contractions: strong, every 2 min. or less, lasting 90 sec. or more; poor relaxation between ctx.Sudden sharp abdominal pain followed by boardlike abdomen and shock (abruptio placenta or uterine rupture).Marked vaginal bleeding.FHR periodic pattern decelerations – late; variable; absent.
42Baseline FHR: Amniotic fluid: Maternal hypotension. Bradycardia (<100 bpm)Tachycardia (>160 bpm)Amniotic fluid:Amount: excessive; diminished.OdorColor: meconium stained or particulate; port-wine; yellow.24 hr or more since ROM.Maternal hypotension.
44Postpartum Hemorrhage: Definition:More than 500cc of blood loss after vaginal birth.More than 1000cc of blood loss after C/S.Blood loss is often underestimated by up to 50% (ACOG, 1998). Subjective.#1 cause of PP Hemorrhage = Uterine Atony.
45Risk Factors for PP Hemorrhage: Uterine Atony: Marked hypotonia of the uterusOverdistended uterusAnesthesia and analgesiaPrevious history of uterine atonyHigh parityProlonged labor, oxytocin-induced laborTrauma during labor and birthOverdistended Uterus:Large fetus’Multiple fetusesHydramniosDistention with clotsAnesthesia and analgesia:Conduction anesthesiaTrauma during labor and birth:Forceps-assisted birthVacuum-assisted birthCesarean birth
46Risk Factors for PP Hemorrhage: Lacerations of the birth canalRetained placental fragmentsRuptured uterusInversion of the uterusPlacenta accretaCoagulation disordersPlacental abruption
47Risk Factors for PP Hemorrhage: Placenta previaManual removal of a retained placentaMagnesium sulfate administration during labor or postpartum periodEndometritisUterine subinvolution
48Lacerations: Cervix, vagina, perineum. Suspected when bleeding continues despite a firm, contracted uterine fundus.Characteristics: bleeding can be a slow trickle, an oozing, or frank hemorrhage.Influencing factors: structural, maternal, fetalLacerations = the most common cause of injuries in the lower portion of the genital tract.Influencing factors having to do with the Mom:Operative birthPrecipitate birthCongenital abnormalities of the maternal soft partsContracted pelvisPrevious scarring from infection, injury or operationVulvar, perineal, and vaginal varicosities also can cause lacerationsPelvic hematomas can be vulvar, vagtinal or retroperitoneal in origin.Vulvar hematomas are the most common, and generally the most visible.Cervical lacerations usually occur at the lateral angles of the external os. Most are shallow, and bleeding is minimal. More extensive lacerations may extend into the vaginal vault or into the lower uterine segment.Influencing factors having to do with the baby:SizeAbnormal presentationPosition of the fetus
49Retained Placenta: Causes: Types: Partial separation of normal placentaEntrapment of the partially or completely separated placenta by uterine constriction ringMismanagement of the 3rd stage of laborAbnormal adherence of the entire placenta or a portion of placenta to the uterine wallTypes:Nonadherent retained placentaAdherent retained placentaPlacental retention because of poor separation is common in very preterm births (20 to 24 weeks gestation).NONADHERENT RETAINED PLACENTAManagement: manual separation and removal of placentaDon’t usually need supplemental anesthesia if woman has had regional anesthesiaAfter removal woman is still at risk for severe PPH and infectionADHERENT RETAINED PLACENTAAbnormal adherence of the placentaCause unknown. Placenta adheres to an area of defective endometrium so that there is no separation between placenta and the decidua.Attempts to remove are usually unsuccessful. Laceration or perforation of the uterine wall may result. Risk for severe PPH and infection.Can be partal or complete. Treatment may include blood replacement and hysterectomy.Degrees of attachement:Placenta accreta = slight penetration of myometrium by placental trophoblastPlacenta increta = deep penetration of myometrium by placentaPlacenta percreta = perforation of uterus by placenta.
50Inversion of the Uterus Rare, but life threatening. (1 in births). May recur with additional births.Contributing factors:Fundal implantation of placentaVigorous fundal pressureExcessive traction applied to cordUterine atonyLeiomyomasAbnormally adherent placental tissueMost often occurs in multiparous women and with placenta accreta or increta.Presenting signs:HemorrhageShockpain
51Uterine Subinvolution Causes:Retained placental fragmentsPelvic infectionSigns and symptoms:Prolonged lochial dischargeIrregular or excessive bleedingHemorrhagePelvic exam reveals a uterus that is larger than normal and may be boggy
52Assessing Cardiac Output: PPH NURSING ASSESSMENTS:Palpation of pulses (rate,quality, equality)AuscultationInspectionObservationPalpation of pulses:ArterialBlood pressureAuscultation:Heart sounds and murmursBreath soundsInspection:Skin color, temperature, turgorLevel of consciousnessCapillary refillUrinary outputNeck veinsPulse oximetryMucous membranesObservationPresence or absence of anxiety, apprehension, restlessness, disorientation
53Meds used to Rx PP Hemorrhage Oxytocin (Pitocin)Methylergonovine (Methergine; Ergotrate)Prostaglandin F2 (Prostin / 15M; Hemabate)Pitocin:action – contraction of uterusSide effects = infrewuent; water intoxication; nausea and vomitingContraindications = none for PPHNsg considerations = continue to monitor vaginal bleeding and uterine toneMethergine / Ergotrate:Action = contraction of the uterusSide effects = hypertension, nausea, vomiting, h/aContraindications = hypertension, cardiac diseaseNsg consideration = check BP before giving and don’t give if >140/90; continue monitoring vaginal bleeding and uterine toneProstin / Hemabate:Action = contraction of uterusSide effects = headache, nausea, vomiting, feberContraindications = asthma, hypersensitivityNsg consideration = continue to monitor vaginal bleeding and uterine tone
54Emergency: Hemorrhagic Shock Assessments:Respirations = rapid and shallowPulse = rapid, weak, irregularBP = decreasing (late sign)Skin = cool, pale, clammyUrinary Output = decreasingLevel of Consciousness = lethargy to comaMental status = anxiety to comaCentral venous pressure = decreased
55Emergency: Hemorrhagic Shock Intervention:Summon assistance and equipmentStart IV per standing orders (large bore preferable)Ensure patent airway; administer oxygenContinue to monitor status
56Coagulopathies Idiopathic Thrombocytopenic Purpura: (ITP) von Willebrand Disease: a type of hemophilia, factor VIII deficiency, most common congenital clotting defect of women in childbearing years.Disseminated Intravascular Coagulation: (DIC) a pathologic form of clotting, diffuse. Includes platelets, fibrinogen, prothrombin, and factors V and VII.Thromboembolic Disease: formation of clot(s) in blood vessels caused by inflammation or partial obstruction of the vessel.DIC:Renal failure is a consequence of DIC, output must be maintained at more than 30 cc/hr.Thromboembolic conditions in PP period:Superficial venous thrombosis = involvement of the superficial saphenous venous system.Deep venous thrombosis = involvement varies but can extend from the foot to the iliofemoral region.Pulmonary embolism = complication of deep venous thrombosis occurring when part of a blood clot dislodges and is carried to the pulmonary artery, where it occludes the vessel and obstructs blood flow to the lungs.
58Intrapartal Factors Cesarean birth PROM Chorioamnionitis Prolonged laborBladder catheterizationInternal fetal or uterine pressure monitorMultiple vaginal exams after ROM
59Intrapartal Factors (continued) Epidural anesthesiaRetained placental fragmentsPP hemorrhageEpisiotomy or lacerationsHematomas
60Types of PP InfectionEndometritis (most common – usually begins as a localized infection at the placental site, but can involve entire endometrium)Wound infections (c/s incision, episiotomy, repaired laceration site)UTIs (2-4 % of PP women)Mastitis (1% of BF moms, usually 1st)
61Sequelae of Childbirth Trauma Uterine Displacement & prolapseCystocele and RectoceleUrinary IncontinenceGenital FistulasUterine Displacement & prolapse:Normally: the round ligaments hold the uterus in anteversion, and the uterosacral ligaments pull the cervix backward and upward.Displacement: is a variation of this normal placement. Most common = posterior displacement or retroversion, in which the uterus is tilted posteriorly and the cervix rotates anteriorly. May also be retroflexion and anteflexion.Cystocele and Rectocele: often asymptomaticUsually accompany uterine prolapse, causing the uterus to sag even further backward and downward into the vagina.Cystocele = protrusion of the bladder downward into the vagina that develops when supporting structures in the vesicovaginal septum are injured.Rectocele = the herniation of the anterior rectal wall through the relaxed or ruptured vaginal fascia and rectovaginal septum. It appears as a large bulge that may be seen through the relaxed introitus.Urinary Incontinence:Incidence increases as women age.Stress incontinence can follow injury to bladder neck structures.Urine leaks or spurts out when women laugh, sneeze, cough, or bear down.Genital fistulas: perforations between genital tract organs. Most occur between the bladder and the genital tract; the urethra and the vagina; the rectum or sigmoid colon and the vagina.
62PP Psychologic Complications Mood Disorders: with or without psychotic features, if the onset occurs within 4 weeks of childbirth.“Baby Blues” – occurs in up to 70% of PP momsPostpartum DepressionPostpartum Psychosis
64Infants With Special Needs PrioritiesInitiation & maintenance of respirationsEstablishment of extrauterine circulationControl of body temperatureIntake of adequate nourishmentEstablishment of waste eliminationEstablishment of an infant-parent relationshipPrevention of infectionProvision of developmental care for mental & social developmentPriorities for preterm or posterm infants are the same as for term infants.
65High-Risk Infants May need resuscitation at birth. Most institutions require AHA Certification in Neonatal Resuscitation of all personnel at deliveriesRequirements may include:WarmthOxygenIntubationSuctioning
66Small for Gestational Age (SGA) Definition: birth weight is below the 10th percentile on an intrauterine growth curve for that age infant.Infant could be preterm, term, or postterm.Have difficulty maintaining body warmth d/t low fat stores; may develop hypoglycemia from low glucose stores.
67Large for Gestational Age (LGA) Definition: birthweight is above the 90th percentile on an intrauterine growth chart for that gestational age.Infant could be preterm, term, or postterm.Often are IDM (infants of diabetic mothers), and particularly prone to hypoglycemia or birth trauma.
68Preterm Infants Definition: born before 37 weeks of gestation. Particular problems: respiratory function, anemia, jaundice, persistent patent ductus arteriosus, & intracranial hemorrhage.Low-birthweight infants = those weighting grams.
69Very-low-birthweight infants = those weighing 1000-1500 grams. Extremely-very-low-birthweight infants = those weighing between grams.All such infants need intensive care from the moment of birth.Risks: neurologic after-effects caused by being so critically close to the age of viability.
70Postterm Infants Definition: born after 42 weeks gestation. Particular problems: establishing respirations, meconium aspiration, hypoglycemia, temperature regulation, and polycythemia.
71Respiratory Distress Syndrome Commonly occurs in preterm infants from a deficiency or lack of surfactant in the alveoli.Without surfactant the alveoli collapse on expiration & require extreme force for reinflation.Primary Rx: synthetic surfactant replacement at birth by ET tube insufflation, followed by oxygen and ventilatory support.
72Transient TachypneaA temporary condition caused by slow absorption of lung fluid at birth.Close observation of the infant is necessary until the fluid is absorbed and respirations slow to a normal rate.C/S infants may be more prone to this because of the excess fluid in their lungs at birth.
73Meconium Aspiration Syndrome Occurs when infant inhales meconium-stained amniotic fluid during birth.Results in irritation to the airway (from meconium) & may lead to both airway spasm and pneumonia.Infant needs: oxygen, ventilatory support, & possibly antibiotic until the effects of the airway subside.It is important that they are suctioned before oxygen administration undeer pressure to prevent meconium being forced further into their lungs.
74Apnea:Definition: a pause in respirations longer than 20 seconds, with accompanying bradycardia.Occurs in preterm infants who have secondary stresses such as: infection, hyperbilirubinemia, hypoglycemia, or hypothermia.Apnea monitors are used to detect this, and infants who are high risk for this are discharged home on a home monitoring program.At birth, infants can suffer from primary apnea and secondary apnea.Primary = a period of halted respirations during the first few seconds of life.Secondary = a weakening of a newborn’s respiratory effort after attempts to initiate respirations with a few strong gasps after 1-2 minutes of apnea.
75Sudden Infant Death Syndrome Definition: the sudden, unexplained death of an infant.Associated with infants sleeping on their stomachs (prone) and infants who were born premature.Nursing prevention: advising parents to position their infant on the back for sleeping.
76HyperbilirubinemiaResults from: destruction of RBCs, due either to a normal physiologic response or an abnormal destruction of the RBCs.Hemolytic disease of the newborn is destruction of RBCs from Rh or ABO incompatibility.Phototherapy or exchange transfusion is used to prevent kernicterus.The administration of Rhogam (RHIG) (Rh antibodies) to Rh-negative mothers during pregnancy and after the birth of an Rh-positive infant to an Rh-negative mother has greatly reduced the incidence of the condition.Affected infants are jaundiced from release of bilirubin from injured RBCs.Kernicterus = deposition of bilirubin in brain cells, causing destruction of the cells.
77Neonatal Hemorrhagic Disease Definition: a lack of clotting ability resulting from a deficiency of vitamin K at birth.Prevention is by injection of vitamin K to all infants at birth.
78Retinopathy of Prematurity Definition: destruction of the retina due to exposure of immature retinal capillaries to oxygen.Monitoring oxygen saturation via arterial blood gases is an important prevention measure.
79Infections of the Newborn Streptococcal Group B pneumonia: from maternal GBBS.Hepatitis B infectionOphthalmia neonatorum: from gonococcal and chlamydial conjunctivitis.Herpes Virus infection.
80Other Neonatal Risks: Infants of diabetic mothers (IDM) Infants of drug abusing womenNOTE: respiratory distress, hypoglycemia, hypo/hyperthermia are common S&S of neonatal infection.