Lecture on Assisted Deliveries, PROM, and Preterm Labor
Introduction
- Topics Covered:
- Vacuum-assisted delivery
- Forcep-assisted delivery
- Premature rupture of membranes (PROM)
- Preterm labor
- Resources: Maternity flashcards from Level Up RN
- Note: Forceps-assisted deliveries are rare due to updated clinical practices.
Assisted Deliveries
Vacuum-assisted Delivery
- Description:
- Suction cup applied to fetal head for traction
- Helps in fetal descent
- Complications:
- Cephalohematoma or caput
- Risk of birth trauma (maternal/fetal lacerations, subdural hematoma)
- Indications:
- Prolonged second stage of labor
- Abnormal fetal presentation
- Fetal distress
- Maternal exhaustion
- Ineffective pushing
- Nursing Care Requirements:
- Lithotomy position
- Empty bladder
- Ruptured membranes
- Fetal presenting part engaged
Forceps-assisted Delivery
- Uncommon and not typically seen in modern practice
Premature Rupture of Membranes (PROM)
Definitions
- PROM: Rupture of membranes before true labor
- PPROM: Rupture of membranes before 37 weeks gestation
Causes
- Maternal infection
- Incompetent cervix
- Previous preterm birth
Signs and Symptoms
- Leaking fluid
- Verification needed (amniotic vs. other fluids)
Diagnostic Tests
- pH test with nitrazine paper (turns blue with amniotic fluid)
- Positive ferning test
Treatment and Management
- Medications:
- Ampicillin for infection
- Betamethasone for fetal lung maturity
- Hospitalization:
- Observation or bed rest
- Instructions on avoiding intercourse, temperature monitoring, infection signs
Risks
- Infection
- Prolapsed umbilical cord
Preterm Labor
Definition
- Uterine contractions causing cervical changes between 20-37 weeks
Risk Factors
- Infection
- Diabetes
- Hypertension
- Smoking
- Multifetal pregnancy
- PROM and placenta previa
Signs and Symptoms
- Cervical dilation
- Vaginal discharge of amniotic fluid
- Uterine contractions
Diagnostic Test
- Fetal fibronectin test: Indicates risk for preterm delivery
Medications Used
- Magnesium:
- Used to relax the uterus
- Monitor for magnesium toxicity (antidote: Calcium gluconate)
- Nifedipine: Calcium channel blocker
- Terbutaline: Tocolytic
- Indomethacin: NSAID
- Betamethasone: For fetal lung maturity
Management
- Bed rest and pelvic rest (no intercourse)
Quiz Questions
- What color does nitrazine paper turn in the presence of amniotic fluid?
- Which drug promotes fetal lung maturity?
- Which substance in vaginal secretions may indicate increased risk of preterm labor?
- What is the antidote to magnesium?
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