risks associated with post-term births are
- induction
- dysfunctional labour
- c-section
- fatigue
- macrosomnia
- decreased amniotic fluid
- meconium aspiration
what is the key concern with going post term?
- fetal demise (still birth)
risk factors for still births:
- maternal age (over 35)
- maternal infections
- poor nutrition
- lifestyle factors (smoking/obesity)
most common approaches to prolonged pregnancy are:
- induction of labour
- increased surveillance of fetus
factors considering the decision for post term pregnancies are:
- maternal choices
- fetal well-being
- maternal age
- health status
what is the first recommendation to reduce IOL?
- first term ultrasound (dating US)
what is SOGC second recommendation for post-term pregnancy
- offer membrane sweep between 38-41 weeks gestation
the third SOGC recommendation to reduce IOL is:
- offer IOL once the gestation hits 41 weeks
- twice weekly assessments to be done if not chosen (fetal movement, NST, US)
what is cervical ripening
- pharm or mechanical method to soften, efface, or dilate cervix
what is the bishop score
- assessment to determine status of cervix (position, consistency, length, dilation)
- station of presenting part
what are 6 indications for induction of labour
- preeclampsia (>37 weeks)
- post dates
- uncomplicated dichorionic twin (>38 weeks)
- IUGR
- gestational diabetes
- oligohydramnios
- PROM
- gestational HTN >38 weeks
3 methods used to induce labour
- prostaglandin gel
- amniotomy
- oxytocin
- misoprostol
what does SHARE acronym stand for
- Seek patients participation
- Help her explore each option
- Assess what matters to her
- Reach a decision together
- Evaluate her decision and assess if its been implemented
what are the lamaze 6 care practices that promotes, protect, and support normal birth
- labour begins on own
- continuous labour support
- no routine interventions
- freedom of movement
- spontaneous pushing
- no separation of mom and babe
what are some negative effects on the intrauterine environment when placental function deteriorates
- reduced amniotic fluid
- decreased Whartons jelly around cord
- decreased cord blood flow
what is OFTEN and consequence of oxytocin administration
- reduced placental perfusion diminishing fetal reserves of PaO2
post-mature infant has decreased
- subcut fat
- lacks lanugo and vernix
- dry cracked/peeling skin, meconium stained skin
what are 3 possible reasons there would be meconium present in amniotic fluid?
- normal physiological function occurring with maturity or breech presentation
- the result of hypoxia-induced peristalsis and sphincter relaxation
- umbilical cord compression induced vagal stimulation in mature fetuses
it is most common for meconium aspiration to occur in infants who have experienced:
- hypoxic event in utero
pathophysiology of meconium aspiration includes:
- airway obstruction
- atelectasis and air trapping
- inflammatory response and chemical pneumonitis
- inhibition of surfactant function
- increased pulmonary vascular resistance
infants with MAS are at increased risk for
- cerebral palsy
- developmental delays
- long-term pulmonary problems
