2: High Risk or With Complications during Labor and Delivery Flashcards
High Risk Factors
- Powers
- Passenger
- Passageway
- Psyche or Psychologic state
- Position
- Powers (________)
- Passenger (________)
- Passageway (________)
- Psyche (________)
- Position (________)
- Uterine Contractions
- Fetus and Placenta
- Pelvic Bones and Other Pelvuc Structures
- Woman and Family Perception of the Event
- Woman’s Position which Influence Labor and Birth
Complications with Power
Dystocia
Ineffective Uterine Force
Dystocia is ________, ________, or ________ labor
Long
Difficult
Abnormal
S/Sx of Dystocia
— Alteration in the characteristics of uterine contractions
— Lack of progress in the rate of cervical dilatation
— Lack of progress in fetal descent and expulsion
Causes of dystocia
— Dysfunctional labor (most common cause)
— Alteration in Pelvic Structure
— Fetal causes (malpresentation, anomalies, excessive size, no. of fetuses)
— Maternal Position during labor and birth
— Psychological response of the mother to labor
Risk Factors (Dystocia)
— Body Fluid (Overweight or Short Structure)
— Uterine Abnormalities (Congenital Malformations)
— Malpositoon and Malpresentation of fetus
— Cephalopelvic Disproportion (CPD)
— Overstimulation with oxytocin
— Maternal Factirs (fear, fatigue, dehydration, electrolyte imbalance)
— Inappropriate timing of anesthetic
Normal fetal heartbeat (FHB)
Bradycardia:
Tachycardia:
120-160 bpm
Brady: <120 bpm
Tachy: >160 bpm (Fetal distress)
External Cephalic Version (ECV) and values
— Oligohydramnios (<500 ml)
— Normohydramnios (800 ml)
— Polyhydramnios (>800-1200 ml)
— Anhydramnios (absence of amniotic fluid)
Signs of Cervical Ripening
- Bishop’s Score
- Cervical Dilatation
- Cervical Effacement
- Cervical Ripening Agents (Buscopan, prostaglandins, etc.)
Artifical rupturing of the amniotic membrane
Amniotomy
What are Operative or Assisted Birth Procedures
Vacuum or Forceps Assisted Birth
3 types of Ineffective Uterine Force
- Hypotonic Uterine Contraction
- Hypertonic Uterine Contraction
- Uncoordinated Contractions
Hypotonic Uterine Contraction is when number of contractions is ___________ (number _______ of occurence in ________ period)
Usually low or infrequent
No more than 2 or 3
10-minute
Hypotonic Uterine Contraction
Resting tone of uterus:
Strength of contractions:
Resting tone: less than 10 mmHg
Strength: does not rise above 25 mmHg
True or False.
Hypotonic Uterine Contraction increases chance of postpartum hemorrhage
TRUE
because uterus can’t contract effectively due to exhaustion from prolonged labor which requires more uterine contractions to achieve cervical dilatation
Risk Factors
(Hypotonic Uterine Contraction)
- Maternal obesity unaccompanied by diabetes
- Bowel or bladder distention which prevents descent or firm engagement
- Uterus overstretched by multiple gestation, macrosomia, hydramios, or lax abdominal muscles from grand multiparity
- Pharmacological agents used for pain relief
Hypertonic Uterine Contraction is occurs because muscle fibers of ___________ do not __________ or _______ after contraction
Myometrium
Repolarize
Relax
Hypertonic Uterine Contraction
Contractions:
Resting tone:
Contractions: frequently
Resting tone: increased, >15 mmHg
True or False.
Hypertonic Uterine Contraction can cause fetal anoxia because of lack of relaxation between contractions may not allow optimal uterine artery filling
TRUE
Risk Factors
(Hypertonic Uterine Contraction)
- Increased Maternal Catecholamine Release (epinephrine, norepinephrine)
- Maternal anxiety (primiparous labor, fear of loss of control, history of sexual abuse, lack of support, cultural differences)
- Fetal occiput-posterior malposition
Uncoordinated Contractions occur when ______________ may be initiating contractions. A fetal external monitor reveals an ________________.
More than one pacemaker
Abnormal pattern
