3 Labor & Birth Complication Part 2 Flashcards
C-section birth
Pre- op care
Informed consent
NPO
Iv w/ fluids
CBC/type and cross
FHR and mom VS
Spinal anesthesia
Foley catheter
C-section
Intra-op care
Table tilt/ hip wedges
Strap legs to table
SCDs
FHR
VS/IVF/UOP
Time out
Support person brought in
C-section
Immediate post-op care
VS q15 for 2hrs
Assess incision/fundus/lochia
Skin to skin for baby
Assess for HOTN from anesthesia
Dysfunctional (dystocia) labor
Difficult or abnormal labor
Indications leading to c-section usually due to:
5 P’s passenger, passageway, powers, position, psychologic response
How the passanger and passageway can cause dysfunctional labor
Narrow pelvic inlet
CPD (cephalopelvic disproportion)
Malposition (OP) head rubbing down spine
Malpresentation: breech, shoulder
Multifetal pregnancy (twins/triplets)
How powers can cause dysfunction labor
Hypertonic uterine dysfunction
Hypotonic uterine dysfunction
Secondary power problems
Hypertonic uterine dysfunction
Tx
Therapeutic rest (bedrest w/ BRP)
D/c oxytocin
Tocolysis
Hypotonic uterine dysfunction rx
Augmentation: amniotomy, oxytocin
Encourage regular voiding
Encourage ambulation, position changes
Secondary power problem (pushing problem) tx
Reduce epidural infusion
Favorable position for pushing
Forcep/vacuum assisted birth
Precipitous delivery
Labor lasting less than 3 hours from onset of contractions
Precipitous delivery RF
Multiparous client (multiple babies)
Oxytocin use
Precipitous delivery care
Do not leave pt alone
Prepare for delivery
Apply light pressure on perineal area to ease delivery
Support head, assess for nuchal cord, suction mouth and nose
Delivery anterior shoulder then posterior
Precipitous labor
Assess for complications
Mother vs fetus
Mother:
Cervical/vaginal/perineal lacerations
Uterine rupture
Postpartum hemorrhage
Fetus:
Hypoxia
Head trauma/intracrania hemorrhage
Prolapsed cord contributing factors
Long cord
SGA
Breech
Transverse lie
Unengaged
Prolapsed cord tx
Do
Dont
Call for help
Used sterile gloves and elevate presenting part
Place mom trandelenburg knees to chest
O2 NRB 10L
IVF
Prepare for emergency birth
DONT TRY TO REPLACE CORD
Shoulder dystocia
Risks
Management
Risk:
Macrosomia
Hx of shoulder dystocia
Management:
Mcroberts maneuver (knees to chest)
Suprapubic pressure (not fundal pressure)
Shoulder dystocia
Mom and fetus effects
Mom:
PPH
Trauma to vag/rectum
Fetus:
Asphyxia
Brachial plexus damage
Fx clavicle
Chrorioamnionitis
Clinical manifestations
Neonatal risks
Tx
CM:
Mom fever
Mom/baby tachycardia
Foul odor of amniotic fluid
Neonatal risks: ifection and sepsis
Tx:
Birth
Ampicillin/PCN & gentamicin IV
Risk of meconium aspiration syndrome (MAS)
Tx
What needed
Person needed
Assess what
If good then we can do what
If bad what do we do
Equipment for resuscitation
Person for ET tube
Assess newborn respiratory effort
Suction newborns mouth and nose if Baby has:
-strong respirtory efforts
-good muscle tone
HR 100+
If respirtory support needed then:
-tracheal suction performed prior to assisted ventilations
Do this if:
-Depressed RR, muscle tone
-HR less100
Uterine rupture
Types
Risks during labor
Complete vs incomplete
Risks:
-Uterine tachysystole (oxytocin use)
-Previous c-section w/ (TOLAC/VBAC)
-Multigravida women
-Overdistended uterus
-Malpresentation (external/internal version)
-Difficult forceps assisted birth
Uterine rupture clinical manifestations
Pt in sharp pain feel ripping
Abd pain, uterine tenderness
Stopping of contractions, change in uterine shape
Non reassuring FHT (⬇️100bpm, ⬇️ variablility)
S/s of hypovolemic shock
(⬇️BP,⬆️HR,⬇️UOP,⬆️RR, pale,⬇️LOC)
Uterine rupture management
O2
IVF/Blood Product
Prep for surgery
Need repair for torn segment, may need hysterectomy for some completes
AFE (amniotic fluid embolus)
AKA
What is happening
AKA: anaphylactoid syndrome
Amniotic fluid penetrated vascular space
AFE (amniotic fluid embolus) RF
Placenta previa/ abruption
Preeclampsia/eclampsia
HTN disorder
DM
C-section birth
AFE (amniotic fluid embolism)
Clinical manifestations
Sudden chest pain/SOA
S/s of:
Respiratory distress
Circulatory collapse
Coagulation failure (DIC)
AFE (amniotic fluid embolism)
Tx
O2 NRB/ assist with intubation/ventilartions
CPR if needed
IVF, blood products
Foley to monitor hourly urine output
