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OB 1 Exam > Birth Complications During Labor > Flashcards

Birth Complications During Labor Flashcards

1
Q

Dystocia

A

Long, difficult labor
- Consequence of persistent posterior positions in labor **

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2
Q

Dysfunctional Labor

A

Abnormalities in Uterine Contraction

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3
Q

Precipitous Labor

A

Labor less than 3 hrs

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4
Q

Hypertonic Uterine Contractions

A
  • More than 5 UC in 10 mins
  • UC lasting over 2 minutes
  • Less than 30 seconds between

Treatment:
- Decrease oxytocin
- Maternal position change
- Oxygen
- Notify provider

*If it is abnormal FHR STOP Oxytocin!

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5
Q

Shoulder Dystocia

A
  • Rare, head is born but the anterior shoulder does not pass under the pubic arch
  • Mcroberts Maneuver ( Maternal legs flexed far back, knees on abdomen )
  • Suprapubic pressure : on fetal shoulder
  • FUNDAL PRESSURE NOT ADVISED!
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6
Q

Avoid inductions…

A

Before 39 weeks to prevent fetal maturity issues

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7
Q

Induction of Labor
( Prostaglandin Agents )

A
  1. Cervidil
  2. Cyotec
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8
Q

Cervical Ripening Agents

A
  • Cytotec: Cervical ripening
  • Cervical Ripening Balloon: Catheter
  • Stripping of membranes: Provider inserts gloved fingers into cervical os, sweeps across membranes releasing prostaglandins = Increasing softening agents
  • ^ Risk for infection
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9
Q

Cervical Ripening Agents
( Interventions )

A
  • Assess fetal heart tones
  • Medications
  • Monitor UC and fetal HR after insertion
  • Assess for uterine hyperstimulation ( More than 5 UC in 10 mins )
  • Remove med if hyperstimulation occurs
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10
Q

Oxytocin
( Pitocin )

A
  • IV Med given to induce UC
  • Do not give pitocin if given Misoprostol 4 hrs before
  • Risk: Hyperstimulation of Uterus
    • tachysystole
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11
Q

Desired Contraction Pattern

A
  • Every 2-3 mins, 60-90 sec long
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12
Q

Pitocin Interventions

A
  • Monitor BP, pulse, respirations with each increase of dose ( Every 15 mins )
  • Brady, late/ deep respirations
  • I/O
  • FHR
  • If uterine hyperstimulation occurs STOP pitocin
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13
Q

Steps for Pitocin

A
  1. Stop IV infusion
  2. Open primary solution ( lactated ringers )
  3. Turn mother to left side
  4. Admin 8-10L / min oxygen by tight face mask
  5. Notify provider
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14
Q

Other Induction Methods

A
  • Sex, nipple stim, accupuncture, aroma therapy
  • NO castor oil, enema
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15
Q

Umbillical Cord Prolapse

A

-Emergency
- RARE
- When cord lies below the presenting part of fetus, causing compression of the cord
- Cord should NOT be touched or manipulated may cause vasospasm and compression
- Left side lying ( Trendelenberg/ Sims )
- Oxygen

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16
Q

Uterine Rupture

A

Risk Factors:
-Past classical cesarean birth ( vertical )
- Hypertonic contractions caused by induction or oxytocin
S/S:
- Non-reassuring FHT or loss
- Sudden, sharp abdominal pain
- Hypovolemic shock symptoms
Treatment:
- Immediate delivery
- Small: Repair of laceration and blood transfusion
- Large: Immediate Csection and hysterectomy

17
Q

Amniotic Fluid Embolism

A
  • Extremely rare!
  • Amniotic fluid and fetal cells into maternal circulation = pulm vessels to collapse
  • Dyspnea, SOB, Cyanosis, Respitory arrest
  • Treatment: O2, IV fluids, CPR, C-section
18
Q

Meconium stained fluid

A

Risks: Full term, umbillical cord compression, hypoxia
Considerations: Document color, notify CPR team, follow suction protocol
- Suction below vocal cords using endotracheal tube before spontaneous breath is depressed

19
Q

Indications for C-Sections

A
  • Complete placenta previa
  • Placental abruption (EMERGENCY)
  • Failure to progress
  • Umbilican Cord Prolapse ( EMERGENCY )
  • Nonreassuring fetal status EMERGENCY)
  • Previous CLASSIC incision on uterus
  • Breech presentation
20
Q

Uterine Incisions

A
  • CANNOT be determined by looking at external skin
  • Classical incision places patient at a higher risk for uterine rupture ( Vertical )
  • Classic incision ALWAYS has repeat C-Section
21
Q

Risks of C-Section

A

Maternal:
-Hemorrhage
- Infection
- Injury to pelvic and abdominal organs
Fetal:
- Premature birth
- Resp distress
- Low APGAR score

22
Q

External Fetal Monitoring

A
  • Toco pressure transducer
  • Fetal ultrasound transducer
  • FHR
  • Not reliable for accessing intensity of contractions
23
Q

Internal Fetal Monitoring

A
  • IUPC
  • FSE
  • Scalp electrode
  • Contraction strength
24
Q

FHR Tracing

A
  • Infant ( Top )
  • Mom ( Bottom )
25
Q

Baseline

A
  • The mean fetal heart rate over a 10 min period
  • Normal: 110-160
  • Brady: Less than 110
  • Tachy: Over 160
26
Q

Variabillity

A
  • Flunctuations in the FHR baseline over time that are irregular in amplitude and frequency
    : Absent- Undectable
    : Minimal- Equal or less than 5
    : Mod- 6 to 25
    : Marked- More than 25
27
Q

Accelerations

A
  • Abrupt increase of at least 15 BPM in fetal HR above baseline
  • Accelerations are defined as an increase of 10 BPM or more above baseline which lasts 10 seconds or more
28
Q

Decelrations

A
  • Decrease in fetal heart rate below baseline
29
Q

Early Decelerations

A
  • Usually symmetrical, gradual decrease in fetal HR and return to baseline
  • The lowest point of the deceleration usually occurs at the same time as the peak
  • Cause: Head compressions
30
Q

Late Decelerations

A

-Usually symmetrical, gradual decrease in fetal HR and return to baseline
-The lowest point of the deceleration usually occurs after the peak
Cause: Uteroplacental insufficiency
- Turn off pitocin, left side, o2, contact md

31
Q

Variable Decelerations

A
  • Disrupt decrease in fetal heart rate below baseline which may or may not be associated with uterine contractions
  • 15 BPM
    Cause: Cord compression
32
Q

Variable =

A

Cord compression

33
Q

Early =

A

Head compression

34
Q

Acceleration =

A

Okay!

35
Q

Late =

A

Placental insuffiency

36
Q

Treatment of abnormal FHR patterns

A
  1. Stop pitocin
  2. Left side lying
  3. O2
  4. Hydrate
  5. Inform
    - Close monitoring
    - Terbutaline
    - Aminioinfusion
37
Q

UC are based on contractions that are occuring…

A

10 min segment, averaged over 30 mins
Normal: 5 or less contractions in a 10 min segment over a 30 min period

OB 1 Exam (6 decks)

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