Birth Complications During Labor Flashcards
Dystocia
Long, difficult labor
- Consequence of persistent posterior positions in labor **
Dysfunctional Labor
Abnormalities in Uterine Contraction
Precipitous Labor
Labor less than 3 hrs
Hypertonic Uterine Contractions
- 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!
Shoulder Dystocia
- 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!
Avoid inductions…
Before 39 weeks to prevent fetal maturity issues
Induction of Labor
( Prostaglandin Agents )
- Cervidil
- Cyotec
Cervical Ripening Agents
- 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
Cervical Ripening Agents
( Interventions )
- 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
Oxytocin
( Pitocin )
- IV Med given to induce UC
- Do not give pitocin if given Misoprostol 4 hrs before
- Risk: Hyperstimulation of Uterus
- tachysystole
Desired Contraction Pattern
- Every 2-3 mins, 60-90 sec long
Pitocin Interventions
- 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
Steps for Pitocin
- Stop IV infusion
- Open primary solution ( lactated ringers )
- Turn mother to left side
- Admin 8-10L / min oxygen by tight face mask
- Notify provider
Other Induction Methods
- Sex, nipple stim, accupuncture, aroma therapy
- NO castor oil, enema
Umbillical Cord Prolapse
-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
Uterine Rupture
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
Amniotic Fluid Embolism
- 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
Meconium stained fluid
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
Indications for C-Sections
- Complete placenta previa
- Placental abruption (EMERGENCY)
- Failure to progress
- Umbilican Cord Prolapse ( EMERGENCY )
- Nonreassuring fetal status EMERGENCY)
- Previous CLASSIC incision on uterus
- Breech presentation
Uterine Incisions
- 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
Risks of C-Section
Maternal:
-Hemorrhage
- Infection
- Injury to pelvic and abdominal organs
Fetal:
- Premature birth
- Resp distress
- Low APGAR score
External Fetal Monitoring
- Toco pressure transducer
- Fetal ultrasound transducer
- FHR
- Not reliable for accessing intensity of contractions
Internal Fetal Monitoring
- IUPC
- FSE
- Scalp electrode
- Contraction strength
FHR Tracing
- Infant ( Top )
- Mom ( Bottom )
Baseline
- The mean fetal heart rate over a 10 min period
- Normal: 110-160
- Brady: Less than 110
- Tachy: Over 160
Variabillity
- 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
Accelerations
- 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
Decelrations
- Decrease in fetal heart rate below baseline
Early Decelerations
- 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
Late Decelerations
-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
Variable Decelerations
- Disrupt decrease in fetal heart rate below baseline which may or may not be associated with uterine contractions
- 15 BPM
Cause: Cord compression
Variable =
Cord compression
Early =
Head compression
Acceleration =
Okay!
Late =
Placental insuffiency
Treatment of abnormal FHR patterns
- Stop pitocin
- Left side lying
- O2
- Hydrate
- Inform
- Close monitoring
- Terbutaline
- Aminioinfusion
UC are based on contractions that are occuring…
10 min segment, averaged over 30 mins
Normal: 5 or less contractions in a 10 min segment over a 30 min period
