BirthComplications

Question 1

What is the nurse’s role in promoting labor progress?

Answer 1

Evaluate regularly: contractions, FHR, descent. Cervical dilation, 1cm/hr for active labor. I/O
Provide support: relaxation and stress reduction
Promote empowerment: allow expression of fears and concerns. Provide encouragement.

Question 2

Abnormal or difficult labor wherein the progression of labor deviates from normal. Characterized by slow progression of labor.

Answer 2

Dystocia.
Primary reason for C/S. becomes apparent during the “active phase of labor” (4cm). Termed “failure to progress” of dilation or descent of the head.

Question 3

Contractions start too early

Contractions won’t start

Answer 3

Preterm labor

Prolonged pregnancy

Question 4

Prior to the end of the 37th week of gestation. Regular contractions with dilation and effacement. Symptoms?

Answer 4

Preterm labor (PTL)
Uterine contractions, cramping or low back pain. Pelvic pressure or "fullness." Increase in vaginal discharge over normal. N/v, diarrhea. Unusual leaking fluid from the vagina.

Question 5

Preterm labor risk factors?

Answer 5

Maternal age, black ethnicity, low socioeconomic status. ETOH, drugs, smoking. History of preterm labor or birth. Diabetes and/or chronic HTN. Pregnancy with multiples. PROM and late or no prenatal care.

Question 6

How does one know if it’s really preterm labor?

Answer 6

How do the contractions feel?

Do these things help to stop or decrease contractions: resting on side, emptying bladder, increasing fluids.

Question 7

Management of PTL?

Answer 7

Tocolytic therapy, corticosteroids, home monitoring, diagnostic testing (fetal fibronectin)

Question 8

What does magnesium sulfate (MgSO4) do for PTL and preeclampsia?

Answer 8

PTL: Relaxes the uterine muscle to stop and prevent contractions
Preeclampsia: Decreases cerebral excitability and thus the risk of seizures in women with preeclampsia

Question 9

Administration and care with magnesium sulfate?

Answer 9

Loading doses then 1-4gm/hr. Continuous monitoring of fetal heart tones. Monitor and report hypotension, depressed DTRs, LOC, blurred vision, headache, u/o less than 30mL/hr, RR <12.
Calcium gluconate at the bedside for reversal of MgSO4

Question 10

This med promotes fetal lung maturity by increasing surfactant. Repeat in 7 days until lungs are mature or delivery.

Answer 10

betamethasone (Celestone)

2 doses IM 24 hours apart. Improvement in lung maturity can be seen after 24 hrs. Monitor mother for infection

Question 11

Risks of being “post term”?

Answer 11

Past the end of the 42nd week. Placental insufficiency, fetal macrosomia, shoulder dystocia, brachial plexus injuries, cephalopelvic disproportion

Question 12

Prolong pregnancy management?

Answer 12

Non-stress tests (NST) twice a week, daily fetal movement counts (at least 10 per day), biophysical profile, possible cervical ripening and induction of labor

Question 13

Indications for induction of labor?

Answer 13

Being post term, uncontrolled or worsening gestational HTN, gestational diabetes, PROM or PPROM, uterine infection, maternal or fetal medical conditions, placental insufficiency, non-reassuring non-stress tests

Question 14

Induction of labor?

Answer 14

Cervical ripening based on Bishop score, possible amniotomy, oxytocin (pitocin). Monitor contraction and fetal HR monitoring

Question 15

This med ripens the cervix to begin contractions. Inserted into the cervix every 6 hours.

Answer 15

misoprostol (Cytotec)
Monitor FHR and contraction pattern closely. May cause hypertonicity of uterus or FHR changes. Induction cannot be done for 4 hours after the last dose

Question 16

Uterotonic agent used for induction or augmentation of labor.

Answer 16

oxytocin (Pitocin)
IV, on med pump per protocol. Baseline/ongoing vital signs and FHR assessments. Contraction pattern may become hypersonic causing decreased FHR variability. Rapid dilation may occur leading to precipitous delivery, cervical laceration, or rupture of uterus.

Question 17

Oxytocin (pitocin) for induction of labor

Answer 17

10 units in 1000mL lactated ringers. Infusion pump piggybacked into main line IV. Start at 1-2 mU/hr. Assess contraction and FHR patterns every 15 min in first stage and every 5 min second. Monitor I/O, voiding, vitals, pain. Emotional support.

Question 18

What problems can present with the passenger?

Answer 18

Position, presentation, number, and size

Question 19

What does the McRoberts maneuver do?

Answer 19

Tilts the pelvis by lifting the knees up, orienting the symphysis more horizontally to facilitate shoulder delivery.

Question 20

What problems may occur with the psyche?

Answer 20

Psychiatric illness. Increased stress related hormones reduce uterine contractility and reduce utero-placental perfusion.

Question 21

What are examples of obstetric emergencies?

Answer 21

Prolapsed umbilical cord, uterine rupture, placental abruption, amniotic fluid embolism

Question 22

Cord protrudes along or ahead of the presenting part of the fetus. Risks?

Answer 22

Prolapsed umbilical cord. Total or partial occlusion of the cord. Rapid deterioration of fetal perfusion. Risks include malpresentation, growth restriction, prematurity, ruptured membranes at high station, hydramnios, grandmultiparity, multifetal gestation

Question 23

What is to be done when a prolapsed cord presents?

Answer 23

Verify station prior to the artificial rupture of membranes. Check fetal heart tones during artificial rupture and after.
Gloved hand on the presenting part to keep it of the cord. Position changes on bed rest. Monitor fetal heart tones and apply oxygen if needed/ordered. Prepare for emergency c/s.

Question 24

Premature separation from a normally implanted placenta after 20 weeks. Caused by forcing blood into the under layer of the placenta causing detachment.

Answer 24

Abruptio placentae.
Focus is on the cardio status of the mother and on the delivery of the fetus quickly by c/s if alive. Will deliver vaginally if the fetus is not alive.

Question 25

Risk factors for abruptio placentae?

Answer 25

Any HTN problems, seizures, uterine rupture. Trauma, previous history of abruption, placental pathology. Coagulation defects, smoking, cocaine use.

Question 26

Tearing of the uterus at the sire of a previous c/s scar.

Answer 26

Uterine rupture. First and most reliable sign is sudden fetal distress. Acute, continuous ab pain w/ or w/o epidural. Irregular ab contour. Loss of the station of the presenting part of the fetus. Hypovolemic shock of the fetus or mother.

Question 27

Break in the barrier between maternal circulation and amniotic fluid. From a placental abruption or uterine trauma.

Answer 27

Significant maternal and newborn morbidity and mortality. Rare and often fatal. Sudden onset hypotension, hypoxia, and coagulopathy. Suspect in any woman with sudden dyspnea.

Question 28

Warm, sterile normal saline or lactated ringer’s infused into uterus through intrauterine pressure catheter after membranes are ruptured.

Answer 28

Amnioinfusion.
250mL to 500mL by infusion pump over 20-30 minutes. Watch for hypertonic uterus. Observe for pad under mother for leaking infused liquid.

Question 29

Indications for amnioinfusion? Contraindications?

Answer 29

Oligohydramnios. Thick meconium stained fluid. Severe or longed variable decelerations.
Amnionitis, hydramnios, uterine hypertonia, known uterine anomaly, placental abruption or placenta previa.

Question 30

Assisted delivery devices?

Answer 30

Forceps.
Vacuum extraction. Provider performed, not nursing. Woman pushes while provider pulls suction attached to scalp. Can be done a certain number of times if suction cap come off. Once maximum has been reached, most use alternate device or c/s. Nurse’s responsibility to track number of unsuccessful tries.

Question 31

Vaginal birth after c/s?

Answer 31

VBAC. Risks for laboring after previous c/s. Uterine rupture, hemorrhage.
Contraindications include previous classical uterine incision and myomectomy.