Care During Labor & Complications (exam 2) Flashcards
reasons a pregnant woman should go to the hospital
- contractions
- ROM
- bloody show
- no fetal movement
cervical changes and UC occurring after 20 week but before 38 weeks
preterm labor
any birth occurring before completion of 20 to 36.6 weeks
preterm birth
risk factors for preterm labor
- diabetes
- cardiac disease
- preeclampsia
- over distention of the uterus
- placenta previa
- infection (especially UTI)
bishops score rating system to indicate readiness for induction
- dilation
- effacement
- station
- cervical consistency
- position of cervix
- each criteria scored 0-3
- score of 8 or more indicates readiness
- should be done before ripening agents are applied or induction started
chemical cervical ripening
Prostaglandin E - to increase cervical readiness for induction of labor
- Misoprostol (Cytotec)
- Dinoprostone (Cervidil)
some clients go into labor after admin of prostaglandin and will not need oxytocin
mechanical cervical ripening
Balloon catheter
Hydroscopic dilators
- Laminaria Tents (seaweed based)
- Lamicel (magnesium sulfate)
Nitrazine paper/swab
- fluid from vaginal area placed on paper or swab
- turns blue for amniotic fluid (alkaline)
- stays yellow if urine (acidic)
- fluid from vaginal area placed on slide
- if amniotic fluid, it looks like fern leaves
fern test
oxytocin to initiate UC
- Favorable Bishop score >8 (5 for multiple)
- EFM
- Hydrate client
- Pitocin piggybacked into most proximal primary port next to client
- infusion pump - titration
- 1-2 mU/min to begin and increasing at increments of 1-2mU every 30-60min (or based on hospital protocol)
- max amount is based on hospital protocol
oxytocin MUST be on a pump
after birth, pump pitocin up to 250mL/hr to prevent bleeding
when to stop pitocin
- UC frequency less than 2 minutes
- duration >240 seconds
- indication of fetal distress
more than 5 contractions in 10 minutes, averaged over a 30 minute window
tachysystole
amniotomy to induce labor
- AROM when the condition of cervix is favorable
- presenting part of fetus must be engaged to prevent cord prolapse and compression
- no active infections present in maternal genital tract
- once AROM is performed, committed to labor
nursing observations for AROM
- note FHR and pattern
- note color, consistency, amount, and odor of the fluid
- note presence of meconium or blood
- record time of rupture
risk factors for cord prolapse
- may occur at any time during labor
- presenting part not completely engaged
- very small fetus
- abnormal presentation
- hydramnios
symptoms of cord prolapse
- cord can be seen or palpated
- fetal bradycardia with variable decels during UC
- variability decreased (minimal or absent)
cord prolapse interventions
- place client in knee-chest position
- O2
- apply firm upward pressure to raise head off cord
- prepare for emergency CS
pelvic dystocia notes
- breech diagnosis by palpation/vaginal exam and confirmed with US
- preferred delivery is cesarean
- descent is slow (breech not a good dilating wedge)
- ROM increases risk of cord prolapse
- meconium not necessarily sign of distress in breech
- CPD (cephalopelvic disproportion)
shoulder dystocia
- head delivered but shoulders impacted above maternal symphysis pubis
- head outside/chest inside -> preventing respirations
- McRoberts maneuver may straighten the pelvic curve
- suprapubic pressure
McRoberts maneuver
thighs flexed sharply against abdomen
tear of the perineum
laceration
documented by degree
laceration that extends through the skin & vaginal mucous membrane (NO fascia or muscle involved)
1st degree laceration
laceration that extends through fascia and muscle but not the anal sphincter
2nd degree laceration
laceration that involves the external anal sphincter
3rd degree laceration
laceration that extends completely through rectal mucosa
4th degree laceration
a cut of the perineum
episiotomy
documented by type
types of episiotomies
- Midline (directly down the middle)
- Left Mediolateral
- Right Mediolateral
positive episiotomy
used to enlarge the vaginal outlet
- easily repaired
negative episiotomy
can extend into a 3rd or 4th degree laceration
a widespread, pro-inflammatory, anaphylactic-like reaction that can occur when amniotic fluid enters the maternal blood circulation
Anaphylactoid Syndrome of Pregnancy (ASP)
aka Amniotic Fluid Embolism (AFE)
- a rare but serious complication of pregnancy in which maternal and neonatal mortality rates are dismal
