Dystocia risk factors 7

congenital uterine abnormalities malpresentation of fetus cephalopelvic disproportion uterine tachysystole maternal fatigue or dehydration anesthesia early in labor extreme maternal fear or exhaustion

hypertonic contraction interventions 3

hydrate promote rest (change environment) assess

Hypotonic contraction interventions 4

hydrate oxytocin amniotomy ambulate/change positions

nursing care for arrest 4

pushing techniques oxytocin pain relied operative vaginal delivery

pelvic dystocia nursing care 3

leopolds SVE for fetal station US for fetal position

Ch 10- Labor complications Flashcards by Courtney Burke

Definition of Dystocia

slow abnormal progression of labor

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Causes of dystocia

lack of…
* cervical dilation
* descent of the fetal head
* weak, uncoordinated UCs

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Dystocia risk factors

congenital uterine abnormalities
malpresentation of fetus
cephalopelvic disproportion
uterine tachysystole
maternal fatigue or dehydration
anesthesia early in labor
extreme maternal fear or exhaustion

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uterine dystocia

and what it leads to

weak or uncoordinated UCs in labor
* Leads to prolonged labor and fetal intolerance

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hypertonic contractions

like uterine systole
uncoordinated uterine activity
UCs frequent
ineffectove dilation and effacement
not good resting tone

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hypertonic contraction interventions

hydrate
promote rest (change environment)
assess

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Hypotonic contractions

UCs insufficient to dilate and efface (in frequency, strength, and duration)

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Hypotonic contraction interventions

hydrate
oxytocin
amniotomy
ambulate/change positions

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arrest in 1st stage

cervical change STALLS

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Arrest in second stage

no progress with pushing

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nursing care for arrest

pushing techniques
oxytocin
pain relied
operative vaginal delivery

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Precipitous labor definition

<3 hours from onset of labor to birth

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precipitous risks and nursing care

3 risks, 2 cares

Risk
* PPH
* uterine atony/lacerations
* fetal hypoxia /CNS depression
Care
* assess closely
* prepare for delivery quickly

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fetal dystocia causes

excessive size
malpresentation
multiples
anomalies

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pelvic dystocia

definition and maternal & fetal risks

anything not gynecoid
maternal risk: lacerations and cephalopelvic disproportion
fetal risk: asphyxia (head stuck), injury

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pelvic dystocia nursing care

leopolds
SVE for fetal station**
US for fetal position

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Examples of Induction of labor

artificial ROM
balloons
oxytocin
cervical ripening agents

what is augmentation

and 1 example

stimulation of UCs using pharmacological methods or AROM to manage dystocia
* Ex: oxytocin

What is cervical ripening

process of effecting softening and distensibility for labor and birth

bishop score

purpose and indication

scores dilation, effacement, station, cervical consistency, & position
> 8 = favorable, 6=consider labor stimulation

mechanical cervical ripening

hygroscopic dilators (seawead)
balloon catheters (cook balloon)

Pharmacological cervical ripening

what it is, 2 examples

medication placed in or near the cervix to soften and thin the cervix
* Ex: cervidil, misoprostol

Membrane interventions

sweeping/stripping the membrane
amniotomy (AROM)

what is external cephalic rotation (ECV)

procedure where the fetus is rotated from breech to cephalic by manipulation (must be done in hospital setting!)

operative vaginal delivery | 2

* vacuum assisted * forceps assisted (not common at all)

risks to mom in operative vaginal delivery | 5

* vaginal/cervical lacerations * extension of episiotomy * hemorrhage * bladder trauma * perineal wound infection

Risks to baby in operative vaginal delivery | 4 ( 1 specific to forceps)

* cephalohematoma & jaundice risk * intracranial & retinal hemorrhage * scalp lacerations/bruising * Forceps: nerve injuries!

What is VBAC and what are the risks

Vaginal birth after cesarean * failure = repeat c/s * uterine rupture risk

VBAC contraindications | 2

* misoprostol for cervical ripening * prior vertical incision

Late term vs Post Term

* Late Term: 41 0/7 - 41 6/7 * Post Term: > 42 wks

Post Term risks to mom | 4

* dysfunctional labor * injury to perineum, vagina, labia, & rectum * increase risk of PPH * increase risk of c/s

Post Term Risks to Baby | 6

* stillbirth * macrosomia * fetal dysmaturity * meconium aspiration syndrome (MAS) * oligohydramnios (low amniotic fluid) * decreased placental reserve

Nusring care for multiple gestation | 4

* US for #, presentation, and placenta locations * continuous FHR * PPH supplies available * neonatal team for each infant

Multiple gestation risks | 3

* PTB * preeclampsia * PPH

Intraamniotic infection (IAI)/ chorioamnionitis (chorio)/ Triple I | what is it

infection with inflammation with any combo of amniotic fluid, placenta, fetus, fetal membranes

suspected Triple 1 Dx | 3

* fetal tachycardia * elevated WBC * purulent fluid from discharge

confirmed Triple 1 Dx | 3

* +gram stain of amniotic fluid * low glucose + amniotic fluid culture * placental pathology

Triple 1 nursing care | 3

* admin intrapartum abx * antipyretics * hydration

list of obstetrical emergencies | 5

* shoulder dystocia * prolapse of umbilical cord * vasa previa * uterine rupture * anaphylactic syndrome/amniotic fluid embolism

what is turtle sign

retraction of the fetal head against the maternal perineum after delivery of the head (happens in shoulder dystocia)

Nursing care for cord prolapse | 4

* elevate presenting part to relieve compression * position mom knee to chest * admin oxygen * emergency c/s

What is vasa previa

when fetal vessels unsupported by placenta or umbilical cord cross over the cervix (these can rupture leading to ruptured vasa previa)