CH 21 Labor and Birth at Risk

Question 1

risk factors for dystocia

Answer 1

maternal exhaustion, hydramnios, prior injury (pelvic fracture), occiput posterior position, VBAC, ineffective uterine contractions,

Question 2

definition of dystocia

Answer 2

slow or difficult labor or delivery

Question 3

hypertonic uterine dysfunction

Answer 3

uterus never fully relaxes b/w contractions
- mom gets really tired from these frequent, intense, and painful contractions with little progress
-mom usually stays at 2-3cm and doesn’t dilate as she should

Question 4

hypotonic uterine dysfunction

Answer 4

occurs during active labor
- contractions become poor in quality and lack sufficient intensity to dilate and efface the cervix.

Question 5

what is the biggest risk with hypotonic uterine dysfunction

Answer 5

postpartum hemorhage because mother;s uterus cannot contract effectively to compress blood vessels

Question 6

protracted disorders

Answer 6

abnormal labor pattern
“failure to progress”

Question 7

arrest disorders

Answer 7

no progress
contractions all of a sudden stop; baby stops decending; birth is progressing very slowly

Question 8

maneuvers to help with shoulder dystocia

Answer 8

McRobert

Question 9

precipitate labor

Answer 9

abrupt onset of higher-intensity contractions occurring in a shorter period instead of a more gradual increase in frequency, duration, and intensity

Question 10

persistent occiput posterior position

Answer 10

baby’s occiput is facing mom’s posterior/spine

Question 11

face and brow presentation

Question 12

what is the favorable fetal presentation for childbirth

Answer 12

vertex presentation; complete flexion

• huddled in completely

Question 13

what is a breeched position

Answer 13

fetal buttocks or breech are presenting first rather than head

Question 14

what would mom report if the baby is in posterior occiput position

Answer 14

intense back pain

Question 15

nursing care for a mom with hypertonic contractions

Answer 15

maintain hydration, promote rest and relaxation in between contraction, place client in lateral position

Question 16

what is “problems with the passageway”

Answer 16

contraction of one or more of the three planes of the maternal pelvis (become to narrow

Question 17

what is the ideal female pelvis shape for vaginal birth

Answer 17

gynecoid

Question 18

which part of the women’s pelvis is usually the one that is contracted/ misshapen that can affect birth

Answer 18

the midpelvis

Question 19

what weeks of gestation is considered preterm labor

Answer 19

20-37 weeks

Question 20

what is the contraction pattern for preterm labor

Answer 20

4 contraction every 20 minutes or 8 contractions in 1 hour

Question 21

diagnostic test for preterm labor

Answer 21

CBC to detect infection, urinalysis to detect bacteria and nitrates, amniotic fluid analysis to determine fetal lung maturity

PRESENCE OF BOTH: uterine contractions AND cervical change

Question 22

Tocolytic therapy

Answer 22

Primary goal is for pretermlabor and can prolong it for up to 48 hours to initiation corticosteroid therapy to stimulate fetal lung maturity

Question 23

post term or prolonged pregnancy
- ranges

Answer 23

extends beyond 42 weeks

Question 24

terbutaline

Answer 24

this is THE med for preterm labor, prolongs the labor for 2-7 days so that you can administer the betamethasone for baby’s lungs to mature

Question 25

fetal risk of postterm labor

Answer 25

macrosomia, shoulder dystocia, brachial plexus injuries, LOW APGAR, postmaturity syndrome, risk for jaundice

Question 26

what is CPD (cephalopelvic disproprtion)

Answer 26

baby's head is too big or mom'spelvis is too small

Question 27

what do postertm babies have less of on their skin

Answer 27

less vernix, verrrrry wrinkly, dry and pealy skin

Question 28

what tests will we do on moms that are heading towards post term

Answer 28

nonstress test twice a week, daily fetal movement counts (same time everyday), biophysical profile every 3 days

Question 29

What are the 3 obstetric emergencies

Answer 29

umbilical cord prolapse, amniotic fluid embolism, and uterine rupture

Question 30

what is umbilical cord prolapse

Answer 30

-partial or total occlusion of the cord with rapid fetal deterioration - you habe one minute to save

Question 31

if a nurse discovers there is a cord prolapse what can we do

Answer 31

try to find presenting part of baby and push up to releave pressure on the cord or tell mom to go on hands and knees position (stick her ass in the air doggy style)

Question 32

amniotic fluid embolism

Answer 32

sudden onset of hypotension, hypoxia due to breaking in barrier between maternal circulation and amniotic fluid

Question 33

s/s in mom if she has amniotic fluid embolism

Answer 33

difficulty breathing, hypotension, cyanosis, seizures, tachycardia, pulmonary edema, coagulation failure

Question 34

what will you do for a mom that is having an amniotic fluid embolism

Answer 34

administer oxygen/ intubate administer blood products to correct coagulation failure prepare for emergency c section

Question 35

what is labor augmentation

Answer 35

enhancing innefective contractions after labor has begun

Question 36

labor induction

Answer 36

stimulating contractions via medical or surgical means

Question 37

Bishop score

Answer 37

helps identify women who would be most likely to achieve a successful induction want a score of 6+

Question 38

Misoprostol (Cytotec)

Answer 38

- most effective for a vaginal delivery within 24 hrs - used to ripen the cervix

Question 39

uterine rupture is marked by what assessment finding

Answer 39

sudden fetal bradycardia

Question 40

risk factors for uterine rupture

Answer 40

VBAC, previous incision/scar on uterus, previous rupture,

Question 41

why is uterine rupture so life-threatening

Answer 41

mom delivers 500ml of blood to the term fetus every minute so maternal death is a real possibility without rapid intervention.

Question 42

amnioinfusion

Answer 42

procedure that involves injecting fluid (lactated ringers) into the amniotic cavity of the uterus - done when the baby is showing slow/irregular heart rate due to low amniotic fluid

Question 43

what should you monitor during an amnioinfusion

Answer 43

that there is no fluid coming back out