CH 21 Labor and Birth at Risk Flashcards
risk factors for dystocia
maternal exhaustion, hydramnios, prior injury (pelvic fracture), occiput posterior position, VBAC, ineffective uterine contractions,
definition of dystocia
slow or difficult labor or delivery
hypertonic uterine dysfunction
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
hypotonic uterine dysfunction
occurs during active labor
- contractions become poor in quality and lack sufficient intensity to dilate and efface the cervix.
what is the biggest risk with hypotonic uterine dysfunction
postpartum hemorhage because mother;s uterus cannot contract effectively to compress blood vessels
protracted disorders
abnormal labor pattern
“failure to progress”
arrest disorders
no progress
contractions all of a sudden stop; baby stops decending; birth is progressing very slowly
maneuvers to help with shoulder dystocia
McRobert
precipitate labor
abrupt onset of higher-intensity contractions occurring in a shorter period instead of a more gradual increase in frequency, duration, and intensity
persistent occiput posterior position
baby’s occiput is facing mom’s posterior/spine
face and brow presentation
what is the favorable fetal presentation for childbirth
vertex presentation; complete flexion
- huddled in completely
what is a breeched position
fetal buttocks or breech are presenting first rather than head
what would mom report if the baby is in posterior occiput position
intense back pain
nursing care for a mom with hypertonic contractions
maintain hydration, promote rest and relaxation in between contraction, place client in lateral position
what is “problems with the passageway”
contraction of one or more of the three planes of the maternal pelvis (become to narrow
what is the ideal female pelvis shape for vaginal birth
gynecoid
which part of the women’s pelvis is usually the one that is contracted/ misshapen that can affect birth
the midpelvis
what weeks of gestation is considered preterm labor
20-37 weeks
what is the contraction pattern for preterm labor
4 contraction every 20 minutes or 8 contractions in 1 hour
diagnostic test for preterm labor
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
Tocolytic therapy
Primary goal is for pretermlabor and can prolong it for up to 48 hours to initiation corticosteroid therapy to stimulate fetal lung maturity
post term or prolonged pregnancy
- ranges
extends beyond 42 weeks
terbutaline
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
fetal risk of postterm labor
macrosomia, shoulder dystocia, brachial plexus injuries, LOW APGAR, postmaturity syndrome, risk for jaundice
what is CPD (cephalopelvic disproprtion)
baby’s head is too big or mom’spelvis is too small
what do postertm babies have less of on their skin
less vernix, verrrrry wrinkly, dry and pealy skin
what tests will we do on moms that are heading towards post term
nonstress test twice a week, daily fetal movement counts (same time everyday), biophysical profile every 3 days
What are the 3 obstetric emergencies
umbilical cord prolapse, amniotic fluid embolism, and uterine rupture
what is umbilical cord prolapse
-partial or total occlusion of the cord with rapid fetal deterioration
- you habe one minute to save
if a nurse discovers there is a cord prolapse what can we do
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)
amniotic fluid embolism
sudden onset of hypotension, hypoxia due to breaking in barrier between maternal circulation and amniotic fluid
s/s in mom if she has amniotic fluid embolism
difficulty breathing, hypotension, cyanosis, seizures, tachycardia, pulmonary edema, coagulation failure
what will you do for a mom that is having an amniotic fluid embolism
administer oxygen/ intubate
administer blood products to correct coagulation failure
prepare for emergency c section
what is labor augmentation
enhancing innefective contractions after labor has begun
labor induction
stimulating contractions via medical or surgical means
Bishop score
helps identify women who would be most likely to achieve a successful induction
want a score of 6+
Misoprostol (Cytotec)
- most effective for a vaginal delivery within 24 hrs
- used to ripen the cervix
uterine rupture is marked by what assessment finding
sudden fetal bradycardia
risk factors for uterine rupture
VBAC, previous incision/scar on uterus, previous rupture,
why is uterine rupture so life-threatening
mom delivers 500ml of blood to the term fetus every minute so maternal death is a real possibility without rapid intervention.
amnioinfusion
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
what should you monitor during an amnioinfusion
that there is no fluid coming back out
