ch 32 alterations in labor and birth, OB emergencies Flashcards by McKenna Michael

5 causes dystocia

-dysfunctional labor
-alterations in pelvic structure
-fetal causes
-position of woman
-psychological responses

How well did you know this?

Not at all

Perfectly

risk factors for dystocia

-overweight
-short stature (<5 ft)
-uterine abnormalities
-fetal malpositions/presentations/CPD
-uterine overstimulation w/ oxytocin
-maternal fatigue, dehydration, electrolyte imbalance, fear
-early admin analgesic
-use of continuous epidural
-other (advanced maternal age, h/o infertility, h/o prior fetal version, masculine characteristic)

How well did you know this?

Not at all

Perfectly

CPD

cephalopelvic disproportion

How well did you know this?

Not at all

Perfectly

2 types dysfunctional labor

-protracted/prolonged: slower than expected
-arrest: progress stops

How well did you know this?

Not at all

Perfectly

type of dysfunctional labor (stage 1, latent phase):
-frequent, painful, inefficient contractions
-Tx: therapeutic rest

hypertonic uterine dysfunction

How well did you know this?

Not at all

Perfectly

type of dysfunctional labor (stage 2):
-normal progress initially, then stalls
-contractions become weak/inefficient or stop
-assess status, possible augmentation

hypotonic uterine dysfunction

How well did you know this?

Not at all

Perfectly

fetal causes dystocia

-anomalies
-macrosomia/CPD
-malposition
-malpresentation
-multifetal gestation

How well did you know this?

Not at all

Perfectly

3 complications dystocia

-maternal lacerations
-fetal injuries/fractures
-neonatal asphyxia

How well did you know this?

Not at all

Perfectly

nursing interventions for dystocia

-positioning and movement
-pain and anxiety management
-labor support
-environmental control
-pt and family teaching
-open glottis pushing
-patient advocacy

How well did you know this?

Not at all

Perfectly

labor that lasts <3 hours from onset of Cxs to time of birth

precipitous labor

How well did you know this?

Not at all

Perfectly

what might precipitous labor be associated with

hypertonic uterine Cxs:
-placental abruption
-uterine tachysystole
-recent cocaine use

(increased risk trauma to mom and baby)

How well did you know this?

Not at all

Perfectly

medical procedures for dystocia

-external cephalic version (before baby is engaged)
-operative vaginal birth (forceps, vacuum)

How well did you know this?

Not at all

Perfectly

fetal risk with use of vacuum during birth

increased risk for jaundice due to blood buildup in head

How well did you know this?

Not at all

Perfectly

how many times can a hcp try to use vacuum extraction if it pops off

3 times total
then switch to forceps or C/S

How well did you know this?

Not at all

Perfectly

induction v augmentation of labor

induction: starting labor
augmentation: labor already started, helping it move along

How well did you know this?

Not at all

Perfectly

how many weeks EGA does woman have to be to have elective induction

39 wks

How well did you know this?

Not at all

Perfectly

maternal indications for medically indicated induction

-pregnancy complications (HTN)
-fetal death
-chorio

How well did you know this?

Not at all

Perfectly

fetal indications for medically indicated induction

fetal jeopardy:
-maternal complications (DM, GDM, HTN)
-post term (42 wks EGA)
-IUGR
-Rh sensitization
-chorio
-term ROM without labor

How well did you know this?

Not at all

Perfectly

contraindications for induction

-acute severe fetal distress (C/S)
-malpresentation
-floating presenting part (not engaged)
-uncontrolled hemorrhage
-previa
-some previous uterine incisions

How well did you know this?

Not at all

Perfectly

relative contraindications for induction (with caution)

-grandmultiparity (G>5, increased risk PPH)
-multiple gestations
-suspected CPD
-breech
-inability to monitor FHR (obesity, previa)

How well did you know this?

Not at all

Perfectly

purpose of bishop score

assess readiness of cervix prior to induction

How well did you know this?

Not at all

Perfectly

what bishop score is considered successful, and equivalent to spontaneous labor

How well did you know this?

Not at all

Perfectly

what is evaluated in bishop score (5)

-dilation
-effacement
-station
-cervical consistency (firm, medium, soft)
-cervical position (posterior, midposition, anterior)

How well did you know this?

Not at all

Perfectly

methods to facilitate cervical ripening (3 mechanical, 2 chemical)

MECHANICAL (stimulates cervix to release prostaglandins)
-balloon catheter
-hydroscopic dilator
-amniotic membrane stripping/sweeping (separates chorion from uterus)

CHEMICAL:
-misoprostol (cytotec)
-dinoprostone (prepidil gel, cervidil insert)

How well did you know this?

Not at all

Perfectly

adverse effects of prostaglandins (misoprostol, dinoprostone)

-headache -fever -N/V/D -hypoTN -uterine tachysystole -fetal passage meconium

absolute contraindication for use of cytotec

previous uterine scar

contraindications for use of dinoprostone (prepidil, cervidil)

-asthma -glaucoma -hypoTN/HTN CAUTION WITH: -cardiac/renal/hepatic disease -anemia -diabetes -epilepsy -GU infections

indications of use for oxytocin

-induction -augmentation -prophylaxis against PPH -treat PPH

what does steady state of a med mean

max effect of med is reached

how long does it take for oxytocin to reach steady state

40 minutes

considerations for admin of oxytocin

given IVPB always given at port closest to skin documented in mIU/min

S+S uterine tachysystole

-5+ contractions in 10 mins -contractions longer than 2 mins -less than 1 minute resting time between Cxs

interventions for uterine tachysystole with oxytocin infusion for category 1 FHR

-side lying position -IV fluid bolus LR -decrease oxytocin by half if uterine activity not returned to normal after 10 mins -discontinue oxytocin if not normal after another 10 mins

interventions for uterine tachysystole with oxytocin infusion for category 2 or 3 FHR

-discontinue oxytocin immediately -side lying position -IV fluid bolus LR -O2 10L/min -possibly give terbutaline -notify hcp

guidelines before admin of oxytocin

-verify woman understands indications, risks and benefits -verify order -implement order -comfort and position for woman -fetal monitoring atleast 15 mins before -bathroom before

goal for contractions with oxytocin infusion

-200-220 MVU (only can monitor if have IUPC) -contraction q2-3min lasting 80-90 secs, strong

nursing considerations for oxytocin (assessments and frequency)

-EFM continuous -VS q30-60mins and with dose change -FHR and contraction pattern q15mins and with change in dose (2nd stage labor: q5mins) -monitor I&O (limit IV to 1000 mL/8 hr)

side effect of oxytocin? max mainline IV infusion?

water retention 1000 mL/8hr

what is the low dose of oxytocin

-1 mu/min start -increase 1-2 mu/min q30min

what is the high dose of oxytocin

-6 mu/min start -increase 6 mu/min q15-20min

adverse effect high doses oxytocin

increased C/S rates due to fetal distress

alternative methods to induce labor

-herbals (black cohosh, evening primrose oil, blue cohosh, castor oil) -acupuncture *ask because she might have faster response to oxytocin induction

VBAC

vaginal birth after C/S

TOL/TOLAC

trial of labor (after C/S)

standard preop care for C/S

-NPO 8-12 hrs -consent -anesthesia preop -IV -foley -preop meds (Abx, antacids) -SCDs

intraop care for C/S: positioning

-tilt -foley -SCDs -legs secured -bovie pad -blankets

intraop care for C/S: time out

-pt and procedure ID w/ indication -consents -preop meds -blood if needed -drug and food allergies -neonatal team

2 types skin incisions for C/S

-transverse -vertical

who can't do TOLAC/VBAC (3)

woman who had previous C/S with: -low vertical uterine incision -J shape uterine extension -T shape uterine extension

3 types uterine incisions for C/S +2 extensions

-low transverse -low vertical -classical extensions: -J shape -T shape

postpartum care for C/S mom

-pain management -intestinal gas management -diet -ambulation, foley, SCDs -peri care, breast care -fundal and lochia assessments

possible causes meconium stained amniotic fluid (3)

-post term -breech presentation -hypoxia-induced peristalsis

intervention for meconium stained amniotic fluid before birth

-early recognition -prep for neonatal resuscitation/intubation

intervention for meconium stained amniotic fluid immediately after birth

ASSESS -good cry, tone, HR>100: wipe face and mouth, bulb suction -depressed resps, decreased tone, HR<100: tracheal suction with ET tube

risk factors shoulder dystocia

-**diabetes (esp uncontrolled glucose during 2nd half pregnancy) -prior macrosomia -obesity -AMA (>35 yo) -excessive weight gain in pregnancy -abnormal pelvis -post term

S+S shoulder dystocia

-prolonged 2nd stage labor -protracted/arrest of descent -pronounced fetal head molding -head delivers, shoulders don't -no external rotation -"turtle sign" (head retracting back into pelvis)

dangers of shoulder dystocia

-fractures (esp humerus or clavicle) -asphyxia -brachial plexus damage

nursing intervention for shoulder dystocia

-McRoberts maneuver: legs onto chest, suprapubic pressure -other positions: hands/knees, squatting

maternal complications shoulder dystocia

-uterine atony and PPH -vaginal and perineal tears -episiotomy with extension -endometritis

nursing documentation for shoulder dystocia

-delivery time (time between head and shoulders) -anesthesia -all maneuvers in order they occurred -consultants -infant/maternal status at completion

OB emergency: occurs when cord lies below presenting part of fetus

prolapsed umbilical cord

contributing factors to prolapsed umbilical cord

-long cord (>100 cm) -malpresentation (breech) -transverse lie -unengaged presenting part