Chapter 21 Flashcards
risk factors for dystocia
epidural analgesia/excessive analgesia multiple gestation hydramnios maternal exhaustion ineffective maternal pushing occiput posterior pos longer first stage nulliparity short femal stature big baby abnormal presentation over 35 yo overweight BMI over 41 weeks
precipitate labor
completed in less than 3 hours
what can cause slow labor progress
CPD
Maneuvers to relieve shoulder dystocia
McRoberst
suprapubic pressure
preterm labor
regular uterine contractions accompanied by cervical effacement and dilation after start of 20th week before the end of 37th week of gestation
symptoms of preterm labor
contractions cramping mucus plug release bleeding discomfort backpain uneasiness
Interventions for preterm labor
3
risk prediction
tocolytic drugs (may prolong pregnancy for 2 to 7 days)
Antibiotic prophylaxis for GBS
Mag sulfate
preterm labor:
relaxes uterine muscles
reduces infant CP risk
INdomethacin
inhibits prostaglandins
Nidfedipine
inhibits uterine contractions
betamethasone adminstration
2 doses, IM, 24 hours apart
Fetal fibronectin
normally present up to week 22 then 1-3 weeks before labor
If present in weeks 22-34 (>0.05) impending membrane rupture within 7-14 days
Best strategy to improve outcomes of preterm labor
early detection
other nursing mgmt re preterm labor
tocolytic admin
client edu
psychological support
preterm labor prevention tips
avoid long trips avoid lifting heavy objects avoid hard work mild to mod exercise wait 18 months between pregnancies treat periodontal disease no sex until after 37 weeks
what to do if exp preterm preg s/s
stop and rest 1 hour empty bladder lie down on side drink 2-3 glasses of water note hardness of contraction, call provider
Prolonged pregnancy post-term labor risks
42 weeks
c/s dystocia birth trauma post partum hem macrosomia shoulder dystocia low apgar CPD meconium stained
drugs for cervical ripening and labor induction
dinoprostone
misoprostol
oxytocin
Bishop’s score
higher number - more inducible
lower than 6 - use cervical ripening measure
What does sudden fetal bradycardia indicate?
uterine rupture
amniotic fluid embolism
sudden onset maternal hypotension, hypoxia, coagulaopahty
Post c/s instruction
splint incsion apply heating pad to abdomen ambulate often avoid gas-forming foods use anti-gas stool softeners
contraindications for VBAC
classic uterine incision, prior transfundal uterine surgery (myomectomy), uterine scar other than low-transverse, contracted pelvis
prolonged latent phase, stay at 2-3 cm
utereus never fully relaxes
hypertonic uterine dysfunction
