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NURS 414: OB > Chapter 22: Complications Occurring During Labor and Delivery > Flashcards

Chapter 22: Complications Occurring During Labor and Delivery Flashcards

Exam 2

1
Q

Group BStreptococcus(GBS):

How is GBS colonization for adults v infants?

A

GBS colonization is often asymptomatic for patients but canbe devastating for infants.

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2
Q

Group BStreptococcus(GBS):

Signs and symptoms of GBSinfections in infants include:

A

Signs and symptoms of GBSinfections in neonates include:

sepsis,

pneumonia,

or meningitis.

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3
Q

Group BStreptococcus(GBS):

When should patients be screened for GBS?

A

Patients should be screened for GBSat 35 to 37 weeks of gestation.

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4
Q

Group BStreptococcus(GBS):

How are GBS positive patients treated? When?

A

GBS-positive patients are treated inlabor with antibiotics that must bestarted at least 4 hours before birth.

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5
Q

Group BStreptococcus(GBS):

How are patients with preterm labor treated?

A

Patients with preterm labor aretreated for GBS without screening.

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6
Q

Five Ps of Labor:

What is abnormal labor?

A

Abnormal labor is any labor with abnormally fast or slow progression.

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7
Q

What is a precipitous labor?

A

A precipitous labor lasts 3 hours or less.

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8
Q

Five Ps of Labor: What are they?

A

Power
Passageway
Passenger
Psyche
Position

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9
Q

Five Ps of Labor:

Power- What does it refer to?

A

refers to uterine contractions and pushing efforts

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10
Q

Five Ps of Labor:

Passageway- What does it refer to?

A

refers to the maternal bony pelvis and soft tissues

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11
Q

Five Ps of Labor:

Passenger—What does it refer to?

A

refers to fetal factors

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12
Q

Five Ps of Labor:

Psyche—What does it refer to?

A

refers to maternal state of mind

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13
Q

Five Ps of Labor:

Position- What does it refer to?

A

refers to maternal position

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14
Q

Abnormal Labor Risk Factors:

What are abnormal labor risk factors in the first stage of labor?

A

Chorioamnionitis

Pelvic abnormalities

Large fetus

Epidural

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15
Q

Abnormal Labor Risk Factors:

What are abnormal labor risk factors in the Second Stage of Labor:

A

Prolonged 1st stage
Nulliparity
Occiput posterior
Short stature
High station at complete dilation
Epidural

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16
Q

Abnormal Labor includes what kind of problems?

A

Problems with POWERS

Problems with PASSAGEWAY

Problems with PASSENGER

Problems with PSYCHE

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17
Q

Abnormal Labor: Problems with POWERS
include:

A

Hypertonic uterine dysfunction

Hypotonic uterine dysfunction

Protracted or arrest disorders

Precipitous labor

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18
Q

Abnormal Labor: Problems with POWERS

Hypertonic uterine dysfunction- What phase?

A

Hypertonic uterine dysfunction - latent phase

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19
Q

Abnormal Labor: Problems with POWERS

Hypotonic uterine dysfunction- What phase?

A

Hypotonic uterine dysfunction- active phase

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20
Q

Abnormal Labor: Problems with POWERS

Protracted or arrest disorders- What phase?

A

Protracted or arrest disorders- dilation or descent

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21
Q

Abnormal Labor: Problems with POWERS

Precipitous labor- how long?

A

Less than 3 hours

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22
Q

Abnormal Labor:

Problems with PASSAGEWAY include?

A

Pelvic contraction

Obstructions in maternal birth canal

CPD- cephalopelvic disproportion

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23
Q

Abnormal Labor:

Problems with PASSENGER include?

A

Position
Fetal lie

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24
Q

Abnormal Labor: Problems with PSYCHE

A

Exhaustion

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25
Q

Abnormal Labor Assessment and Management:

Nursing Assessment- What to collect?

A

History of risk factors

Maternal frame of mind

Vital signs

Uterine contractions

Fetal heart rate, fetal position

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26
Q

Abnormal Labor Assessment and Management: Nursing Management

A

Promoting labor progress

Providing physical and emotional comfort

Promoting empowerment

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27
Q

Five Ps of Labor: Power

Hypotonic uterine dysfunction- What is it?

A

Hypotonic uterine dysfunction is a condition where uterine contractions are either too uncoordinated or too weak to effectively dilate the cervix.

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28
Q

Five Ps of Labor: Power

When does Hypotonic uterine dysfunction occur?

A

Occurs in the active phase of labor

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29
Q

Five Ps of Labor: Power

What is Hypotonic uterine dysfunction related to?

A

Is related to polyhydramnios, macrosomia, or multiple pregnancy.

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30
Q

Five Ps of Labor: Power

How do hypotonic contractions occur?

A

Hypotonic contractions palpate soft and occur at a rate of less than three or four every 10 minutes lasting less than 50 seconds.

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31
Q

Five Ps of Labor: Power

What may be indicated for hypotonic uterine contractions?

A

Internal contraction monitoring may be indicated.

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32
Q

Five Ps of Labor: Power

What is treatment for hypotonic uterine dysfunction?

A

Treatment may include rest, an amniotomy, or oxytocin (Pitocin) administration.

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33
Q

Five Ps of Labor: Power

What is Hypertonic uterine dysfunction?

A

A condition where uterine contractions are frequent, irregular, ineffective.

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34
Q

Five Ps of Labor: Power

Where does Hypertonic uterine dysfunction occur?

What is not present?

A

Occurring in midsection of the uterus

No cervial dilation or effacement

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35
Q

Five Ps of Labor: Power

Who does Hypertonic uterine dysfunction occur to the most?

A

Nulliparas

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36
Q

Five Ps of Labor: Power

What phase is Hypertonic uterine dysfunction seen?

A

Seen in latent phase of first stage of labor

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37
Q

Five Ps of Labor: Power

In Hypertonic uterine dysfunction, how is the uterus?

A

Uterus does not completely relax- Category 2 or 3

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38
Q

Five Ps of Labor: Power

What doe Hypertonic uterine dysfunction differ from?

A

Not the same as tachsystole- contractions are strong, regular and fundal

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39
Q

Five Ps of Labor: Power

Second Stage issues: Power

What can prolong labor?

A

Ineffective pushing by the patient can also lead to prolonged labor.

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40
Q

Five Ps of Labor: Power

Second Stage issues: What is laboring down?

A

Laboring down is a process of allowing the primary powers to facilitate fetal descent in the second stage.

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41
Q

Five Ps of Labor: Power

When does pushing resume in labor?

A

Pushing resumes when the patient feels the urge to bear down.

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42
Q

Five Ps of Labor: Power

Second Stage issues:

What this slide mean IDK

A

Frequently used in patients with epidurals.

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43
Q

Five Ps of Labor: Passageway

What does passageway complications occur in conjunction with?

A

Passageway complications often occur in conjunction with passenger issues.

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44
Q

Five Ps of Labor: Passageway

What can lead to dystocia?

A

A maternal pelvis that is smaller than normal, or contracted can lead to dystocia.

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45
Q

Five Ps of Labor: Passageway

What is pelvimetry associated with?

A

Pelvimetry is associated with higher cesarean risks but not overall improved outcomes.

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46
Q

Five Ps of Labor: Passageway

What can lead to soft tissue dystocia?

A

Soft tissue dystocia can be caused by a full bladder or bowel.

Scar tissue on the cervix can lead to soft tissue dystocia.

Pushing before the cervix is fully dilated can lead to swelling and soft tissue dystocia.

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47
Q

Five Ps of Labor: Passenger

What is Cephalopelvic disproportion (CPD)?

A

Cephalopelvic disproportion (CPD) is a mismatch between the size of the fetal head and the size of the maternal pelvis.

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48
Q

Five Ps of Labor: Passenger

What can impact labor progress?

A

Fetal position in relation to the maternal pelvis can impact labor progress.

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49
Q

Five Ps of Labor: Passenger

What is the most common fetal malpresentation?

A

The most common fetal malpresentation is the occiput posterior (OP) position.

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50
Q

Five Ps of Labor: Passenger

What does the OP position do to the patient?

A

OP position often causes low back pain for patients in labor.

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51
Q

Five Ps of Labor: Passenger

What percent of pregnancies occur with breech presentation?

A

Breech presentation occurs in about 3% of births.

52
Q

Five Ps of Labor: Passenger

What are the types of breech?

A

Types of breech presentations include frank breech, footling breech, or complete breech.

53
Q

Five Ps of Labor: Passenger

Breech births are at greater risk for what?

How are these infants delivered?

A

Breech births are at greater risk for asphyxia or birth trauma and are often delivered by cesarean.

54
Q

Five Ps of Labor: Passenger

How are breech births diagnosed?

How are they confirmed?

A

Breech births are often diagnosed by Leopold maneuvers and confirmed by ultrasound visualization.

55
Q

Five Ps of Labor: Passenger

What may be attempted to fix breech? When?

What does this mean?

A

An external cephalic version (ECV) may be attempted after 36 weeks to turn the fetus to a head down position.

56
Q

Five Ps of Labor: Passenger

What are the cephalic presentations?

A
  1. Vertex
  2. Sinciput
  3. Brow
  4. Face
57
Q

SHOULDER DYSTOCIA- What is it?

A

A shoulder dystocia is obstruction by the shoulders after the birth of the head.

57
Q

Five Ps of Labor: Passenger

What is the most suitable fetal presentation?

A

Vertex

58
Q

SHOULDER DYSTOCIA:

What are risk factors?

A

Infant >4,000 g (Macrosomia)
Maternal diabetes
Operative vaginal delivery
Previous shoulder dystocia
Precipitous second stage of labor
Prolonged second stage of labor
Postterm pregnancy (>42 weeks gestation)
Maternal obesity and excess weight gain in pregnancy

59
Q

SHOULDER DYSTOCIA

What percent of neonates experience complications with should dystocia?

How are the complications?

A

Approximately 5% of neonates with shoulder dystocia experience complications that may be temporary or permanent.

60
Q

SHOULDER DYSTOCIA

What is the first sign of shoulder dystocia?

A

Turtle sign is often the first sign of a shoulder dystocia.

61
Q

SHOULDER DYSTOCIA

What are the first interventions to resolve a shoulder dystocia?

A

First interventions to resolve a shoulder dystocia include McRobert maneuver and the application of suprapubic pressure.

62
Q

Interventions for Shoulder Dystocia include: (Not just first interventions)

A

McRoberts maneuver:

Suprapubic pressure:

Rubin’s maneuver:

Gaskin maneuver:

Fracture of clavicle:

63
Q

Interventions for Shoulder Dystocia

McRoberts maneuver:

A

McRoberts maneuver: Hyperflexion of the hip to bring the knees back toward the laboring woman.

64
Q

Interventions for Shoulder Dystocia

McRoberts maneuver: What does it cause?

A

Causes rotation of pubic symphysis so it may release anterior shoulder.

65
Q

Interventions for Shoulder Dystocia

McRoberts maneuver: What is it often used with?

A

Often used with suprapubic pressure.

66
Q

Interventions for Shoulder Dystocia:

Suprapubic pressure:

A

Downward pressure just above the pubic bone in an attempt to rotate anterior shoulder.

67
Q

Interventions for Shoulder Dystocia:

Rubin’s maneuver:

A

Provider inserts fingers into the vagina behind fetal posterior shoulder to move it into a more oblique position.

68
Q

Interventions for Shoulder Dystocia:

Gaskin maneuver:

A

The woman is moved onto hands and knees.

69
Q

Interventions for Shoulder Dystocia:

Fracture of clavicle:

A

May reduce shoulder diameter.

70
Q

Slide 17 read

A
71
Q

Brachial Plexus Palsy

A

Injury to network of nerves in the lateral aspect of the neck that results in loss of movement or weakness in one arm.

72
Q

Brachial Plexus Palsy: What is it caused by?

A

Caused by stretching of the nerve fibers when the head is pulled one direction and the shoulder the other.

73
Q

Brachial Plexus Palsy- How does it resolve?

A

Often spontaneously resolves.

74
Q

Brachial Plexus Palsy:

What does it look like?

A

One arm remains straight with the shoulder curving toward the front of the body.

75
Q

Brachial Plexus Palsy;

Assessments for injury:

A

Moro reflex

Further assessments completed by pediatric neurologists.

76
Q

Brachial Plexus Palsy;

Assessments for injury: How is the moro reflex?

A

Moro reflex. Will be asymmetric, restricted movement on one side.

77
Q

Five Ps of Labor: Psyche and Position:

Psyche: What is the impact of anxiety?

A

Anxiety can have a negative impact on normal labor progress and fetal outcomes.

The nurse may play a role in labor support.

78
Q

Five Ps of Labor: Psyche and Position

Position: What can shorten the first stage of labor?

A

Upright positions such as sitting, kneeling, squatting, or standing can shorten the first stage of labor by 90 minutes.

79
Q

Intrapartum Procedures

Episiotomy: What is it?

A

An episiotomy is a surgical incision of the posterior aspect of the vulva made during the second stage of labor.

80
Q

Intrapartum Procedures:

Episiotomy: Why is it used?

A

An episiotomy is used if the patient is at high risk for a third- or fourth-degree perineal tear or if an expedited birth is needed because of fetal compromise.

81
Q

Intrapartum Procedures:

Episiotomy: Why else would this procedure be done?

A

May also be performed to allow more room for a forceps-assisted birth, a vacuum-assisted birth, or manipulation by an obstetric provider in the case of shoulder dystocia.

82
Q

Intrapartum Procedures

Episiotomy: What are risks associated with this?

A

Risks include infection, bleeding, and pain.

83
Q

Intrapartum Procedures:

Why would Operative vaginal birth be attempted?

A

Operative vaginal birth may be attempted for a prolonged second stage of labor, fetal compromise, or a disorder that limits the patient’s ability to push.

84
Q

Intrapartum Procedures:

operative vaginal birth:

What are risks of operative vaginal birth?

A

Risks for operative vaginal birth include shoulder dystocia and tissue damage to the mother and fetus.

85
Q

Intrapartum Procedures:

Forceps-assisted birth: when is it applied?Why?

A

Forceps-assisted birth is applied to either side of the fetal head to allow the provider to pull with contractions.

86
Q

Intrapartum Procedures:

Why is c-sections done?

A

Cesarean birth is performed if it is difficult to apply forceps safely or birth does not occur within 15 to 20 minutes.

87
Q

Intrapartum Procedures:

Vacuum-assisted birth: What is it?

A

Vacuum-assisted birth is a device that applies suction to the fetal head to aid in extraction.

88
Q

Intrapartum Procedures:

What are different thresholds for stopping vacuum extraction attempts?

A

Different guidelines suggest different thresholds for stopping vacuum extraction attempts:

including one or two pop-offs of the cup from the fetal head,

three sets of pulls (traction),

and a total vacuum application time of 15 to 30 minutes.

89
Q

Cesarean Birth:

What is the C-section birth rate in the US?

A

The cesarean birth rate in the United States remains around 32%.

90
Q

Cesarean Birth: How may they occur?

A

Cesarean births may be unplanned, planned, or elective.

91
Q

Cesarean Birth:

Indications for unplanned cesarean birth include:

A

Failure to progress
Nonreassuring fetal heart rate
Fetal malpresentation
Umbilical cord prolapse
Uterine rupture

92
Q

Cesarean Birth:
What may unplanned c-sections cause?

A

Unplanned cesarean births may cause the patient a sense of frustration, disappointment, even failure.

93
Q

Cesarean Birth:

What are indications of c-section births?

A

Indications for planned cesarean birth include:

Fetal macrosomia
Placenta previa
Active genital herpes outbreak
Previous cesarean birth

94
Q

Cesarean Birth:

Complications of c-section births include:

A

Complications of cesarean birth for patients include:

bowel and bladder injury during surgery,

hemorrhage,

air or amniotic fluid embolism,

and infection.

95
Q

Cesarean Birth:

Complications of c-section births for neonate include:

A

A major neonatal complication is respiratory distress.

96
Q

Cesarean Birth :
Why else may a c-section be performed?

A

An elective cesarean birth may be performed without an obstetric or medical indication for the procedure at the request of the patient.

97
Q

Cesarean Birth:

What are the types of uterine incisions?

A

Types of uterine incisions include:

  1. classical (vertical),
  2. low vertical, or
  3. low transverse.
98
Q

Cesarean Birth:

What type of c-section incision is safest to have a normal birth after?

A

It is safest to attempt a vaginal birth after cesarean if a low transverse incision was used.

99
Q

Cesarean Birth: Nursing Considerations

A

Slide 25

100
Q

Labor and Delivery: Complications and Interventions

Uterine rupture: Who may this occur in?

A

May occur in patients attempting a trial of labor after cesarean (TOLAC).

101
Q

Labor and Delivery: Complications and Interventions

Uterine rupture: What are symptoms?

A

Symptoms include the sudden development of a category II or category III fetal heart rate pattern, weakening contraction, and abdominal pain.

102
Q

Labor and Delivery: Complications and Interventions

Uterine rupture:

A

Treatment includes cesarean birth and possible hysterectomy.

103
Q

Labor and Delivery: Complications and Interventions

Cord prolapse: What is it?

A

Condition where umbilical cord precedes fetal head in the birth canal.

104
Q

Labor and Delivery: Complications and Interventions

Cord prolapse: What is the first sign of a cord prolapse?

A

The first sign of a cord prolapse is often a change in fetal heart rate tracing, typically severe fetal bradycardia and variable decelerations.

105
Q

Labor and Delivery: Complications and Interventions

What is cord prolapse considered?

A

A cord prolapse is an obstetric emergency typically requiring immediate cesarean birth.

106
Q

Labor and Delivery: Complications and Interventions

Cord prolapse: WHHATT?

A

The presenting part should be held off the cord.

107
Q

Labor and Delivery: Complications and Interventions

Cord prolapse: How should the cord be handled?

A

The cord should be handled as little as possible to prevent spasm of the umbilical artery.

108
Q

Cord Prolapse:

What are the types of cord prolapse?

A

Overt cord prolapse:

Occult cord prolapse:

109
Q

Cord Prolapse:

What are the types of cord prolapse?

A

Overt cord prolapse:

Occult cord prolapse:

110
Q

Cord Prolapse:

Overt cord prolapse

A

Cord comes out ahead of the presenting part of fetus.

111
Q

Cord Prolapse:

Overt cord prolapse: What is needed to handle this?

A

An emergency cesarean is needed.

112
Q

Cord Prolapse:

Occult cord prolapse: What is it and what is still possible with it?

A

Cord alongside the presenting part of fetus.

Vaginal delivery may be possible.

113
Q

Cord Prolapse:

Cord compression: What is it?

A

Cord compression – fetus does not get enough oxygen.

114
Q

Cord Prolapse:

When is the fetus at most risk?

A

Fetus is most at risk when the fetal presenting part is not engaged into the maternal pelvis.

115
Q

Labor and Delivery: Complications and Interventions

Amniotic fluid embolism: AKA?

A

An amniotic fluid embolism, referred to as anaphylactoid syndrome of pregnancy

116
Q

Labor and Delivery: Complications and Interventions

Amniotic fluid embolism: When may it occur?

A

An amniotic fluid embolism, referred to as anaphylactoid syndrome of pregnancy, may occur in pregnancy, labor, birth, and the immediate postpartum period.

117
Q

Labor and Delivery: Complications and Interventions

What is amniotic fluid embolism caused by?

A

An amniotic fluid embolism is caused when amniotic fluid enters maternal circulation and is associated with a maternal mortality rate of 20%.

118
Q

Labor and Delivery: Complications and Interventions

What are initial symptoms of amniotic fluid embolism

A

Initial symptoms include respiratory failure and cardiac arrest.

119
Q

Labor and Delivery: Complications and Interventions

If a patient survives an amniotic fluid embolism, what is the patient at risk for?

A

If the patient survives an amniotic fluid embolism, the patient is at risk for hemorrhagic shock with disseminated intravascular coagulation.

120
Q

Labor and Delivery: Complications and Interventions

A

Slide 31

121
Q

Perinatal Loss:

Stillbirth occurs in how many pregnancies?

A

Stillbirth occurs in approximately 6 of 1,000 pregnancies that reach 20 weeks of gestation.

122
Q

Perinatal Loss:

Who is still birth common in?

A

Risk is higher for adolescents, patients over 35 years old, patients of African descent, unmarried patients, congenital anomalies, intrauterine growth restriction, multiple gestations, male fetuses, and maternal disease.

123
Q

Perinatal Loss:

What do these families experience?

A

Families who experience perinatal loss may experience anxiety, depression, or posttraumatic stress disorder.

124
Q

Slides 34-35

A

read them!

NURS 414: OB (15 decks)

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