Chapter 22: Complications Occurring During Labor and Delivery Flashcards
Exam 2
Group BStreptococcus(GBS):
How is GBS colonization for adults v infants?
GBS colonization is often asymptomatic for patients but canbe devastating for infants.
Group BStreptococcus(GBS):
Signs and symptoms of GBSinfections in infants include:
Signs and symptoms of GBSinfections in neonates include:
sepsis,
pneumonia,
or meningitis.
Group BStreptococcus(GBS):
When should patients be screened for GBS?
Patients should be screened for GBSat 35 to 37 weeks of gestation.
Group BStreptococcus(GBS):
How are GBS positive patients treated? When?
GBS-positive patients are treated inlabor with antibiotics that must bestarted at least 4 hours before birth.
Group BStreptococcus(GBS):
How are patients with preterm labor treated?
Patients with preterm labor aretreated for GBS without screening.
Five Ps of Labor:
What is abnormal labor?
Abnormal labor is any labor with abnormally fast or slow progression.
What is a precipitous labor?
A precipitous labor lasts 3 hours or less.
Five Ps of Labor: What are they?
Power
Passageway
Passenger
Psyche
Position
Five Ps of Labor:
Power- What does it refer to?
refers to uterine contractions and pushing efforts
Five Ps of Labor:
Passageway- What does it refer to?
refers to the maternal bony pelvis and soft tissues
Five Ps of Labor:
Passenger—What does it refer to?
refers to fetal factors
Five Ps of Labor:
Psyche—What does it refer to?
refers to maternal state of mind
Five Ps of Labor:
Position- What does it refer to?
refers to maternal position
Abnormal Labor Risk Factors:
What are abnormal labor risk factors in the first stage of labor?
Chorioamnionitis
Pelvic abnormalities
Large fetus
Epidural
Abnormal Labor Risk Factors:
What are abnormal labor risk factors in the Second Stage of Labor:
Prolonged 1st stage
Nulliparity
Occiput posterior
Short stature
High station at complete dilation
Epidural
Abnormal Labor includes what kind of problems?
Problems with POWERS
Problems with PASSAGEWAY
Problems with PASSENGER
Problems with PSYCHE
Abnormal Labor: Problems with POWERS
include:
Hypertonic uterine dysfunction
Hypotonic uterine dysfunction
Protracted or arrest disorders
Precipitous labor
Abnormal Labor: Problems with POWERS
Hypertonic uterine dysfunction- What phase?
Hypertonic uterine dysfunction - latent phase
Abnormal Labor: Problems with POWERS
Hypotonic uterine dysfunction- What phase?
Hypotonic uterine dysfunction- active phase
Abnormal Labor: Problems with POWERS
Protracted or arrest disorders- What phase?
Protracted or arrest disorders- dilation or descent
Abnormal Labor: Problems with POWERS
Precipitous labor- how long?
Less than 3 hours
Abnormal Labor:
Problems with PASSAGEWAY include?
Pelvic contraction
Obstructions in maternal birth canal
CPD- cephalopelvic disproportion
Abnormal Labor:
Problems with PASSENGER include?
Position
Fetal lie
Abnormal Labor: Problems with PSYCHE
Exhaustion
Abnormal Labor Assessment and Management:
Nursing Assessment- What to collect?
History of risk factors
Maternal frame of mind
Vital signs
Uterine contractions
Fetal heart rate, fetal position
Abnormal Labor Assessment and Management: Nursing Management
Promoting labor progress
Providing physical and emotional comfort
Promoting empowerment
Five Ps of Labor: Power
Hypotonic uterine dysfunction- What is it?
Hypotonic uterine dysfunction is a condition where uterine contractions are either too uncoordinated or too weak to effectively dilate the cervix.
Five Ps of Labor: Power
When does Hypotonic uterine dysfunction occur?
Occurs in the active phase of labor
Five Ps of Labor: Power
What is Hypotonic uterine dysfunction related to?
Is related to polyhydramnios, macrosomia, or multiple pregnancy.
Five Ps of Labor: Power
How do hypotonic contractions occur?
Hypotonic contractions palpate soft and occur at a rate of less than three or four every 10 minutes lasting less than 50 seconds.
Five Ps of Labor: Power
What may be indicated for hypotonic uterine contractions?
Internal contraction monitoring may be indicated.
Five Ps of Labor: Power
What is treatment for hypotonic uterine dysfunction?
Treatment may include rest, an amniotomy, or oxytocin (Pitocin) administration.
Five Ps of Labor: Power
What is Hypertonic uterine dysfunction?
A condition where uterine contractions are frequent, irregular, ineffective.
Five Ps of Labor: Power
Where does Hypertonic uterine dysfunction occur?
What is not present?
Occurring in midsection of the uterus
No cervial dilation or effacement
Five Ps of Labor: Power
Who does Hypertonic uterine dysfunction occur to the most?
Nulliparas
Five Ps of Labor: Power
What phase is Hypertonic uterine dysfunction seen?
Seen in latent phase of first stage of labor
Five Ps of Labor: Power
In Hypertonic uterine dysfunction, how is the uterus?
Uterus does not completely relax- Category 2 or 3
Five Ps of Labor: Power
What doe Hypertonic uterine dysfunction differ from?
Not the same as tachsystole- contractions are strong, regular and fundal
Five Ps of Labor: Power
Second Stage issues: Power
What can prolong labor?
Ineffective pushing by the patient can also lead to prolonged labor.
Five Ps of Labor: Power
Second Stage issues: What is laboring down?
Laboring down is a process of allowing the primary powers to facilitate fetal descent in the second stage.
Five Ps of Labor: Power
When does pushing resume in labor?
Pushing resumes when the patient feels the urge to bear down.
Five Ps of Labor: Power
Second Stage issues:
What this slide mean IDK
Frequently used in patients with epidurals.
Five Ps of Labor: Passageway
What does passageway complications occur in conjunction with?
Passageway complications often occur in conjunction with passenger issues.
Five Ps of Labor: Passageway
What can lead to dystocia?
A maternal pelvis that is smaller than normal, or contracted can lead to dystocia.
Five Ps of Labor: Passageway
What is pelvimetry associated with?
Pelvimetry is associated with higher cesarean risks but not overall improved outcomes.
Five Ps of Labor: Passageway
What can lead to soft tissue dystocia?
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.
Five Ps of Labor: Passenger
What is Cephalopelvic disproportion (CPD)?
Cephalopelvic disproportion (CPD) is a mismatch between the size of the fetal head and the size of the maternal pelvis.
Five Ps of Labor: Passenger
What can impact labor progress?
Fetal position in relation to the maternal pelvis can impact labor progress.
Five Ps of Labor: Passenger
What is the most common fetal malpresentation?
The most common fetal malpresentation is the occiput posterior (OP) position.
Five Ps of Labor: Passenger
What does the OP position do to the patient?
OP position often causes low back pain for patients in labor.
Five Ps of Labor: Passenger
What percent of pregnancies occur with breech presentation?
Breech presentation occurs in about 3% of births.
Five Ps of Labor: Passenger
What are the types of breech?
Types of breech presentations include frank breech, footling breech, or complete breech.
Five Ps of Labor: Passenger
Breech births are at greater risk for what?
How are these infants delivered?
Breech births are at greater risk for asphyxia or birth trauma and are often delivered by cesarean.
Five Ps of Labor: Passenger
How are breech births diagnosed?
How are they confirmed?
Breech births are often diagnosed by Leopold maneuvers and confirmed by ultrasound visualization.
Five Ps of Labor: Passenger
What may be attempted to fix breech? When?
What does this mean?
An external cephalic version (ECV) may be attempted after 36 weeks to turn the fetus to a head down position.
Five Ps of Labor: Passenger
What are the cephalic presentations?
- Vertex
- Sinciput
- Brow
- Face
SHOULDER DYSTOCIA- What is it?
A shoulder dystocia is obstruction by the shoulders after the birth of the head.
Five Ps of Labor: Passenger
What is the most suitable fetal presentation?
Vertex
SHOULDER DYSTOCIA:
What are risk factors?
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
SHOULDER DYSTOCIA
What percent of neonates experience complications with should dystocia?
How are the complications?
Approximately 5% of neonates with shoulder dystocia experience complications that may be temporary or permanent.
SHOULDER DYSTOCIA
What is the first sign of shoulder dystocia?
Turtle sign is often the first sign of a shoulder dystocia.
SHOULDER DYSTOCIA
What are the first interventions to resolve a shoulder dystocia?
First interventions to resolve a shoulder dystocia include McRobert maneuver and the application of suprapubic pressure.
Interventions for Shoulder Dystocia include: (Not just first interventions)
McRoberts maneuver:
Suprapubic pressure:
Rubin’s maneuver:
Gaskin maneuver:
Fracture of clavicle:
Interventions for Shoulder Dystocia
McRoberts maneuver:
McRoberts maneuver: Hyperflexion of the hip to bring the knees back toward the laboring woman.
Interventions for Shoulder Dystocia
McRoberts maneuver: What does it cause?
Causes rotation of pubic symphysis so it may release anterior shoulder.
Interventions for Shoulder Dystocia
McRoberts maneuver: What is it often used with?
Often used with suprapubic pressure.
Interventions for Shoulder Dystocia:
Suprapubic pressure:
Downward pressure just above the pubic bone in an attempt to rotate anterior shoulder.
Interventions for Shoulder Dystocia:
Rubin’s maneuver:
Provider inserts fingers into the vagina behind fetal posterior shoulder to move it into a more oblique position.
Interventions for Shoulder Dystocia:
Gaskin maneuver:
The woman is moved onto hands and knees.
Interventions for Shoulder Dystocia:
Fracture of clavicle:
May reduce shoulder diameter.
Slide 17 read
Brachial Plexus Palsy
Injury to network of nerves in the lateral aspect of the neck that results in loss of movement or weakness in one arm.
Brachial Plexus Palsy: What is it caused by?
Caused by stretching of the nerve fibers when the head is pulled one direction and the shoulder the other.
Brachial Plexus Palsy- How does it resolve?
Often spontaneously resolves.
Brachial Plexus Palsy:
What does it look like?
One arm remains straight with the shoulder curving toward the front of the body.
Brachial Plexus Palsy;
Assessments for injury:
Moro reflex
Further assessments completed by pediatric neurologists.
Brachial Plexus Palsy;
Assessments for injury: How is the moro reflex?
Moro reflex. Will be asymmetric, restricted movement on one side.
Five Ps of Labor: Psyche and Position:
Psyche: What is the impact of anxiety?
Anxiety can have a negative impact on normal labor progress and fetal outcomes.
The nurse may play a role in labor support.
Five Ps of Labor: Psyche and Position
Position: What can shorten the first stage of labor?
Upright positions such as sitting, kneeling, squatting, or standing can shorten the first stage of labor by 90 minutes.
Intrapartum Procedures
Episiotomy: What is it?
An episiotomy is a surgical incision of the posterior aspect of the vulva made during the second stage of labor.
Intrapartum Procedures:
Episiotomy: Why is it used?
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.
Intrapartum Procedures:
Episiotomy: Why else would this procedure be done?
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.
Intrapartum Procedures
Episiotomy: What are risks associated with this?
Risks include infection, bleeding, and pain.
Intrapartum Procedures:
Why would Operative vaginal birth be attempted?
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.
Intrapartum Procedures:
operative vaginal birth:
What are risks of operative vaginal birth?
Risks for operative vaginal birth include shoulder dystocia and tissue damage to the mother and fetus.
Intrapartum Procedures:
Forceps-assisted birth: when is it applied?Why?
Forceps-assisted birth is applied to either side of the fetal head to allow the provider to pull with contractions.
Intrapartum Procedures:
Why is c-sections done?
Cesarean birth is performed if it is difficult to apply forceps safely or birth does not occur within 15 to 20 minutes.
Intrapartum Procedures:
Vacuum-assisted birth: What is it?
Vacuum-assisted birth is a device that applies suction to the fetal head to aid in extraction.
Intrapartum Procedures:
What are different thresholds for stopping vacuum extraction attempts?
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.
Cesarean Birth:
What is the C-section birth rate in the US?
The cesarean birth rate in the United States remains around 32%.
Cesarean Birth: How may they occur?
Cesarean births may be unplanned, planned, or elective.
Cesarean Birth:
Indications for unplanned cesarean birth include:
Failure to progress
Nonreassuring fetal heart rate
Fetal malpresentation
Umbilical cord prolapse
Uterine rupture
Cesarean Birth:
What may unplanned c-sections cause?
Unplanned cesarean births may cause the patient a sense of frustration, disappointment, even failure.
Cesarean Birth:
What are indications of c-section births?
Indications for planned cesarean birth include:
Fetal macrosomia
Placenta previa
Active genital herpes outbreak
Previous cesarean birth
Cesarean Birth:
Complications of c-section births include:
Complications of cesarean birth for patients include:
bowel and bladder injury during surgery,
hemorrhage,
air or amniotic fluid embolism,
and infection.
Cesarean Birth:
Complications of c-section births for neonate include:
A major neonatal complication is respiratory distress.
Cesarean Birth :
Why else may a c-section be performed?
An elective cesarean birth may be performed without an obstetric or medical indication for the procedure at the request of the patient.
Cesarean Birth:
What are the types of uterine incisions?
Types of uterine incisions include:
- classical (vertical),
- low vertical, or
- low transverse.
Cesarean Birth:
What type of c-section incision is safest to have a normal birth after?
It is safest to attempt a vaginal birth after cesarean if a low transverse incision was used.
Cesarean Birth: Nursing Considerations
Slide 25
Labor and Delivery: Complications and Interventions
Uterine rupture: Who may this occur in?
May occur in patients attempting a trial of labor after cesarean (TOLAC).
Labor and Delivery: Complications and Interventions
Uterine rupture: What are symptoms?
Symptoms include the sudden development of a category II or category III fetal heart rate pattern, weakening contraction, and abdominal pain.
Labor and Delivery: Complications and Interventions
Uterine rupture:
Treatment includes cesarean birth and possible hysterectomy.
Labor and Delivery: Complications and Interventions
Cord prolapse: What is it?
Condition where umbilical cord precedes fetal head in the birth canal.
Labor and Delivery: Complications and Interventions
Cord prolapse: What is the first sign of a cord prolapse?
The first sign of a cord prolapse is often a change in fetal heart rate tracing, typically severe fetal bradycardia and variable decelerations.
Labor and Delivery: Complications and Interventions
What is cord prolapse considered?
A cord prolapse is an obstetric emergency typically requiring immediate cesarean birth.
Labor and Delivery: Complications and Interventions
Cord prolapse: WHHATT?
The presenting part should be held off the cord.
Labor and Delivery: Complications and Interventions
Cord prolapse: How should the cord be handled?
The cord should be handled as little as possible to prevent spasm of the umbilical artery.
Cord Prolapse:
What are the types of cord prolapse?
Overt cord prolapse:
Occult cord prolapse:
Cord Prolapse:
What are the types of cord prolapse?
Overt cord prolapse:
Occult cord prolapse:
Cord Prolapse:
Overt cord prolapse
Cord comes out ahead of the presenting part of fetus.
Cord Prolapse:
Overt cord prolapse: What is needed to handle this?
An emergency cesarean is needed.
Cord Prolapse:
Occult cord prolapse: What is it and what is still possible with it?
Cord alongside the presenting part of fetus.
Vaginal delivery may be possible.
Cord Prolapse:
Cord compression: What is it?
Cord compression – fetus does not get enough oxygen.
Cord Prolapse:
When is the fetus at most risk?
Fetus is most at risk when the fetal presenting part is not engaged into the maternal pelvis.
Labor and Delivery: Complications and Interventions
Amniotic fluid embolism: AKA?
An amniotic fluid embolism, referred to as anaphylactoid syndrome of pregnancy
Labor and Delivery: Complications and Interventions
Amniotic fluid embolism: When may it occur?
An amniotic fluid embolism, referred to as anaphylactoid syndrome of pregnancy, may occur in pregnancy, labor, birth, and the immediate postpartum period.
Labor and Delivery: Complications and Interventions
What is amniotic fluid embolism caused by?
An amniotic fluid embolism is caused when amniotic fluid enters maternal circulation and is associated with a maternal mortality rate of 20%.
Labor and Delivery: Complications and Interventions
What are initial symptoms of amniotic fluid embolism
Initial symptoms include respiratory failure and cardiac arrest.
Labor and Delivery: Complications and Interventions
If a patient survives an amniotic fluid embolism, what is the patient at risk for?
If the patient survives an amniotic fluid embolism, the patient is at risk for hemorrhagic shock with disseminated intravascular coagulation.
Labor and Delivery: Complications and Interventions
Slide 31
Perinatal Loss:
Stillbirth occurs in how many pregnancies?
Stillbirth occurs in approximately 6 of 1,000 pregnancies that reach 20 weeks of gestation.
Perinatal Loss:
Who is still birth common in?
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.
Perinatal Loss:
What do these families experience?
Families who experience perinatal loss may experience anxiety, depression, or posttraumatic stress disorder.
Slides 34-35
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