Chapter 27: Intrapartum Complications

Question 1

Back labor

Answer 1

Intense back pain associated with fetal occiput posterior position

Question 2

K-B test

Answer 2

Identifying presence of fetal erythrocytes in the maternal circulation.

Question 3

Premature rupture of the membranes (PROM)

Answer 3

Rupture of the membranes before the onset of labor

Question 4

Preterm premature rupture of the membranes (PPROM)

Answer 4

Rupture of the membranes before the end of week 37

Question 5

Shoulder dystocia

Answer 5

Delayed or difficult birth of the shoulders after the head has emerged

Question 6

Tocolytic

Answer 6

Medication to stop preterm or hypertonic uterine contractions

Question 7

Turtle sign

Answer 7

Retraction of fetal head against the mother’s perineum after in emerges

Question 8

What are three characteristics of effective uterine activity?

Answer 8

Uterine contractions must be:

a. coordinated
b. Strong enough, and
c. Numerous enough to propel the fetus through the woman’s pelvis

Question 9

Why are nursing measures to manage stress and anxiety important when caring for women with hypotonic or hypertonic labor dysfunction?

Answer 9

Hypotonic dysfunction mau cause anxiety because the woman expects to be progressing faster; hypertonic dysfunction is stressful because of the near-contstant discomfort without significant progress. The stress response, associated with anxiety and fear, causes the secretion of catecholamines and consumption of glucose, which interfere with normal uterine contraction Nursing measure include therapeutic communication, pain relief, promotion of relaxation and rest, and positioning.

Question 10

What is the central principle of nursing actions when dysfunctional labor is a result of ineffective maternal pushing?

Answer 10

All nursing actions center on helping the woman make each push most effective. Examples include laboring down or delayed using, pushing with every other contraction, use of upright positions to push, explaining the expected sensations, coacher her if she cannot feel the urge to push, and reassuring her that there is not an absolute deadline for delivery.

Question 11

Why are upright positions good for women who have ineffective second-stage pushing?

Answer 11

Upright positions add the force of gravity to maternal pushes.

Question 12

List nursing measures to promote normal labor when maternal pushing is ineffective for each reason listed.

a. Fear of injury:
b. Epidural block analgesia:
c. Exhaustion:

Answer 12

a. Fear of injury: Help the woman understand that her tissues can distend to accommodate the fetus; apply warm compresses to the perineum.
b. Epidural block analgesia: Coach her about when to push and stop pushing if she cannot feel contractions well. Help her understand that effective pain management by any method, including non-pharmacologic measures, promotes the progress of labor.
c. Exhaustion: Teach the woman to push only when she feels the urge or with every other contraction; administer fluids as ordered; offer reassurance.

Question 13

Why are upright maternal positions best to relieve persistent occiput posterior positions?

Answer 13

Upright positions favor fetal descent (gravity) and, wiht that descent, fetal head rotation. Effective positions for pushing may include squatting, semisitting, side-lying, pushing on the toilet, and/or lunging.

Question 14

What are some intrapartum problems that are more likely if a woman has a multifetal pregnancy?

Answer 14

a. uterine overdistention with hypotonic dysfunction
b. abnormal fetal presentations
c. fetal hypoxia
d. postpartum hemorrhage caused by uterine overdistention

Question 15

What are expected average rates for dilation and fetal descent for the following women after the active phase of labor has been reached?

a. Nulliparas:
b. Parous women:

Answer 15

a. Nulliparas: Dilation at least 1.2 cm/hr, descent at least 1.0 cm/hr
b. Parous women: Dilation at least 1.5 cm/hr, descent at least 2.0 cm/hr

Question 16

What are nursing measures for a woman having prolonged labor and for her fetus?

a. Maternal:
b. Fetal:

Answer 16

a. Maternal: Promotion of comfort, conservation of energy, emotional support position changes that favor normal progress, and assessments for infection
b. Fetal: Observation for signs of intrauterine infection and for compromised fetal oxygenation

Question 17

What are nursing measures that can be used when a woman has precipitate labor?

a. Promoting fetal oxygenation:
b. Promoting maternal comfort:

Answer 17

a. Promoting fetal oxygenation: Place her in side-lying position, administer oxygen, maintain blood volume with nonoxytocin IV fluids, stop oxytocin if in use, administer terbutaline or other tocolytic drug that may be ordered.
b. Promoting maternal comfort: Help the woman focus on nonpharmacologic pain control methods if analgesia is not possible or has not yet taken effect; remain with the woman.

Question 18

What factors might make a woman think that her membranes have ruptured when they have not?

Answer 18

Urinary incontinence, increased vaginal discharge, loss of mucous plug

Question 19

What side effects may occur with beta-adrenergic drugs, such as terbutaline?

Answer 19

Maternal and fetal tachycardia, decreased blood pressure, wide pulse pressure, dysrhythmias, myocardial ischemia, chest pain, pulmonary edema, hyperglycemia and hypokalemia, headache, tremors, and restlessness.

Question 20

How do the following drugs stop preterm labor?

a. Prostaglandin synthesis inhibitors:
b. Calcium channel blockers:

Answer 20

a. Prostaglandin synthesis inhibitors: Block the action of prostaglandins, which stimulate uterine contractions; an example is indomethacin
b. Calcium channel blockers: Block the action of calcium, which is necessary form muscle contraction; an example is nifedipine.

Question 21

What are the primary nursing assessments related to each of these drugs used in teh treatment of preterm labor?

a. Terbutaline:
b. Magnesium sulfate:
c. Indomethacin:
d. Nifedipine:
e. Corticosteroids:

Answer 21

a. Terbutaline: Observe maternal BP, pulse, and respirations and fetal heart rate to identify tachycardia or hypotension; assess lung sounds; assess for the presence of dyspnea or chest pain to identify pulmonary edema or myocardial ischemia; obtain ordered glucose and potassium levels.
b. Magnesium sulfate: Observe for urine output of at least 30mL/hr, presence of deep tendon reflexes, and respirations of at least 12 breaths/min; assess heart and lung sounds; observe bowel sounds and assess for constipation; have calcium gluconate available.
c. Indomethacin: Observe for nausea, vomiting, heartburn skin rash, and prolonged bleeding; observe for signs of infection other than fever; check fundal height; have woman do kick counts to identify fetal movements.
d. Nifedipine: Teach about flushing of the skin and headache; observe maternal pulse rate, fetal heart rate, and maternal blood pressure; warn of postural hypotension, and teach woman to assume a sitting or standing position slowly after lying down.
e. Corticosteroids: Assess lung sounds; teach woman to report chest pain or heaviness or any difficulty in breathing.

Question 22

What are three variations of prolapsed cord?

Answer 22

a. Occult prolapsed cord cannot be seen or felt on vaginal examination but is suspected based on fetal hear rate.
b. The cord may slip into the vagina, where it can be felt as a pulsating mass during vaginal examination.
c. Complete prolapsed cord slips outside the vagina, where it is visible.

Question 23

What are the two objectives if umbilical cord prolapse occurs or is suspected? Why should the nurse avoid handling the prolapsed cord?

Answer 23

Relieve pressure on the cord by any of several measures, including positioning the woman so that her hops are higher than her head and pushing the fetal presenting part upward; increase oxygen delivery to the placenta. Handling the cord may induce arterial spasm in the cord vessels.

Question 24

What are 3 variations of uterine rupture?

Answer 24

a. Complete rupture: direct communication between the uterine and peritoneal cavities.
b. Incomplete rupture: rupture into the peritoneum or broad ligament but not into the peritoneal cavity.
c. Dehiscence: partial separation of a previous uterine scar.

Question 25

Why is it important that the nurse not push on the uncontracted uterine fundus after birth? What is the correct procedure?

Answer 25

Pushing on an uncontracted uterus to expel clots after birth may result in uterine inversion. Massage the uterus until it is firm before expelling clots with fundal pressure. Support the lower uterus with one hand just above the symphysis.

Question 26

Why can anaphylactoid syndrome result in disseminated intravascular coagulation?

Answer 26

Amniotic fluid is rich in thromboplastin, initiating uncontrolled clotting that consumes normal clotting factors.

Question 27

What are the priorities during the initial treatment of a pregnant woman who has had a traumatic injury?

Answer 27

Evaluation and stabilization of maternal injuries; following basic resuscitation rules; arresting hemorrhage; avoiding prolonged supine positioning; evaluating injuries to mother and fetus; expecting large fluid resuscitation needs; providing Rh immune globulin if a fetal to maternal hemorrhage is suspected in the Rho(D)-negative woman.