chapter 33 Flashcards
dysfunctional labor
does not result in normal progress of cervical dilation, effacement or descent
(so no progress but could have normal contractions)
dystocia
any difficult labor or birth
powers =
uterine contractions
ineffective uterine contractions
A) Hypotonic dysfunction- Secondary Inertia
B) Hypertonic dysfunction- Primary Inertia
Hypotonic dysfunction- Secondary Inertia
more common, mom starts labor and does good until gets to 4cm and stays there (active phase)
“falls out of labor”
decrease frequency - intensity of contractions, decrease to 2-3 contractions/10 min
causes: cephalapdric dysportion (baby cant get through), positions of body, over distention of uterus, exhaustion, infection risk
if baby not born in 24 hrs then c-section
Hypertonic dysfunction- Primary Inertia
occurs during early phase of 1st stage so 0-3 cm
contractions are uncoordinated
in a lot of pain, never really goes away
want to stop labor and give analgesic to knock her out of labor
within 2-3 hours labor starts normally
get pt to rest while contractions stop
SECONDARY POWERS–INEFFECTIVE MATERNAL PUSHING; may result from
Incorrect pushing (if pushing correctly will see bulging of peritoneum) Fear Decreased/absent urge to push Exhaustion Analgesics/anesthesia Psychologically unready
with secondary powers want to
promote effect pushing, make sure pt hydrated, don’t wast energy between contractions,relax, may need forceps or vacuum
using what graph for abnormal labor patterns
friedman graph
causes of abnormal labor patterns
contractibility, prob with fetus (too big), fetal presentation, med to knock out of labor
prolonged labor
Active phase- dilation should proceed at a minimum rate of 1.2cms./hr. (prima) or 1.5 cms./hr. in the multipara
Descent at a minimum of 1 cm/hr. in prima or 2cm/hr in the multipara
(don’t mem numbers)
precipate labor
birth occurs within 3 hours of onset
hard/fast labor - babies can have damage from it
mom more likely to have birth traumas, in a lot of pain but can’t give meds
passenger problems
I. FETAL SIZE
II. ABNORMAL FETAL PRESENTATION OR POSITION
III. MULTIFETAL PREGNANCY
IV. FETAL ANOMALIES
fetal size -
Macrosomia can cause Shoulder Dystocia
more likely if mom diabetic
abnormal fetal position/presentation
Rotation Abnormalities
Face Presentation
Breech (more difficult to deliver, more likely to have meconium/prolapsed cord)
multifetal preg
more likely preterm or mal presentations
fetal anomalies
big head baby, breech
PROBLEMS WITH THE PASSAGE
I. PELVIS
II. MATERNAL SOFT TISSUE OBSTRUCTION
(full bladder can be a problem)
gynecoid pelvis
50% of all women have
anthropoid pelvis
25% of all white, 50% of nonwhite
android pelvis
30%, heart shaped, narrow diameter, difficult to deliver
PROBLEMS WITH THE PSYCHE
STRESS - tense, decrease blood flow to muscles = increase pain, decrease contractility (increase hypoxia)
ANXIETY
FEAR
can affect ability to tolerate pain
intrauterine infection
Signs/symptoms: fetal HR >160, maternal
temp. > 100.4 F, elevated pulse (above 90)/respirations (above 20), foul smelling amniotic fluid
REDUCED THE RISK BY:
Limiting vaginal exams, maintaining aseptic technique, keeping bed pads dry, cleaning perineum
other interpatum complications
I. intrauterine infection
II. obesity
III. premature rupture of membranes
IV. preterm labor
obesity -
ultrasound may not work
Premature Rupture of membranes (PROM)-
rupture before the onset of labor
may increase infection
24 hr period to have baby
Preterm Premature Rupture of Membranes (PPROM)-
rupture of membranes before the 37th week of gestation
Premature Rupture of membranes (PROM) causes -
a lot of times dont know, infections, chorioamnionitis - can cause rupture
Premature Rupture of membranes (PROM) complications -
preterm labor - broad spectrum antibiotic, compressed umbilical cord
Premature Rupture of membranes (PROM) management -
Gestation Near Term
Preterm Gestation - watch for s/s and sac
Premature Rupture of membranes (PROM) nursing considerations -
if sent home then no sex
if contractions/ elevated temp - notify physician
take temp 4 times a day
modified bed rest
preterm labor
33% of infant mortality associated with preterm birth
12.3% of all births in 2008
Labor that begins after the 20th week but before the 37th week of gestation
causes - preclampsia, small babies, placenta problems, cognitive malformation
MANIFESTATIONS OF PRETERM LABOR
Uterine contractions Baby “balling up” Low back pain Pelvic pressure (baby "dropping") Pain, discomfort, pressure vulva/thighs Change in vaginal discharge - increase amount, more watery, bloody/brown “feeling bad”
EDUCATING ABOUT PRETERM LABOR
TEACH HOW TO RESPOND IF S/S OCCUR:
Drink 3 glasses of water - dehydration can cause contractions
Empty the bladder- full bladder cause contractions
Lie down - on left side for at least 1 hour
Palpate contractions for one hour
Notify medical personnel if more than 4 contractions in an hour
CALL IMMEDIATELY IF—fluid leaking from vagina, vaginal bleeding, foul odor of vaginal discharge
STOPPING PRETERM LABOR
THERAPEUTIC MANAGEMENT INCLUDES:
- Identifying preterm labor early
- Delaying birth
- Accelerating fetal lung maturity if preterm birth is likely
IDENTIFYING PRETERM LABOR
Frequent prenatal visits Check for S/S Ultrasound/cervical exams Identify infections and treat Biochemical marker- fetal fibronectin (FFN) - protein found in amniotic fluid, found in vagina can swab to see if preterm
Home Uterine Activity Monitoring
Stopping Preterm Labor Initial measures
Identifying and treating infections
Identifying other causes for preterm contractions
Limiting activity
Hydrating woman - to make sure she doesn’t release oxytocin on ovum
Stopping Preterm Labor Tocolytics
Beta-adrenergic drugs - uterine relaxant, stop contractions
Magnesium sulfate
Prostaglandin synthesis inhibitors
Calcium antagonists
Bethine
beta antagonist
injection every 4 hours subq
once contractions stop and decrease eventually put them on bethine PO and go home
antidote - inderal
mg sulfate -
tropolic, CNS depressant
relaxes smooth muscle
calcium glutamate
flushing/hot
ACCLERATING FETAL LUNG MATURITY
Betamethasone 12 mg IM for 2 doses 24 hrs apart
