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NURS 4500: Midterm Material > Class 6: Postterm Labor > Flashcards

Class 6: Postterm Labor Flashcards

1
Q

what is considered postterm

A
  • pregnancy extends beyond the end of week 42 of gestation
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2
Q

postterm pregnancy is more common in…

A
  • primiparous people
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3
Q

what maternal risks are associated w postterm pregnancy (4)

A
  • perineal injury during birth due to macrosomia
  • hemorrhage (d/t macrosomia)
  • infection
  • interventions
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4
Q

what weight is considered macrosomia

A

> 4000 g

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5
Q

what interventions cause maternal risks w postterm pregnancy (3)

A
  • induction
  • instrument assisted birth
  • c-section
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6
Q

what fetal risks are associated w postterm pregnancy (5)

A
  • injury due to macrosomia
  • placenta begins to age = increased infarcts
  • oligohydramnios
  • meconium stained amniotic fluid
  • postmaturity syndrome
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7
Q

what is meconium

A
  • the 1st stool of a newborn or fetus
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8
Q

meconium can occur?

A
  • in utero or out of utero
  • anytime after 38 weeks
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9
Q

describe the appearance of meconium stained amniotic fluid

A
  • tar-like substance
  • dark green
  • sticky
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10
Q

meconium can be naturally passed after…

A
  • 38 weeks
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11
Q

meconium can be expected w… (2)

A
  • post-date pregnancy
  • if breech (d/t compression of abdomen)
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12
Q

meconium can mix with ____, causing ??

A
  • can mix with amniotic fluid
  • can interfere w first breath
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13
Q

meconium can be a sign of?? how??

A
  • of fetal hypoxia
  • causes sphincters to relax –> meconium passed
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14
Q

if there are changes in FHR and meconium, what is the concern?

A
  • fetal hypoxia
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15
Q

what are the characteristics of post-maturity syndrome (4)

A
  • greenish maconium staining
  • dry
  • flaking skin
  • long nails
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16
Q

what is included in collab care for postterm pregnancy

A
  • induction of labor between 41+0 and 42+0 weeks gestation
  • ongoing assessments of fetus
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17
Q

w postterm pregnancy, the pregnant person is usually placed on the induction list at…

A
  • 41+3 weeks gestation
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18
Q

induction of labor between 41 and 42 weeks gestation may.. (2)

A
  • reduce perinatal mortality
  • reduce meconium aspiration syndrome without increasing c-section birth rate
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19
Q

what is included in ongoing assessments of the fetus w postterm pregnancy & L&D (5)

A
  • daily fetal mvmt counts
  • NST
  • amniotic fluid index
  • BPP
  • doppler flow
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20
Q

if any of the postterm fetal assessments indicate fetus is not tolerating postterm, what happens?

A
  • moved to top of priority list for induction
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21
Q

what is dystocia

A
  • abnormally slow progress of labor
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22
Q

what is defined as dystocia (2)

A
  • greater than 4hrs of less than 0.5 cm per hour of cervical dilation in active labor
  • or greater than 1 hr of active pushing with no descent
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23
Q

dystocia can occur..

A
  • in either 1st or 2nd stage of labor
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24
Q

dystocia can be caused by.. (4)

A
  • abnormal uterine activity
  • ineffective pushing ***(most common)
  • alterations in pelvis structure (passageway)
  • fetal causes (passenger)
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25
Q

what are fetal causes of dystocia (7)

A
  • abnormal presentation/position –> malpresentation
  • anomalies
  • excessive size
  • number of fetuses
  • maternal position during L&D –> malposition
  • psychological response
  • cephalopelvic disproportion (CPD)
26
Q

dystocia is dysfunctional labor from abnormal uterine contractions preventing normal progress of… (3)

A
  • cervical dilation
  • effacement
  • descent
27
Q

what is considered abnormal uterine activity w dystocia (4)

A
  • hypertonic uterine dysfunction
  • hypotonic, uncoordinated, or infreq uterine contractions
  • alteration in secondary powers
  • abnormal labor patterns
28
Q

what is the most common abnormal uterine activity that causes dystocia

A
  • hypotonic
29
Q

what does hypotonic uterus mean

A
  • weak, inefficient contractions
30
Q

what can cause hypotonic uterus (2)

A
  • cephalic pelvis disproportion
  • malposition of the fetus (ex. OP)
31
Q

what should be assessed w hypotonic uterus (2)

A
  • FHR (EFM)
  • infection due to prolonged labor
32
Q

what are interventions for hypotonic uterus (4)

A
  • alter positions (esp. if malposition of fetus is present)
  • AROM
  • physical removal of membranes from cervix w finger
  • augmentation w oxytocin
33
Q

how can AROM help w hypotonic uterus

A
  • prostagloandins in amniotic fluid can help promote labor
34
Q

how can removal of membranes help w hypotonic uterus

A
  • can increase pressure on servic
35
Q

when is the most common time for hypertonic uterine dysfunction

A
  • early or latent phase
36
Q

what does hypertonic uterine dysfunction lead to? (2)

A
  • early exhuastion
  • poor psychological state of birther

(due to it occuring in early/latent phase)

37
Q

what is included in interventions for hypertonic uterus (2)

A
  • morphine to help mother relax & keep energy
  • promote rest
38
Q

describe contractions w hypertonic uterus

A
  • contractions radiate from midpoint instead of fundus = not very effective
39
Q

what is included in interventions for alterations in 2ndary powers (2)

A
  • lithotomy position exhausts mother, do not have them in this position for more than 2 hrs
  • encourage them to work w their body
40
Q

what is considered alteration in pelvic structure (passageway) r/t dystocia (2)

A
  • pelvis dystocia
  • soft tissue dystocia
41
Q

what is pelvic dystocia

A
  • contractures of pelvic diameter that reduce capacity of bony pelvis, inlet, midpelvis, or outlet
42
Q

what is soft tissue dystocia

A
  • results from obstruction of birth passage by an anatomical abnormality other than bony pelvis
43
Q

what can cause soft tissue dystocia (6)

A
  • tumors
  • full bladder
  • full rectum
  • nutrition
  • placenta previa
  • STIs (impact cervical effacement & dilation)
44
Q

what impact can psychological responses have on dystocia

A
  • hormones and neurotransmitters released in response to stress can cause dystocia
45
Q

what impact can position of the pregnant person have on dystocia (3)

A
  • with OP position, get mother on hands and knees to encourage transition to OA
  • position changes throughout 1st and 2nd stage (ex. sitting, rocking, etc.)
  • do not want pushing on back too much
46
Q

what can cause increased risk for dystocia (5)

A
  • maternal fatigue (impacts 2ndary powers)
  • dehydration
  • electrolyte imbalance (impacts muscle contractions)
  • fear
  • inappropriate timing of analgesic or anaesthetic admin (ex. epidural too early)
47
Q

what are fetal causes of dystocia (passenger) (6)

A
  • anomalies (ex. acites)
  • fetal size –> macrosomia
  • cephalopelvic disproportion (CPD)
  • malposition
  • malpresentation
  • multiple fetuses
48
Q

what is CPD

A
  • considers the relationship between the fetus head to pelvis
    ex. head too big for pelvis or vice versa
49
Q

what is malposition of the fetus ? whats an example

A
  • abnormal position of the fetus
    ex. direct OP
50
Q

what is malpresentation? examples (2)?

A
  • abnormal presentation
    ex. breech, face or brow
51
Q

what is the criteria for a vaginal breech delivery (4)

A
  • frank or complete breech
  • fetal weight between 2000-3800 g
  • need to see good progress
  • flexed fetal head
52
Q

what are concerns w a footling breech (3)

A
  • umbilical cord prolapse (since foot does not take up entire cervical opening)
  • infection
  • head might get stuck
53
Q

what type of delivery is done w a footling breech

A
  • no vaginal birth
54
Q

what is included in nursing care for dystocia (4)

A
  • EFM
  • US to determine fetal positioning
  • risk assessment (continuous)
  • prevention
55
Q

interventions for dystocia depend on… (2)

A
  • the cause (which P)
  • and timing of the dystocia (1st or 2nd stage)
56
Q

what are possible interventions for dystocia (4)

A
  • external cephalic version
  • augmentation of labor/induction of labor
  • forceps or vacuum assisted birth (operative procedures)
  • c-section
57
Q

what is external cephalic version

A
  • turning of fetus from one presentation to another
    ex. from breech to cephalic/vertex presentation
58
Q

operative procedures for dystocia are considered when?

A
  • in second stage
59
Q

what is included in prevention of dystocia (2)

A
  • positioning
  • proper diagnosis of active phase of labor
60
Q

what should be monitored after ECV (4)

A
  • monitor FHR
  • monitor for vaginal bleeding
  • NST
  • monitor for labor (may induce)

NURS 4500: Midterm Material (19 decks)

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