Class 6: Postterm Labor Flashcards
what is considered postterm
- pregnancy extends beyond the end of week 42 of gestation
postterm pregnancy is more common in…
- primiparous people
what maternal risks are associated w postterm pregnancy (4)
- perineal injury during birth due to macrosomia
- hemorrhage (d/t macrosomia)
- infection
- interventions
what weight is considered macrosomia
> 4000 g
what interventions cause maternal risks w postterm pregnancy (3)
- induction
- instrument assisted birth
- c-section
what fetal risks are associated w postterm pregnancy (5)
- injury due to macrosomia
- placenta begins to age = increased infarcts
- oligohydramnios
- meconium stained amniotic fluid
- postmaturity syndrome
what is meconium
- the 1st stool of a newborn or fetus
meconium can occur?
- in utero or out of utero
- anytime after 38 weeks
describe the appearance of meconium stained amniotic fluid
- tar-like substance
- dark green
- sticky
meconium can be naturally passed after…
- 38 weeks
meconium can be expected w… (2)
- post-date pregnancy
- if breech (d/t compression of abdomen)
meconium can mix with ____, causing ??
- can mix with amniotic fluid
- can interfere w first breath
meconium can be a sign of?? how??
- of fetal hypoxia
- causes sphincters to relax –> meconium passed
if there are changes in FHR and meconium, what is the concern?
- fetal hypoxia
what are the characteristics of post-maturity syndrome (4)
- greenish maconium staining
- dry
- flaking skin
- long nails
what is included in collab care for postterm pregnancy
- induction of labor between 41+0 and 42+0 weeks gestation
- ongoing assessments of fetus
w postterm pregnancy, the pregnant person is usually placed on the induction list at…
- 41+3 weeks gestation
induction of labor between 41 and 42 weeks gestation may.. (2)
- reduce perinatal mortality
- reduce meconium aspiration syndrome without increasing c-section birth rate
what is included in ongoing assessments of the fetus w postterm pregnancy & L&D (5)
- daily fetal mvmt counts
- NST
- amniotic fluid index
- BPP
- doppler flow
if any of the postterm fetal assessments indicate fetus is not tolerating postterm, what happens?
- moved to top of priority list for induction
what is dystocia
- abnormally slow progress of labor
what is defined as dystocia (2)
- 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
dystocia can occur..
- in either 1st or 2nd stage of labor
dystocia can be caused by.. (4)
- abnormal uterine activity
- ineffective pushing ***(most common)
- alterations in pelvis structure (passageway)
- fetal causes (passenger)
what are fetal causes of dystocia (7)
- abnormal presentation/position –> malpresentation
- anomalies
- excessive size
- number of fetuses
- maternal position during L&D –> malposition
- psychological response
- cephalopelvic disproportion (CPD)
dystocia is dysfunctional labor from abnormal uterine contractions preventing normal progress of… (3)
- cervical dilation
- effacement
- descent
what is considered abnormal uterine activity w dystocia (4)
- hypertonic uterine dysfunction
- hypotonic, uncoordinated, or infreq uterine contractions
- alteration in secondary powers
- abnormal labor patterns
what is the most common abnormal uterine activity that causes dystocia
- hypotonic
what does hypotonic uterus mean
- weak, inefficient contractions
what can cause hypotonic uterus (2)
- cephalic pelvis disproportion
- malposition of the fetus (ex. OP)
what should be assessed w hypotonic uterus (2)
- FHR (EFM)
- infection due to prolonged labor
what are interventions for hypotonic uterus (4)
- alter positions (esp. if malposition of fetus is present)
- AROM
- physical removal of membranes from cervix w finger
- augmentation w oxytocin
how can AROM help w hypotonic uterus
- prostagloandins in amniotic fluid can help promote labor
how can removal of membranes help w hypotonic uterus
- can increase pressure on servic
when is the most common time for hypertonic uterine dysfunction
- early or latent phase
what does hypertonic uterine dysfunction lead to? (2)
- early exhuastion
- poor psychological state of birther
(due to it occuring in early/latent phase)
what is included in interventions for hypertonic uterus (2)
- morphine to help mother relax & keep energy
- promote rest
describe contractions w hypertonic uterus
- contractions radiate from midpoint instead of fundus = not very effective
what is included in interventions for alterations in 2ndary powers (2)
- lithotomy position exhausts mother, do not have them in this position for more than 2 hrs
- encourage them to work w their body
what is considered alteration in pelvic structure (passageway) r/t dystocia (2)
- pelvis dystocia
- soft tissue dystocia
what is pelvic dystocia
- contractures of pelvic diameter that reduce capacity of bony pelvis, inlet, midpelvis, or outlet
what is soft tissue dystocia
- results from obstruction of birth passage by an anatomical abnormality other than bony pelvis
what can cause soft tissue dystocia (6)
- tumors
- full bladder
- full rectum
- nutrition
- placenta previa
- STIs (impact cervical effacement & dilation)
what impact can psychological responses have on dystocia
- hormones and neurotransmitters released in response to stress can cause dystocia
what impact can position of the pregnant person have on dystocia (3)
- 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
what can cause increased risk for dystocia (5)
- maternal fatigue (impacts 2ndary powers)
- dehydration
- electrolyte imbalance (impacts muscle contractions)
- fear
- inappropriate timing of analgesic or anaesthetic admin (ex. epidural too early)
what are fetal causes of dystocia (passenger) (6)
- anomalies (ex. acites)
- fetal size –> macrosomia
- cephalopelvic disproportion (CPD)
- malposition
- malpresentation
- multiple fetuses
what is CPD
- considers the relationship between the fetus head to pelvis
ex. head too big for pelvis or vice versa
what is malposition of the fetus ? whats an example
- abnormal position of the fetus
ex. direct OP
what is malpresentation? examples (2)?
- abnormal presentation
ex. breech, face or brow
what is the criteria for a vaginal breech delivery (4)
- frank or complete breech
- fetal weight between 2000-3800 g
- need to see good progress
- flexed fetal head
what are concerns w a footling breech (3)
- umbilical cord prolapse (since foot does not take up entire cervical opening)
- infection
- head might get stuck
what type of delivery is done w a footling breech
- no vaginal birth
what is included in nursing care for dystocia (4)
- EFM
- US to determine fetal positioning
- risk assessment (continuous)
- prevention
interventions for dystocia depend on… (2)
- the cause (which P)
- and timing of the dystocia (1st or 2nd stage)
what are possible interventions for dystocia (4)
- external cephalic version
- augmentation of labor/induction of labor
- forceps or vacuum assisted birth (operative procedures)
- c-section
what is external cephalic version
- turning of fetus from one presentation to another
ex. from breech to cephalic/vertex presentation
operative procedures for dystocia are considered when?
- in second stage
what is included in prevention of dystocia (2)
- positioning
- proper diagnosis of active phase of labor
what should be monitored after ECV (4)
- monitor FHR
- monitor for vaginal bleeding
- NST
- monitor for labor (may induce)
