Common disorders in Intrapartum- EXAM 1 Flashcards
What are the problems of the powers
Ineffective contractions
Uterine disoverextension
Hypotonic labor dysfunction
Hypertonic labor dysfunction
Ineffective maternal pushing
What are problems with the passenger
Fetal size
Macrosomia: too large
Shoulder dystocia: shoulders too big
Abnormal fetal presentation or position
Multi-fetal pregnancy
Fetal anomalies
Precipitate labor
A rapid birth that occurs within 3 hours of onset of labor
Signs associated with intrapartum infection
Fetal tachycardia, Maternal fever, Foul or strong smelling amniotic fluid, Cloudy or yellow amniotic fluid
Preterm Labor
Begins after 20th week but before 37 weeks
How can you prevent preterm labor
Education, improving access to care, identifying rid factors, progesterone supplements, promoting adequate nutrition
How would you stop preterm births
Taking initial measures
Identifying and treating infections
Other causes for preterm contractions
Limiting activities
Hydration
Accelerating fetal lung maturity
Tocolytics: calcium channel blocker
Prolonged pregnancy
Lasts longer then 42 weeks
Can be due to insufficiency of placental function, meconium aspiration or dysfunctional labor due to continued fetal growth
Amnioinfusion
Induction
Use bishop scoring system
Used to look at dilation, effacement, fetal station, cervical consistency and position
Induction and Augmentation indications
Fetal compromises, Rh compatibility, Ruptured membranes, Postterm pregnancy, Hypertension in pregnancy, or fetal death
Mom may still have to go through labor and deliver baby
Induction nd Augmentation contraindications
Placenta previa
Vasa previa
Abnormal presentation
Umbilical cord prolapse
Previous uterine surgery
non reassuring fetal heart patterns
What are the techniques used for inductions
Cervical ripening: medication is used aka prostaglandins and catheter or laminaria is used to remove
Oxycotin used then given as a secondary infusion
What would cause complication to prostaglandins
If mother has asthma or heart disease or glaucoma
What would you observe for in inducation procedure
The fetal response to any meds given to mom
Fetal bradycardia, tachycardia, or late decelerations
The mothers response as well; any tachycardia
Cephalopelvic disproportion
Risk factor in intrapartum
Neonates head is too large to pass the pelvis
Retained placenta
Risk factor in intrapartum
A hemorrhage risk
Shoulder dystocia
Risk factor in intrapartum
Neonates shoulder becomes lodged in mothers pelvic cavity
Perinatal loss
Death inside the uterus
When is labor induced
To STIMULATE uterine contractions to help ACCOMPLISH BIRTH due to non ruptured membranes
What must be done first before labor induction is attempted
Assessment must indicate that both the mom and baby are ready for labor based on fetal maturity and cervical readiness
What are some indications that induced labor must be done
Gestational hypertension
Ruptured membranes without onset of labor
Infection in the uterus
Medical problems that worsen in pregnancy
Fetal problems:prolonged pregnancy, slowed growth
Placental insufficiency
Fetal death
What are some contraindications that may occur when trying induced labor
Patient may refuse
Placenta previa or vasa previa
Fetus might be in transverse lie
Mom has bad too many c-sections
There may be active genital herpes
Umbilical cord prolapse
Sephalopelvic disproportion
Abnormal size or structure of the mothers pelvis
What would you do to prepare the mom for labor augmentation
WHEN MEDS ARE ADMINISTERED
Explain procedure
Obtain baseline vital signs and fetal heart rate
Ensure they have an IV
Tell her to remain in bed for up to 2 hours
Induce oxy 6-12 hours after done
Assess for signs of uterine tachycardia
Friedman curve
Used to graph the process of cervical dilation and fetal descent
Used as a guide to assess and manage the normal progress of labor
What can prolonged labor cause
Maternal or newborn infection
Maternal exhaustion
Postpartum hemorrhage
Greater anxiety and fear
When is a force assisted birth done
First time mom
Maternal age of 35 and over
Maternal height of less then 4’11
Weight gain of more than 33
Midline episiomity
When is vacuume extraction done
When forcep assist does not work
Can cause fetal scape trauma
What are the risks to forcep and vacuum extractions
Trauma to mom and fetal tissues
Lacerations or hematoma in moms vagina
Infant may have bruising, facial or scalp lacerations
Episiotomy
Done if head can’t get out of vagina
Midline is done to allow bigger opening
What do you stop oxycotin with
tachsystole
First degree perineal laceration
Uncontrolled tearing caused on superficial vagina or on perineal skin
Second degree perineal laceration
Uncontrolled tearing caused on vaginal mucosa and perineal skin
Third degree perineal laceration
Uncontrolled tearing , same as second degree but also involves anal sphincter
Fourth degree perineal laceration
Uncontrolled tearing that extends through the anal sphincter into the rectal musosa
C-Section indications
Abnormal labor
Inability of fetus to pass
Mother has GH or DM
Previous surgery on the uterus
If mother is obese
Some mothers prefer them over vaginal delivery
What incision is done in C-section
Low transverse incision
What do you do to prepare for a c-section
Run labs to identify anemia or any blood clotting abnormalities
Identify blood typing and CBC and coagulation studies
Get baseline vitals and fetal heart rate
Have IV line in and foley catheter
Vaginal birth after C-section
If C-section has been done in the past, mom needs to be monitored in case she is unable to do a vaginal labor and needs to get a c-section done again
What would be the main concern in vaginal birth after having c-seciions
Uterine scar may rupture
May be placenta blood flow disrupt
Can lead to hemorrhage
What are some intrapartum emergencies that may arise
Placental abnormalities
Umbilicalcord prolapse: cord may slip down and compress the fetus and pelvis
What is umbilical cord prolapse and cause an increase for it
When the cord slips down and becomes compressed between the fetus and pelvis
Prompt delivery is performed
Ruptured membranes, fetus is too small or his in abnormal presentation or threes excess amniotic fluid volume may be risk factors
How would you alleviate pressure on the prolapsed cord
Going in through the vagina, push the fetus upward and off the cord and elevate the moms hips
What is anaphylactoid syndrome
AFE, embolisation of amniotic fluid
When the amniotic fluid is drawn into the mothers circulation and gets into her lungs
