Common disorders in Intrapartum- EXAM 1 Flashcards by El S

What are the problems of the powers

Ineffective contractions
Uterine disoverextension
Hypotonic labor dysfunction
Hypertonic labor dysfunction
Ineffective maternal pushing

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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

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Precipitate labor

A rapid birth that occurs within 3 hours of onset of labor

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Signs associated with intrapartum infection

Fetal tachycardia, Maternal fever, Foul or strong smelling amniotic fluid, Cloudy or yellow amniotic fluid

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Preterm Labor

Begins after 20th week but before 37 weeks

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How can you prevent preterm labor

Education, improving access to care, identifying rid factors, progesterone supplements, promoting adequate nutrition

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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

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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

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Amnioinfusion

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Induction

Use bishop scoring system
Used to look at dilation, effacement, fetal station, cervical consistency and position

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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

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Induction nd Augmentation contraindications

Placenta previa
Vasa previa
Abnormal presentation
Umbilical cord prolapse
Previous uterine surgery
non reassuring fetal heart patterns

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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

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What would cause complication to prostaglandins

If mother has asthma or heart disease or glaucoma

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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

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Cephalopelvic disproportion

Risk factor in intrapartum
Neonates head is too large to pass the pelvis

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Retained placenta

Risk factor in intrapartum
A hemorrhage risk

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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