Complications of Birth Flashcards
Recognition of signs of poor fetal perfusion
Interventions for poor fetal perfusion
Uterine rupture
OBSTETRIC EMERGENCY
caused by scarring on the uterus
Risk factors for uterine rupture
- multiple C-sections
- no previous vaginal deliveries
- induced labor
- multifetal gestation
- infection
- short interval between pregnancies
S/S of uterine rupture
- fetal distress
- loss of fetal station
- severe lower abd pain
- shock
- pale skin
- tachycardia
- diaphoresis
Nursing Interventions for uterine rupture
- O2
- IV fluids
- Continuous fetal monitoring
- prepare for immendiate C-section
Indications for VBAC
- Women with 1 or 2 previous C-sections & low transverse uterine incision
- Clinically adequate pelvis based on pelvimetry or prior vaginal birth.
- Undocumented uterine scars unless there is a high suspicious there was a classic incision performed previously.
- Absence of other uterine scars or Hx of previous uterine rupture
Cord Prolapse
MEDICAL EMERGENCY; fetus O2 supply is cut off
cord enters the pelvis in front of the fetal head & as the head descends it puts pressure on the cord.
Risk factors for cord prolapse
- polyhydramnioes
- premature rupture of membrane
- fetal malpresentation
- fetus small for gestational age
Nursing Intervention for cord prolapse
- Displacement of the presenting part by knee chest position OR
- Manual displacement with your hand
- -followed by a STAT c-section
- indicators of transient cord compression are variable decels on the fetal heart tracing
Assessment & Interventions for dysfunctional labor pattern
(2 types)
- Hypertonic (tachysystolic)
* there is more than 5 contractions in 10 min window.
* can decrease fetal perfusion
Interventions:
* turn pitocin off if its running
* provide O2 & IV fluids to help perfusion - Hypotonicity
* there is too few contractions which prolong labor
**Interventions **
administer pitocin to increase strength & frequency of contraction
Interventions for both dysfunctional labor patterns
- Monitor fetal heart rate & maternal VS
- watch for infection
Chorioamniontitis
infection of the amniotic cavity; bacteria in the vagina can be introdiced into uterus due to frequent vaginal exams
thats why we only want to check cervix when membranes are ruptured
Risk factors for chorioamnionitis
prolonged ruptures of membranes & frequent vaginal exams are the two main causes
Signs for chorioamnionitis
clinical manifestations
- maternal fever
- fetal tachycardia
- uterine tenderness
- foul odor of amniotic fluid
Shoulder Dystocia
- when the head is delivered but the shoulders are stuck
- can cause brachial plexus injuries, fractured clavicles in newborn, hemorrhage, perineal, & rectal injuries in mothers
Care for shoulder dystocia
NURSE & PROVIDERS
- Nursing interventions:
* Mc Roberts maneuvers
* Suprapubic pressure - Providers may cut episiotomy, perform :
* screw maneuver
* Zavagnelli maneuver (last ditch effort try to push head back in & perform C-section)
Care of pt who has experience FETAL DEMISE
9 bullets
- Mom is at risk for infection if baby died in utero
- We wait for labor or can induce it
- nurses should support mother & family
- encourage to share feelings
- offerst to take pictures & create memory box
- prepare family for what hte baby will look like & allow them to hold, touch & say goodbye
- help actualize loss of by: actualizing birth, use honesty dealing w/ situation; its ok to grieve, if baby was name use it, treat baby as if its still alive, dont rush the process, autopsy if ordered otherwise its expensive, perinatal hospice; support services
- attend moms physcial needs, encourage communication, adress spiritual needs as well
- After death: follow up, phone calls to check up on emotions of family dont forget sibilings & grandparents
Precipitous Delivery
- when the entire labor occurs w/in 3 hrs
- Can cause fetal distress, placental abruption, perineal lacerations, PPH, meconium stained amniotic fluid, meconium aspiration, fetal creanial trauma
Care of pt experiencing Precipitous Delivery
nursing interventions
- close monitoring
- have delivery pack nearby for pts with this Hx
- encourage pt to pant & blow instead of pushing to slow down the fetal decent
- dont attemp to stop baby from coming out
- support the mother
- if delivery happens; dry baby, suction mouth & nose & stabilize as you normally would
Care of pt during operative vaginal delivery
- ensure bladder is empty
- assess FHR durin procedure
- assess mom & newborn for trauma after birth
- manage pain
Assessment & management of Oxytocin infusion
AKA Pitocin
ASSESS:
* FHR; frequency, duration & intensity of contractions, delcels, accelerations & uterine resting tone every 15 mins & before increasing infusion rate
* cervical dilation as needed
* ADRs or SE: FHR; bradycardia, late or deep repetitive variable decels, contractions every 2 mins, exceed duration of more than 60 secs or insufficient relaxation of uterus between contractions or steady increase in resting tone
Management
*contractions every 2 mins should decrease (or d/c) infusion
Duramorph
morphine sulfate injection via epidural or spinal anesthesia cath
Provides 16-24 hrs of pain relief
what should you monitor for Duramorph
*** RR airway/breathing is the priority **
* Bleeding
* pulse ox
* BP
* pulse
* pain
* return of sensation
* urine output
