Dysfunctional Labor (Dystocia) Flashcards
Dystocia: overview
Long, difficult, or abnormal labor
- most common indication for c-birth
- five factors affect labor
The powers
The passage
The passenger
Maternal position
Psychologic responses
Abnormal uterine activity: hypertonic uterine dysfunction
- therapeutic rest
Hypertonic uterine dysfunction - frequent and painful contractions that are ineffective in causing cervical dilation or effacement. Force of contractions are in the midsection of the uterus rather than in the fundus, the uterus is unable to apply downward pressure to push the presenting part against the cervix. women are exhausted, and complain of loss of control
Therapeutic rest: warm bath, shower, narcotic to ensure rest
Abnormal uterine activity - hypotonic uterine dysfunction
Initially makes normal progress into the active phase of first-stage labor but then the contractions become weak and inefficient or stop altogether
Treatment: ambulation, hydrotherapy, ROM, nipple stimulation, oxytocin
Secondary powers problems
Problems with bearing-down efforts: due to large amounts of analgesic. sleepy and doesn’t have the energy
Abnormal labor patterns
- Updated, evidence-based awareness of “normal” labor
- individualized to each woman. only guidelines
Precipitous labor
- labor that lasts less than 3 hours from the onset of contractions to the time of birth
Complications for mother: uterine rupture lacerations of birth canal, postpartum hemorrhage
complications for fetus: should dystocia, hypoxia, even intracranial trauma
Fetal Causes of Dystocia
- anomalies
- cephalopelvic disproportion (CPD), also called fetopelvic disproportion (FPD)
- Malposition (OP-Position) - face to pubis (longer turning must take place)
- Malpresentation (breech)
- multifetal pregnancy
Fetal Causes of Dystocia
- anomalies
- cephalopelvic disproportion (CPD), also called fetopelvic disproportion (FPD)
- Malposition (OP-Position) - face to pubis (longer turning must take place)
- Malpresentation (breech)
- multifetal pregnancy
Alterations in pelvic structure
Pelvic dystocia: contractures of pelvic diameters that reduce the capacity of the bony pelvis, inlet, midpelvis, or outlet
Soft-tissue dystocia: results from obstruction of the birth passage by an anatomic abnormality other than that of bony pelvis
Position of the woman causing dystocia
maternal position alters relationship between uterine contractions, fetus, and mother’s pelvis
Psychologic responses
- hormones and neurotransmitters released in response to stress can cause dystocia
- sources of stress and anxiety vary
Obstetric Procedures: induction of labor
- the chemical or mechanical initiation of uterine contraction before their spontaneous onset for the purpose of bringing about birth
- labor may be induced either electively or for indicated reasons
Elective induction of labor
- labor is initiated without a medical indication
- many are for the convenience of the woman or her primary health care provider
- risks: increased rates of c/s, increased neonatal morbidity, increased cost
- elective induction of labor should not be initiated until the woman reaches 39 completed weeks of gestation
High priority for induction
PET (preeclampsia toxemia): high BP, edema, proteinuria that can lead to seizures.
- other disease processes, when the mother has stable antepartum hemorrhage, if baby is having difficulties, term pregnancy but the membranes ruptures.
- IUGR, oligohydramnios, PROM, post-term, GDM (more than 38 wks), uncomplicated twins post 38 wks, LGA baby
Bishop’s Score
A rating system used to evaluate inducibility or cervical ripeness
- dilation
- effacement
- station
- cervical consistency
- cervical position
Cervical ripening methods
- chemical agents: prostaglandings to ripen (soften) the cervix. cervical suppositories
- mechanical and physical methods (catheter inserted through the intracervical canal and put pressure and stretching on the lower uterine segment and the cervix. do very slowly
- alternative methods: sex, nipple stimulation, ambulating
Amniotomy
induction method
- rupture of the membrane
Oxytocin
- hormone normally produced by the posterior pituitary gland, which stimulates uterine contractions and aids in milk let-down
- synthetic oxytocin (Pitocin) may be used either to induce labor or to augment labor that is progressing slowly because of inadequate uterine contractions
Augmentation of Labor
- stimulation of uterine contractions after labor has started spontaneously and progress is unsatisfactory
- common augmentation methods include oxytocin infusion and amniotomy
- active management: FHR, inform woman re procedure, monitor uterine contraction patterns, blood pressure, respiration, intake and output, observe for N&V, headache, hypotension
Operative Vaginal Birth
- operative vaginal births are performed using either forceps or vacuum extractor
- forceps-assisted birth
instrument to help guide the baby NOT pull it out - help the head to go more into flexion and guide them out
- cervix must be completely dilated and effaced
- can do episiotomy prophylactic to make more space. forceps used prophylactic of protect the soft head of preme
- usually the head is crowning and then you use forceps
- work with a contraction
- ## indications: prolonged pushing stage (>2 hr), abnormal HR after contraction
C-Section Birth Overview
- birth of a fetus through a transabdominal incision of the uterus to preserve the well-being of the mother and her fetus
- cesarean birth rate in the US has been over 32% since the early 2000s
- VBAC = vaginal birth after cesarean
- TOLAC = trial of labor after cesarean
Complications and risks C/S
- complications and risks (she had an operation, now has a baby, hormones returning to normal, feeding, infection, uterine rupture)
- anesthesia
- prenatal preparation
- preoperative care
Immediate postoperative care
routine, pain, breastfeeding
- postpartum care
- nursing interventions
- trial of labor
- vaginal birth after cesarean
Trial of labor
observing of woman in labor for a reasonable length of time (4-6 hours) to assess the safety of vaginal birth. CPD, presentation or position, mostly VBAC
Post anesthesia Recovery
The woman who has given birth by cesarean or has received regional anesthesia for a vaginal birth requires special attention during the recovery period
- post anesthesia recovery (PACU)
Obstetric Emergencies: Meconium-stained amniotic flulid
- indicates fetus has passed stool prior to birth
- dark green
- possible causes: normal physiologic function of maturity, breech presentation, hypoxia-induced peristalsis, umbilical cord compression
Obstetric Emergencies: Shoulder dystocia
- head is born, but anterior shoulder cannot pass under pubic arch
- newborn more likely to experience birth injuries related to asphyxia, brachial plexus damage, and fracture
- mother’s primary risk stems from excessive blood loss from uterine atony or rupture, lacerations, extension of episiotomy, or endometritis
Obstetric Emergencies: prolapsed umbilical cord
Occurs when cord lies below the presenting part of the fetus
Contributing factors include: long cord (longer than 100 cm), malpresentation (breech), transverse lie, unengaged presenting part
- use fingers to keep cord off the bony pelvis or the babies head
- do a c/s immediately
Obstetric Emergencies: Rupture of the uterus
- rare, serious obstetric injury
- most frequent causes of uterine rupture during: separation of scar of a previous classic c/s
- uterine trauma (accidents, surgery)
- congenital uterine anomaly
Key Points
- the onset of labor may be difficult to determine for both nulliparous and multiparous women
- the familiar environment of home is often the ideal place for a woman during the latent phase of the first stage of labour
- the nurse assumes much of the responsibility for assessing the progress of labor and keeping the nurse- midwife/physician informed of progress and deviations from expected findings
- the fetal heart rate and pattern reveal the fetal response to the stress of the labor process
- assessing the labouring woman’s urinary output and bladder is critical to ensure her progress and to prevent bladder injury
- the progress of labor is enhanced when a woman changes her position frequently during the first stage of labour
- the cultural beliefs and practices of a woman and her significant others, including her partner, can have a profound influence on their approach to labour and birth
- siblings present for labour and birth need preparation and support for the event
- women with a history of sexual abuse often experience profound stress and anxiety during childbirth
