Dystocia

Question 1

Dystocia Define

Answer 1

long, difficult abnormal labor

Question 2

causes of dystocia

Answer 2

5 P’s

• Powers
• Passage through pelvis
• Passenger (newborn)
• Positioning
• Psychological stress

Question 3

powers of labor (3)

Answer 3

Primary
Secondary
Precipitous

Question 4

Primary Power

Answer 4

abnormal contractions

Uterine dysfunction; does not completely relax

Question 5

Secondary Power

Answer 5

Abnormal fetal descent; more common one

Question 6

Precipitous Power

Answer 6

Labor that is less than 3 hours

hypertonic contractions

Question 7

Fetal Station

Answer 7

Station 0 is at ischial spine, just ready to surface

Question 8

Primary Power Tx

Answer 8

analgesics; help the pt relax

Question 9

Secondary Power Tx

Answer 9

ultrasound to determine the position of fetus

Question 10

Pelvic Dystocia causes

Answer 10

• congenital abnormalities
• maternal malnutrition
• neoplasms
• spinal disorders

Question 11

Soft Tissue Dystocia (tumor of placenta previa)

Answer 11

obstruction in birth passage

Question 12

Fetus Anomalies

Answer 12

• tumors
• neural tube defects
• hydrocephalus

Question 13

Malposition

Answer 13

25% in ROP or LOP

Question 14

Most Common Malpresentation

Answer 14

Breech is most common

But also: frank breech, and complete breech

Question 15

External Version of Uterus

Answer 15

moving the fetus from breech to head down (vertex) from the outside.
**give a tocolytic if needed to relax the uterus

Question 16

Most Favorable Position for Birth

Answer 16

upright and squatting is most favorable

*lithotomy– will need to use a vacuum or forceps

Question 17

Oxytocin (Pitocin)

Answer 17

Used to induce labor, chemically

Question 18

Prolonged Labor (time)

Answer 18

24+ hours

Question 19

risks of prolonged labor

Answer 19

• fatigue
• pain
• fetus hypoxia

Question 20

Nursing Diagnosis for Dystocia

Answer 20

watch for pain

potential for maternal injury

Question 21

Goals for Dystocia Patient

Answer 21

to educate patient regarding dysfunctional labor
prevent complications
provide support

Question 22

Tx for Dysctocia

Answer 22

Assist with position, version, augmentation, and cervical ripening
provide support

Question 23

Cervical Ripening & Stimulation

Answer 23

Prostoglandin E: softens and thins out the cervix
Misoprostol
(give only 1/2 of the tablet)

Question 24

Oxytocin

Answer 24

stimulates uterine contractions

Given IV

Question 25

Oxytocin Complications

Answer 25

• water intoxication
• tetanic contractions
• premature seperation of placenta
• uterine rupture

Question 26

Emergency: prolapsed cord

Answer 26

when cord lies below the presenting part of the uterus

Question 27

Release of Cord Compression

Answer 27

manually moving the cord around

Question 28

Forceps Delivery Risks (mother)

Answer 28

• lacerations
• hematoma
• urinary incontinance

Question 29

Forceps Delivery Risks (infant)

Answer 29

• facial bruising
• retinal hemorrhage
• corneal abrasion
• other ocular damage

Question 30

When to use a vacuum

Answer 30

• second stage is too prolonged
• non-reassuring fetal HR on strip
• eases on mother pushing

Question 31

How often are vacuums used in birth

Answer 31

68% of all operative births

*created a pressure of about 50-60mmHg

Question 32

Vacuum Fetal Complications

Answer 32

• bruising
• cephalohematoma
• Erb’s Paralysis
• VI and VII nerve damage
• retianl hemorrhage

Question 33

Cephalohematoma

Answer 33

bump of blood on infants head crated from using a vacuum for delivery, limited to suture lines