Exam 2 - Labor Variations Flashcards
process that prepares the cervix for labor induction
cervical ripening
procedure that stimulates uterine contractions of labor
labor induction
stimulates uterine contractions after labor has already started
augmentation
artificial initiation of labor before spontaneous onset
induction of labor (IOL)
maternal indications of IOL include…
(1) PROM
(2) HTN disorders
(3) IUFD
(4) maternal diabetes
(5) post-term pregnancy
(6) elective
fetal indications of IOL include
(1) fetal growth restriction
(2) oligohydramnios
(3) chorioamnionitis
(4) non-reassuring FHR tracings
complete placenta previa, non-cephalic presentation, prior uterine rupture, and active genital herpes are what?
contraindications for IOL
if we can’t do IOL, we ___
do a c-section
to start an induction we do a ____
vaginal exam
bishop score of ___ or less means you are eligible for cervical ripening
6
the two main methods of cervical ripening are
mechanical and pharmacologic
___ is the mechanical method of cervical ripening
intracervical balloon
the benefit of an intracervical balloon is
it is safe for those with previous c-section
intracervical balloon can ____ when inserted
rupture the membranes and displace the fetal head
____ are the pharmacologic method of cervical ripening
prostaglandins
the prostaglandins used for cervical ripening are
misoprostol; dinoprostone (cytotex, cervidil)
pharmacologic cervical ripening is contraindicated in ____
those with previous C-section or uterine surgery
____ is a main risk of pharmacologic cervical ripening
tachysystole
prostaglandins are given ____ (route)
vaginally
What are the main nursing interventions for tachysystole?
(1) reposition
(2) stop pitocin and/or cervadil (miso)
(3) fluid bolus
the most common methods of IOL and augmentation are
(1) IV pitocin
(2) artificial rupture of membranes (AROM)
___ is the synthetic version of oxytocin
pitocin
the 3 main risks of pitocin are
(1) tachysystole
(2) uterine rupture
(3) uterine atony and PPH
why do you hang the IV pitocin as close to the venipuncture site as possible?
it limits the amount of drug that is infused after stopping it
how do you administer IV pitocin?
start at a low dose and increase every 20-30 minutes until regular uterine contractions
___ is a high-risk med
pitocin
monitor what q30 minutes when giving pitocin?
maternal BP and HR
continuous fetal monitoring should be on when
giving pitocin
if you see non-reassuring FHR while giving pitocin, what can you do?
(1) reduce or stop infusion
(2) increase rate of primary IV line
(3) move pt to side-lying position
(4) monitor FHR and contractions
(5) administer terbutaline
2 reasons for AROM are
labor augmentation and induction
risks of AROM are
cord prolapse and chorioamnionitis
amnihook used by provider to perforate the amniotic sac
AROM
what should you obtain before the AROM procedure?
baseline FHR tracing
what should you assess for after AROM?
signs of infection
what are the two types of operative vaginal delivery?
vacuum and forceps
the main purpose of operative vaginal delivery is…
to shorten the 2nd stage with indicated reason
name at least 3 indications for operative vaginal delivery
(1) exhaustion
(2) cardiac or pulmonary disease
(3) intrapartum infection
(4) fetal cord compression
(5) premature separation of placenta
(6) non-reassuring FHR pattern
maternal risks of operative vaginal delivery are
(1) laceration
(2) hematoma
(3) episiotomy
fetal risks of operative vaginal delivery are
(1) ecchymoses
(2) facial and scalp lacerations or abrasions
(3) facial nerve injury
(4) cephalohematoma
(5) intracranial hemorrhage
make sure pt’s bladder is empty before ____
operative vaginal delivery
3 things to assess in the newborn after operative vaginal delivery are
(1) skin breaks
(2) facial asymmetry
(3) neuro abnormalities
(4) scalp edema
TOLAC stands for
trial of labor after cesarean
VBAC stands for
vaginal birth after cesarean
what are contraindicated in TOLAC?
prostaglandins
benefits of TOLAC - name at least 3
(1) achieved VBAC
(2) avoid surgery
(3) lower rates of hemorrhage, infection, TE
(4) shorter recovery
unsuccessful TOLAC ending in C-section is ____ than elective repeat
worse
the 2 major indications for cesarean delivery are…
(1) labor dystocia
(2) abnormal / indeterminate FHR tracing
name at least 3 other indications of C-section
(1) fetal malpresentation
(2) suspected macrosomia
(3) active genital herpes
(4) cord prolapse
(5) placental abnormalities
name at least 3 risks of cesarean birth
(1) major hemorrhage
(2) uterine rupture
(3) anesthetic complications
(4) shock
(5) cardiac arrest
(6) infection
(7) wound disruption
(8) injury to newborn
how long do you need to be NPO before c-section?
8 hours
the typical pre-op antibiotic before c-section is ____
Ancef - IV push
____ or ___ can be used to manage gastric secretions during cesarean birth
Bicitra, pepcid
