Exam 3: At-Risk Labor and Birth Flashcards
Labor Dystocia
Long, difficult or abnormal labor occurs in approx. 10% of births
Powers: Dysfunctional labor patterns
Passage: Pelvic dystocia or soft tissue dystocia
Passenger: Macrosomia, malposition, malpresentation, multifetal pregnancies
Indications of labor induction
Preeclampsia
Diabetes
Infection
Post term pregnancy
PROM
Fetal death
Contraindications of labor induction
Complete placenta previa
Transverse fetal lie
Umbilical cord prolapse
Previous trans-fundal surgery
Active vaginal herpes infection
Bishop Score
Tool used to identify those most likely to have a successful induction (ideal score: 8 or above)
Cervical ripening
Process of softening and thinning the cervix through the use of medication or by mechanical means
Cervical ripening medications
Cytotec
Prepidil/Cervidil
Mechanical cervical ripening
Foley catheter
Laminaria
Labor induction
Artificial labor initiation by mechanical (stripping membranes, amniotomy) or medication (Pitocin)
Dinoprostone
Cervadil, Prepidil
Softens and dilates the cervix, FDA approved for cervical ripening
Side effects: n/v/d, headache
Adverse effects: tachysystole (a lot of contractions)
Cesarean birth indications
Previous classical cesarean
Placental abnormality
Gestational hypertension
Diabetes
Active herpes
Positive HIV status
Prolapsed cord
Dystocia
Fetal distress
Some congenital anomalies
What incision has a higher chance of uterine rupture?
Classical
Maternal risks of cesarean birth
Infection
Hemorrhage
Aspiration
Pulmonary embolism
Urinary tract trauma
Thrombophlebitis
Paralytic ileus
Atelectasis
Fetal risks of cesarean birth
Fetal injury
Transient tachypnea
VBAC candidates
One or two previous low transverse uterine incision cesarean births
Absence of other uterine scars
VBAC management during labor
Availability to perform emergency cesarean
Continuous fetal monitoring
Cervical ripening medications are contraindicated
Tachysystole
What type of twins are more prone to complications?
Monozygotic
Prolapsed umbilical cord
Umbilical cord slips between presenting part and cervix
May or may not be visible
Treatment of prolapsed umbilical cord
Priority: Relieve pressure on cord
Reposition laboring person
Knee-chest position
Manually lift presenting part off of cord
Delivery by cesarean section unless it’s quicker to deliver vaginally
Shoulder dystocia interventions
McRobert’s maneuver: Put head of bed down so PT is flat, hyperflex knees back toward abdomen
Suprapubic pressure: Steady, firm pressure right on suprapubic bone to dislodge anterior shoulder
Uterine inversion
Ensure you are supporting the lower uterine segment when doing fundal checks
Uterus pushed out of vagina
Sometimes happens with short cord when trying to deliver placenta
Emergency - Hemorrhage
Anaphylactoid Syndrome of Pregnancy (amniotic fluid embolism)
Allergic reaction/inflammatory response to circulatory products which find an entry route to maternal circulatory system
Very high mortality rate
Profound hypotension, unable to get pulse, multisystem collapse
Uterine rupture
Classical cesarean section
Loss of fetal station
Fetal bradycardia
Extreme abdominal pain in PT