Exam 4: Ch 32 Labor & Birth Complications Flashcards
Oxytocin (Pitocin)
Oxytocin: stimulates uterine contractions and aids in milk let down
Pitocin: synthetic form
Indication of Oxytocin
labor induction and augmentation and control postpartum bleeding
Dose of oxytocin
IV: secondary line
- 10 units in 1000 ml of fluid
- 20 units in 1000 ml of fluid
- 30 units in 500 ml of fluid
goal of oxytocin
produce uterine contractions:
- consistent achievement 200-220 MVUs or
- conssitent pattern of one contraction every 2-3 min, lasting 80-90 sec, strong to palpation
Maternal Adverse effect of oxytocin use
- uterine tachysystole
- plancental abruption
- uterine rupture
- unplanned cesarean birth caused by abnormal FHR and patterns
- postpartum hemmorage
- infection
- death from water intoxication
Fetal adverse effect to oxytocin
hypoxemia and acidosis
abnormal FHR
Signs of uterine tachysytole r/t oxytocin use
- more then 5 contractions in 10 min
- single contractions lasting >2 min
- contractions of normal duration occurring within 1 min of each other
Interventions with abnormal FHR during oxytocin
- discontinue oxytocin
- reposition mother
- admin bolus 500mL LR
- Consider giving 10L/min O2
- if nothing: 0.25 terbutaline following protocol
- Notify Dr
When to resume Oxytocin
less then 20 -30 min: resume at no more than half the previous rate
more than 30-40 min: resume at same rate
Mazzanti technique:
- want suprapubic pressure
- suprapubic pressure can be applied to the anterior shoulder in an attempt to push the shoulder under the synthesis pubis.
Rubin technique
➢ Pressure is applied oblique and posterior against the anterior shoulder to get shoulder to deliver
McRobert’s Maneuver
➢ Hyperextend her legs- take legs and bring them up to her head to open pelvis
➢ The womans legs are flexed apart, with her knees on her abdomen
Signs that indicate shoulder dystocia
o Slowing of the progress of the second stage of labor and formation of a caput succedaneum that increases in size
o The nurse should observe for the “turtle sign” which is retraction of the fetal head against the perineum immediately following its emergence (early sign)
o The most serious complication is brachial plexus (Erb palsy)
o The major maternal complications associated w/ shoulder dystocia are PP hemorrhage and rectal injury.
Signs of prolapsed cord
o Variable or prolonged decelerations during UC
o Woman reports feeling the cord after ROM
o Cord is seen or felt in or protruding from vagina
always do what to oxytocin
Discontinue it !
Precipitate labor
less than 3 hour labor
very fast
Precipitate birth
− Maternal risks: cervical, vaginal, or rectal laceration and hemorrhage
− Fetal risks: hypoxia, intracranial hemorrhage, or injury
− Nursing care:
• Sterile gloves and place hands on presenting part and guide and support baby and instruct mom to push with contractions
Uterine rupture
EMERGENCY
− During labor and birth the major risk factors for uterine rupture is a TOL for attempted VBAC
− Could occur with put pitocin induction and giving a lot of pitocin and not paying attention
s/s of uterine rupture
o (most common) abnormal (nonreasuring) FHR tracing, including bradiacardia, and absent or minimal variability
o Constant abdominal pain, uterine tenderness, change in uterine shape, and cessation of contractions
o May also show signs of hypovolemic shock caused by hemorrhage • Hypotension • Tachycardia • Pallor • Cool, clammy skin
TOLAC
o Bring on contractions and see how baby tolerates trial
- they will see if the baby engages into the pelvic inlet
VBAC
o Indications for primary cesarean birth, such as dystocia, breech presentation, or fetal distress, are often nonrecurring
o Must have an adequate pelvic size and uterine incision is a low transverse incision and baby in right position, presentation
o Problem for primary c-section was the baby was not tolerating labor- nothing to do with pelvic size
o Classic incision: not a candidate
Pelvic Dystocia
o Abnormal size of pelvis , contractures that reduce the diameters of boney pelvis, including the inlet, the midpelvis, the outlet, or a combination of any of these
Trial of Labor
o add pitocin and have contractions; see if labor will start and see if baby can move down pelvis
o observance of a woman and her fetus for a reasonable period (4-6 hrs) of spontaneous active labor to assess safety of vaginal birth for the mother and infant
o A woman who has had a previous cesarean birth w/ a low transverse uterine incision may be a candidate for a TOL.
o During TOL, the woman is evaluated for the occurrence of active labor, including adequate contractions, engagement and descent of the presenting part, and effacement and dilation of the cervix
o The nurse assess maternal V/S and FHR and pattern and is alert for signs of potential complication
Cephalopelvic Disproprotion
o presenting part of the baby in the inlet is disprortional; may not be able to engage into inlet or may get stuck in inlet pelvis
o is disproportion between the size of the fetus and the size of the mothers pelvis
o fetus cannot fit through the maternal pelvis to be born vaginally
o problem is malposition of the fetal presenting part rather than true CPD
oIf the maternal pelvis is too small, abnormally shaped, or deformed, CPD may be of maternal origin.
Mazzanti technique
suprapubic pressure applied to the anterior shoulder in an attempt to push the shoulder under the synthesis pubis
hand is at the body of pelvis
McRoberts maneuver
hyperextend her legs-take legs and bring them up to her head to open pelvis
Rubin technique
pressure applies oblique and posterior against the anterior shoulder to deliver shoulder
prolapse cord
with breech; the fetus is not engaged well
intervention: press the presenting part up to decrease the pressure from the vessels
modified sims or knee to chest position to take pressure off the umbilical cord
forceps may be used
Precipitate labor
less than 3 hours
Uterine rupture
emergency: s/s
- abnormal FHR tracing, bradycardia , absent or minimal
