Exam 4: Ch 32 Labor & Birth Complications

Question 1

Oxytocin (Pitocin)

Answer 1

Oxytocin: stimulates uterine contractions and aids in milk let down

Pitocin: synthetic form

Question 2

Indication of Oxytocin

Answer 2

labor induction and augmentation and control postpartum bleeding

Question 3

Dose of oxytocin

Answer 3

IV: secondary line

• 10 units in 1000 ml of fluid
• 20 units in 1000 ml of fluid
• 30 units in 500 ml of fluid

Question 4

goal of oxytocin

Answer 4

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

Question 5

Maternal Adverse effect of oxytocin use

Answer 5

• uterine tachysystole
• plancental abruption
• uterine rupture
• unplanned cesarean birth caused by abnormal FHR and patterns
• postpartum hemmorage
• infection
• death from water intoxication

Question 6

Fetal adverse effect to oxytocin

Answer 6

hypoxemia and acidosis

abnormal FHR

Question 7

Signs of uterine tachysytole r/t oxytocin use

Answer 7

• more then 5 contractions in 10 min
• single contractions lasting >2 min
• contractions of normal duration occurring within 1 min of each other

Question 8

Interventions with abnormal FHR during oxytocin

Answer 8

• discontinue oxytocin
• reposition mother
• admin bolus 500mL LR
• Consider giving 10L/min O2
• if nothing: 0.25 terbutaline following protocol
• Notify Dr

Question 9

When to resume Oxytocin

Answer 9

less then 20 -30 min: resume at no more than half the previous rate

more than 30-40 min: resume at same rate

Question 10

Mazzanti technique:

Answer 10

• want suprapubic pressure
• suprapubic pressure can be applied to the anterior shoulder in an attempt to push the shoulder under the synthesis pubis.

Question 11

Rubin technique

Answer 11

➢ Pressure is applied oblique and posterior against the anterior shoulder to get shoulder to deliver

Question 12

McRobert’s Maneuver

Answer 12

➢ 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

Question 13

Signs that indicate shoulder dystocia

Answer 13

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.

Question 14

Signs of prolapsed cord

Answer 14

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

Question 15

always do what to oxytocin

Answer 15

Discontinue it !

Question 16

Precipitate labor

Answer 16

less than 3 hour labor

very fast

Question 17

Precipitate birth

Answer 17

− 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

Question 18

Uterine rupture

Answer 18

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

Question 19

s/s of uterine rupture

Answer 19

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

Question 20

TOLAC

Answer 20

o Bring on contractions and see how baby tolerates trial

• they will see if the baby engages into the pelvic inlet

Question 21

VBAC

Answer 21

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

Question 22

Pelvic Dystocia

Answer 22

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

Question 23

Trial of Labor

Answer 23

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

Question 24

Cephalopelvic Disproprotion

Answer 24

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.

Question 25

Mazzanti technique

Answer 25

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

Question 26

McRoberts maneuver

Answer 26

hyperextend her legs-take legs and bring them up to her head to open pelvis

Question 27

Rubin technique

Answer 27

pressure applies oblique and posterior against the anterior shoulder to deliver shoulder

Question 28

prolapse cord

Answer 28

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

Question 29

Precipitate labor

Answer 29

less than 3 hours

Question 30

Uterine rupture

Answer 30

emergency: s/s

- abnormal FHR tracing, bradycardia , absent or minimal