High Risk Intrapartum Flashcards
3 Dysfunctional powers of labor
Hypertonic, hypotonic, precipitous
What can dysfunctional labor be caused by?
powers (uterine contractions), passenger (fetus), passage (pelvis)
What can dystocia be caused by?
any of the powers of labor
What are the 4 problems with the powers that can occur?
frequency, duration, intensity, resting tone of the uterus
When does hypertonic labor typically occur?
latent phase of labor
What are the characteristics of hypertonic labor?
resting tone of myometrium increases, contractions are more frequent but intensity decreases, painful but ineffective contractions
What may hypertonic labor cause?
maternal exhaustion, fetal intolerance of labor which may lead to fetal hypoxia/asphyxia
What are the nursing priorities for a laboring mother experiencing hypertonic labor?
promote sleep/rest, promote relaxation, PO/IV hydration, assess FHR, UCs, and vaginal exam, administer pain meds as ordered
When does hypotonic labor typically occur?
active phase of labor
What are the characteristics of hypotonic labor?
Less than 2-3 UCs in 10 minutes, insufficient UC pressure, contractions are not strong enough to dilate or efface cervix
What are the risks of hypotonic labor?
Maternal exhaustion/infection, fetal intolerance of labor (resulting in asphyxia, decrease in variability, or late decelerations)
What are the nursing priorities for a mother who is experiencing hypotonic labor?
administer pitocin, encourage voiding/emptying bladder, prevent/treat dehydration (PO/IV fluids), encourage position changes, evaluate FHR, UCs, limit vaginal exams if ROM, provide emotional support/info, consider a sedative to promote rest and relaxation
What do “arrest” disorders occur?
in stage 1 or stage 2 of labor (>6cm dilated, >4 hrs of adequate cxs/6 hours inadequate cxs)
What are 2 ways to describe “arrest” disorders?
failure to progress, failure to descend
How long does precipitous labor last?
<3 hours
What are the characteristics of precipitous labor/birth?
UCs occur more frequently, longer duration, and more intense
What are risk factors of precipitous labor?
grand multip, history of precip
What is the delivery like for precipitous labor?
Delivery is sudden, unexpected, and often unattended (nurse delivery)
What are the risks of precipitous labor?
PPH, lacerations, placental abruption, fetal hypoxia/CNS depression
Nursing priorities for precipitous labor
monitor closely, comfort measures, assess FHR, UCs Q15min, monitor cervical change, perform SVE if patient feels urge to push, bear down, prep for delivery
Which fetal presentations can cause fetal dystocia?
Persistent occipital posterior, brow, face, breech, shoulder (transverse lie)
What are 6 reasons that fetal dystocia may be present?
mal-presentation, excessive size, multiples, fetal anomalies, cephalopelvic disproportion (CPD), failure to descend
What is the turtle sign? What is this indicative of?
retraction of the fetal head against the perineum. This indicates shoulder dystocia
What gets compressed when there is shoulder dystocia?
neck and cord, which causes respiratory exchange to cease
What are some things that should be done when shoulder dystocia is present?
suprapubic pressure, midline episiotomy, McRoberts maneuver, empty bladder, request additional staff, anticipate neonatal resuscitation, explain what is going on to the patient and the family
How is the McRoberts maneuver performed?
Legs flexed onto abdomen and apply suprapubic pressure to the fetal anterior shoulder
What are neonatal complications that are associated with shoulder dystocia?
brachial plexus injury, broken clavicle, neurological injury, asphyxia, death
What happens with pelvic dystocia?
One or more of the three planes of the pelvis (inlet, midpelvis, outlet) narrows
What are two reasons that CPD may be present?
Fetus is larger than pelvis diameter, abnormal position/presentation of the fetus
What are the nursing priorities for CPD?
position changes, support/encouragement, fetal monitoring, teach and provide comfort measures, prep for a C-section
How often should NSTs be performed after 42 weeks gestation?
2-3 times a week
When is induction considered for a fetus that is post date?
at 41 weeks or greater
What happens during an umbilical cord prolapse?
umbilical cord precedes the presenting part
Why is an umbilical cord prolapse a cause for concern for the fetus?
it will compress the cord, decrease fetal blood flow, FHR drops and does not recover
What are risk factors for an umbilical cord prolapse?
malpresentation, presenting part not engaged, preterm/small infants, multiple gestation, polyhydramnios
What is the nurse’s first priority when there is an umbilical cord prolapse?
Relieve pressure on cord ASAP
What are the nursing priorities when there is an umbilical cord prolapse?
lift presenting part off cord with gloved hand, call for help–> notify provider, administer oxygen and IV bolus, position changes (knee to chest), DC oxytocin, administer a tocolytic, prep for a vaginal/instrumental delivery, prep for c-section
What is another name for amniotic fluid embolism?
anaphylactoid syndrome
What happens during an amniotic fluid embolism?
amniotic fluid enters into maternal circulation and a massive immune response to fluid/particulate occurs
What are the risk factors for an amniotic fluid embolism?
precipitous delivery, AMA, placenta previa or abruption, preeclampsia, instrumental/c-section delivery, cervical lacerations, grand multips
What is anaphylactoid syndrome considered?
an EMERGENCY
What are some indications of amniotic fluid embolism?
acute dyspnea, hypoxia, cyanosis, hypotension, cardiac and respiratory arrest, uterine atony, massive hemorrhage, disseminated intravascular coagulation
What should be done if an amniotic fluid embolism is suspected?
call code, initiate CPR, notify provider, administer oxygen, ensure IV access, administer RBCs/platelets as ordered, provide emotional support, anticipate transfer to the ICU
What are risk factors for disseminated intravascular coagulation?
AFE, placental abruption, preeclampsia, HELLP syndrome, sepsis, PPH
