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Obstetrics > High Risk Labor and Birth > Flashcards

High Risk Labor and Birth Flashcards

1
Q

What are two cause dystocia?

A
  1. Lack of progressive cervical dilation.
  2. Lack of descent of the fetal head.
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2
Q

Define

Hypertonic dystocia

A

Contractions are frequent and painful, but ineffective in promoting dilation and effacement.

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3
Q

Define

Hypotonic dystocia

A

Decreased frequency, strength, and duration of contractions causing ineffective cervical change (dilation, effacement).

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4
Q

Which pregnant women are most at risk for hypertonic contractions?
Which phase of labor?

A

Nulligravida in the early phase of labor

A person who has never been pregnant or given birth.

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5
Q

Which pregnant women are most at risk for hypotonic contractions?
Which phase of labor?

A

Multigravida in the active phase of labor

Multiple pregnancies

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6
Q

What is second-stage arrest?

A

Inability for the baby to fully descend into the pelvis after certain period of time has passed.

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7
Q

What effects does hypertonic contractions have on the fetal heart rate?

A

Potential for category II or III FHR.

possibly leading to lack of oxygenation (hypoxia).

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8
Q

What maternal complications may occur due to precipitous labor?

A

Hemorrhage and lacerations

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9
Q

What should the nurse do during precipitous labor?

A

Stay in the room since birth may occur rapdily.

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10
Q

Nursing Intervention (5)

Hypertonic contractions

A
  1. Promote relaxation and rest.
  2. Stopping pitocin
  3. Tocolytics
  4. Pain med (morphine ↓ labor contractions)
  5. IV administration (possible dehydration)

after sleep possible for woman to return to normal labor pattern.

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11
Q

Extreme fear may cause what type of dystocia?

A

Hypotonic contractions

catecholamine release may interfere w/ contractility. Provide support.

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12
Q

What are the fetal risks for precipitous labor?

A

Fetal risk of hypoxia and CNS depression

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13
Q

What is suspected to be occurring?

  1. Hypertonic contractions occuring every 2 mins
  2. Cat II or III FHR
  3. Rapid cervical dilation
A

precipitous labor

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14
Q

Fetal macrosomia parameter

A

> 9 lbs or 4500 g

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15
Q

Malpresentation such as brow, breech, or face is an example of what type of dystocia?

A

Fetal dystocia

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16
Q

What is suspected to be occurring?

Delayed descent of fetal head

A

Pelvis dystocia

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17
Q

What are the three induction interventions?

A
  1. Cervical ripening (balloon, prostaglandins)
  2. Oxytocin (Pitocin titration)
  3. Aminotomy (AROM)

artifical rupture of membranes

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18
Q

What is the requirement of induction of labor?

A

Must be medically necessary

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19
Q

What is the most important predictor of sucessful labor induction?

A

cervical status

20
Q

A Bishop score of < 6 puts the patient at risk for (?) if labor is induced.

A

cesarean delivery

21
Q

What is a favorable Bishop score for induction?

A

≥ 6

6 or more, 8 being very favorable

22
Q

What are the 5 cervical status that effect Bishop scores?

A
  1. Position
  2. Consistency (firm, medium, soft)
  3. Effacement (%)
  4. Dilation (cm)
  5. Station
23
Q

When a Bishop score is unfavorable cervical ripening may be considered by what methods?

normal process of softening and opening the cervix before labor starts

A
  1. Mechanical (balloon)
  2. Pharmalogical (prostaglandins)
24
Q

What is Pitocin?
What are its effects?
How is it adminstered?

A
  1. Analog of Oxytocin
  2. Induce contractions and decrease risk of PPH in PP
  3. IV
25
Q

What is the difference b/w prostaglandins (cervidil/misoprostol) and oxytocin (Pitocin)?

A

Prostaglandins are used to induce labor by softening the cervix, but they may also cause contractions.
Oxytocin is used to augment labor during vaginal delivery by causing contractions.

26
Q

What are the operative vaginal delivery methods?

A

Vaginal birth assisted by either:
1. vacuum extraction
2. Forceps

27
Q

What are the advantages of vacuum over forceps delivery?

(4)

A
  1. Easier application
  2. Less anesthesia
  3. Less material soft tissue damage (pelvis)
  4. Fewer fetal injuries
28
Q

Cup detachment during vacuum delivery is a warning sign of what?

A

too much pressure or ineffective force is being exerted on the fetal head.

29
Q

What should the nurse expect after three failed attempts of vacuum delivery?

A

cesarean birth

30
Q

What are the fetal risks of vacuum delivery?

(3)

A
  1. Cephalohematoma (15%) increases risk of jaundice
  2. Intrancranial and/or retinal hemorrhage
  3. Scalp lacerations or bruising (10%)
31
Q

When/why are operative vaginal delivery methods are used?

A

To shorten second stage labor or due to prolonged second stage labor.

32
Q

What is the first sign of shoulder dystocia?

A

The first sign is a retraction of the fetal head against the maternal perineum after delivery of the head, sometimes referred to as turtle sign.

33
Q

What is the first intervetion if shoulder dystocia has occurred?

A

McRoberts maneuver

34
Q

What pressure should be applied during McRoberts maneuver?

|What pressure should be avoided?

A

Suprapubic pressure

Avoid fundal pressure

35
Q

What would the nurse anticipate next?

If both McRoberts maneuver and suprapubic pressure has been unsuccessful

A

The Woods corkscrew maneuver

36
Q

Nursing actions

Hypotonic Contractions (3)

A
  1. Ambulate and change posiitions
  2. Augment labor w/ oxytocin as per protocol
  3. Hydrate w/ IV or Po as per order
37
Q

First Stage Arrest

A

Not reaching full dilation after assessing for adequate contractions

38
Q

What are different malpresentation of the fetus?

5

A
  1. Occiput posterior
  2. Face
  3. Brow
  4. Shoulder
  5. Breech (Frank, Complete, Footling)
39
Q

When is augmentation indicated?

A

Frequency of contraction is < 3 contractions per 10 minutes
and/or
intensity of contraction is less than 25 mmHg above baseline

40
Q

What are the contraindications to augmentation?

(5)

A
  1. Prior uterine scarring
  2. Placenta abnormalities
  3. Active genital herpes
  4. Pelvic structural deformities
  5. Invasive cervical cancer

similar to induction of labor

41
Q

Maternal Risks for shoulder dystocia

(4)

A
  1. Lacerations (additionally: sphincter, pelvis injury, peripheral neuropathy)
  2. Postpartum Hemorrhage
  3. Infection
  4. Bladder injury
42
Q

Fetal risks from shoulder dystocia (3)

A
  1. Compression of fetal neck (hypoxia)
  2. Brachia plexus injuries (nerve damage)
  3. fractures of clavicle and humerus.
43
Q

What is umbilical cord prolapse?

A

occurs when the cord drops through the open cervix into the vagina before your baby moves into the birth canal.

44
Q

What is disseminated intravascular coagulation?

A

A syndrome that occurs when the body is breaking down blood clots faster than it can form a clot.
Can lead to maternal death

45
Q

Define

Effacement

A

Effacement is the thinning and shortening of the cervix.

Obstetrics (9 decks)

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