High Risk Labor/Birth Flashcards
dystocia
dysfunctional/difficult labor and common reason for C-section
most concerning side effect of dystocia is
tachysystole
associated factors of dystocia
weak contractions, fetal presentation/position/development, not good pelvis
uterine dystocia
weak or uncoordinated contractions
hypotonic uterine dystocia
low tone, no dilation, long labor, no fetal perfusion, exhaustion/infection, fetal asphyxia,
risk factor of hypotonic dystocia
multiparous women
management of hypotonic dystocia
oxytocin, amniotomy, c section
hypertonic dystocia
uncoordinated frequent contractions, painful, exhaustion
risk factor of hypertonic dystocia
nulliparous women
manage hypertonic dystocia
hydration, pain meds, monitor
nursing interventions for hypo dystocia
assess fetal/maternal status, admin oxytocin, minimize vag exams
nursing interventions for hyper dystocia
pain meds(morphine), epidural, relax, hydrate
long second stg of labor disorder is from
delayed pushing, epidural, BMI over 35, macrosomia, occiput posterior, high fetal station
risks of long second stg labor
mortality, fetal asphyxia, perineal trauma, no natural birth
manage long second stg labor
monitor, pitocin, vacuum/forceps, consider c-section
nursing actions of long second stg labor
coach pushing, open glottis pushing, pain relief, change positions, support
precipitous labor
less than 3 hr delivery w increased pain/anxiety
precipitous labor risk factors
grand multiparas, hx of precipitous
risks of precipitous labor
PPH, fetal hypoxia/CNS depression if mother given narcotics
nursing actions of precipitous labor
monitor FHR every 15 mins, assess cervix change, anticipate complications
fetal dystocia
fetus delaying delivery
causes of fetal dystocia
macrosomia, malpresentation, multifetal preg, fetal anomaly
risks of fetal dystocia
asphyxia, injuries, maternal lacerations, cephalopelvic disporportion
labor induction (medically only)
oxytocin, cervical ripening, strip membranes, amniotomy
induction of labor
start of contractions before spontaneous onset to cause birth
cervical ripening
softening cervix with cervidil/cytotec
mechanical methods of induction
balloon cath, dilators, amniotic membrane stripping
amniotomy
AROM w pitocin but presenting part must be at least -2 or below
oxytocin induction
when cervix is a bishop score of 8 or more
risks of oxytocin induction
tachysystole, category 2/3 FHR, failed induction, water intoxication
augmentation
stimulation of contraction when labor fails to progress
nursing actions of inducing labor
informed consent, auscultation, fetal monitoring, FHR, assess strength, duration and frequency, monitor dilation/descent, amniotic fluid
external cephalic version
change fetal position vertex and often give terbutaline to relax uterus
contraindications of external cephalic version
placental abnl
risks of external cephalic version
severe variable decels
vacuum assisted delivery
easier to apply, less anesthesia, less tissue irritation, fewer injuries
effects of vacuum assisted
cephalic hematoma
forceps
vag lacerations, tissue/perineal damage, hemorrhage, hematomas, bladder trauma
effects of forceps
facial bruise, corneal abrasions, skull fracture, hemorrhage
trial of labor after c-section/vaginal birth after c-section
fewer risks for mother, fetal hypoxia, neuro issues, acidosis, seizures, cerebral palsy, death
post term preg risk to mom
dysfunctional labor, infection, PPH, poor blood flow to placenta
post term preg risk to fetus
Stillbirth, macrosomia, post maturity syndrome, oligo, meconium aspiration
meconium stained fluid
GI maturation/neural stimulation as a result from hypoxic stress that can easily be aspirated
meconium stained fluid maternal risk
difficult labor, perineal injuries, infection, PPH, anxiety
meconium stained fluid fetal risk
stillbirth, macrosomia, dysmaturity, oligo, aspiration/resp distress, placenta insufficiency
multiple gestation risks
PPH, preeclampsia, PTB, labor dystocia
manage multiple gestation
IV, positions, blood prn
intrauterine fetal demise
fetal death after 20 wks
risk factors of fetal demise
age, african, 1st time mom, obese, diabetes, hypertension, ART, smoking/alc, multi gestation, male fetus
intraamniotic infection (chorioamniotitis)
infection of fluid, lining, membrane, placenta
S/S of chorioamniotitis
fever, tachycardia, high WBC over 1500, discharge
nursing actions of chorioamniotitis
cultures, antibiotics, blood transfusion if loss of 500cc or more
pregestational complications
shoulder dystocia, macrosomia, high hemorrhage risk, delayed wound healing, DVT, infection
shoulder dystocia
shoulder coming out first
maternal risks of shoulder dystocia
perineal lacerations, bladder injury, hemorrhage, trauma
management of shoulder dystocia
dont want more than 5 mins btw head and body delivery
fetal risks of shoulder dystocia
asphyxia, neuro injury, intracranial pressure, death
umbilical cord prolapse
cord coming out first so nurse must stick fingers in to relieve pressure and give C-section
vasa previa
blood vessels run in front of cervix blocking exit and can pop causing blood loss
risk factors of vasa previa
low laying placenta, multiple gestation, IVF
manage vasa previa
odd FHR and bleeding indicate this
uterine rupture
separation of uterine muscle common from previous C-section
risks of uterine rupture
fetal shock/compromise, maternal shock/hemorrhage
amniotic fluid embolism/anaphylactic syndrome
amniotic fluid enters maternal circulation causing proinflammatory response, acute pulmonary hypertension and cardiovascular failure/arrest, DIC
risk factors of AFE
older, multi gestation, labor induction, vacuum/forceps, pre/eclampsia
DIC
Body breaking down blood clots faster than they can form them and deplete bodies clotting factors leading to hemorrhage and maternal death
DIC cause
placental abruption, amniotic fluid/anaphylactic syndrome, HELLP syndrome, precreta
DIC S/S
Low UO, cyanosis, LOC, chest pain
