Intrapartum Concerns Flashcards
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CTX > 2 min, 5 or more/10 min, frequency every 1 minute
Uterine hyperstimulation
Any deviation from normal progress of labor
Dystocia
Slow progress in the active phase
Hypertonic uterine motility
Seen in most android pelvis
Occiput posterior
Where is FHT located in posterior occiput?
Located in flank and is slower
How do you evaluate for occiput posterior position?
Leopold’s maneuvers, abdominal contour, suture lines
Occiput posterior effects on contractions
Diminish in frequency and intensity
Where is labor felt in occiput posterior?
Back
What happens to dilation and descent with occiput posterior?
Dilation slows and descent is delayed
What is prolonged with occiput posterior?
Active labor and second stage
What can happen to the fetus if they are occiput posterior?
Asphyxia
How do you manage occiput posterior?
Manual rotation, forceps delivery, forceps rotation, may extend episiotomy
How often does breech presentation occur?
3-4%
When is breech most common?
Preterm deliveries
What risks are associated with breech presentation?
Prolapsed cord, fetal asphyxia, intercranial hemorrhage, birth injuries
What is preferred for delivery of a breech?
C-section
Helps prevent entrapment of fetal head in a breech
Wigand Martin maneuver
When can you do external version?
36-37 weeks
What do you use to confirm external version?
Ultrasound
What is the success rate with external version?
58%
Any head to body delivery time greater than 60 seconds
Shoulder dystocia
Risk factors for shoulder dystocia
A- advanced age D- diabetes O- obese P- postterm or previously large baby E- excessive weight gain in pregnancy
Physician tries to go in vaginally and rotate shoulder
Wood’s corkscrew
Lift the knees toward the head and apply suprapubic pressure for shoulder dystocia
McRobert’s
Get on all fours to deliver with shoulder dystocia
Gaskin maneuver
Replace the head in the pelvis and deliver via c-section
Zanvanelli maneuver
When do you use Zanvanelli maneuver?
After all other efforts are attempted
What does the Zanvanelli move require?
Uterine relaxation (terbutaline) and general anesthesia
What are cues to shoulder dystocia?
Long transition and long second stage
What do you need to document during the labor?
Delivery of the head
What management does the nurse do with shoulder dystocia?
Maneuver, postpartum assessment, and notify nursery
Damaged or torn nerve due to extreme traction on the infants head
Erb’s palsy
Cord palpated through intact membranes ahead of the presenting part
Fundic cord prolapse
Cord not visible or palpable and cord lies beside the presenting part
Occult cord prolapse
Cord is seen or palpated ahead of the presenting part
Complete cord prolapse
What are symptoms of cord prolapse?
Severe repetitive variables, bradycardia after SROM or AROM, and prolonged deceleration
What can you do to manage cord prolapse?
Disengage presenting part, use gravity, fill bladder, tocolytic, IV fluids, oxygen, anticipate c-section
What should you never do with a cord prolapse?
Attempt to push it in and do not cover it with anything wet
