L&B/2 Gestational Disorders & Disease Considerations in Labor

Question 1

Fetal Distress: Overview (4)

Answer 1

Fetal distress is present when:
◯ The FHR is below 110/min or above 160/min.
◯ The FHR shows decreased or no variability.
◯ There is fetal hyperactivity or no fetal activity.
◯ The fetal blood pH is less than 7.2.

Question 2

Fetal Distress: Risk Factors (3)

Answer 2

● Fetal anomalies
● Uterine anomalies
● Complications of labor and birth

Question 3

Fetal Distress:  Assessment
Objective Data (1)
Diagnostic Procedures (3)

Answer 3

● Objective Data
◯ Nonreassuring FHR pattern with decreased or no variability

◯ Diagnostic procedures
■ Monitor uterine contractions.
■ Monitor FHR.
■ Monitor findings of ultrasound and any other prescribed diagnostics.

Question 4

Fetal Distress: Collaborative/Nursing Care (6)

Answer 4

● Nursing Care
◯ Monitor maternal vital signs and FHR.
◯ Position the client in a left side-lying reclining position with legs elevated.
◯ Administer 8 to 10 L of oxygen via a face mask.
◯ Discontinue oxytocin (Pitocin) if being administered.
◯ Increase IV fluid rate to treat hypotension if indicated.
◯ Prepare the client for an emergency cesarean birth.

Question 5

Precipitate Labor:

What is it?

Answer 5

Precipitate labor is defined as labor that lasts 3 hr or less from the onset of contractions to the time of delivery.

Question 6

Precipitate Labor:
Risk Factors
Hypertonic Uterine Dysfunction (3)
Oxytocin (1)
Multiparous Client (1)

Answer 6

Hypertonic uterine dysfunction
■ Nonproductive, uncoordinated, painful, uterine contractions during labor that are too frequent and too long in duration and do not allow for relaxation of the uterine muscle between contractions (uterine tetany).
■ Hypertonic contractions do not contribute to the progression of labor (cervical effacement, dilation, and fetal descent).
■ Hypertonic contractions can result in uteroplacental insufficiency leading to fetal hypoxia.

Oxytocin (Pitocin) stimulation may be administered to augment or induce labor by increasing intensity and duration of contractions.
■ Oxytocin stimulation can lead to hypertonic uterine contractions.

Multiparous client
■ May move through the stages of labor more rapidly

Question 7

Precipitate Labor
Subjective Data (During labor) (2)
Objective Data (6)

Answer 7

Subjective Data (during labor)
◯ Low backache
◯ Abdominal pressure and cramping

● Objective Data
◯ Increased or bloody vaginal discharge
◯ Palpable uterine contractions
◯ Progress of cervical dilation and effacement
◯ Diarrhea
◯ Fetal presentation, station, and position
◯ Status of amniotic membranes (membranes can be intact or ruptured)

Question 8

Precipitate Labor

Physical Assessment Findings (Postbirth) (3)

Answer 8

Physical Assessment Findings (postbirth)
■ Assess maternal perineal area for signs of trauma or lacerations.
■ Assess the neonate’s color and for signs of hypoxia.
■ Assess for signs of trauma to presenting part of neonate, especially on cephalic presentation.

Question 9

Precipitate Labor:  Collaborative/Nursing Care
Pre delivery (6)

Answer 9

1) Do not leave the mother unattended.
2) Prepare for emergency delivery of the neonate.
3) Encourage the mother to pant with an open mouth between contractions to control the urge to push.
4) Encourage the client to maintain a side-lying position to optimize uteroplacental perfusion and fetal oxygenation.
5) Prepare for the rupturing of membranes upon crowning (fetal head visible at perineum) if not already ruptured.
6) Do not attempt to stop delivery.

Question 10

Precipitate Labor: Collaborative/Nursing Care
During deliver

1) Control the rapid delivery by applying light pressure to the perineal area and fetal head, gently pressing upward toward the vagina. What is the result?
2) Deliver the fetus between contractions assuring the cord…?
3) If the cord is around the fetal neck…?
4) If not possible to deal with the cord around neck…?
5) Suction mucus from…?
6) Next deliver which shoulder first?
7) After delivery assess for?

Answer 10

1) This will ease the rapid expulsion of the fetus and help to prevent cerebral damage to the newborn and perineal lacerations to the mother.
2) Deliver the fetus between contractions assuring the cord is not around the fetal neck.
3) attempt to gently slip it over the head.
4) Clamp the cord with two clamps and cut between the clamps.
5) The neonate’s mouth and nose with a bulb syringe when the head appears.

6a) The anterior shoulder located under the maternal symphysis pubis:
6b) next, the posterior shoulder
6c) then allow the rest of the fetal body to slip out.

7) Assess for complications of precipitate labor.

Question 11

Precipitate Labor: Collaborative/Nursing Care

Maternal Assessment post delivery (5)

Answer 11

Maternal
■ Cervical, vaginal, and/or perineal lacerations
■ Resultant tissue trauma secondary to rapid birth
■ Uterine rupture
■ Amniotic fluid embolism
■ Postpartum hemorrhage

Question 12

Precipitate Labor: Collaborative/Nursing Care
Fetal/Neonate Assessment post delivery

1) Fetal hypoxia caused by…? (2)
2) Fetal intracranial hemorrhage resulting from…? (1)

Answer 12

1a) uteroplacental insufficiency resulting from hypertonic uterus.
1b) An umbilical cord around the fetal neck can result in asphyxia and cause a decrease in fetal oxygenation.

2) Cephalic trauma during rapid birth