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Sophomore 1 Test 5 > Labor and Delivery at Risk > Flashcards

Labor and Delivery at Risk Flashcards

1
Q

Dystocia

A

Abnormal or difficult labor

* The key is early identification

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2
Q

Dystocia can arise from problems with what?

A

P - powers
P - passenger
P - passageway
P - psyche

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3
Q

Issues with Powers

A
  1. Hypertonic uterus

2. Hypotonic uterus

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4
Q

Hypertonic uterus

A

Never fully relaxes (contracting too much)

  • Contractions are ineffectual, erratic, and poorly coordinated because they involve only a portion of the uterus
  • Prolonged latent phase, stay at 2-3 cm, and do not dilate as they should
  • Placental perfusion becomes compromised
  • Affects nulliparous women more than multiparous
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5
Q

Hypotonic uterus

A

Relaxes too much (ineffective contractions)

  • Occurs during active labor (dilation more than 5-6 cm)
  • The major risk with this complication is hemorrhage after giving birth because the uterus cannot contract effectively to compress blood vessels
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6
Q

Issues with Passenger

A
  1. Presentation other than occiput anterior (such as occiput posterior and breech)
  2. Multiple gestation (twins, triplets, etc.)
  3. Macrosomia
  4. Shoulder dystocia
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7
Q

Issues with Passageway

A
  1. Gynecoid is best pelvis shape
  2. Swelling of soft tissue (“soft tissue dystocia”)
    - When the external structures (labia, perineum) gets too swollen (too tight)
    * Should be dilating 1 cm per hour average
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8
Q

Four basic pelvis shapes

A
  1. Gynecoid
  2. Anthropoid
  3. Android
  4. Platypelloid
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9
Q

Preterm Labor

A
  1. Before the end of the 37th week
  2. Regular contractions that cause cervical dilation and effacement
  3. Largest contributor to perinatal morbidity and mortality worldwide
  4. Most common OB complication
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10
Q

Possible Causes of Preterm Labor

A
  1. Hormone changes
  2. Dehydration
  3. UTI
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11
Q

Subtle Symptoms of Preterm Labor

A
  1. Change in vaginal discharge
  2. Pelvic pressure
  3. Low dull backache
  4. Cramping
  5. Heaviness in thighs
  6. Contractions
  7. Labs - fetal fibronectin
    * Urinary tract infection symptoms
    * GI upset (N/V/D)
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12
Q

Management of Preterm Labor

A
  1. Psychological support
  2. Bedrest/hydration
  3. Tocolytic drugs
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13
Q

Tocolytic Drug Therapy for Preterm Labor

A
  • After confirmed diagnosis
  • To stop labor especially if before 34 weeks
  • Helps to delay (not necessarily prevent)
    Common Medications:
    1. Magnesium sulfate
    2. Indomethacin
    3. Nifedipine
  • Corticosteroids for fetal lung maturity
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14
Q

PPROM

A

Preterm Premature Rupture of Membranes

- Prior to onset of labor in women before the end of the 37th week of gestation

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15
Q

PROM

A

Premature Rupture of Membranes

  • Rupture of BOW (bag or waters) before the onset of TRUE labor in woman at term gestation
  • Single most common diagnosis associated with preterm birth
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16
Q

PROM Risks

A
  1. If ruptured for more than 24 hours = infection
  2. Prolapsed cord
  3. Sepsis
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17
Q

PROM Assessment Focus

A
  1. S/sx of labor
  2. Increase or change in vaginal discharge
  3. Accurate determination of gestational age
  4. Continuous electronic fetal monitoring
  5. Verification of rupture with nitrazine paper; fern test
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18
Q

Management PPROM or PROM

A
  1. Prevent infection (only doing vaginal exams when absolutely necessary)
  2. Identify contractions
  3. FHR monitoring
  4. Temp monitoring
  5. Daily fetal kick counts
  6. Corticosteroids for fetal lung maturity if less than 37 weeks
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19
Q

Postterm Labor

A

Continues past 42 weeks

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20
Q

Postterm Labor Risks for Mother and Fetus

A
  1. Macrosomia
  2. Dystocia/shoulder dystocia
  3. PP hemorrhage
  4. Infection
  5. Birth trauma
  6. Uteroplacental insufficiency
  7. Meconium aspiration
  8. Oligohydramnios
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21
Q

Postterm Assessment Focus

A
  1. Dates (need to know if dates are right)
  2. Ultrasound confirmation of gestational age - if questionable
  3. Cervical exam
  4. Determining fetal well-being is priority
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22
Q

Reasons for Induction

A
  1. Most common reason - post dates
  2. Prolonged rupture of membranes
  3. Gestational HTN
  4. Renal disease
  5. Preeclampsia
  6. Chorioamnionitis
  7. DM
  8. IUFD
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23
Q

Contraindications to Induction

A
  1. Complete placenta previa
  2. Abruptio placenta
  3. Transverse lie of fetus
  4. Prolapsed cord
  5. Previous c-section with classical scar
  6. Nonreassuring FHR tracing
  7. Vaginal bleeding of unknown cause
  8. Previous myomectomy
  9. Invasive cervical cancer
  10. Active genital herpes
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24
Q

Bishop Score

A

Score greater than 8 - likely successful vaginal birth

Score less than 6 - need a cervical ripening method first

25
Q

Non-Pharmacological Cervical Ripening

A
  1. Castor oil
  2. Hot baths
  3. Enemas
  4. Sexual intercourse
  5. Breast stimulation
26
Q

Pharmocological Cervical Ripening

A
  1. Dinoprostone

2. Misoprostol

27
Q

Mechanical Cervical Ripening

A
  1. Stripping of membranes

2. Amniotomy

28
Q

Oxytocin

A

Synthetic form of naturally occurring hormone produced in the body by the posterior pituitary gland that stimulates contractions contraction of the uterus
- Most common pharmacologic agent for induction or augmentation once cervix is ripened

29
Q

Oxytocin Nursing Management

A
  1. Always teaching before administration
  2. Response widely varied
  3. Continuous fetal and maternal monitoring
  4. Titrated according to contractions
  5. Short half-life
  6. Antidiuretic effect
    • SE: water intoxication, hypotension, uterine hypertonicity
    • Accurate I/O
  7. Nurse patient ratio 1:2
  8. Pain management
  9. Does not cross placental barrier
30
Q

IUFD

A

Intrauterine Fetal Demise (after 20 weeks)

  • Due to numerous conditions (sometimes never know)
  • Immense grief - many emotions - special attention to psyche
31
Q

Nursing Management of IUFD

A
  1. Accurate understandable information
  2. Encourage expression of feelings
  3. Allow unlimited time with stillborn
  4. Provide photos/momentos
  5. Encourage touch/hold infant
  6. Consult chaplain
  7. Assist with funeral arrangements or hospital disposition
  8. Provide outreach resources/community referrals
32
Q

Obstetric Emergencies

A
  1. Shoulder dystocia
  2. Umbilical cord prolapse
  3. Placental abruption
  4. Uterine rupture
33
Q

Shoulder Dystocia Complications

A
  1. PP hemorrhage from uterine atony or vaginal lacerations, bladder trauma
  2. Brachial plexus palsies, clavicle or humerus fractures for infant
34
Q

Shoulder Dystocia Management

A
  1. McRoberts maneuver
  2. Suprapubic pressure
  3. Maternal position changes
  4. Anticipate c-section
35
Q

Umbilical Cord Prolapse

A
  • Protrusion of the cord alongside or ahead of the presenting fetal part
  • Partial or total occlusion of cord
  • Must act FAST
36
Q

Risks for Umbilical Cord Prolapse

A
  1. Breech presentation
  2. Premature infant
  3. Multiparous
  4. High station
37
Q

Umbilical Cord Prolapse Treatment

A
  1. Holding presenting part off cord until delivery
  2. Position changes
  3. Monitor FHR
  4. Emotional support and explanations to mother
38
Q

Abrutio Placentae

A

Premature separation of placenta from maternal myometrium after 20th week

39
Q

Risk Factors for Abruptio Placentae

A
  1. Preeclampsia
  2. Cocaine use
  3. Coagulation disorders
  4. Trauma
  5. Smoking
40
Q

S/Sx of Abruptio Placentae

A
  1. Painful dark red vaginal bleeding
  2. Knife like pain
  3. Decreased fetal movement
41
Q

Classification of Abruptio Placentae

A

Grade 1 - mild
Grade 2 - moderate
Grade 3 - severe

Can also be classified as partial or complete

42
Q

Abruptio Placentae Management

A
  1. Depends on gestational age, degree of abruption, and the maternal-fetal oxygenation perfusion
  2. Lateral position (complete bedrest, left lateral)
  3. Oxygen
  4. Frequent VS (assess fundal height frequently also)
  5. C-section (if baby is alive, vaginal if fetal demise)
43
Q

Uterine Rupture

A
  • Tearing of the uterus at site of previous scar into abdominal cavity
  • Disastrous
  • Must recognize and diagnose quickly
  • 10 to 30 minutes before significant fetal morbidity
  • Often only symptom is sudden fetal bradycardia
44
Q

Uterine Rupture Focus Assessment

A
  1. History of previous c-sections, or uterus scars, prior rupture, cocaine use
  2. Sudden fetal distress
  3. Abdominal pain
  4. Vaginal bleeding
  5. Loss of station of fetal presenting part
  6. Irregular abdominal wall
  7. Maternal shock
45
Q

Uterine Rupture Management

A
  1. Emergent c-section
  2. 500 mL blood is delivered to uterus every minute
  3. Maternal and fetal survival depend on the rapid time of intervention
46
Q

Amnioinfusion

A

IUPC instills fluid into uterus

47
Q

Indications for Amnioinfusion

A
  1. Oligohydramnios
  2. Thick meconium fluid - does not prevent meconium aspiration syndrome
  3. Variable decels from cord compression
48
Q

Nursing Management for Amnioinfusion

A
  1. Bedrest
  2. I/O
  3. FHR pattern
  4. Assess contractions
49
Q

Vacuum Assisted Birth

A
  • Apply traction to fetal head

- Method of rotating head during birth

50
Q

Indications for Vacuum Assisted Birth

A
  1. Prolonged second stage of labor
  2. Non-reassuring FHR pattern
  3. Failure of presenting part to fully rotate and descend
  4. Maternal fatigue
  5. Fetal distress
51
Q

Vacuum Assisted Birth Risk to Mother

A
  1. Trauma
  2. Lacerations - cervix, vagina, perineum
  3. Hematoma
  4. Hemorrhage
  5. Infection
  6. Extension of episiotomy
52
Q

Vacuum Assisted Birth Risk to Fetus

A
  1. Trauma
  2. Facial/scalp lacerations
  3. Ecchymosis
  4. Cephalohematoma
  5. Caput succedaneum
53
Q

Cesarean Birth

A

Delivery of fetus through incision through abdomen and uterus
- Adds increased risks to child birth - it is a MAJOR surgical procedure

54
Q

Potential Complications of Cesarean Birth

A
  1. Infection
  2. Hemorrhage
  3. Aspiration
  4. PE
  5. Atelectasis
  6. Paralytic ileus
  7. Urinary trauma
  8. Thrombophlebitis
55
Q

Why would you do a Cesarean Birth?

A
  1. Active genital herpes
  2. Macrosomia
  3. Fetopelvic disproportion
  4. Prolapsed cord
  5. Placenta previa or abruption
  6. Positive HIV status
  7. Hydrocephalus
  8. Neural tube defects
  9. Fetal distress
  10. Previous classic uterine incision
56
Q

Nursing Management of C-Section

A
  1. Preparing for surgery
  2. Informed consent
  3. Labs/foley/pre-op antibiotics
  4. Large bore IV
  5. Epidural/spinal
  6. Emotional support
  7. Involvement of support persons
57
Q

Post Op Care of C-Section

A
  1. Routine post op care
  2. VS and lochia q 15 minutes for 1 hour, q 30 minutes for 2 hours, q hour for 4 hours
  3. Assist with perineal care
  4. Pain management
  5. Allow to bond with infant/breastfeed
58
Q

VBAC

A

Vaginal Birth After Cesarean

  • Can have choice to VBAC if had low uterine incision
  • Always have to know how the uterus was cut - not just the abdomen
  • Has increased risk for uterine rupture
59
Q

Contraindications for VBAC

A
  1. Classic uterine incision
  2. Prior uterine surgery
  3. Contracted pelvis
  4. Scar other than low-transverse uterine scar
  5. Lack of adequate staff to perform emergent surgery
    * ** Use of cervical ripening agents INCREASES risk of uterine rupture so cervical ripening agents are contraindicated to VBAC patients

Sophomore 1 Test 5 (5 decks)

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