Labour Related Complications Flashcards
What is dystocia
Abnormal labor pattern due to problems with:
Power
-uterine contractions
-maternal expulsion forces
Passenger
-Fetal size
-Fetal position
-Fetal presentation
Passage
-Soft tissue
-pelvis
What is typical for active labor?
3 to 5 contractions in a 10 minute period
Uterus relaxed for at least 1 minute between contractions
What is tachysystole
More than 5 contractions in a 10 minute period
Less than 60 seconds of relaxation between contractions
Or with individual contractions lasting longer than 2 minutes
What is hypotonic labour
Decreased frequency, possibly irregular.
Decreased intensity
Slow progress of labor
What are the risk factors for tachysystole?
Oxytocin use
Cocaine
Uterine rupture
Placental abruption
What is the nursing care for tachysystole
First, stop oxytocin and reposition patient
Begin continuous fetal monitoring if not already in use
Empty the patient’s bladder
Notify HCP
If accompanied by non-reassuring FHR tracing, also:
- Left side
-02 by facemask at 10L/min
- IV bolus
Support and comfort measures for patient
What causes hypotonic labor?
False labor
Early labor
Induction with unripe cervix
Cephalopelvic disproportion (CPD)
Passenger problems:
-Marcosomia
- malpresentation
-Malposition
Nursing care for hypotonic labor pattern
Monitor:
- maternal vital signs
- Contraction pattern
- Fetal heart rate
- Color of amniotic fluid
- Intake and output
Manage oxytocin protocol if ordered
Teach and support patient
What is post term pregnancy?
It extends more than 294 days or 42 completed weeks past the first day of the last menstrual period (LMP)
What is post term pregnancy associated with?
Deterioration of the placenta and related problems for baby, such as reduced blood supply, decreased fetal oxygenation and reduced nutritional supply
What is the clinical therapy for post term pregnancy?
Specialized monitoring of fetus once the woman completes the 40th week of gestation
Non-stress test
Biophysical profile: fetal breathing movements, body movements, tone, amniotic fluid volume (by sonogram), and FHR accelerations
If problems discovered, induction of labor may be recommended
Nursing care for post term pregnancies
Assess estimate date of birth and the criteria that were used to establish the date
Evaluate FHR as part of non-stress test
Be prepared to intervene for a non-reassuring FHR tracing
What is fetal malposition?
Position abnormal - typically persistent occiput posterior
Nursing care for fetal malposition
Recognize that complaints of intense back pain during first stage may indicate OP presentation
Assess position of head by feeling fontanelle during vaginal exam and with Leopold maneuvers
Encourage alternate positioning during labor to facilitate possible rotation
What are the different cephalic malpresentations?
Military
Brow
Face
What causes breech malpresentations?
Placenta implantation problems
Uterine anomalies
Fetal anomalies such as anencephaly or hydrocephaly
Multiple gestation
What happens in a breach malpresentations?
Once membranes have ruptured, umbilical cord prolapse more likely, because presenting part may not fill outlet completely
Higher morbidity and mortality rates
Head entrapment possible during second stage
Problems with malpresentations?
Malpresentations can slow, endanger, or stop progress of labor
What is transverse lie malpresentation
Also known as shoulder presentation, the infants long access, lies perpendicular to mom spine
What is macrosomia?
Fetal macrosomia is defined as a weight of more that 4000 grams (8 pounds and 13 ounces)
More common for mothers who are obese, or who have diabetes
What are some complications for marcosomia?
Shoulder dystocia (a medical emergency)
Possible brachial plexus injury
If vaginal delivery results in shoulder dystocia, possible interventions include:
McRoberts maneuver
Suprapubic pressure
Episiotomy
Woods screw maneuver
Breaking the babies clavicle
Nursing care for macrosomia
Monitor for dysfunctional labor pattern, and report to HCP
Note excessive molding or caput during vaginal exams
What is cephalopelvic disproportion (CPD)
A narrowing or contracture of any part of the pelvis or maternal tissues that cause the size of the birth passage to be inadequate for the baby
What is non-reassuring fetal status
Non-reassuring fetal status is caused by insufficient oxygen supply to meet the needs of the fetus
What are the most common signs of non-reassuring fetal status?
Meconium stained amniotic fluid
Changes in the fetal heart rate
What is the clinical therapy for non-reassuring fetal status?
Relieve the hypoxia
Minimize effects of anoxia on fetus
If fetal status remains non reassuring and deliver is non imminent, cesarean birth is indicated
Nursing care for non-reassuring fetal status
Be alert for:
-Risk factors
-Meconium stain fluid
-Fetal heart rate changes
Intervene:
-Position
-Correct maternal hypotension
-Discontinue oxytocin or Pitocin
-Administer O2
-Assess for prolapsed cord
-Notify HCP
What is placenta malformations?
Succenturiate placenta - may lead to retained placenta fragments and bleeding
Circumvalllate placenta- may cause miscarriage, IUGR, preterm labor
Battledore placenta- may cause preterm labor, and bleeding
What is a prolapsed umbilical cord
An umbilical cord that precedes the fetal presenting part and becomes trapped and compressed against the bones of the pelvis- an emergency
Can be obvious at opening of vagina, or occult (hidden)
Incidence highest with abnormal lie, such as footling breach or shoulder presentation
Can seriously affect oxygen supply to baby
Clinical therapy for a prolapsed umbilical cord
Prevention is preferred approach
Once a membranes rupture, bedrest usually indicated until engagement of the presenting part occurs
If prolapse occurs, relieving pressure on the cord is essential
Nursing care for a prolapsed umbilical cord
Observe perineum once rupture of membranes occurs to look for cord
Listen for FHR decelerations or bradycardia
Nursing interventions if cord is prolapsed
Call for help stat
Used gloved hand to lift presenting part away from cord
Knee- chest or trendelenburg position may help
Administer oxygen
Prep for emergent delivery
