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NURS 330: Obstetrics > LEC 9: Obstetrical Emergency > Flashcards

LEC 9: Obstetrical Emergency Flashcards

1
Q

Complications in Labour and Delivery

A
  • Dystocia
  • Preciptious labour and delivery
  • Malpresentation/ Position
    • POP
    • Breech and ECV
  • Operative and assisted deliveries
    • Caesarean birth
    • Forceps/ Vaccuum
  • TOLAC/ VBAC
  • Obstetrical emergencies
    • Shoulder dystocia
    • Cord prolapse
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2
Q

Dystocia

A
  • Abnormal or difficult labour
  • Problems with powers
    • ​Hypotonic or hypertonic uterine contraction
    • Arrested labour
    • Preciptious labour (<3 hours)
  • Problems with Passenger
    • ​POP
    • CPD
    • Breach
    • Shoulder systocia
    • Cord prolapse
  • May result in
    • Operative delivery
      • ​Forceps, vacuum, c-section
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3
Q

Breach Presentation

A
  • 3 to 4% of all term pregnancies
    • Frank
      • 50 to 70%
    • Footling
      • 10 to 30%
    • Complete
      • 5 to 10%
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4
Q

Diagnosis of Breech

A
  • Maternal
  • Leopold’s Maneuver’s
  • FH auscultated above umbilicus
  • Vaginal examination
  • Ultrasound
  • Meconium (if ROM)
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5
Q

Fetal Risks

A
  • Cord prolapse more likely with ROM
  • Traumatic injury to the aftercomin head can → intracranial hemorrhage of anoxia
  • Preterm breech: Footlin and body may deliver before full dilation → entrapment
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6
Q

2009 SOGC - Vaginal Delivery of Breech

A
  • Vaginal delivery os the best method of delivering an uncompliated term, frank, of complete breech, singleton, ?35oo and <4000g with flexed ehad
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7
Q

External Cephalic Version

A
  • Ultrasound
  • Reactive NST
  • Can’t be engaged
  • Tocolytic to relax uterus
  • Risk of nuchal cord
  • Fetal monitoring
  • Monitor for SOL
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8
Q
A
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9
Q

Types of Operative Delivery

A
  • Cesarean birth
  • Operative vaginal delivery
    • Forceps
    • Vaccum
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10
Q

Indications for C-Section

A
  • Can be planned or unplanned
  • Non-reassuring fetal heart rate findings
  • Active genital herpes
  • Multiple gestation (three or more fetuses)
  • Umbilical ccord prolapse
  • Pelvic size (tumors that obstruct birth canl, cephalopelvic disproprotion_
  • Lack of labour prgression/ failed induction
  • Maternal infection/ severe disease
  • Placenta previa
  • Previous cesarean section (relative)
  • Fetal anomalies or extremes in size (low, high)
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11
Q

C-Section Incision

A
  • Transverse in lower segment
  • Vertical in lower segment
  • Classical incsision: in body of the uterus
  • Wounds are closed based on physican specific
  • Important to look at the incision before sending someone home
  • Usually take out incision on post-op day 5
  • Can be doen at home by healthy-and-home or got ot their physicians office
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12
Q

Women who have C-Section are at Increased Risk For:

A
  • Intra-Opeative
    • ​Aspiration
    • Difficult airway managment
    • PPH (>100 mls)
  • Post-Op
    • ​Endometritis/ Infection
    • Hemorrhage
    • Poor bladder emptying
    • Paralytic ileus (rare)
    • Thrombophlebitis
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13
Q

Preparation in C-Section

A
  • Cesarean birth requires
    • Establishing IV lines
    • Placing indwelling catheter
    • Performing abdominal prep
    • Ranitidine or sodium citrate
    • NICU
  • Teaching Needs Include
    • What to expect before, during, and after delivery
    • Why is it being done
    • What sensations will the woman experience
    • role of significant other
    • Interaction with newborn
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14
Q

Post-op/Post partum

A
  • Pain
  • Analgesia/ antiemetic. antipruritic
    • Naproxen PRN for vaginal delivery
    • C-Section: Naproxen is scheduled for first 24 hours and then PRN
  • Comfort measures
  • Assess fro hemmorhage
  • Assess for infection
  • Get her MOVING
  • Postpartuma nd postoperative checks
    • Fatigue: Different for scheduled vs. non-scheduled c-section
  • Attention to fatigue
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15
Q
A
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16
Q

Trial Of Labour After Cesarean Section (TOLAC)

A
  • Depends on indication and type of 1st section, maternal health
  • Most common risks:
    • Hemorrhage
    • Uterine rupture - Complete separation of the myometrium with/ without extrusion of fetal parts into the maternal peritoneal cavity
    • Infant death or neurological complications
  • Successful TOLAC becomes VBAC
    • Fetal monitoring
    • Avoid cervical ripening
    • Need to be papered for c-section quickly if things go wrong
17
Q

Operative Vaginal Birth: Indications

A
  • Fetal indications
    • Non-assuring fetal heart rate
  • Maternal
    • Exhaustion or inability to push
    • Lack of rotation
    • Maternal disease
18
Q

Operative Vaginal Birth: Intervnetion During

A
  • Support and educate
  • Fetal heart assessment
19
Q

How can we prevent operative vaginal birth?

A
  • Support throughout labour
  • Mobility
  • Positionc hanges
  • Rest
  • Keep bladder empty
  • Well hydrated and nourished
20
Q

Important Considerations in Forceps/ Vaccuum

A
  • Need to be completely dilated/ membranes ruptured
  • Empty bladder
    • May need an in-and-out catheter
  • Fetal position known/ adequate pelvis
  • Analgesia if able
  • If it is a failed forceps and vacuum = C-section
21
Q

Forceps

A
  • Applied by a physician
  • Downward pressure and then upward once the larges part of the head has come through
  • Would be done while a women is pushing
  • Fetal scalp is visible- presenting part is 2+- head is clearly engaged
22
Q

Vacuum Extractor

A
  • Suction applied to fetal head (occiput)
  • Should be progressive descent with first two pulls (with contractions) Used during contractions and pushing
  • Geneally would not do more than 3 pulls
23
Q

Complications with Operative Vaginal Births: Newborn

A
  • Common
    • Bruising
    • Laceration
    • Edema
  • Uncommon
    • Renal hemorrhages
    • Nerve injury
    • Cephallhematoma
    • Cerebreal hemorrahge
    • Skull fracture (forceps)
    • Intracranial bleeding, subgaleal hemorrhage (vaccuum)
  • Watch for hyperbilirubinemia
24
Q

Complications with Operative Vaginal Births: Woman

A
  • Genital tract trauma
  • Increased bleeding
    • Risk for PPH
  • Bruising and edema
  • Shoulder dystocia
25
Q

Nursing Care During

A
  • Attention to bladder
  • Assessment of fetal well being throuhout
  • Documentation
    • Ease of application
    • Timeon, off, number of pulls
    • Difficulties suchas pop-offs
26
Q

Nursing Care After

A
  • Maternal
    • PPH: Lacerations, atony
    • Analgesia
    • Watch for hematome
  • Neonatal
    • Trauma/ injuries
    • Jaundice
27
Q

Shoulder Dystocia

A
  • Anterior shoulder impacts against maternal symphysis pubis
  • Fetal shoulder do not deliver spontaneously
  • Failure to deliver with expulsive effort and usual maneuvers
28
Q

Major Risk Factors for Should Dystocia

A
  • Maternal obesity
  • Macrosomic infant
  • Hisotry where a baby had should dystocia
  • If you can mange diabetes = less risk
    • Non-Diabetic
      • babies >4000 gms 4%
      • babies >4500 gms 10%
    • Diabetic:
      • babies over 4000 gms 15%
      • babies >4500 gms 42%
29
Q

Turtle Sign

A
  • Nuco-cord x3- risk- cord around the neck and quite tight
  • Turtle sign is a heralding sign of shoulder dystocia
30
Q

Shoulder Dystocia: ALARER

A
  • Ask for help
  • Lift / hyperflex legs
  • Anterior shoulder disimpaction
  • Rotate posterior shoulder
  • Manual removal of posterior arm
  • Episiotomy
  • Roll over onto ‘all fours’
    • Do not see often
31
Q

McRobert’s Manoeuvre

A
  • Before McRoberts Positioning: Diagonal orientation of symphysis makes shoulder delivery difficult
  • McRobert’s Maneuver: Pelvis tilts, orienting symphysis more horizontally to facilitate should delivery; looks like knees to ears
32
Q

Suprapubic Pressure

A
  • NOT fundal pressure
  • Lateral pressure in direction of fetal nose
  • Protect your back
  • Support/ inform patient and support person
33
Q

Shoulder Dystocia Complications: Maternal

A
  • Episotomy
  • Extended lacerations
  • Hematomas
  • Uterine atony
  • Hemorrhage
  • Bladder injury
  • Rectal injury
34
Q

Shoulder Dystocia Complications: Fetal

A
  • Number of clavical or humerus
  • Brachial plexus injury or spinal nerve damage
  • Erb’s palsy
  • Asphyxia
  • Death
35
Q

Cord Prolapse

A
  • Obstetrical emergency
  • Sudden, severe, variable decelerations or no fetal heart
    • Feel or see cord
36
Q

Cuases of Cord Prolapse

A
  • Polyhydramnios
  • Long cord
  • Malpresnetation (breech, transverse)
  • Premature rupture of membranes
  • Amniotomy before engaged vertex
37
Q

Obsterical Emergency

A
  • Precaution - Always check fetal heart after ROM!!
  • Get help, Prepare for Cesarean section delivery
  • Keep pressure (presenting part) OFF cord
    • Trendelnburg, Knee-chest position
    • Keep hand in vagina
    • ↓ contractions if able
    • Warm wet sterile cloth if outside vagina
    • Vaginal delivery only if fully dilated

NURS 330: Obstetrics (19 decks)

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