Module 10 (Exam 3) Intrapartal Complications

Question 1

What are intrapartal complications?

Answer 1

1. Dysfunctional Labor
2. Precipitate Labor (fast)
3. Preterm Labor
4. Obstetrical Emergencies

Question 2

Single Dysfunction

Answer 2

Causes:

• Irregular contraction pattern
• Ineffective Pushing
• Fetal size or position
• Maternal pelvic size or shape

Question 3

Multifaceted Dysfunction (Dystocia)

Answer 3

1. Prolonged Labor
   
   1. Combination of issues
   2. Depletion of resource (maternal fatigue, dehydration, energy stores)
   3. Maternal and/or fetal infection is a concern if membranes ruptured for greater than 24 hours
   4. Treat underlying causes
   5. Comfort measures and emotional support
   6. Monitor for infection
   7. C-section
2. Precipitate Labor
   
   1. Birth occurs within 3 hours of onset
   2. No gradual change in contraction pattern
   3. May be associated with drug use (vasoconstrictor)
   4. Potential result: fetal oxygen compromise, precipate birth, newborn respiratory depression, postpartum hemorrhage
   5. Assist mother with breathing and relaxation
   6. Monitor fetal heart rate (rapid pelvic descent = variable decels or bradycardia)
   7. Call for help for patient room
   8. Don gloves
   9. Support infant’s head as it emerges onto perineum
   10. Encourage blowing or puffing to slow bearing down efforts but allow patient to bear down

Question 4

Irregular Contraction PAttern

Answer 4

1. Increase maternal movement (walk)
2. Rest
3. IV hydration
4. Amniotomy (so then the head can act like a dilating wedge to open up the cervix)
5. Augmentation with Pitocin
6. Pain relief
7. Emotional support

Question 5

Ineffective Pushing

Answer 5

1. Passive descent or “laboring down”
2. Education regarding correct technique
3. Emotional support
4. Rest during some contractions
5. Repositioning
6. Feedback

Question 6

Fetal Size or Position

Answer 6

1. If fetal size is an issue = c-section
2. If fetal position is an issue:
   
   1. (shoulder dystocia) McRoberts Maneuver, Suprapubic pressure
   2. C-section

Question 7

Maternal Pelvic Size or Shape

Answer 7

1. Maternal position change
2. Maintain empty bladder
3. C-section

Question 9

PROM (premature rupture of membranes)

Answer 9

1. Membranes rupture before the onset of labor
2. Greater than 24 hours before birth occurs

Question 10

PPROM (Preterm/Premature Rupture of membranes)

Answer 10

1. Rupture of membranes happens before the end of the 37th week gestation
2. Happens before the onset of labor (greater than 24 hours before birth of baby)

Question 11

Etiology of PROM and PPROM

Answer 11

1. Infection of maternal reproductive tract
2. Incompetent cervix
3. Polyhydraminos (puts pressure on cervix)
4. Invasive tests or procedures

Question 12

Effects of PROM

Answer 12

1. Chorioamnionitis and newborn infection (ascending pathway for infection)
2. Umbilical cord compression

Question 13

Effects of PPROM

Answer 13

1. Respiratory distress syndrome
2. Complications related to prematurity

Question 14

Medical management of PROM

Answer 14

1. Maternal antibiotics
2. Avoid vaginal examination
3. Near term - induce labor

Question 15

Medical management of PPROM

Answer 15

1. Management determined by stability of fetus
2. Assess lung maturity if 32-35 weeks
3. Steroids
4. Frequent nonstress test/biophysical profile
5. Home management if stable

Question 16

Nursing management or PROM or PPROM

Answer 16

1. Labor inducted as indicated OR labor prevention
2. Monitor FHR and contraction pattern if any
3. Monitor for infection (VS q4h, WBC, amniotic fluid color, odor, clarity)
4. Home care edcuation: activity restriction, signs/symptoms of labor and infection, importance of follow-up care

Question 17

Preterm Labor

Answer 17

Onset of labor after 20 weeks but before 37 weeks’ gestation

Question 18

Etiology and Risk Factors of Preterm Labor

Answer 18

• Etiology unknown
• Risk Factors:
  
  • Short cervical length
  • Previous preterm labor or PROM
  • Positive fetal fibronectin
  • Smoking
  • Infection during pregnancy
  • Smoking
  • Infection during pregnancy

Question 19

Signs/Symptoms of Preterm Labor

Answer 19

1. Uterine contractions or “cramps”
2. Back pain
3. Pelvic pressure
4. Bleeding or spotting
5. Cervical effacement and/or dilation

Question 20

Medical and Nursing Management of Preterm Labor

Answer 20

1. Prevention
2. Prenatal care
3. Education (signs of labor)
4. Identification of risk factors
5. High risk group testing and monitoring

Question 21

Treatment of Preterm Labor

Answer 21

1. Treat underlying cause if possible
2. Labor suppression by use of tocolytics
3. Decrease activity
4. Hydration (decrease uterine irritabiltiy)
5. Steroids
6. Home monitoring: decreased contraction pattern, no further cervical effacement and dilation

Question 22

Tocolytics

Answer 22

• Magnesium sulfate
  
  • High alert medication
  • Smooth muscle relaxation
  • IV
• Beta-adrenergic- Terbutaline
  
  • Smooth muscle relaxation
  • SQ, PO
• Prostaglandin Inhibitors - Indomethacin
  
  • Decrease cervical effacement
  • PO
• Calcium Channel Blockers - Nifedipine
  
  • Inhibits contractions
  • IV, PO

Question 23

Nursing Considerations of Preterm Labor

Answer 23

1. Education
2. Medication Therapy
3. Diagnostic tests/procedures
4. Warning signs: similar to initial signs/symptoms of labor
5. Infant milestones based on gestational age

Question 24

Fetal Lung Maturity

Answer 24

1. Corticosteriods
   
   1. Betamethasone/Dexamethasone
   2. Administered to mother for fetus
   3. Accelerates lung maturity
   4. Minimum of two spaced doses
   5. Anticipated birth less than 34 weeks OR Amniocentesis L/S less than 2:1 PG absent

Question 25

What are some intrapartal emergencies?

Answer 25

1. Placental Abruption
2. Umbilical Cord Prolapse
3. Uterine Rupture

Question 26

Umbilical Cord Prolapse

Answer 26

• Fetal vertex not engaged
• Membranes rupture
• Umbilical cord slips toward fetal head
• Cord compressed by head
• Umbilical blood flow decreased to fetus
• May be occult or complete

Question 27

Signs of Umbilical Cord Prolapse

Answer 27

• FHR change associated with ruptured membranes (occult prolapse)
• Protrusion of umbilical cord (complete prolapse)

Question 28

Immediate Nursing Management of Umbilical Cord Prolapse

Answer 28

1. Initial care for FHR pattern unless cord is visible
2. Call for help
3. Brief, calm explanations

If it is a confirmed prolapse or visible cord:

1. Knee-chest or trendelenberg position
2. Elevate fetal head with sterile gloved hand
3. Anticipate emergency c-section

Question 29

Classifications and Risk Factors of Uterine Rupture

Answer 29

Classifications: separation (dehiscence) at site of past uterine incision, complete rupture of uterus

Risk Factors: previous surgery, uterine overdistention, multiparity, pitocin induction/augmentation

Question 30

Signs and Symptoms of Uterine Rupture

Answer 30

1. Sudden onset
2. Abdominal pain
3. Hypovolemic shock
   
   1. Decreased BP, Elevated P, Change in LOC, Disphoresis
4. FHR pattern change or loss of FHR (bradycardia)

Question 31

Medical and Nursing Management of Uterine Rupture

Answer 31

1. Prevention: monitor patients at risk, treat uterine tachysystole
2. Treatment: initial supportive therapy (IV hydration, oxygne), emergent delivery, repair or removal of uterus