Nursing Care of a Family Experiencing a Complication of Labor or Birth Flashcards by Shania Twain

A difficult labor that can arise from any of the four main components of the labor process (4 Ps):

DYSTOCIA

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force that propels the fetus (uterine contractions)

POWER

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The fetus is also known as

PASSENGER

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Common Types of Deviations That Can Cause Complications During Labor or Birth: PASSAGE

Inlet contraction
Outlet contraction
Trial labor
External cephalic version
Forceps birth
Vacuum extraction

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Common Types of Deviations That Can Cause Complications During Labor or Birth: POWER

Ineffective uterine force
Dysfunctional labor and associated stages of labor

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The birth canal

PASSAGEWAY

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woman’s and family’s perception of the event

PSYCHE

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Assessment for complications in labor and birth is based on careful ______

UTERINE & FETAL MONITORING

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Therapeutic interventions for HYPOTONIC CONTRACTIONS

Oxytocin
Ambulation
Nipple stimulation
Enema
Amniotomy

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Common Types of Deviations That Can Cause Complications During Labor or Birth: PASSENGER

Umbilical cord prolapse
Multiple gestation
Problems with fetal position, presentation, or size

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can occur at any point in labor, but it is
generally classified as Primary or Secondary

DYSFUNCTION

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This dysfunction occurs LATER in labor

SECONDARY DYSFUNCTION

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denote that
sluggishness of
contractions, or
the force of labor,
has occurred.

INERTIA OR DYSFUNCTIONAL LABOR

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are the basic force moving the
fetus through the birth canal.

UTERINE CONTRACTIONS

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This dysfunction occurs at the ONSET of labor

PRIMARY DYSFUNCTION

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Complications w/ POWER

> Ineffective Uterine Force
Dysfunctional Labor and Associated > Stages of Labor
Contraction Rings
Precipitate Labor
Induction & Augmentation of Labor
Uterine Rupture
Inversion of Uterus
Amniotic Fluid Embolism

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3 types of uterine dysfunction

Hypotonic Contractions
Hypertonic Contractions
Uncoordinated Contractions

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When uterine contractions become abnormal or ineffective they are called

INEFFECTIVE UTERINE FORCE

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Common causes of Dysfunctional labor

-Primigravida status (first pregnancy)
-Pelvic bone contraction that has NARROWED the pelvic diameter (CPD); could occur in a woman with rickets
Posterior fetal position; extension of the fetal head
-Unripe cervix
-Full rectum or urinary bladder; impedes fetal descent
-Woman exhausted from labor
-Inappropriate use of analgesia (excessive/too early administration)

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Etiology of hypotonic contractions

Overstretching of the fetus
Bowel/bladder distention
Excessive use of analgesia

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Symptom of hypotonic contractions

PAINLESS

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HYPERTONIC CONTRACTIONS:

Number of Contractions:
Resting Tone:
Phase of Labor
Symptom:
Cause:

Number of Contractions: NOT PRODUCTIVE; frequent prolonged contractions
Resting Tone: >15 mmHg
Phase of Labor: Latent (1st Stage)
Symptom: PAINFUL
Cause: Muscle fibers of myometrium (outer layer of uterus) do not relax after contraction

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Number of Contractions: not more
than 2 or 3 occurring in a 10-minute period

HYPOTONIC CONTRACTIONS

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Complication of Hypertonic Contractions

FETAL ANOXIA

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Hypotonic Contractions: Number of Contractions: Resting Tone: Strength of Contractions: Phase of Labor Symptom:

Number of Contractions: <2 or 3 in 10 minutes Resting Tone: <10 mmHg Strength of Contractions: ≤25 mmHg Phase of Labor: Active Stage (1st Stage) Symptom: PAINLESS

frequent prolonged contractions that are not productive

HYPERTONIC CONTRACTIONS

Management for hypertonic contractions to avoid fetal anoxia

Provide comfort measures Bed rest/position changes Hydration Mild sedation Tocolytics Cesarean delivery

more than one pacemaker may be initiating contractions, or receptor points in the myometrium may be acting independently of the pacemaker.

UNCOORDINATED CONTRACTIONS

may occur so closely together that they do not allow good cotyledon( one of the visible segments on the maternal surface of the placenta) filling.

UNCOORDINATED CONTRACTIONS

Dysfunction at the First Stage of Labor

Prolonged latent phase Protracted active phase Prolonged deceleration phase Secondary arrest of dilatation

is usually associated with cephalopelvic disproportion (CPD) or fetal malposition, although it may reflect ineffective myometrial activity.

Protracted Active Phase

Dysfunction at the Second Stage of Labor

Prolonged descent Arrest of descent

Contractions that become ineffective during the first stage of labor * Latent phase that is longer than 20 hours in a nullipara or 14 hours in a multipara.

PROLONGED LATENT PHASE

* Uterus tends to be in a hypertonic state. * Relaxation between contractions is inadequate, and the contractions are only mild (less than 15 mm Hg on a monitor printout) and therefore ineffective. * One segment of the uterus may be contracting with more force than another segment.

PROLONGED LATENT PHASE

Progress in dilation slows after 8 cm and uterine contractions become dysfunctional, even after oxytocin administration.

Prolonged Deceleration Phase

* This phase is prolonged if cervical dilatation does not occur at a rate of at least 1.2 cm/hr in a nullipara or 1.5 cm/hr in a multipara, or if the active phase lasts longer than 12 hours in a primigravida or 6 hours in a multigravida.

Protracted Active Phase

This has occurred if there is no progress in cervical dilatation for longer than 2 hours.

Secondary Arrest of Dilatation

occurs if the rate of descent is less than 1.0 cm/hr in a nullipara or 2.0 cm/hr in a multipara.

PROLONGED DESCENT

Can be suspected if second stage lasts over 3 hrs in multipara

PROLONGED DESCENT

results when no descent has occurred for 1 hour in a multipara or 2 hours in a nullipara.

Arrest of Descent

This has occurred when expected descent of the fetus does not begin or engagement or movement beyond 0 station has not occurred.

ARREST OF DESCENT

The most frequent type seen is termed a ____ which usually appears during the second stage of labor and can be palpated as a horizontal indentation across the abdomen

Pathologic Retraction ring (Bandl’s ring).

a hard band that forms across the uterus at the junction of the upper and lower uterine segments and interferes with fetal descent

Contraction Rings

The most likely cause for arrest of descent during the second stage is ___

CPD

> occur when uterine contractions are so strong that a woman gives birth with only a few, rapidly occurring contractions. > It is often defined as a labor that is completed in fewer than 3 hours.

Precipitate labor

cervical dilatation that occurs at a rate of 5 cm or more per hour in a primipara or 10 cm or more per hour in a multipara

Precipitate dilatation

This is a risk to fetus

SUBDURAL HEMORRHAGE

Conditions for Induction of Labor

> Fetus is in longitudinal lie > Cervix is ripe; ready for birth > Presenting part is engaged > NO CPD

This means that labor is started artificially

INDUCTION OF LABOR

change in the cervical consistency from firm to soft

CERVICAL RIPENING

It refers to assisting labor that has started spontaneously but is not effective.

AUGMENTATION LABOR

Conditions for induction of labor

> Fetus is in a longitudinal lie > Cervix is ripe, or ready for birth > Presenting part is engaged > No CPD > Fetus is estimated to be mature by date, demonstrated by lecithin -sphingomyelin ratio or ultrasound biparietal dimeter to rule out preterm birth

What are the complications of augmentation of labor

-Overstimulation of contractions -Water Intoxication

Pharmacological method to stimulate contraction

OXYTOCIN INDUCTION

- Occurs when a uterus undergoes more strain that it can sustain

UTERINE RUPTURE

This is done to relieve pressure on cord

AMNIOINFUSION

Non-pharmacological methods to stimulate contraction

-Ambulation -Sitting upright -Nipple stimulation

If amniotic fluid embolism is suspected, what would the nurse do first?

OXYGEN ADMINISTRATION

Ideal occiput presentation during birth

LOA & ROA

- Uterus turning inside out with either birth of the fetus or delivery of the placenta

UTERINE INVERSION

What are the signs of shock

> rapid, weak pulse > falling BP > cold & clammy skin > dilatation of nostril from air hunger

- Occurs when amniotic fluid is forced into an open maternal uterine blood sinus through some defect in the membranes or after membrane rupture or partial premature separation of the placenta

AMNIOTIC FLUID EMBOLISM

What will the patient be experiencing if she has uterine rupture?

a sudden, severe pain during a strong labor contraction, which she may report as a “tearing” sensation

2 types of uterine rupture

COMPLETE & INCOMPLETE

part of the baby’s body that is closes to the birth canal

FETAL PRESENTATION

due to cord compression (preventing venous return to fetus and arterial vasospasm—secondary to exposure to air)

BIRTH ASPHYXIA

- Descent of the umbilical cord through the cervix

CORD PROLAPSE

In cephalic presentation, this is the presenting part

OCCIPITAL FONTANEL

A persistent occipito-posterior pos’n results from what?

a failure of internal rotation prior to birth

occiput is placed over RIGHT sacroiliac joint

Right Occipito Posterior (ROP)

- Vertex position where the occiput is placed posteriorly over the sacroiliac joint or directly over the sacrum

OCCIPITO-POSTERIOR POSITION

How many degrees does the fetal head rotate during internal rotation

APPROX. 135 DEGREES

occiput points TOWARDS the sacrum

Direct Occipito Posterior Position

occiput placed over LEFT sacroiliac joint

Left Occipito Posterior (LOP or KO

What should the nurse teach the client to aid rotations from a posterior position

-Hands and knees position (on all 4s) -Squatting -Lying to the side opposite the fetal back

experienced by the woman in her lower back due to sacral nerve compression when fetal head rotates against the sacrum

PRESSURE & PAIN

- Also called ASYNCLITISM or fetal head presenting at a different angle than expected

FACE PRESENTATION

The rarest among presentations

BROW PRESENTATION

-Occurs during 2nd stage of labor -When fetal head is born but the shoulders are too broad to enter and be born through the pelvic inlet

SHOULDER DYSTOCIA

occurs because the head becomes jammed in the brim of the pelvis as the occipitomental diameter presents

OBSTRUCTED LABOR

instruct woman to flex her thighs sharply on her abdomen to widen the pelvic outlet and allow the anterior shoulder to be born

MCROBERT'S MANEUVER

A fetus that weighs more than 4000-4500g

MACROSOMIA

Macrosomic babies usually weigh ____ at birth

>4000-4500

to compare size of fetus w/ the woman’s pelvic capacity

PELVIMATERY

- Narrowing of the anteroposterior diameter to less than 11 cm or the transverse diameter to 12 cm or less

INLET CONTRACTION

Narrowing of the transverse diameter at the outlet to less than 11 cm

OUTLET CONTRACTION

- A forceps outlet procedure in which forceps are applied after the fetal head reaches the perineum

FORCEPS BIRTH

- Determination of the progress of labor in a woman who has borderline inlet measurement with a good fetal lie ad position

TRIAL LABOR

Turning of the fetus from a breech to a cephalic position before birth

EXTERNAL CEPHALIC VERSION