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NU314 OB > Nursing Management of Labor/Birth at Risk > Flashcards

Nursing Management of Labor/Birth at Risk Flashcards

1
Q

Dystocia

A

abnormal or difficult labor

-slow abnormal progression of labor

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2
Q

Hypertonic Uterine Dysfunction

A

occurs when the uterus never fully relaxes between contractions
-prolonged latent phase = stays at 2-3 cm and do NOT dilate as they should

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3
Q

Hypotonic Uterine Dysfunction

A

occurs during active labor; dilation more than 5-6 cm; when contractions become poor in quality and lack sufficient intensity to dilate and efface cervix

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4
Q

What factors are associated with Hypotonic Uterine Dysfunction?

A 
Overstretching of the uterus
Large fetus
Multiple fetuses 
Hydramnios 
Multiple parity 
Bowel/bladder distention 
Excessive use of analgesia
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5
Q

What is the major risk with Hypotonic Uterine Dysfunction after birth?

A

Hemorrhage after giving birth because the uterus cannot contract effectively to compress blood vessels

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6
Q

Labor

A

refers to uterine contractions resulting in progressive dilation and effacement of cervix and accompanied by descent and expulsion of fetus

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7
Q

Protracted Disorders

A

series of events including slower than normal rate if cervical dilation and delayed descent of fetus

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8
Q

Arrest Disorders

A

complete cessation of progress

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9
Q

Precipitate Labor

A

labor that is completes in less than 3 hours from the start of contractions to birth

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10
Q

Maternal Trauma from Precipitate Labor

A
  • Cervical lacerations

- Uterine rupture

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11
Q

Potential Fetal complications from Precipitate Labor

A

Intracranial hemorrhage
Nerve damage
Hypoxia

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12
Q

Problems with Powers

A 
Hypertonic uterine dysfunction
Hypotonic uterine dysfunction 
Protracted disorders 
Arrest disorders
Precipitate labor
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13
Q

Problems with Passenger

A 
Occiput posterior position
Breech presentation
Multifetal pregnancy
Macrosomia and CPD
Structural abnormalities
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14
Q

Occiput Posterior Position

A
  • Most common malposition

- Presents slightly larger diameters to the maternal pelvis first

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15
Q

External Cephalic Version

A

a procedure in which the fetus is rotated from breech to the cephalic presentation by manipulation through the mother’s abdominal wall

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16
Q

Breech Position

A

Buttocks or feet presenting first

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17
Q

Shoulder Dystocia

A

obstruction of fetal descent and birth by the axis of the fetal shoulders after the fetal head has been delivered

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18
Q

Multifetal Pregnancy

A

twins, triplets, or more infants within a single pregnancy

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19
Q

What is the most common maternal complication with multifetal pregnancies?

A

Postpartum hemorrhage resulting from uterine atony

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20
Q

Macrosomia

A

Newborn weighs 8.81-9.92 lbs or more at birth

-result of change in body composition w/ an increase in percentage of fat and fat mass

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21
Q

Macrosomia as been associated with what complications later in life?

A

Obesity
Diabetes
Cardiovascular disease

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22
Q

Problems with Passageway

A

Pelvic contraction

Obstructions in maternal birth canal

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23
Q

Contraction of the midpelvis is bad because it can cause what?

A

Arrest of fetal descent

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24
Q

Obstructions of Maternal Birth Canal

A

Swelling of soft maternal tissue and cervix

Termed soft tissue dystocia

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25
Q

Problems with Psyche

A

Psychological distress

-fear, anxiety, helplessness, isolation, and weariness

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26
Q

Nursing Management for Dystocia

A 
History of risk factors
Maternal frame of mind
Vital Signs 
Uterine contractions
FHR, fetal position
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27
Q

Nursing Management for Dystocia

A

Promoting labor progress
Providing physical and emotional comfort
Promoting empowerment

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28
Q

How often should you monitor the clients bladder for distention?

A

q 2hours

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29
Q

Preterm Labor

A

occurrence of regular uterine contractions accompanied by cervical effacement and dilation before the end of the 37th week of gestation

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30
Q

What is one of the most common obstetric complications?

A

Preterm labor

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31
Q

When is predicting the risk of preterm labor valuable?

A

When there is an available intervention that is likely to improve the situation

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32
Q

Tocolytic Drugs

A

No clear first-line drugs to manage preterm labor

-may prolong pregnancy for 2-7 days while steroids can be given for fetal lung maturity

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33
Q

Antibiotics should be reserved for what?

A

For group B streptococcal prophylaxis in women in whom birth is imminent

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34
Q

Why are Corticosteroids recommended for all pregnant women?

A

significantly reduce the incidence and severity of neonatal respiratory distress syndrome

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35
Q

When are corticosteroids recommended to be given?

A

A pregnant women between 24-34 weeks of gestation who are at risk of preterm birth within 7 days

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36
Q

Nursing Assessment of Preterm Labor

A

Risk factors
Subtle signs
Contraction pattern
Laboratory and diagnostic testing

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37
Q

What are some signs of preterm labor?

A
  • Change/increase in vaginal discharge
  • Pelvic pressure
  • Low-dull backache
  • Menstrual like cramps
  • UTI symptoms
  • GI upset: N/V and diarrhea
  • General sense of discomfort/unease
  • Heaviness or aching in thighs
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38
Q

Labs/Diagnostic testing of Preterm Labor

A

CBC, urinalysis, amniotic fluid analysis, fetal fibronectin, cervical length via transvaginal ultrasound, salivary estriol, home uterine activity monitoring

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39
Q

How early can a Fetal fibronectin test detect ROM?

A

1-2 weeks before

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40
Q

What medications are commonly used for Tocolytic administration?

A

Magnesium Sulfate
Indomethacin
Atosiban
Nifedipine

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41
Q

What should you monitor for after administering Magnesium sulfate?

A

Flushing, N/V, dry mouth, lethargy, blurred vision, headache, and hypotension

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42
Q

Educating the Client Preterm

A 
Harmful lifestyles 
Signs of genitourinary infections and preterm labor
Appropriate response 
How to palpate and time contractions 
Importance of prenatal care
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43
Q

Postterm Labor

A

pregnancy that continues past the end of the 42 week of gestation

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44
Q

Postterm Labor Maternal Risks

A 
Increased risk of cesarean birth
Dystocia 
Birth trauma
Postpartum Hemorrhage
Infection
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45
Q

Postterm Labor Fetal Risks

A 
Macrosomia 
Shoulder Dystocia
Brachial plexus injuries 
Low APGAR scores
Post-maturity syndrome 
Cephalopelvic disproportion
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46
Q

What can happen as amniotic fluid begins to decline after 38 weeks?

A

Oligohydramnios resulting in fetal hypoxia and an increased risk of cord compression

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47
Q

Hypoxia and Oligohydramnios predispose the fetus to what?

A

Aspiration of meconium

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48
Q

Nursing Assessment for Postterm Pregnancy

A
  • Estimated date of birth
  • Fetal movement counts
  • Non-stress test twice weekly
  • Amniotic fluid analysis
  • Weekly cervical exams
  • Client understanding
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49
Q

Nursing Management for Postterm Labor

A

Fetal Surveillance
Decision for labor induction
Support/Education
Intrapartal care

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50
Q

Intrauterine Fetal Demise (IUFD)

A

Fetal death that occurs after 20 weeks gestation, but before birth
-Numerous causes

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51
Q

Nursing Assessment of IUFD

A

Inability to obtain fetal heart sounds
Ultrasound to confirm absence of fetal activity
Labor induction

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52
Q

Nursing Management IUFD

A

Assistance w/ grieving process

Referrals

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53
Q

What risks are considered obstetric emergencies?

A
  • Umbilical cord prolapse
  • Placental abruption
  • Uterine rupture
  • Amniotic fluid embolism
54
Q

Umbilical Cord Prolapse

A

protrusion of the umbilical cord ahead of the presenting part of the fetus

55
Q

What is key to managing umbilical cord prolapse?

A

Prevention by identifying clients at risk

56
Q

What pregnancies would be considered most at risk for umbilical cord prolapse?

A 
Malpresentation (breech)
Growth restriction
Prematurity 
ROM w/ fetus at high station
Hydramnios 
Grandmultiparity
Multiple gestations
57
Q

What is often the first sign of umbilical cord prolapse?

A

Sudden fetal bradycardia or recurrent variable decelerations that become progressively more severe

58
Q

Nursing Management for Umbilical Cord Prolapse

A

Prompt recognition

Measures to relieve compression

59
Q

What measures would the nurse take to relieve compression of cord during umbilical cord prolapse?

A
  • Call for help ASAP
  • Do NOT leave mom
  • Place sterile gloved hand into the vagina and holds the presenting part off the umbilical cord until delivery
60
Q

What can you change mom’s position to during umbilical cord prolapse to help relieve compression?

A
  • modified Sims (all 4’s)
  • Trendelenburg
  • Knee-chest position
61
Q

Placental Abruption

A

premature separation of a normally implanted placental from the maternal myometrium

62
Q

What are the risk factors for Placental Abruption?

A 
Preeclampsia 
Gestational hypertension
Seizures
Advanced maternal age
Uterine rupture 
Uterine Trauma
Smoking/Cocaine 
Coagulation defects
Chorioamnionitis 
PROM
Hydramnios
63
Q

Management for Placental Abruption depends on what?

A

Gestational age
Extent of hemorrhage
Maternal-fetal oxygen perfusion

64
Q

What is typically the main focus once diagnosis of Placental Abruption is confirmed?

A

Maintaining the cardiovascular status of mom

Developing plan to deliver fetus quickly

65
Q

If the fetus is still alive during placental abruption what type of birth typically happens?

A

emergency c/s

66
Q

If Fetal Demise happens during placental abruption how will the mother give birth?

A

Vaginally

67
Q

Uterine Rupture

A

catastrophic tearing of the uterus at the site of previous scar into the abdominal cavity

68
Q

The onset of Uterine Rupture is typically marked only by?

A

Sudden fetal bradycardia

69
Q

How much time from diagnosis to delivery is there to still have a living baby?

A

10-30 minutes

70
Q

Risk Factors of Uterine Rupture

A 
Uterine scars
Prior c/s
Prior rupture 
Trauma
Prior invasive molar pregnancy 
History of placental percreta or increta
Congenital uterine anomalies 
Multiparity 
Previous uterine myomectomy 
Malpresentation
Cocaine use
Labor induction w/ excessive uterine stimulation
71
Q

What is the first and most reliable symptom of uterine rupture?

A

Sudden fetal distress

72
Q

Signs of Uterine Rupture

A

Sudden fetal distress
Acute-continuous abdominal pain w/ or w/o epidural
Vaginal bleeding
Hematuria
Irregular abdominal wall contour
Loss of station in fetal presenting part
Hypovolemic shock of women, baby, or both

73
Q

Nursing Management of Uterine Rupture

A

Prepare for urgent c/s

Continuous maternal and fetal monitoring

74
Q

Hypotension and tachycardia may indicate what?

A

Hypovolemic shock

75
Q

Amniotic Fluid Embolism

A

amniotic fluid containing particles of debris enters the maternal circulation and obstructs the pulmonary vessels causing respiratory distress and circulatory collapse

76
Q

Amniotic Fluid Embolisms are characterized by what?

A

Sudden onset of hypotension, hypoxia, and coagulopathy

77
Q

Amniotic Fluid Embolism causes what?

A

Respiratory distress and circulatory collapse

78
Q

What are some predisposing factors for Amniotic Fluid Embolism?

A 
Placental Abruption
Uterine over distention
Fetal demise
Uterine trauma 
Oxytocin-stimulated labor 
Amnioinfusion
Multi-parity
Advanced maternal age
ROM
79
Q

Signs/Symptoms of Amniotic Fluid Embolism

A 
Difficulty breathing 
Hypotension
Cyanosis
Hypoxemia
Uterine atony w/ or w/o subsequent hemorrhage 
seizures
tachycardia 
coagulation failure
DIC
Pulmonary edema 
ARDS
Cardiac arrest
80
Q

Upon recognition of Amniotic Fluid Embolism what supportive measures should be implemented?

A
  • maintain oxygenation and circulation function

- Correct and control hemorrhage and coagulopathy

81
Q

How would you manage DIC if it was to occur?

A

replacement with packed red blood cells or fresh frozen plasma

82
Q

What can be used to address uterine atony?

A

Oxytocin infusions and prostaglandin analogs

83
Q

Labor Induction

A

stimulation of uterine contractions by medical or surgical means before the onset of spontaneous labor

84
Q

What is the most common reason to have labor induced?

A

prolonged gestation

85
Q

Indications for Labor Induction

A 
Prolonged gestation
PPROM
Gestation hypertension
Cardiac or Renal disease
Chorioamnionitis 
Dystocia
Intrauterine fetal demise 
Isoimmunization
Diabetes
86
Q

A Bishop score less than 6 typically indicates what?

A

Indicates that a cervical ripening method should be used prior to induction

87
Q

What does a Bishop score greater than 8 indicate?

A

A successful vaginal birth

88
Q

Bishop Score

A

Most commonly used scoring system to determine cervical ripeness
-indicates who is likely to have a successful induction

89
Q

What herbal agents are believed to induce labor?

A 
Cabbage leaves
Evening primrose oil
Black haw
Black and blue cohosh 
Red raspberry leaves
90
Q

What home remedies are believed to induce labor?

A

Castor oil, hot baths, enemas, sexual intercourse with breast stimulation

91
Q

How can sexual intercourse induce labor?

A

Promotes the release of oxytocin which stimulates uterine contractions
Human semen is a biologic source of prostaglandins

92
Q

What are the risks of using mechanical methods of induction?

A

infection
bleeding
ROM
placental disruption

93
Q

Mechanism of action for Mechanical method of induction

A

Application of local pressure stimulates the release of prostaglandins to ripen the cervix

94
Q

Advantages of Mechanical Methods

A

Simplicity or preservation of the cervical tissue or structure, lower cost, and fewer side effects

95
Q

Labor Augmentation

A

enhancing ineffective contractions after labor has begun

96
Q

What are the 2 surgical methods of inducing labor?

A

Stripping of membranes

Amniotomy

97
Q

Stripping of Membranes

A

inserting a finger through the internal cervical os and moving in circular direction causing membranes to detach

98
Q

Amniotomy

A

inserting cervical hook through the cervical os to deliberately rupture the membranes

99
Q

What will an amniotomy promote?

A

Pressure of the presenting part on the cervix and stimulating an increase in the activity of prostaglandins

100
Q

What are the risks associated with Surgical methods of induction?

A 
Umbilical cord prolapse or compression
Maternal or neonatal infections 
FHR decelerations
Bleeding 
Client discomfort
101
Q

What should be monitored closely after surgical induction?

A

FHR pattern and amniotic fluid characteristics

102
Q

What are the 2 pharmacological agents used to induce labor?

A

Prostaglandin analogs and Oxytocin

103
Q

Advantages of using prostaglandins to induce labor:

A

Promotes both cervical ripening and uterine contractility

104
Q

What is the disadvantage of using prostaglandins?

A

Their ability to induce excessive uterine contractions which can increase maternal and perinatal morbidity

105
Q

What Prostaglandin analogs are often used for induction?

A

Prepidil, Cervidil, Cytotec

106
Q

Oxytocin

A

used to stimulate uterine contractions

107
Q

What is typically done before oxytocin is introduced?

A

Cervical ripening is initiated before oxytocin by using a prostaglandin analog

108
Q

What is the most common effect of oxytocin?

A

Uterine hyperstimulation leading to fetal compromise and impaired oxygenation

109
Q

What other type of effect does oxytocin have on the body?

A

Antidiuretic effect resulting in decreased urine flow that may lead to water intoxication

110
Q

What symptoms should be watched for with water intoxication?

A

Headaches and vomiting

111
Q

Side effects of Oxytocin

A

Water intoxication
Hypotension
Uterine hypertonicity
Uterine hyperstimulation

112
Q

Nursing Assessment for Induction/Augmentation

A
  • Review history for relative indications for induction/augmentation
  • Assist w/ determining gestational age
  • Assess fetal and maternal status
  • Bishop Score
113
Q

Amnioinfusion

A

a volume of warmed, sterile normal saline or LR is introduced into the uterus transcervically through an intrauterine pressure catheter

114
Q

What is an Amnioinfusion typically indicated for?

A
  • Severe variable decelerations due to cord compression
  • Oligohydramnios due to placental insufficiency
  • Post-maturity or ROM
  • Preterm labor w/ PROM
  • Thick meconium fluid
115
Q

Nursing Management for Amnioinfusion

A

Teaching
Maternal and fetal assessment
Prep for possible c/s

116
Q

Vacuum Extractor

A

cup-shaped instrument attached to a suction pump used for the extraction of the fetal head

117
Q

What part of the fetal head is the vacuum extractor applied to?

A

Occiput

118
Q

Forceps

A

stainless steel instruments with rounded edges that fit around the fetal head

119
Q

When is the use of the vacuum extractor/forceps indicated?

A

Prolonged second stage of labor, non-reassuring FHR pattern, failure of presenting part to fully rotate and descend, limited sensation or inability to push effectively, fetal distress, maternal heart disease, acute pulmonary edema, intrapartum infection, maternal fatigue, infection

120
Q

What are the risks of using vacuum/forceps?

A

Risk of tissue trauma to mom and baby

121
Q

Maternal trauma from Vacuum/forceps

A

lacerations of cervix, vagina, or perineum
hematoma
extension of episiotomy incision into the anus
hemorrhage
infection

122
Q

Newborn trauma from vacuum/forceps

A 
ecchymoses 
facial and scalp lacerations 
facial nerve injury
cephalhematoma 
caput succedaneum
123
Q

What can be done to try and prevent the use of vacuum/forceps?

A

Frequent position changes
Ambulation if permitted
Frequent reminding to empty bladder
Providing adequate hydration

124
Q

Cesarean Birth

A

surgical birth of the fetus through an incision in the abdomen and uterine wall
-classic (vertical) or low transverse (horizontal)

125
Q

Which c/s incision is more common today?

A

Low transverse

126
Q

Risks from c/s

A 
infection
hemorrhage 
aspiration
pulmonary embolism 
urinary tract trauma
thrombophlebitis 
paralytic ileus 
atelectasis 
fetal injury and transient tachypnea
127
Q

Nursing Assessment for C/S

A

History and physical exam for maternal and fetal indications

128
Q

Preoperative care for C/S

A
  • Ascertain family understanding of procedure
  • Explain what to expect postop
  • Explain incentive spirometer and leg exercises
  • Prep surgical site
  • Start IV fluids; foley catheter
  • Administer any preop meds
129
Q

Postoperative care for C/S

A
  • Vitals/ Lochia flow
  • Perineal care
  • Assess abdominal dressing
  • Assess uterine tone
  • Assess woman’s LOC
  • Assess for evidence of abdominal distention and auscultate bowel sounds
  • Early ambulation
  • Cough, deep breathing, incentive spirometer
  • Encourage bonding
130
Q

Vaginal Birth after C/S (VBAC)

A

a women who gives birth vaginally after having at least one previous c/s

131
Q

Contraindications for VBAC

A
  • prior uterine incision
  • prior uterine surgery
  • uterine scar
  • contracted pelvis
  • inadequate staff/facility
132
Q

Special areas of focus for VBAC

A

Consent
Documentation
Surveillance
Readiness for emergency

NU314 OB (21 decks)

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