Problems with Labor and Birth

Question 1

Premature Rupture of Membranes

Answer 1

• spontaneous rupture of the amniotic membranes before the onset of labor.
• when happens before term, birth will be delayed and infection becomes a risk.
• amount, color, consistency, and odor of fluid need to be assessed.
• fetal monitoring is necessary, tachycardia in the fetus may indicate maternal infection.
• Avoid vaginal examinations because of the risk of infection and adm ATB as prescribed.

Question 2

Prolapsed Umbilical Cord

Answer 2

• umbilical cord is displaced causing compression of the cord and compromising fetal circulation.
• client has a feeling that something is coming through the vagina.
• umbilical cord may be visible or palpable.
• FHR is irregular and slow.
• fetal heart monitor shows variable decelerations or bradycardia after rupture of the membranes.
• if fetal hypoxia is severe, violent fetal activity may occur and then cease.
• elevate the fetal presenting part that is lying on the cord by applying finger pressure with a gloved hand.
• place the client in extreme trendelenburg’s or modified sims or a knee-chest position.
• adm 8-10L/min by face mask.
• prepare for immediate birth.
• nurse stays with client and ask someone else to contact the PHCP.
• NEVER attempt to push the cord into the uterus. If cord is protruding from the vagina, wrap loosely a sterile towel saturated with warm saline
• is an emergency and delivery must occur, usually via c-section.

Question 3

Supine Hypotension (Vena Cava Syndrome)

Answer 3

• occurs when the venous return to the heart is impaired by the weight of the uterus on the vena cava.
• the syndrome results in partial occlusion of the vena cava and aorta and in reduced cardiac return, cardiac output, and blood pressure.
• assessment: palllor, faintness, dizziness, tachycardia, hypotension, sweating, cool and damp skin, fetal distress.
• position the client on her side to shift the weight of the fetus of the vena cava. Avoid supine position.
• monitor VS and FHR.

Question 4

Preterm Labor

Answer 4

• occurs after the 20th week but before the 37th week.
• risk factors: history of medical conditions, present and past obstetric problems, infection, and social and environmental factors (including substance abuse). Multifetal pregnancy, anemia (decreases oxygen supply to uterus), age < 18 or > 40 years.
• focus on stopping the labor (identify and treat infection, restrict activity, and ensure hydration), maintain bed rest and a lateral position, monitor fetal status, adm fluids and meds as prescribed and monitor for side effects of tocolytes.
• use of 17 alpha-hydroxyprogesterone caproate known as 17P injection to decrease risk of preterm delivery.

Question 5

Precipitous Labor and Delivery

Answer 5

• labor lasting less than 3 hours
• ensure that a precipitous delivery tray is available (hemostats, scissors, and cord clamp).
• prepare for rupturing membranes when the head crowns (if not already).
• do not prevent the fetus from being delivered.

Question 6

Dystocia

Answer 6

• is a difficult labor that is prolonged or more painful
• occurs because of problems caused by uterine contractions, the fetus, or the bones and tissues of the maternal pelvis.
• fetus may be excessively large, malpositioned, or in an abnormal presentation.
• contractions may be hypotonic (short, irregular, weak) or hypertonic (6 or more in a 10 min time period, uncoordinated).
• can result in maternal dehydration, infection, fetal injury, or death.

Question 7

Amniotic Fluid Embolism

Answer 7

• the escape of amniotic fluid into the maternal circulation.
• the debris-containing amniotic fluid deposits in the pulmonary arterioles and is usually fatal to the mother.
• assessment: abrupt onset of respiratory distress and chest pain, cyanosis, fetal bradycardia and distress if delivery has not occurred.
• adm oxygen with face mask 8-10L/min or resuscitation bag at 100%. Prepare for intubation and MV.
• position client on her side
• adm fluids, blood products, and medications as prescribed.
• monitor fetal status and prepare for emergency delivery if necessary.

Question 8

Fetal Distress

Answer 8

• FHR < 110 or >160 bpm
• meconium-stained amniotic fluid
• fetal hypo or hyperactivity
• progressive decrease in baseline variability
• severe variable decelerations or late decelerations
• discontinue oxytocin if infusing
• place client in lateral position
• adm IV fluids and oxygen via face mask at 8-10l/min
• monitor maternal and fetal status
• prepare for emergency delivery

Question 9

Rupture of the Uterus

Answer 9

• complete or incomplete separation of the uterine tissue as a result of a tear in the wall of the uterus from the stress of labor.
• risk factors: labor after previous c-section, overdistended uterus (multiples or hydramnios), abdominal trauma.
• assessment: abd pain or tenderness, chest pain, contractions may stop or fail to progress, rigid abd, absent FHR, signs of maternal shock, fetus palpated outside the uterus.
• interventions: monitor for signs of shock, prepare for cesarean delivery (with possible hysterectomy).

Question 10

Uterine Inversion

Answer 10

• uterus completely or partly turns inside out.
• can occur during delivery or after delivery of placenta
• risk factors: fundal implantation of the placenta, manual extraction of the placenta, short umbilical cord, uterine atony, leiomyomas, and abnormally adherent placental tissue.
• assessment: depression in the fundal area, interior of the uterus may be seen through the vagina, severe pain, hemorrhage, and signs of shock.
• interventions: monitor and prepare the client for a return of the uterus to the correct position (via vagina or laparotomy).