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MATERNAL-CARE FOR AT RISK > PROBLEMS WITH THE POWER > Flashcards

PROBLEMS WITH THE POWER Flashcards

1
Q

What are the 4P’s affecting Labor?

A

1) Power
2) Passenger
3) Passage
4) Psyche

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2
Q

Power refers to what?

A

Uterine Contractions & Maternal Pushing Efforts

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3
Q
  • Is the primary force of labor.
  • Rhythmic tightening & relaxing of the uterus that dilates the cervix and pushes the fetus downward
A

Uterine Contractions

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4
Q

Why do uterine contractions occur?

A

Interplay of different enzymes, hormones (oxytocin), mechanical factors (fetal pressure on the cervix, uterine stretching)

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5
Q

Uterine Contractions is assessed or measured in terms of?

A
  • Frequency
  • Duration
  • Intensity
  • Interval (Resting time)
  • Resting Tone
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6
Q

Refers about the time from the start of one contraction to the start of the next

A

Frequency

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7
Q

Refers to how long each uterine contraction lasts (in secs)

A

Duration

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8
Q

Refers to the strength of the uterine contraction (measured by IUPC)
- By palpation : (mild = cheek, moderate = chin, strong = forehead)

A

Intensity

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9
Q

Refers to the time between the end of one contraction & the start of the next.
- ensures O2 supply to the fetus; allows the mother to prep for the next contraction

Time between contractions

A

Interval (Resting Time)

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10
Q

Refers to the tension in the uterus between contractions (soft, non-tender, or firm, tense uterus)

Measured using palpation & IUPC

A

Resting Tone

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11
Q

IUPC of less than or equal to 20 mmHg refers to?

A

Normal (soft uterus)

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12
Q

IUPC of greater than or equal to 20 mmHg indicated what?

A

High (firm uterus)

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13
Q

A high resting tone would indicate that?

A

Uterus is not relaxing enough → decreased blood flow → fetal distress

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14
Q
A
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15
Q

What happens if the uterus is not relaxing enough in between contractions

A

Decreased fetal blood flow → fetal distress

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16
Q

Is the secondary force of labor.
- Becomes important during the second stage of labor

A

Maternal Pushing Efforts (Bearing Down)

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17
Q

Why must maternal pushing efforts be coordinated with uterine contractions?

A

To assist with fetal descent (continuous downward movement of the fetus)

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18
Q

Problems with the POWER (abnormal contractions)
TYPES OF INEFFECTIVE UTERINE CONTRACTIONS

A
  • Hypotonic
  • Hypertonic
  • Tachysystole
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19
Q

Refers to labor patterns that fail to progress effectively, leading to prolonged or difficult labor.

A

Dysfunctional Labor (Labor Dystocia)

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20
Q

Refers to weak contractions ; infrequent ; slow or no cervical dilation

A

Hypotonic

Intensity-Based Issue

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21
Q

Refers to strong, frequent contractions but uncoordinated or irregular pattern ; ineffective in dilating cervix; uterus does not relax completely between contractions

A

Hypertonic

Uterine-Tone Issue

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22
Q

Refers to excessive contractions
- > 5 contractions in 10 mins that are too long / strong

A

Tachysystole

Frequency-Based Issue

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23
Q

CHARACTERISTICS OF NORMAL UTERINE CONTRACTIONS

Frequency of a normal uterine contraction

A

4-5 contractions in 10 mins

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24
Q

CHARACTERISTICS OF NORMAL UTERINE CONTRACTIONS

Normal intensity of a uterine contractions

A

30-70 mmHg or higher (strong)

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25
Q

CHARACTERISTICS OF NORMAL UTERINE CONTRACTIONS

Normal Resting Tone of a uterine contraction

A

10-15 mmHg

IUPC - Intrauterine Pressure Catheter

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26
Q

CHARACTERISTICS OF NORMAL UTERINE CONTRACTIONS

Describe the pain in a normal uterine contraction

A

Increasing in intensity as labor progresses

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27
Q

CHARACTERISTICS OF NORMAL UTERINE CONTRACTIONS

Cervical dilation of a normal uterine contraction

A

Progressive

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28
Q

CHARACTERISTICS OF A HYPOTONIC UTERINE CONTRACTIONS
- Frequency
- Intensity
- Resting Tone
- Phase of Labor
- Pain

A
  • Frequency : Infrequent uterine contractions (2-3 contractions / 10 mins)
  • Intensity : Less than or equal to 25 mmHg
  • Resting Tone : Normal
  • Phase of Labor : ACTIVE (6-10cm dilation)
  • Pain: Limited / mild

CONCLUSION: INFREQUENT, LOW STRENGTH, AND RESTING TONE IS NORMAL

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29
Q

Causes of Hypotonic Uterine Contractions

A
  • Overstretching of the uterus (large baby, multiple gestation, polyhydramnios or multiparity)
  • Bowel or bladder distention, preventing fetal descent
  • Exhaustion due to prolonged labor
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30
Q

Interventions for Hypotonic Uterine Contractions

A

Oxytocin
Nipple Stimulation
Enema
Ambulation
Amniotomy - (AROM)

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31
Q

Interventions for Hypotonic Uterine Contractions

Why administer oxytocin?

A

To strengthen the uterine contractions further

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32
Q

Interventions for Hypotonic Uterine Contractions

Why stimulate the nipple?

A

Stimulate oxytocin release, thus increasing uterine contractions

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33
Q

Interventions for Hypotonic Uterine Contractions

What is Enema for?

A

Relieve bowel distention

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34
Q

Interventions for Hypotonic Uterine Contractions

Why is ambulation an intervention?

A

Increases the intensity of contractions ; fetal descent

35
Q

Interventions for Hypotonic Uterine Contractions

What is amniotomy for?

A

Triggers prostaglandin release → stimulate stronger uterine contractions; ↑ pressure on cervix

36
Q

CHARACTERISTICS OF HYPERTONIC UTERINE CONTRACTIONS
- Frequency
- Intensity
- Resting Tone
- Phase of Labor
- Pain

A
  • Frequency : frequent uterine contractions ; uncoordinated; ineffective
  • Intensity: moderate-strong but uncoordinated
  • Resting Tone : >20-25 mmHg
  • Phase of Labor: Latent (0-5 cm dilation)
  • Pain: Painful

CONCLUSION: Frequent with stronger contractions

However uterus does not sufficiently relax after each contraction.

37
Q

Causes of Hypertonic Uterine Contractions

A
  • Maternal Stress
  • Uterine Irritability
  • Dehydration
38
Q

Complications of hypertonic uterine contractions

A
  • Fetal anoxia due to decreased oxygenation
  • Prolonged labor due to ineffective cervical dilation
39
Q

Interventions for Hypertonic Uterine Contractions

A
  • Provide comfort measures
  • Bed Rest/Position Changes
  • Hydration
  • Pain relief/mild sedation
  • Tocolytics
  • Cesarean section
40
Q

Interventions for Hypertonic Uterine Contractions

What is the purpose of hydration?

A

Promotes coordinated contractions

41
Q

Interventions for Hypertonic Uterine Contractions

Purpose of pain relief / mild sedation

A

Reduces maternal stess , prevent exhaustion

42
Q

Interventions for Hypertonic Uterine Contractions

Purpose of Tocolytics

A

To relax the uterus

43
Q

Interventions for Hypertonic Uterine Contractions

When is a Cesarean section considered?

A

If hypertonic contractions do not resolve and pose risks to the mother or fetus.

44
Q

Characteristics of Tachysystole Uterine Contractions

A
  • Frequency: too frequent ; excessive contractions
  • Intensity : normal - strong but too frequent
  • Resting tone: normal or elevated
  • Phase of Labor : can occur at any stage
  • Pain : severe, frequent pain, persistent

“Constant uterine tightness” or “cramping that doesn’t go away”

45
Q

Causes of Tachysystole Uterine Contractions

A

Medically-induced
- Excessive oxytocin infusion
- Prostaglandin (misoprostol , dinoprostone) use for labor induction

Spontaneous causes
-Placental abruption (irritation from placental separation)
-Chrioamnionitis
- Hypertonic uterine contractions can lead to tachysystole
- Dehydration - can trigger uterine contractions

46
Q

Management for tachystole uterine contractions if it is due to oxytocin infusion

A
  • Stop or reduce oxytocin infusion (first-line of action)
  • Administer IV fluids to dilute oxytocin in the maternal blood stream
  • Reposition the mother (LLD)
  • Provide oxygen inhalation esp if fetal distress is present
  • Administer tocolytics (terbutaline, nifedipine, MgSO4) to relax the uterus.
47
Q

Management for tachystole uterine contractions if spontaneous tachysystole

A
  • Hydration
  • Pain management & sedation
  • Monitor for fetal distress (tachycardia, decelerations or decrease in FHR)
48
Q

Common Causes of Dysfunctional Labor

A
  • CPD
  • Primigravida
  • Fetal malposition
  • Macrosomia
  • Polyhydramnios
  • Multiple pregnancy / twins
  • Unripe cervix - not effaced & not dilated
  • Full bladder / rectum
  • Exhaustion from labor
  • Analgesia / administration of sedatives
49
Q

Two phases of the 1st stage of labor

A

1) Latent Phase : Onset of labor - 5 cm dilation
2) Active Phase : 6-10 cm dilation

50
Q

Upper normal limit of a nullipara mother for the latent and active phase

A

Latent : 20 hrs
Active : 12 hrs

51
Q

Upper normal limit of a multipara parent for latent and active phase

A
  • Latent : 14 hrs
  • Active : 6 hours
52
Q

This stage full dilation to birth of the baby happens

53
Q

For a nullipara mother , how long does the 2nd stage last, with or w/o epidural

A

Without : less than 2 hrs
With : Less than 3 hrs

54
Q

For a multipara mother , how long does the 2nd stage last, with or w/o epidural

A

Without : less than 1 hr
With : less than 2 hrs

55
Q

What happens on the 3rd stage of a normal labor

A

Delivery of the placenta

56
Q

How long is the delivery of the placenta normally

57
Q

Causes of a prolonged Latent Phase (0-5 cm dilation)

A

Hypertonic contractions

58
Q

Managment for Prolonged Latent Phase

A
  • Pain relief & Hydration
  • If persistent : Amniotomy & C-section
59
Q

Management of Prolonged Active-Phase Dilation

A
  • Amniotomy if membranes are intact
  • Oxytocin augmentation - if CPD is not present
  • C-section
60
Q

Causes of a Prolonged Active-phase dilation

A
  • Hypotonic contractions
  • CPD
  • Malpresentation ; multiple gestation
61
Q

Management of Prolonged Active-Phase Dilation

A
  • Amniotomy if membranes are intact
  • Oxytocin augmentation - if CPD is not present
  • C-section
62
Q

This phase happens when the cervix is almost fully open (8-10 cm) but slows down before reacing 10 cm.

A

Deceleration phase

63
Q

Normal Deceleration Phase of a nullipara

64
Q

Normal Deceleration Phase of a multipara

A

Less than or equal to 1 hr

65
Q

Causes of Prolonged / Protracted Deceleration Phase

A
  • Hypotonic contractions
  • Malpresentation, malposition, CPD
  • Uterine exhaustion
66
Q

Management of a Prolonged / Protracted Deceleration Phase

-

A
  • Amniotomy
  • Oxytocin augmentation
  • C-section
67
Q

Means that the fetus takes too long to descend after cervix has fully dilated.

Fetal station does not advance at least:
- Nullipara : <1cm/hr
- Multipara : <2cm/hr

A

Prolonged Descent

68
Q

Causes of Prolonged Descent

A
  • Hypotonic contractions & inadequate maternal pushing
  • Malposition
  • macrosomia
  • CPD
  • full bladder
69
Q

Management of prolonged descent

A
  • AROM if membranes are intact
  • Oxytocin augmentation
  • Semi-fowler’s, squatting, kneeling & effective pushing may speed up descent
70
Q

Nullipara: no descent has occured for 2 hrs
Multipara : no descent has occured for 1 hr

A

Arrest of Descent

71
Q

Most common cause of arrest of descent

72
Q

Management of Arrest of Descent

A
  • Cesarean delivery : if CPD is present
  • Oxytocin
73
Q

When expected descent of fetus does not begin.
- Engagement beyond 0 station does not occur

A

Failure of Descent

74
Q

Common causes of failure of descent

A
  • CPD
  • Malposition
75
Q

Extremely rapid labor & delivery.
-contactions are so stong & duration is very fast.

A

Precipitate Labor

76
Q

Maternal Risks of Pripitate Labors

A
  • Premature placental separation
  • Perineal laceration
  • Uterine rupture
  • PP Hemorrhage
  • Emotional & Psychological trauma
77
Q

Fetal Risks of Precipitate labor

A
  • Hypoxia & distress
  • MAS
  • Infection
  • Birth injuries like : clavicle fracture & brachial plexus injury
78
Q

Non-pharmacological labor management techniques

A
  • Positioning & Movement
  • Breathing Techniques & Dilation
  • Continous Labor support
  • Nipple stimulation
79
Q

Used when labor does not naturally despite medical necessity

A

Labor Induction

80
Q

Induction is done only when:

A
  • Cephalic presentation
  • No CPD
  • Longitudinal lie
  • maturity 39 weeks
  • cervix is flavorable
81
Q

Change in cervical consistentcy from firm to soft, so dilation & coordination of conractions will occur.

A

Cervical ripening

82
Q

Methods of Cervical Ripening

A
  • Prostaglandins (Misoprostol, Dinoprostone)
  • Evening Primrose Oil -:not advised in PROM
  • Mechanical METHODS
  • Oxytocin
  • Amniotomy (arom)
83
Q

Involves the doctor sweeping a finger between the membranes of the amniotitac sac the uterus to help separate the sac from ther uterine leaning.

A

Stretch & Sleeping

MATERNAL-CARE FOR AT RISK (11 decks)

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