procedures and complications of labor and birth Flashcards
induction of labor
Deliberate initiation of uterine contractions to stimulate labor before spontaneous onset
indications of induction of labor
- Postdates (book says >42 weeks, its 41 weeks in practice)
- Prolonged premature rupture of membranes (PROM)
- IUGR
- Expectant medical conditions: GDM, prececlamsia, cardio, dm 1&2
- Fetal demise: fetus dies in utero
- Chorioamnionitis: uterine infections in membranes lead to fetus sepsis and death
- Elective
IUGR
intra uterine growth restriction
what point do you want ROM
middle of labor bc u have 18 hr till baby needs to come out
bishops score
Bishop’s score- evaluation of how ready or “favorable” the cervix is for induction. It scores: dilation, effacement, consistency (firm, medium, or soft), position (posterior, midposition, or anterior), and station of presenting part.
A bishop’s score of 8
A bishop’s score of 8 or higher means that the cervix is favorable and will respond well to induction methods.
pitocin
Pitocin or oxytocin is a synthetic form of a naturally occurring hormone in the body that stimulates uterine contractions. It is an IV drip that gets titrated based on contraction and FHR pattern.
pitocin dosage
- Normal dosage 1-2 milliunits/min to be titrated up by 1-2 milliunits/min every 20-30 minutes until adequate contractions. We want contraction that are strong to palpation every 2-3 minutes apart.
- Pitocin can be quickly discontinued for fetal or uterine distress.
- Can be an induction method for someone who had a c-section in previous delivery
VBAC
Anytime someone has had a c-section in the past, there is always a risk for another c-section. If the person wants to try for a vaginal delivery then they will have a trial of labor after c-section (TOLAC). We never know if the previous uterine scar will hold during labor, there is a chance of uterine rupture. These people are closely monitored during labor and can only be given Pitocin or mechanical induction methods. If they show any signs of a possible uterine rupture, then we will rush back for a c-section.
prolapsed cord
- When the umbilical cord is displaced and comes out of the vagina before the presenting part
- usually happens when water breaks and baby is up high
- There is high chance of compromised fetal circulation
- This is an obstetric emergency
nursing responsbilities
- Early recognition, place pt in Trendelenburg
- Call for help
- Get a glove and push presenting part off of the cord
- Immediate c-section needed
- Provide emotional support for patient/partner
nursing interventions for proloasped cord
- Call for assistance. Do not leave pt. Stay calm.
- Have someone notify PCP
- Glove hand and push presenting part up to relieve pressure on cord
- Have woman move into knee-chest position (modified Sims position) or extreme Trendelenburg Or place a rolled towel under the mother’s hip
- Do not attempt to replace cord into vagina or cervix
- If cord is protruding from vagina, loosely wrap it in sterile towel with warm saline
- Administer O2 by non-rebreather mask at 8-10 L/min
- Start IV or increase existing rate
- Monitor FHR
- Prepare for delivery
- Explain to pt. & partner what is happening
meconium stained fluid
Baby passed stool in utero, high risk for meconium aspiration syndrome in neonate
uterine rupture
Uterus bursts open, chance for hemodynamic collapse and fetal distress/mortality
most frequent cause of UR and s/s
Most frequent cause
Scarred uterus as a result of
previous cesarean births
Signs and symptoms
- Abnormal FHR tracing w/ sudden bradycardia
- Loss of fetal station
- Abdominal pain
- Shock
