QUIZ 4: NURSING CARE OF A FAMILY EXPERIENCING A SUDDEN COMPLICATIONS OF LABOR OR BIRTH Flashcards
Although labor often proceeds without any deviation from the normal, many potential complications can occur
Dystocia
Ineffective uterine force
Dysfunctional labor and associated stages of labor
Power = force that propels the fetus (uterine contraction)
Umbilical cord prolapse
Multiple gestation
Problems with fetal position, presentation, or size
Passenger = the fetus
Inlet contraction
Outlet contraction
Trial labor
External cephalic version
Forceps birth
Vacuum extraction
Passage = the birth canal
the woman’s and family’s perception of the event
Psyche
is a time-honared term to denote that sluggishness of contractions, or the farce of labor, has occurred.
Inertia
___can occur at any point in labor, but it is generally classified as
Dysfunction
(occurring at the onset of labor)
Primary
(occurring later in labor).
Secondary
___ are the basic force moving the fetus through the birth canal.
Uterine contractions
3 TYPES OF DYSFUNCTION
Hypotonic Contractions
Hypertonic Contractions
Uncoordinated Contractions
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.
Occur if the cervix is not “ripe” at the beginning of labor and time must be spent getting truly for labor.
May also occur if there is excessive use analgesic early in labor.
PROLONGED LATENT PHASE
A ____ is usually associated with cephalopelvic disproportion (CPD) or fetal malposition, although it may reflect ineffective myometrial activity.
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
Progress in dilation slows after 8 cm and uterine contractions become dysfunctional, even after oxytocin administration.
Extends beyond 3 hours in a nullipara or 1 hour in a multipara.
Most often results from abnormal fetal head position.
PROLONGED DECELARATION PHASE
A ____ has occurred if there is no progress in cervical dilatation for longer than 2 hours.
Again, cesarean birth may be necessary.
SECONDARY ARREST OF DILATION
____ of the fetus 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
____ results when no descent has occurred for 1 hour in a multipara or 2 hours in a nullipara.
Arrest of descent
A _____ is a hard band that forms across the uterus at the junction of the upper and lower uterine segments and interferes with fetal descent.
contraction ring
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 AND BIRTH
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
Such rapid labor is likely to occur with grand multiparity, or it may occur after induction of labor by oxytocin or amniotomy.
PRECIPITATE DILATION
___ means that labor is started artificially.
Induction of labor
___ refers to assisting labor that has started spontaneously but is not effective.
Augmentation of labor
___, or a change in the cervical consistency from firm to soft
stripping the membranes, separating the membranes from the lower uterine segment manually, using a gloved finger in the cervix. use of hygroscopic
Cervical ripening
___ (synthetic form of naturally occurring pituitary hormone) initiates contractions in a uterus at pregnancy term
always administered intravenously, so that, if hyperstimulation should occur, it can be quickly discontinued.
INDUCTION OF LABOR BY OXYTOCIN
Occurs when a uterus undergoes more strain than it is capable of sustaining
Occurs most commonly when a vertical scar from a previous cesarean birth or hysterotomy repair tears
UTERINE RUPTURE
refers to the uterus turning inside out with either birth of the fetus or delivery of the placenta
INVERSION OF THE UTERUS
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
is defined as the descent of the umbilical cord through the cervix alongside (occult) or past (overt) the presenting part in the presence of ruptured membranes
PROLAPSE OF THE UMBILICAL CORD
is due to cord compression - preventing venous return to the fetus and arterial
Birth asphyxia
- secondary to exposure to air
vasospasm
The occipital fontanel is the presenting part, and this presentation is referred to as a vertex or occiput presentation
Cephalic Presentation
Assuming that the presentation is vertex, the occiput is directed diagonally and posteriorly, either to the left or to the right.
Occiput Presentation
The ___ position is ideal for birth
Occipito-anterior
It is the vertex position where the occiput is placed posteriorly over the sacroiliac joint or directly over the sacrum
Occipito - posterior Position
Most fetuses are in a ____ early in pregnancies; however, by week 38, It turns into a cephalic presentation.
Breech Presentation
___ are called asynclitism or a fetal head presenting at a different angle than expected
Face and brow presentations
The rarest among the presentations is the __
Brow Presentation
___ occurs in women with pendulous abdomens, with uterine fibroid tumors that obstruct the lower uterine segment, with contraction of the pelvic brim, with congenital abnormalities of the uterus, or with hydramnios.
Transverse lie
___ or an oversized fetus weighs more than 4000 to 4500g, and this size may become a problem.
Macrosomia
___occurs during the second stage of labor when the fetal head is born but the shoulders are too broad to enter and be barn through the pelvic outlet.
Shoulder dystocia
___ is the narrowing of the anteroposterior diameter to less than 11 cm or the transverse diameter to 12 cm or less.
Inlet contraction
___ is the narrowing of the transverse diameter at the outlet to less than 11 cm.
Outlet contraction
___ refers to determination of the progress of labor in a woman who has borderline inlet measurement with a good fetal lie and position.
Trial labor
____ version is the turning of a fetus from a breech to a cephalic position before birth.
External cephalic
Obstetric forceps is a double-bladed metal instrument used for extraction of fetal head
Forceps Birth
A fetus, if positioned far enough down the birth canal, may be born by
Vacuum Extraction
A normal cord has one vein and two arteries
If one of the umbilical arteries is absent, this may indicate that the infant may have congenital heart and kidney anomalies.
TWO VESSEL CORD
An unusually short umbilical cord may predispose the fetus to premature separation of placenta or an abnormal fetal lie.
An unusually long cord has a great tendency of twisting or knatting-
A cord naturally forms a knot but the natural pulsations of the blood through the vessels and the muscular vessel walls usually keep the blood flow adequate.
UNUSUAL CORD LENGTH
The normal placenta weighs approximately 500 g and is 15 to 20 cm in diameter and 1.5 to 3.0 cm thick.
Placenta succenturiata is a placenta that has one or more accessary lobes connected to the main placenta by the blood vessels.
This is not a fetal abnormality; however, it must be recognized upon assessment after birth.
PLACENTA SUCCENTURIATA
Normally, the chorion membrane begins at the edge of the placenta and spreads to cover the fetus.
The fetal side of the placenta is not usually covered by the chorion.
In placenta circumvallata, the fetal side of the placenta is covered with chorion.
PLACENTA CIRCUMVALLATA
refers to anunusually deep attachment of the placenta to the uterine myometrium that the placenta will not loosen and deliver.
PLACENTA ACCRETA
refers to the cord that is inserted marginally rather than centrally.
This is a rare anomaly and it has no known clinical significance.
BATTLEDORE PLACENTA
cord occurs when the cord, instead of entering the placenta directly, separates into small vessels that reach the placenta by spreading across a fold of amnion.
VELAMENTOS INSERTION OF THE CORD
The umbilical vessels of a velamentous cord insertion cross the cervical os and therefore deliver before the fetus.
VASA PREVIA
