Quiz 9 Flashcards
Dystocia
Abnormal or difficult labor
Progress of labor deviates from normal
Risk factors for dysocia
Epidural analgesia/excessive analgesia Multiple gestation Hydramnios Maternal exhaustion Ineffective maternal pushing technique Occiput posterior position Longer first stage of labor Nulliparity, short maternal stature Fetal birth weight over 8.8 lb. Shoulder dystocia Abnormal fetal presentation or position Fetal anomalies Maternal age over 35 years High caffeine intake Overweight Gestational age over 41 weeks Corioamnionitis Ineffective uterine contractions High fetal station at complete cervical dilation
Causes of dystocia (probs with powers)
Hypertonic uterine dysfunction (never relaxes)
Hypotonic uterine dysfunction (relaxes too much)
Protraction disorders (slower than normal progress)
Dilation
Descent
Arrest disorders (complete cessation of progress)
Precipitate labor (
Causes of dystocia (probs with passengers)
Occiput posterior position Breech presentation Shoulder dystocia Multi-fetal pregnancy Macrosomia and CPD Shoulder Dystocia & Brachial Plexus Injury
Causes of Dystocia (Problems With the Passageway)
Pelvic contraction
Obstructions in maternal birth canal
Preterm Labor
Regular uterine contractions with cervical effacement and dilation between 20 and 37 weeks’ gestation
One of most common obstetric complications
Preterm labor: nursing assessment
Risk factors
Contraction pattern (4 contractions every 20 minutes or 8 contractions in 1 hour)
Cervical effacement >80% & dilation >1cm
Laboratory and diagnostic testing:
CBC
Urinalysis
Amniotic fluid analysis
Fetal fibronectin (R/O diagnosis of PTL)
Cervical length via transvaginal ultrasound (R/O dx of PTL)
Preterm Labor: Therapeutic Management
Tocolytic drugs: there are no clear first-line drugs to manage preterm labor; may prolong pregnancy for 2 to 7 days
Corticosteroids can be given to improve fetal lung maturity
Antibiotic prophylaxis for women with group B streptococcus
Magnesium Sulfate
Relaxes uterine muscles
Indomethacin
Inhibits prostaglandins (which stimulate contractions)
Nifedipine
Blocks calcium movement into muscle cells (inhibits uterine activity)
Post-term labor
pregnancy continuing past end of 42 weeks gestation
Post- term pregnancy: nursing assessment
non-stress test twice weekly
Daily fetal movement counts
amniotic fluid analysis
weekly cervical examinations
Labor Induction: Therapeutic Management
Cervical ripening is the softening of the cervix and the 1st step in the process of effacement and dilation.
Ripe cervix = shortened, centered(anterior), softened, and partially dilated
Unripe cervix = long, closed, posterior, & firm
Bishop Scoring System –> Identifies which women will likely achieve a successful induction
>8 = successful vaginal birth
What is Labor induction
Stimulating contractions via Medical means (cervical ripening, & induction of contractions) Surgical means (stripping the membranes & performing an amniotomy)
What is Labor augmentation
Enhancing ineffective contractions after labor has begun
Labor induction methods
Nonpharmacologic Methods: Herbal agents Castor oil, hot baths, enemas Sexual intercourse with breast stimulation Mechanical methods: Indwelling catheter Surgical methods: Stripping membranes Amniotomy Pharmacologic Agents: Cervidil Cytotec Pitocin
Umbilical cord prolapse
Obstetric emergency (50% perinatal mortality rate) Pathophysiology: partial or total occlusion of cord with rapid fetal deterioration
Labor Induction & Augmentation: Nursing Management
Nurse:patient ratio should not exceed 1:2
Explanations
Simple, clear, thorough
Informed consent signed
Oxytocin Administration
10 units oxytocin in 1000mL of LR
Follow hospital protocols for infusion & dilution
Continuously monitor maternal & fetal status
Record I&O and encourage bladder emptying every 2 hours
Pain relief and support
Medications
Non-pharmacologic measures
Uterine rupture
Obstetric emergency; onset marked by sudden fetal bradycardia
Nursing Management:
Preparation for urgent cesarean birth
Continuous maternal and fetal monitoring for:
V/S
Hypotension
Tachycardia
Amniotic Fluid Embolism
Obstetric Emergency (86% mortality rate)
Sudden onset of hypotension, hypoxia, and coagulopathy
Pathophysiology:
Amniotic fluid enters the maternal circulation
Amniotic fluid embolus obstructs the pulmonary vessels respiratory distress & circulatory collapse
Amnioinfusion Indication
Severe variable decelerations due to cord compression
Oligohydramnios due to placental insufficiency
Postmaturity or rupture of membranes
Preterm labor with premature rupture of membranes
Thick meconium fluid
Amniofusion procedure
250-500 mL warmed normal saline or LR is administered over 20-30 mins
Puerperium
period after delivery of placenta, lasting for 6 weeks
