Unit 2: Nursing Care of the Client Experiencing a High risk or With Complications during Labor and Delivery Flashcards
1
Q
What are the 5 P factors that affect Labor and Delivery?
A
Powers, Passenger, Passageway. Psyche and Maternal Position
2
Q
It refers to the woman and family’s perception of the event during labor.
A
Psyche
3
Q
Apart from the pelvic structure, what other factors may affect the mother’s passageway mentioned by Ma’am Villanueva.
A
Rickets - Vitamin D Deficiency and Adolescent Pelvis.
4
Q
It refers to the long, difficult, or abnormal labor.
A
Dystocia
5
Q
Dystocia might be characterized by alterations in the characteristics of contractions. What are the specific phenomena that may relate to dystocia?
A
Lack of Progress of Cervical Dilation, Fetal Descent and Expulsion
6
Q
Enumerate the 6 cardinal movements during the 2nd Stage of Labor.
A
Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation
Expulsion
7
Q
What are the causes of Dystocia?
A
Dysfunctional Labor
Alterations in pelvic structure
Malpresentation, anomalies, excessive size, number of fetus
Maternal position
Psychological Response
8
Q
What are the factors that may risk developing dystocia?
A
Body Weight (Overweight and short stature)
Uterine Abnormalities (Congenital Malformation)
Malpresentation and Malposition of the Fetus
Cephalopelvic Disproportion (CPD)
Overstimulation with oxytocin
Maternal Factors
Inappropriate timing of Anesthetics
9
Q
What interventions can be done with patients having dystocia?
A
Assessment of Maternal Well-being (Vital Signs)
Assessment of Fetal Well-being
Assist in External Cephalic Version or Podalic Version
Trial of Labor
Cervical Ripening
Induction or Augmentation of Oxytocin
Amniotomy
Operative Procedures (Vacuum or forceps assisted birth)
10
Q
What does VBACS stands for?
A
Vaginal Birth After Cesarean Section
11
Q
What is used to score and evaluate cervical readiness of cervical dilation and effacement to conclude if patient is ready for labor?
A
Bishop Score
12
Q
What are the factors involved in Bishop Scoring?
A
Cervical Dilation
Effacement
Station
Consistency
Position
13
Q
What is the other name for Dysfunction Labor?
A
Inertia
14
Q
This refers to sluggishness of contraction, or that the force of labor is less than usual.
A
Dysfunctional Labor
14
Q
What are the 2 Classifications of Dysfunctional Labor?
A
Primary Dysfunction
Secondary Dysfunction
14
Q
This type of Dysfunction Labor begins at the onset of Labor
A
Primary Dysfunction
15
Q
This type of Dysfunction labor begins at the later part of labor
A
Secondary Dysfunction
16
Q
What are the underlying causes of Dysfunction?
A
Primigravida
Pelvic Bone Contraction/Cephalopelvic Disproportion
Occiput Posterior Malposition
Failure of the Uterine Muscle to contract
Full Bowel or Urinary Bladder
Maternal Examination
Inappropriate use of Analgesia
17
Q
What is the ideal positioning of the baby for a normal delivery?
A
LOA (Left Occiput Anterior) and ROA (Right Occiput Anterior)
18
Q
What are the three types of ineffective uterine force?
A
Hypotonic Uterine Contraction
Hypertonic Uterine Contraction
Uncoordinated Uterine Contraction
19
Q
Number of Contractions is usually low and infrequent (not more than 2 or 3 occurring in a 10 minute period)
A
Hypotonic Uterine Contraction
20
Q
During Hypotonic Uterine Contraction the rise in uterine pressure is no more than _____ mmHg
A
10 mmHg
21
Q
This type of ineffective uterine contraction is considered erratic
A
Uncoordinated Uterine Contraction
22
Q
What are the risk factors for hypotonic uterine contraction?
A
- Maternal Obesity unaccompanied by diabetes
- Bowel and Bladder distention which prevents descent or firm engagement
- Uterus overstretched by multiple gestation, macrosomia, hydramnios, or relax abdominal muscles from grand multiparity
- Pharmacological Agents used for pain relief
23
This type of ineffective uterine contraction is characterized by contractions that occur frequently and insufficient relaxation between contraction?
Hypertonic Uterine Contraction
24
Hypertonic Uterine Contraction has a resting tone range of how much mmHg?
18 - 35
25
What fetal issue might arise due to lack of relaxation between contractions which may not allow optimal atrial artery filling?
Fetal Anoxia
26
What are the risk factors for developing hypertonic uterine contraction?
- Increase maternal catecholamine release (epinephrine and norepinephrine)
- Maternal Anxiety
- fetal occiput posterior malposition
27
This type of ineffective uterine contraction is characterized by more than one pacemaker initiating contractions on various points in the myometrium
Uncoordinated Uterine Contraction
28
Contractions occur so erratically?
Uncoordinated Uterine Contraction
29
What type of abnormal contraction occurs during the latent phase of labor?
Hypertonic Contraction
30
What type of abnormal contraction occurs during the active phase of labor?
Hypotonic Uterine Contraction
31
What is the symptoms of the following uterine contraction:
Hypertonic
Hypotonic
Uncoordinated
Painful
Limited Pain
Painful
32
Label the effectiveness of breathing technique for the following uterine contraction:
Hypertonic
Hypotonic
Uncoordinated
Not effective, Effective, Not effective
33
Label the favorability of Oxytocin for the following type of uterine contraction:
Hypertonic
Hypotonic
Uncoordinated
Unfavorable, Favorable and Favorable
34
What are the dysfunction of the 1st stage labor?
Prolonged Latent Phase
Protracted Active Phase
Prolonged Deceleration Phase
Secondary Arrest in Dilatation
35
What are the causes of prolonged latent phase?
- unripe cervix
- excessive use of analgesic early in labor
- uterus tends to be hypertonic but mild
- One segment of the uterus contracts with more force than the other
36
What are the interventions of prolonged latent phase?
- provide fluid for hydration
- pain relief (morphine sulfate)
- changing linen
- darken lights
- decrease noise and stimulation
37
If the initial interventions for prolonged latent phase do not work what can be done?
- cesarean birth
- amniotomy
- oxytocin infusion
38
What are the causes of Protracted Active Phase of Labor
- Cephalopelvic Disproportion
- Fetal Presentation
- Ineffective Myometrial Activity
39
What are the interventions for Protracted Active Phase of Labor?
- Cesarean birth for CPD
- Oxytocin to augment labor for no CPD
40
What primarily causes Prolonged deceleration phase?
Abnormal Fetal Head Position
41
Prolonged Deceleration Phase can happen for ___ hours in nulliparas?
3 hours
42
Prolonged Deceleration Phase can happen for ___ hour/s in multiparas?
1 hour
43
This phase of primary dysfunctional labor refers to no progress in cervical dilatation for longer than 2 hours where in cesarean birth is necessary?
Secondary Arrest in Dilatation
44
What are the 2 types of secondary dysfunction of labor
Prolonged Descent
Arrest of Descent
45
What are the interventions for prolonged descent?
- ultrasound
- position patient in semi-fowler, squatting, kneeling
- promote rest and encourage fluid intake
- amniotomy
- oxytocin to induce uterine contractions
46
It refers to no descent occurring for 1 hour in multipara and 2 hours in nullipara.
Arrest of Descent
47
What are the available interventions for Arrest of Descent?
Cesarean Birth
Oxytocin if non-contraindicated
48
It is also known as pathologic retraction characterized by hard band that forms across the uterus at the junction of the upper and lower uterine segments and interferes with fetal descent.
Bandl's ring
49
What stage of labor does Bandl's ring occur?
2nd stage
50
It is a warning sign that severe dysfunctional labor is occurring.
Bandl's ring
51
What Causes Bandl's Ring or Pathologic Retraction?
- early labor uncoordinated retraction
- obstetric manipulation
- administration of oxytocin
52
What are the nursing intervention for Pathologic Ring or Bandls ring?
- Administration of IV morphine sulfate
- Inhalation of amyl nitrite to relieve the contraction ring
- Tocolytic (to halt contraction)
- CS birth
- Manual Extraction of placenta under general anesthesia
53
It is referred to as abnormal implantation of the placenta?
Placenta Privia
54
- Happens when contractions are too strong that birth occur only a few hours, rapid contractions occur.
- Completed in fewer than 3 hour
Precipitate Labor
55
Cervical Dilatation that occurs at a rate of 5 cm or more/hour in primipara or 10 cm/hour in multipara
Precipitate Dilatation
56
What causes precipitate labor and precipitate dilatation?
- grand multiparity
- after induction of labor by oxytocin
- after amniotomy
57
What are the complications of precipitate labor?
- Premature Separation of placenta (placenta abruptio)
- hemorrhage
- subdural hemorrhage to the fetus
- Lacerations of birth canal
58
What are the intervention for woman with precipitate labor?
- caution multiparous woman who had precipitate labor 28th week that her labor may also be brief.
- labor room should be prepared to connect into delivery room before full dilation occurs.
- Tocolytic is administered to reduce force and frequency of contractions if predicted in labor graph.
59
It is the term used when administering oxytocin before spontaneous onset.
Induction of labor
60
It is the term used when oxytocin is administered after the labor has started.
Augmentation of labor
61
What are the criteria to be considered for the induction of labor?
- fetus is in the longitudinal lie
- cervix is ripe or ready for birth
- Presenting part engage
- No CPD
- Fetus mature by ultrasound
62
What are the complication with the induction or augmentation of labor?
- Uterine Rupture
- Decrease fetal blood supply
- Premature separation of the placenta
63
Induction or augmentation of labor must be used cautiously in what conditions?
- multiple gestation, hydramnios, grand multiparity, maternal age > 40
64
Insertion of prostaglandin into the posterior fornix of the vagina through the cervix
Cervical Ripening
65
Prostaglandin E1
Prostaglandin E2
Misoprostol
Dinoprostol
66
What are the different methods of Cervical Ripening?
- Stripping
- Hygroscopic suppositories
- Amniotomy
- Oxytocin
67
Also known as sweeping, the simplest method, or separating the membranes from the lower uterine segment manually?
Stripping
68
Suppositories of seaweed shell in contact with cervical secretions. Laminaria Technique suppositories inserted and held in place by gauze sponges saturated with povidone iodine.
Hygroscopic suppositories
69
It is an artificial rupture of the membranes used when the condition of cervix is favorable or used to augment labor if the progress begins to slow,
Amniotomy
70
It is a hormone normally produced by the posterior pituitary gland which stimulates uterine contractions.
Oxytocin
71
What are the indications for using oxytocin?
- inadequate uterine contractions
- Dystocia
- IUGR (intrauterine growth restriction or retardation)
- PROM (premature rapture of membranes)
- Post Term Pregnancy
- Chorioamnionitis
- Maternal Medical Problems
- Fetal Death
72
It refers to infected placenta that may be caused by premature rupture of membrane?
Chorioamnionitis
73
What are the contraindications of induction?
- CPD
- Fetal Malposition or Malpresentation
- Prolapsed Cord
- Non reassuring Fetal Heart Rate
- Placenta Previa
- Prior Classic Uterine incision
- Prior Uterine Surgery
- Active Genital Herpes Infection
- Invasive Cancer of the Cervix
74
- It is defines as uterine contraction and cervical changes occurring between 20 and 37 weeks of pregnancy
Preterm Labor
75
- it is any birth that occurs before completion of 37 weeks of pregnancy
Preterm Birth
76
What are the Diagnostic Criteria for Preterm Labor and Birth
- Gestational age between 20 - 37 weeks
- uterine contractions
- Progressive cervical change ( 80% effacement; 2 cm cervical dilatation)
77
What are the risk factors for preterm labor and birth?
- nonwhite race
- Age (< 15 or > 5)
- Low Socioeconomic Status
- Unmarried
- Low education
78
What are the psychosocial risks preterm labor and birth?
- poor nutrition; weight loss or weight gain
- smoking
- substance abuse
- inadequate prenatal care
- excessive physical activity
- excessive lifestyle stressor
79
What are the biophysical risks of Preterm Labor?
- Previous preterm labor or birth
- Abortion/stillbirths
- Grand Multiparity
- Progesterone Deficiency
-Uterine Anomalies
- Cervical Incompetence
- Maternal Medical Diseases (DM, HPN, Anemia)
- Small Stature (<119 cm in height, <45.5 kg in weight)
80
What are the current pregnancy risks of Preterm Birth or Labor?
- Multiple Pregnancy
- Hydramnios
- Bleeding
- Placental Problems
- Infections
- PROM
- Fetal Anomalies
- Anemia
81
What are the signs and symptoms of Preterm Labor and Birth?
- Uterine Activity
- Vaginal Discharge
-Discomfort
82
Right the values for the following :
Normal amount of amniotic fluid
Hydramnios
Oligohydramnios
800 -1200
> 2000
< 500
83
What are the Biochemical Markers used to predict preterm labor?
Fetal Fibronectins
Salivary Estriol
Endocervical Length
84
- Are glycoproteins found in plasma and produced during fetal life
- they appear in cervical canal early in pregnancy and then again in late pregnancy
Fetal Fibronectins
85
Fetal Fibronectins is a biophysical marker of preterm labor in what weeks does this usually appear?
24 - 34 weeks
86
- It is a form of estrogen produced by fetus that is present in plasma after 9 weeks gestation.
- has been shown to increase during preterm birth
Salivary Estriol
87
The testing of Salivary Estriol is done ever ___ weeks for 10 weeks
2
88
What endocervical length would make a woman more susceptible to preterm labor and birth?
- 35 mm (3.5 cm.) after 24 to 28 weeks gestation
89
What is used to determine the endocervical length?
- Ultrasound
90
What are the interventions for Preterm Birth?
- Educating woman about early symptoms of preterm labor
- Lifestyle modification
91
What activities can induce preterm labor?
- sexual activity
- riding long distance in automobiles
- carrying heavy loads
- Standing more than 50 %
- Heavy Housework
- Climbing Stairs
- Hard Physical Work
92
What are the management of Preterm Labor?
- Bedrest and Homecare
- Tocolytic Agents
- Promotion of Fetal Lung Maturity
93
What are example of Tocolytic Agents?
Ritodrine, Terbutaline, MgSOf, indomethacin and Nifedipine
94
What is given to mothers in order to promote fetal lung maturity?
Antenatal Glucocorticoids (Betamethasone and Dexamethasone)
95
All woman between ____ weeks should be given antenatal glucocorticoids
24 to 34 weeks
96
What are the stages of Fetal Lung Maturity?
Embryonic, Pseudoglandular, Canalicular, Saccular and Alveolar
97
It is a pregnancy that continues to 42 weeks or more after LMP
Post term birth
98
What can fetus experience during post term?
Hypoxia due to oligohydramnios and aging placenta
99
There is no vernix and lanugo present in post term babies? True or False
True
100
What are the common complications of Post term birth?
- Fetal Macrosomia
- Birth Trauma
- Shoulder Dystocia
- Oligohydramnios (cord compression and hypoxia
- Placental Aging (decrease exchange of oxygen and nutrients)
- Passage of meconium
- Risk of MAS (Meconium Aspiration Syndrome)
101
What are the interventions for post term birth?
- Determine LMP, fundic height and serial ultrasound measurement
- Daily FMC
- Weekly Cervical Exam, NST and Ultrasound for the amniotic Fluid
- Possible Amnioinfusion
- Induction after 42 weeks
102
What type of fluid is used in Amnioinfusion?
Sterile Normal Saline
103
Occurs when uterus undergoes more strain from what it is capable of sustaining?
Uterine Rupture
104
What are the Risk Factors for Uterine Rupture?
- Previous Classical CS Birth
- Hysterectomy Repair tears
- Uterine Trauma
- Congenital Uterine Anomaly
105
What type of Cesarean Section Allows VBACS?
Low Transverse Incision and Low Vertical Incision
106
What are the contributing factors of Uterine Rupture?
- Intense Spontaneous Uterine Contraction
- Prolonged Labor
- Abnormal Presentation
- Multiple Gestation
- Overdistended Uterus
- External/Internal Cephalic Version
- Unwise use of Oxytocin
- Difficult Forceps Assisted Birth
107
What are the signs of impending rupture?
- Pathologic Retraction Ring (Bandl's Ring)
- Strong uterine Contractions without Cervical Dilatation
- Severe pain, "Tearing Sensation"
108
What are the classifications of uterine rupture?
Complete Rupture
Incomplete Rupture
109
Damage extends from endometrium, myometrium and peritoneum layer.
Complete Rupture
110
Uterine Muscles are torn leaving Peritoneum Intact
Incomplete Rupture
111
What are the interventions for Uterine Rupture?
- Women who had previous CS are advised to not attempt VBACS
- Monitor V/S and signs of hemorrhagic shock
- Fluid replacement, transfusing blood products, administering oxygen
- Administering Oxytocin
- prepare for emergency laparotomy
- Perform cesarean hysterectomy or bilateral tubal ligation
112
Refers to uterus turning inside and out with either birth of infant or delivery of placenta
Inversion of Uterus
113
What are the primary presenting signs of inversion of the uterus?
Hemorrhage, Shock and Pain
114
What are the different Classification of Inversion of Uterus?
1st degree - Incomplete
2nd degree - Complete
3rd degree - Prolapsed
4th degree - Total
115
This degree of uterine inversion refers to the top of uterus that has collapsed inside uterine cavity?
1st degree (incomplete)
116
Top part of uterus folds into the opening of the uterus.
2nd degree (complete)
117
Top part of the uterus folds into the deepest part of the vaginal canal.
3rd degree (prolapsed)
118
Both vagina and uterus protrude outside the body?
4th Degree (total)
119
What are the causes of uterine inversion?
- excessive traction applied to the umbilical cord to remove placenta
- short umbilical cord
- fundal implantation of the placenta
- vigorous fundal pressure
- Uterine Atony
- Abnormally Adherent Placental Tissue
- Manual Removal of Placenta
120
What are the interventions for Uterine Inversion?
- never attempt to replace an inversion
- never remove the placenta if still attached
- do not administer oxytocin
- IV fluid line needs to be started
- Administer oxygen by mask
- Assess vital signs
- Prepare to perform CPR
- Patient be given general anesthesia
- physician or midwife can replace fundus manually (and administer oxytocin afterwards)
- antibiotic therapy to prevent infection
- Inform that CS birth is necessary in future pregnancies
121
Occurs when amniotic fluid containing particle debris (vernix, hair, skin cells and meconium) is forced into an open maternal uterine blood sinus through some defect in the membranes after membranes rupture or partial premature separation of placenta.
Amniotic Fluid embolism
122
Amniotic Fluid embolism causes?
Respiratory Distress, Circulatory Collapse and Hemorrhage
123
What are the maternal factors of Amniotic fluid embolism?
- oxytocin administration
- Abruptio placenta
- multiparity
124
What are the fetal factors of Amniotic Fluid embolism?
- Macrosomia
- Fetal Death
- Meconium Passage
125
What are the interventions for AFE?-
- Oxygenation
- Administer oxygen by facemask or cannula at a rate of 8 to 10L/min
- Prepare for intubation and mechanical ventilation
- Initiate or assist with CPR. Position the mother in a 30 degree lateral tilt to displace the uterus
- Administer IV fluids and Blood
- Lateral Indwelling Catheter and measure urine output hourly
- continuously monitor maternal-fetal status
- Prepare for emergency birth once the patient is stable.
126
What are the 3 factors affecting AFE Patient?
Oxygenation, Circulation and Coagulopathy
127
It is a complication of the passenger in which the umbilical cord lies below the presenting part of the fetus.
Umbilical Cord Prolapse
128
What are the contributing factors of umbilical prolapse?
- Long Cord
- PROM
- Malpresentation
- Placenta Previa
- Intrauterine tumors
- Small fetus
- CPD
- Hydramnios
- Multiple Gestation
129
How to assess umbilical prolapse?
- Vaginal Exam
- Ultrasound
130
What are the nursing action to reduce the risk of prolapse?
- when rupture of membranes occur maintain the patient in bedrest until the presenting part is engaged
- Amniotomy should not be attempted until engagement has occurred
- Assess FHB immediately after artificial or spontaneous rupture of membrane
131
What is the best position for women with umbilical cord prolapse?
Knee-chest position or Trendelenburg position with hip elevated by to pillows
132
It is the addition of the sterile fluid into the uterus to supplement the amniotic fluid.
Amnioinfusion
133
What are the interventions for Umbilical Cord Prolapse?
- Warm the solution before infusion
- Maintain Aseptic Technique
- Monitor V/S and FHT contractions
- Change the sheet frequently
- If drainage stops, stop the infusion high risk of hydramnios or uterine rupture.
134
Is the delivery of 2 or more fetuses
Multiple Gestation
135
This results from one ovum
Monozygotic (Identical)
136
This result from more than one ovum
Dizygotic (fraternal
137
What can be the causes of multiple gestation?
Use of drugs that induce ovulation
Invitro fertilization
138
Monochorionic
single outside membrane
139
Monoamniotic
single inside amniotic membrane
140
Dichorionic
double outside membrane
141
Diamniotic
double inside amniotic membrane
142
What are the physiological risks of Multiple gestation?
- spontaneous abortions
- Preterm birth: LBW
- abnormal growth: IUGR
- Maternal Anemia
- Postpartal Hemorrhage
- Abnormal fetal presentation
143
Antepartal Complications of Multiple gestation?
- Hypertension of pregnancy
- Anemia
- Gestational Diabetes
144
Fetal/Newborn Complications of Multiple gestation?
-low birth weight infants due to preterm labor
- Intrauterine growth restriction
145
Intrapartal Complications of Multiple gestation?
- Hemorrhage (related to atony from uterine overdistention)
- Abruptio placenta
- Multiple or adherent placenta
- Abnormal fetal presentation
- Fetal Distress (related to cord prolapse or Abruptio placenta)
146
Interventions of Multiple gestation
- Assess a woman's hematocrit level and BP during labor
- If woman is giving birth vaginally, instruct her to come to the hospital early
- Encourage breathing exercise to reduce analgesia or anesthetics
- Monitor FHR
- Watch out for cord prolapsed, abnormal fetal presentation, premature separation of the placenta and dystocia
- No cord clamp
- do not administer oxytocin yet as it may compromise circulation
- lie of the 2nd fetus is determined by external abdominal palpation or UTZ
- if born vaginally, oxytocin infusion may begin to assist uterine contraction
- If uterine relaxant is needed, nitroglycerin may be administered.
147
Approximately 1/10 of all labors are in what kind of fetal position?
Occipitoposterior Position
148
Why is more pain felt in an Occipitoposterior Position?
Because the fetal head rotates against the sacrum owing to sacral nerve compression
149
What is the required rotation in an occiput anterior position?
90 degrees
150
Fetal occiput is on maternal left side and toward back, face is up?
Left Occiput Posterior
151
Fetal occiput is on maternal right side and toward back, face is up?
Right Occiput Posterior
152
What are the risk factors for the occiput posterior position?
- Android pelvis
- Anthropoid pelvis
- Contracted pelvis
153
What are the 2 types of leopold's maneuver that can be used to assess occipitoposterior position?
2nd maneuver and 4th maneuver
154
This type of maneuver reveals the true fetus; lateral side and angular nodulations; may be felt on the surface of the abdomen.
2nd maneuver
155
What part of the abdomen can auscultation of the fetal heart sounds can be heard the best?
The lateral sides
156
This type of examination involves palpating the two fontanelles that will help to identify the posterior position.
Vaginal Examination
157
This is an imaging test used to confirm the position of the fetus.
Ultrasound
158
What are the signs and symptoms of Occipitoposterior position?
- Dysfunctional labor
- prolonged latent phase
- arrested descent
- Lower back pain
- Fetal heart rate is heard at the lateral sides of the abdomen
159
What interventions can be given to an occipitoposterior position?
- encourage nonpharmacologic measures such as:
- breathing
- giving back rubs
- use warm washcloths
- changing sheets
- Complementary therapies are also helpful like music or aroma therapy
- Assist the client to a side-lying position, opposite the fetal back or maintaining hand and knee position, and squatting may help the fetus to rotate.
- Encourage the client to verbalize feelings and concerns related to the labor process
- Provide frequent reassurance
- Encouragement to suck lollipops or hard candy, during labor, drink sports drinks, or eat a light meal if still in early labor
- Encourage to void every 2 hours
- IV glucose therapy to replace glucose energy used
- cesarean birth in instances such as arrest in transverse position, maternal and fetal distress.
160
This type of fetal presentation involves buttocks or lower extremities are the ones presenting first.
Breech Presentation
160
During early pregnancy, fetuses are positioned in what presentation?
Breech Presentation
161
In what week does fetus normal turn into cephalic presentation?
38 weeks
162
What are the different types of breech presentation?
- complete breech
- incomplete breech
- frank breach
- footling breach
163
What are the complications in a breech presentation?
- Anoxia from prolapsed cord
- traumatic injury to the aftercoming head
- fracture of the spine or arm
- dysfunctional labor
- early ROM because of the poor fit of the presenting part
164
What are the complications when the baby is in breech presentation?
- the inevitable contraction of the fetal buttocks from cervical pressure often causes meconium to be extruded into the amniotic fluid after birth.
- passage of meconium occurs not because of fetal anoxia which is a sign of fetal distress but is expected from the buttock pressure. However, this excretion may lead to meconium aspiration.
164
What are the assessments use to identify breech presentation?
- Leopold's maneuver
- Vaginal Exam
- Ultrasound
165
What are the causes of breech presentation?
- Gestational age less than 40 weeks
- abnormality in a fetus such as anencephaly, hydrocephalus, and meningocele
- Hydramnios that allow for free fetal movement
- Congenital anomaly of the uterus such as mid septum that traps the fetus in a presentation
- Any space-occupying mass in the uterus or a placenta previa that does not allow the head to present
- Pendulous abdomen that the uterus may forward
- Multiple gestation
- Unknown factors
166
What are the interventions for breech presentation?
- Monitor FHR and uterine contractions continuously, this allows early detection of fetal distress from a complication such as a a prolapsed cord.
- Explain to the parents that the babies born in the frank breech may tend to keep their legs extended at the level of the face for the first 2-3 days or those born in the footling breech may tend to keep their legs extended in the footling.
167
A fetal head presenting at a different angle than expected.
Asyncilitism
168
What are the causes of face presentation?
- Contracted pelvis
- Placenta previa
- Relaxed Uterus
- Multipara
- Prematurity
- Hydramnios
- Fetal Malformation
169
What is the type of presentation when both the back and the head are felt on the same side of the uterus?
Face presentation
170
What are the interventions used in Face presentation?
- Reassure parents that the edema and bruising are transient and will disappear in a few days with no aftermath.
- Lid edema - if unable to suck, gavage feeding may be necessary to obtain enough fluid until they can suck effectively. They may be transient to NICU.
- if chin is anterior, the pelvic diameter is in normal limits, it may be possible for an infant to be born.
171
It is considered as the rarest presentation which occurs in woman with relax abdominal muscles.
Brow presentation
172
What are examples of shoulder presentation or transverse lie?
shoulder
- scapula
- elbow
- acromion process
173
What are the maternal causes of the face presentation?
- Pendulous abdomen
- Uterine fibroid tumors that obstruct the lower uterine segment
- Contracted pelvis
- Placenta privia
- congenital anomalies of the uterus
- hydramnios
- multiple gestation
-
174
What are the fetal causes of face presentation?
hydrocephalous
prematurity
175
What are the assessments done for face presentation?
- ovoid uterus is found to be horizontal rather than vertical
- Leopold's maneuver
- Ultrasound for further confirmation of the pelvic size.
176
What are the interventions needed for face presentation?
because of the risk of cord prolapsed or arm prolapsed or the shoulder obstructing the cervix, it is necessary...
177
It is a condition where fetus is more than 4000 grams
Macrosomia
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Causes of macrosomia
DB mothers
multiparity
obese women
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Maternal complications of macrosomia
- Uterine dysfunction
- wide shoulder can cause brachial plexus injury
- uterine rupture from obstruction
- postpartal hemorrhage
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Fetal complications for macrosomia
- Cervical nerve palsy
- Diaphragmatic nerve play
- Fractured clavicle
- brachial plexus injury
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Assessment for macrosomia
Pelvimetry and ultrasound
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Interventions of macrosomia
CS
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This happens at the 2nd stage of labor when the fetal head is born, but the shoulders are too broad to be born through the pelvic outlet.
Shoulder Dystocia
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What are the causes of Shoulder Dystocia?
- Diabetes Mellitus
- Maternal Pelvic Abnormality
- Multiparity
- Post date woman
- Fetopelvic Disproportion
- Fetal anomalies
- Hydrocephalus or anencephaly can complicate it because the fetal presenting part does not engage at the cervix wall
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What are the effects of shoulder dystocia?
- failure of fetal head descent
- fetal head fighting applied to the vulva
- failure of restitution of the fetal head
- Retraction of the head against perineum
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What are the complications of shoulder dystocia?
- cervical and vaginal tears, exclusion of the episiotomy
- uterine atony
- rapture of the uterus
- Endometriosis
- Cord compression if the cord is between the fetal body and bony prominences
- fetal birth injuries
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What are the clinical manifestation of Shoulder dystocia?
- prolonged 2nd stage of labor
- Arrest in descent
- Crowning but head retreats with each contraction instead of protruding
- The problem is not often identified until the head has already been born and the wide shoulder locks beneath the symphysis pubis.
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What are the management of shoulder dystocia?
- McRoberts Maneuver
- Moderate suprapubic pressure
- Robin or Reverse Wood's maneuver
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What are the interventions for shoulder dystocia?
- Mazzant technique
- Rubin or Reverse wood's technique
- McRoberts Maneuver
- Gaskin Maneuver
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Pressure is applied directly posteriorly and laterally above the symphysis pubis.
Mazzant maneuver
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pressure is applied obliquely posteriorly against the anterior wall
Rubin Technique or Reverse wood's maneuver
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The woman's legs are flexed apart, with her knees on her abdomen. The maneuver causes the sacrum to straighten and the symphysis pubis rotates toward the mothers head. The angle of pelvic inclination is decreased, freeing the shoulder. Suprapubic pressure can then be applied at this time.
McRoberts Maneuver
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Having the woman to a hands and knees position.
Gaskin Maneuver
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What are the anomalies of the placenta?
- Placenta succenturiata
- Placenta circumvallata
- Battledore Placenta
- Velamentous insertion of the cord
- Vasa Previa
- Placenta Accreta
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Is the placenta that has one or more accessory lobes connected to the man's placenta by blood vessels.
placenta succenturiata
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A placenta that is covered by chorion. Normally the chorion membrane begins at the edge of the placenta and spreads or envelopes the fetus, no chorion covers the fetal side of the placenta.
Placenta Circumvallata
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The cord is inserted marginally rather than centrally.
Battledore Placenta
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The cord instead of entering the placenta directly separates into small vessels that reach the placenta by spreading across a fold of amnion.
Velamentous insertion of the cord
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The umbilical vessels of a velamentous cord insertion cross the cervical os and therefore deliver before the fetus.
Vasa Previa
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It is an unusually deep attachment of the placenta to the uterine myometrium so deeply the placenta will not loosen and delivery.
Placenta Accreta
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What can be used to manage Placenta Accreta
methotrexate
hysterectomy
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What are the types of adherent or retained placenta?
Placenta Accreta
Placenta Increta
Placenta Percreta
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Placenta grows through the uterus and can extend to the nearby organs.
Placenta Percreta
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What are the anomalies of the umbilical cord?
- Two-vessel Cord
- Unusual Cord Length
- Umbilical Cord Length
- Nuchal Cord
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The absence of one of the umbilical arteries is associated with congenital anomalies of heart and kidneys
Two-vessel Cord
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This length of cord may be easily compromised because of the tendency to twist or knot.
Long umbilical cord
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This length of umbilical cord can result in the premature separation of the placenta or an abnormal fetal lie?
Short umbilical cord
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What is the normal umbilical cord length?
45 - 55 cm
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What is the short umbilical cord length?
less 40 cm
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What is the long umbilical cord length?
> 70 cm
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Encircling of the umbilical cord around the neck or coils. Umbilical cord is wrap around the fetal neck 360 degrees?
Nuchal Cord
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What are the types of nuchal cord?
loose nuchal cord and tight nuchal cord
single
multiple
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What is the most common form of nuchal cord?
single cord loop
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This type of nuchal cord is freely sliding and can undo itself.
Type A
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This type encircles the neck lock pattern, cannot undo.
Type B
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What are the grading system of tight nuchal cord?
Grade 1
Grade 2
Grade 3
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This type of tight nuchal cord is conjunctival camouflage.
Grade 1
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This type of tight nuchal cord refers to duskiness of face , facial suffusion, pallor.
Grade 2
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This type of tight nuchal cord refers to respiratory distress, stop or hypotonia requiring resuscitation.
Grade 3
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What are the usual causes of problems with passageway?
- CPD
- Adolescent girls
- History of Pelvic Injury
- Rickets
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Anteroposterior diameter <11 cm
Transverse <12 cm
Contracted inlet
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What causes contracted inlet?
Rickets (D or calcium deficiency)
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It is an attempt to turn the fetus from breach or shoulder to cephalic presentation.
External Cephalic Version
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What are the contraindications for external cephalic version?
- multiple gestation
- severe oligohydramnios
- Nuchal cord
- unexplained 3rd trimester bleeding
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What are the different considerations before ecv?
- ultrasound scanning is done to determine fetal position
- locate the umbilical cord
- Rule out placenta previa
- evaluate the adequacy of maternal pelvis
- assess the amount of amniotic fluid
- fetal age
- presence of any anomalies
- incomed consent is obtained
- NST is performed to confirm fetal well being, FHR pattern is monitored for a period of time.
- Tocolytic agent such as MgSO4 or Terbutaline is given to relax the uterus and to facilitate the maneuver
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What are the considerations after ecv?
- continue to monitor maternal vital signs
- monitor uterine activity and FHR
- assess vaginal bleeding because the manipulation can cause fetomaternal bleeding
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It is referred as the narrowing of the anteroposterior diameter to less than 11 cm or of the transverse diameter to 12 cm or less.
Contracted inlet
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What can be a cause of contracted inlet?
Rickets or Vitamin D or calcium deficiency in early life or inherited small pelvis
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What is a sign of contracted inlet?
If engagement begins before labor begins.
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It is the sinking of the fetal head into the pelvis, it means that is has moved below the pelvic inlet?
Lightening
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- It is the narrowing of the transverse diameter to less than 11 cm.
- narrowing of the distance between ischial tuberosity
Contracted outlet
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It is the narrowing of the midpelvis to less than 9cms.
Midpelvis Contraction
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How narrow should it be to be considered as midpelvis contraction?
< 9 cm
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It is known as the disproportion between fetal head and pelvis?
Cephalopelvic Disproportion
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What are the causes of cephalopelvic disproportion?
- fetal head larger than the usual size
- contracted pelvis
- if on early part of labor when labor pattern shows waveform it usually indicates CDP due to fetal head compression
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What are the complications of Cephalopelvic disproportion?
- Cord prolapsed
- Dysfunctional labor
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What are the interventions for Cephalopelvic disproportion?
- Assess FHT in early labor waveform pattern in FHT monitor. Refer to physician.
- Provide information to the mother what causes dysfunctional labor
- provide comfort to lessen anxiety
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It is a birth accomplished through abdominal incision into the uterus.
Cesarean Birth
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What are the 2 types of Cesarean Births?
- Elective cesarean births or scheduled cesarean birth
- Emergent Cesarean Birth
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A type of cesarean birth that is planned, there is time for thorough preparation for the experience throughout the antepartal period, are chosen by patients for convenience, a history of sexual trauma, or to prevent potential urinary or anal incontinence later in life?
Elective cesarean birth or scheduled cesarean birth
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A type of cesarean birth that are done for reasons that arise suddenly in labor, such as newly discovered placenta previa, abruptio placenta, fetal distress or failure to progress.
Emergent Cesarean Birth
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What are the indications for cesarean birth?
- Active genital herpes
- AIDS or HIV positive status
- Cephalopelvic disproportion
- Cervical cerclage
- Disabling conditions (Cardiac conditions)
- Failed induction or failure to progress in labor
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What are the maternal factors for cesarean birth?
- An obstructive benign or malignant tumor
- Previous cesarean birth by classic incision/previous uterine surgery
- History of sexual trauma/ fear of birth
- Prevent uterine prolapse or urinary incontinence in later years
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What are the placental factors for cesarean birth?
Placenta Previa
Premature separation of the placenta
Placenta
Umbilical cord prolapse
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What are the fetal factors of cesarean birth?
- Compound conditions such as macrosomic fetus in breach lie
- Extreme Low birth weight Fetal distress
- Major Fetal Anomaly (Hydrocephalus)
- Multiple gestations or conjoined twins
- transverse lie
- breach presentation
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What are the types of cesarean incision?
- Classic cesarean incision
- Low segment incision (Low transverse uterine incision/ Pfannenstiel Skin Incision)/ MISGAC-LADACH or Bikini incision)
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The incision is made vertically through both the abdominal skin and the uterus. The incision is made high on the uterus.
Classic cesarean incision
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What are the indications for Classic Cesarean Incision?
- Too much scar tissue in the lower part of the abdomen
- Fetus les than 30 weeks
- Morbid obesity
- Uterine Fibroids
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What are the contraindication of classic cesarean incision?
- it leaves a wide skin scar
- it runs through the active contractile portion of the uterus which may rupture during labor subsequent vaginal birth
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It is the most common type of incision which is made horizontally across the abdomen just over the symphysis pubis and also horizontally across the uterus just over the cervix.
Low segment incision (Low transverse uterine incision/ pfannestiel skin incision/ misgav-ladach or bikini incision)
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What are the advantages of low segment incision?
- results in less blood loss
- is easier to suture
- decreases postpartal uterine infections
- it is less likely to cause postpartum gastrointestinal complication
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What are the disadvantages of low segment incision?
- it takes longer to perform
- impractical for emergent cesarean section
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What are the different nursing diagnosis for cesarean section?
- Fear related to impending surgery
- Pain related to surgical incision
- fluid volume deficiency related to a blood loss from surgery
- powerlessness related to medial need for cesarean birth
- Anxiety related to unanticipated circumstances surrounding birth
- Infection risk related to a surgical incision
- Hemorrhage risk related to surgical procedure
- Altered parent-infant attachment risk related to unplanned method of birth
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An obstetrical forceps is used to assist in the birth of the fetal head.
Forceps-assisted birth
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Are steel instruments consists of two blades that slide together at their shaft to form a handle.
Forceps-assisted Birth
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What are the types of forceps birth
Low forceps birth and Midforceps birth
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It is applied when the fetal head is at +2 station or more
Low forceps birth
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It is applied after the fetal head is engaged but less tan +2 station
Midforceps birth
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Maternal indications of the use of forceps.
- Dystocia
- To shorten the 2nd stage of labor
- Compensate for woman's deficient expulsive efforts
- Spinal or Epidural anesthesia
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Fetal indication for the use of forceps
- fetal distress
- Malpresentations
- Arrest of rotation
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What are the considerations for the use of forceps.
- Membranes must be ruptured
- CPD not present
- Cervix is fully dilated
- Woman's bladder must be empty
- Presenting part must be engaged
- Vertex presentation is desired
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What are the maternal interventions for the use of forceps.
- Record FHR between forceps application
- Assess again after application
- Assess woman's cervix to rule out cervical laceration
- Assess for urinary retention which may result form bladder or urethral injuries
- Assess hematoma formation i the pelvic soft tissue
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What are the fetal interventions for the use of forceps?
- Assess NEWBORN for facial resulting from the pressure of the blades on the facial nerves or subdural hematoma exists.
- Assess for bruising or abrasions at the site of blade applications
- Forceps birth may leave erythematous mark on the newborn's cheek which will fade in 1-2 days with no long-term effects
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Is a birth method involving the attachment of a vacuum cup to the fetal head, using negative pressure to assist in the birth of the head.
Vacuum Extraction
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In what part of the head is the vacuum cup applied?
Posterior Fontanel
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What is the major disadvantage using vacuum cup?
Causes mark caput on the newborn head that is noticeable as long as 7 days after birth
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What are the considerations for using vacuum cup?
Vertex Presentation
Ruptured membranes
Absence of cephalopelvic disproportion
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What are the fetal complications of using vacuum cup?
Cephalhematoma
Scalp lacerations
Subdural Hematoma
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What are the maternal complications of using vacuum cup?
Perineal lacerations
Vaginal lacerations
Cervical lacerations
Sift tissue hematoma
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What are the common nursing diagnosis for using Vacuum cup?
- Fear related to uncertainty of pregnancy outcome
- Anxiety related to medical procedures necessary to ensure health of mother and fetus
- Fatigue related to loss of glucose stores through work and duration of labor
- Risk for ineffective tissue perfusion related to excessive loss of blood with complication of labor
