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OB Nursing > Variations of Spontaneous Labor > Flashcards

Variations of Spontaneous Labor Flashcards

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1
Q

What are some indications for labor induction?

A

PROM, preeclampsia, GHTN, infection, fetal demise, postterm pregnancy, fetal compromise, mild abruptio placentae, logistics

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2
Q

What are some contraindications for induction of labor?

A

Breech/transverse, severe HTN, significant heart dz, umbilical cord prolapse, hx of uterine surgery, vasa previa, complete placenta previa, active genital herpes

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3
Q

What is Bishop’s score?

A

Group of 5 factors to determine favorability of induction based on cervical ripeness & probability of success of induction

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4
Q

What is a favorable Bishop score?

A

> 6

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5
Q

What is an unfavorable Bishop score?

A

<5

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6
Q

What Bishop score indicates likelihood of vaginal birth similar to spontaneous labor?

A

> 8

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7
Q

What are the 5 factors included in the Bishop score?

A

Position, consistency, effacement, dilation, fetal station

*All scored 0-3

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8
Q

What are risks associated w/ induction?

A

Uterine tachysystole/hyperstimulation, uterine rupture, maternal water intoxication, greater risk for chorioamnionitis and/or C-section

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9
Q

How might induction lead to maternal water intoxication?

A

Oxytocin has an antidiuretic effect

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10
Q

What is problematic about uterine tachysystole?

A

Can reduce placental perfusion & fetal oxygenation due to excess frequency/duration/intensity of contractions or insufficient relaxation between contractions

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11
Q

What might be done if a birthing person is to be induced but their Bishop score is too low?

A

Prostaglandins to promote ripening

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12
Q

What positions are included in the Bishop score?

A

Posterior, midposition, anterior

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13
Q

What consistencies are included in the Bishop score?

A

Firm, medium, soft

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14
Q

What is the purpose of cervical ripening?

A

To increase cervical readiness for labor by promoting softening, dilation, & effacement

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15
Q

Techniques for cervical ripening

A

Prostaglandins, mechanical

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16
Q

What are advantages of cervical ripening?

A

Reduce dose or eliminate need for oxytocin

*Low dose oxytocin is used for cervical priming

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17
Q

What are some mechanical techniques of cervical ripening?

A

Balloon catheter in the intracervical canal (inflated w/ 30 cc saline)

Osmotic/hygroscopic dilators absorb body fluids and expand (e.g. seaweed (laminaria tents), Mg sulfate-based)

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18
Q

Disadvantage of balloon catheters

A

Causes pressure on the cervix

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19
Q

Disadvantage of osmotic dilators

A

Increased infection risk

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20
Q

Advantages of mechanical methods

A

Low cost, stable at room temp, reduced risk of uterine tachysystole

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21
Q

How are PGs administered?

A

Oral, vaginal suppository/gel

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22
Q

Cytotec

A

Misoprostol (PE1)

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23
Q

Cervidil

A

Dinoprostone (PE2)

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24
Q

Prepidil

A

PG gel

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25
Q

Complications of cervical ripening

A

Uterine tachysystole, fetal distress

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26
Q

Nursing action for uterine tachysystole

A

Subq terbutaline

27
Q

Nursing actions for fetal distress

A

O2 via face mask at 10 L/min

Left side-lying position

Increase rate of V fluid admin

Notify provider

28
Q

Nursing actions for cervical ripening

A

Assess for urinary retention, rupture of membranes, uterine tenderness/pain, contractions, vaginal bleeding, fetal distress

29
Q

Nursing interventions for cervical ripening

A 
Informed consent
Baseline fetal and maternal data
Void before procedure
Document number of dilators used
Side-lying position
Assist w/ procedure
Monitor FHR, uterine activity
Notify provider of complications
Monitor for AEs (N/V/D, fever, tachysystole)
30
Q

Maternal precaution conditions w/ PG use

A

Asthma - known hypersensitivity
Glaucoma
Ischemic heart disease
Pulmonary, hepatic, renal disease

31
Q

PG mechanism of action

A

PGE2 sensitizes to PGF2 which sensitizes myometrium to endo-/exogenous oxytocin & ripens cervix

*Used in conjunction w/ oxytocin

32
Q

PG contraindications

A 
Known allergy
Fetal distress w/o imminent delivery
Unexplained bleeding
Cephalopelvic disproportion
CI of oxytocic drugs
Prior C-section, major uterine surgery
Prior IV oxytocic admin
Multipara w/ 6+ prior term pregnancies
33
Q

Non-pharmacologic methods of induction

A

Membrane stripping, amniotomy, nipple stimulation, intercourse?

34
Q

What gestational age is required for elective induction?

A

39 weeks

35
Q

Induction indications

A 
Postterm pregnancy (>42 weeks)
Dystocia
Prolonged ROM
IUGR
Maternal medical complications - Rh isoimmunization, DM, pulm dz, GHTN
Fetal demise
Chorioamnionitis (infection)
36
Q

What is membrane stripping?

A

Provider inserts finger into internal cervical os & rotates 360 degrees twice

37
Q

Requirement for membrane stripping

A

Cervical dilation >1 cm

38
Q

Benefit of membrane stripping

A

Increases PGF/PGE release from membranes and cervix

39
Q

What fetal engagement and station are required before oxytocin admin?

A

Engagement in birth canal & minimum station of 0

40
Q

Maternal assessments w/ oxytocin

A

BP, HR, RR q30-60mins & w/ dose change

41
Q

FHR monitoring w/ oxytocin

A

1st stage - q15mins
2nd stage - q5mins
Every dose change

42
Q

Maintain dose of oxytocin when contraction…

A 
Frequency - 2-3 min
Duration - 80-90 sec
Intensity - 40-90 mmHg/strong
Uterine resting tone - 10-15 mmHg
Dilation - 1 cm/hr
Reassuring FHR 110-160 bpm
43
Q

Clinical findings of uterine tachysystole

A 
Frequency <2 min
Duration >90 sec
Intensity >90 mmHg
Resting tone >20 mmHg
No relaxation between contractions
44
Q

Characteristics of nonreassuring FHR

A

Abnormal baseline <110 or >160 bpm

Loss of variability

Late/prolonged decelerations

45
Q

Define amniotomy

A

Artificial rupture of membranes (AROM)

46
Q

Indications for AROM/amniotomy

A

Labor induction, stimulation, internal electronic fetal monitoring

47
Q

Major risks of amniotomy/AROM

A

Umbilical cord prolapse
Chorioamnionitis
Placental abruption

48
Q

How is amniotomy performed?

A

Amnihook perforates amniotic sac

49
Q

Amniotomy considerations

A

Fetal engagement to prevent cord prolapse
Monitor FHR before & after
Assess/document fluid characteristics

50
Q

Amniotomy nursing interventions

A

Document time or rupture
Obtain temp q2hrs
Comfort measures

51
Q

Amniotomy contraindications

A

Fetal presenting part high in pelvis

Non-cephalic presentation

52
Q

How do nipple stimulation & sex promote labor?

A

Nipple stim releases oxytocin

Semen has PGs in it

Orgasms could stimulate contractions

53
Q

Oxytocin (Pitocin) administration

A

IV piggyback
Inserted into primary line at closest port to patient
Start at low dose, increase q20-30mins until regular contractions
Continuous FHR & contraction monitoring (chart q15mins in 1st stage, q5mins in 2nd stage)

54
Q

What should you never use Pitocin w/o?

A

IV pump

55
Q

Pitocin risks

A 
Tachysystole
Hypertonic uterus/increased resting tone
Uterine rupture
Non-reassuring FHR
Increased risk of uterine atony PP
56
Q

Non-reassuring FHR nursing interventions

A 
Reduce/stop Pitocin
Increase IV fluids to 200 mL/hr
Side-lying position
100% O2 at 8-10 L/min via face mask
Continue assessing FHR, contractions
Monitor maternal BP, HR q30mins
Administer subq terbutaline
57
Q

Caput succedaneum

A

Newborn scalp swelling, resolves in 3-5 days

58
Q

C-section indications

A 
Malpresentation (breech)
Cephalopelvic disproportion
Dystocia
Non-reassuring FHR
Placental abnormalities
Placenta previa
Abruptio placentae
Prior C-section
Multiple gestations
Maternal and/or fetal distress
Umbilical cord prolapse
Failed induction
Macrosomia
Congenital malformations
Maternal cardiac/respiratory dz
High risk pregnancy - HIV+, HTN (preeclampsia, eclampsia), DM, active genital herpes
59
Q

C-section risks

A 
Infection
Hemorrhage
UTI, UT trauma
VTE
Ileus
Atelectasis
Anesthesia complications
Transient newborn tachypnea
Persistent pulm HTN of newborn
Newborn injury (lac, bruising, fracture)
60
Q

C-section pre-op nursing interventions

A 
Last oral intake
Allergies
Current meds & last dose
Informed consent
Labs - CBC, blood type/Rh
Pre-op teaching
Start IV and bolus
Clip abdominal hair
Administer GI meds - Bicitra, pepcid
Insert catheter
Assist pt onto table, hip wedge
Grounding pad for electrocautery
Sterile prep of abdomen
Fetal monitoring
61
Q

Types of assisted deliveries

A

Vacuum, Forceps

62
Q

Assisted delivery indications

A 
Need shortened 2nd stage
Exhaustion
Ineffective pushing
Cardiac, pulm dz
Infection
Fetal cord compression
Premature placental separation
Non-reassuring FHR
63
Q

Assisted delivery risks

A

Maternal - lac, vaginal hematoma, perineum, large episiotomy

Fetal - ecchymoses, facial/scalp lacs, facial nerve palsy, cephalohematoma, intracranial hemorrhage

64
Q

Assisted delivery nursing considerations

A 
Empty bladder (straight catheter)
Assess FHR (report <100 bpm)
Assess for trauma of mom/baby
Cold application to perineum/vagina for 12 hours after
Fundus tone

Fetal assessment - skin breaks, facial asymmetry, seizures, scalp edema, facial bruising

OB Nursing (7 decks)

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