week 5 dystocia Flashcards
dystocia
Abnormally slow progress of labour
-greater than 4 hours of less than 0.5 /hr cervical dilation
-greater than 1 hr of active pushing and no decent
Causes-Five P’s of labour- dystocia
-Ineffective uterine contractions or bearing-down efforts (the powers); the most common cause of dystocia
*Alterations in the pelvic structure, including abnormalities of the labouring patient’s bony pelvis or soft-tissue abnormalities of the reproductive tract (the passageway)
*Fetal causes, including abnormal presentation or position, anomalies, excessive size, and number of fetuses (the passenger)
*Position of patient during labour and birth –why we change positions during emergencies
*Psychological responses of the patient to labour that are related to past experiences, preparation, culture and heritage, and support system
Latent phase disorders
-hypertonic uterine dysfunction.
-painful and frequent contractions that are ineffective in causing cervical dilation or effacement to progress
-Exhaustion from pain and lack of progress
-Expectant management-patient eventually goes into active labour
-provide therapeutic rest
-warm bath or shower
-administration of analgesics such as morphine to inhibit
-uterine contractions, reduce pain, and encourage sleep
Comfort measure –massage, music, distraction
Active phase disorders
-progress in labour is slower than normal
-arrest disorders,
-there is no progress in labour
-inadequate uterine activity (hypotonic uterine dysfunction)
-labouring patient initially makes normal progress into the –active stage of labour, then the contractions become -weak and inefficient or stop altogether.
-uterus is easily indented at the peak of contractions.
-Intrauterine pressure during the contraction is insufficient for progress of cervical effacement and dilation.
Assessment of dystocia
-uterine activity
-fetal presentation position
-Fetal station
-Estimated fetal weight U/S
-If normal findings labour augmentation measures may be implemented
-ambulation, hydrotherapy, rupture of membranes, nipple stimulation, or oxytocin infusion
-Assist with measures to enhance the progress of labour (e.g., position changes, ambulation, hydrotherapy).
alterations in secondary powers
-Compromise bearing-down efforts from analgesic medications
-Anesthesia-alter the effectiveness of voluntary bearing-down efforts
-Exhaustion and fatigue resulting from lack of sleep or prolong labour, inadequate hydration and food intake
-Position of the patient during pushing can work against the forces of gravity
-Encourage mother to bear down with contractions; assist with relaxation between contractions.
-Position mother in favourable position for pushing.
-Reduce epidural infusion rate.
-Assist with forceps- or vacuum-assisted birth.
-Prepare for Caesarean birth if abnormal fetal status occurs.
Alterations in pelvic structure- pelvic dystocia
-Contractures of pelvic diameter that reduce the capacity of the bony pelvis, inlet, mid pelvis, or outlet
-pelvic contractures -congenital abnormalities, maternal malnutrition, neoplasms, or lower spinal disorders.
-Immature pelvic size in adolescent patients to pelvic dystocia.
-Pelvic deformities due motor vehicle accidents or other trauma
alternations in pelvic structure -soft tissue dystocia
-obstruction of birth passage by an anatomical abnormality other than bony pelvis
-Placenta previa.
-Uterine fibroids in the lower uterine segment
Ovarian tumours
-Full bladder or rectum may prevent the fetus from entering the pelvis.
-Sexually transmitted infections e.g., HPV alters cervical tissue integrity and interfere with effacement and dilation
Passenger
-Anomalies
-neural tube defects e.g. myelomeningocele and hydrocephalus
-Cephalopelvic disproportion (CPD)
-macrosomia or excessive fetal size
4 000 g or more)
-Malposition
-persistent occipito-posterior position (right occipitoposterior [ROP] or left occipito-posterior [LOP])
-Mal-presentation
-Frank breech
-Complete breech
Footling breech
Tranverse lie
Multifetal pregnancy.
Position of the woman
Limiting movement of labouring patients
Restricting labour to the recumbent or lithotomy position may compromise progress (alter effects if gravity)
Psychological response
Hormones and neurotransmitters released in response to stress can cause dystocia e.g. adrenocorticotropic hormone, cortisol, and epinephrine .
High levels -reduces uterine contractility.
Nursing Care for Dystocia
-Electronic fetal monitoring (EFM)
-Ultrasonography-to identify potential labour complications related to the fetus (e.g., abnormal fetal position) or pelvis of the pregnant patient.
-Risk assessment is a continuous process to identify dysfunctional labour
-Prevention
Interventions is based on assessment and may include
-External cephalic version
-Cervical ripening,
-Induction or augmentation of labour
-Operative procedures [forceps- or vacuum-assisted birth
-Caesarean birth
what is the most common cause of labour dystocia?
postpartum hemorrhage
Complications of Labour Dystocia
-Fetal distress
-Risk of maternal and neonatal infection
-Postpartum hemorrhage-most common cause of complications
-Uterine rupture
-Increased risk of pelvic floor, genital, perineal trauma
-Increased risk of uterine or pelvic organ prolapse
-Increased risk of obstetrical fistula (vesico-vaginal of rectovaginal fistula) and incontinence
-Sacroiliac joint dislocation
prolapsed umbilical cord
cord lying below presenting part of fetus
-obsterical emergency
