Week 5: In-Labour Complications Flashcards
What hormone is used to induce labour?
Oxytocin
How does oxytocin work to induce labour?
Stimulates uterine contractions, synthetic use can induce and augment labour via IV administration
How does the dosage of oxytocin work?
Dosage is increased per protocol until an adequate contraction pattern is established
What are the maternal risks for oxytocin admin?
Placental abruption, uterine rupture, C-section, PPH and infection
After the birth, what should we check for on the baby of the amniotic fluid is stained with meconium?
resp efforts, HR, muscle tone
What should you monitor for when using an IV oxytocin drip?
Uterine tachysystole (hyper stimulated)
What do we assess amniotic fluid for following ROM?
Meconium
T/F: Routine suctioning of the mouth and nose in babies born with meconium stained amniotic fluid
False. Suctioning MAY be required of mouth, nose, or trachea if they aren’t breathing, but it is no longer routine.
Describe meconium aspiration syndrome
Often in term or post-dates, severe form of aspiration pneumonia, give the baby IV antibiotics
External Cephalic Version- when do you use this?
If the baby is in breech position at 36-37 weeks.
How do you perform external cephalic version?
US, manually rotate the baby, in hospital as there is a risk of ruptured membranes, cord prolapse, and fetal distress
What does it mean if a patient presents with shoulder dystocia?
The anterior shoulder cannot pass under the pubic arch
What are some risk factors for shoulder dystocia?
Fetopelvic disproportion, macrosomia, previous Hx
What are some interventions for shoulder dystocia ?
position changes, apply suprapubic pressure, turtling
T/F you should apply fundal pressure as a method of relieving shoulder dystocia
FALSE. You can apply suprapubic pressure though!
Describe Mcroberts maneuver
Hold mom’s legs flexed in the air 45 degrees. Grab behind the knees.
Forceps Birth
Use of forceps in childbirth. This is less common.
TI forceps birth
Prolonged second stage, maternal exhaustion, abnormal FHR, abnormal fetal presentation, arrest of rotation, extraction of head in breech
What are the maternal risks of forceps birth?
Vaginal and cervical lacerations, hematoma, injuries to uretrha and bladder
What are the risks to the baby in a forceps birth?
Subdural hematoma, bruising, abrasions, facial palsy
T/F A forceps birth is more safe than a vacuum birth
False. A vacuum carries less risk
Describe a vacuum assisted birth
Attachment of a vacuum cup to the fetal head with negative pressure
What are the maternal risks associated with vacuum assisted birth?
These are less common, but perineal, vaginal, or cervical lacerations and hematoma
WWYD: A patient presents fully dilated, ruptured membranes, engaged head, vertex presentation, and is greater than 34 weeks gestation. What type of birth would we administer?
Vacuum assisted
What are the newborn risks associated with vacuum assisted birth?
Cephalohematoma, scalp lacerations, subdural hematoma, hyperbilirubinemia
When administering a vacuum assisted birth, what would you tell a patient to do and how would you proceed?
Count times vacuum is applied and pt must remember to help bear down and push. We want the baby in RLOA or RLOP position
Can you elect for a caesarean birth? Is this still a birth at all?
yes and yes
What type of incision is made in a caesarean?
Transabdominal incision of the uterus
What are the maternal-fetal indications for C-section?
Placenta previa, placental disruption, dysfunctional labour, active herpes lesions
What are the maternal indications of c-secion
2+ previous Hx, specific medical conditions
What are the fetal indications for a C-section
Abnormal FHR, malpresentation, congenital abnormalities, maternal HIV with high viral load
What are the risks of C-section with respect to the mom?
Aspiration, hemorrhage, atelectasis, endometritis, And wound dehiscence, bladder and bowel injury, anaesthesia complications
Fetal risks of C-section
Injuries from scalpel, poor placental perfusion if maternal hypotension
As a nurse, how would you engage in prenatal preparation in order to provide a family-centred approach? This is during preoperative care for a C-section.
Informed consent, lab tests, vitals, foley catheter, spinal or epidural, emotional support
As a nurse, how would you provide family-centred care during the intraoperative process in a C-section birth?
Circulating, newborn care
What are the strongest predictors for successful vaginal birth following a previous C-section?
Previous vaginal birth, spontaneous labour
How would you engage in postoperative care with patients to provide family centred care in the post-operative phase of a C-section?
Skin to skin, frequent vitals, assess loch and funds, assess incisional dressing, pain relief, breastfeeding support
What are the Pros and cons of a vaginal birth following a C-section?
Pros: Lower risk of hemorrhage, infection, shorter recovery
Cons: Uterine rupture
What are the CIs for a trial of Labour following a C-section
Previous uterine rupture, major uterine surgery, classic uterine incision or inverted T-incision
