Term
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Definition
| Dystocia is an abnormal or difficult labor |
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Term
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Definition
This is when the uterus relaxes too much causing ineffective contractions. Occurs during the active phase of labor.
1)They may or may not be regular
2)Hydramnios may occur and the uterus may be over distended
3)Usually occurs after 4 cm dilation
4)Medical TX: amniotomy, oxytocin
5)Nursing Care: emotional support, position changes, walking |
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Term
| What is hypertonic labor? |
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Definition
The uterus never fully relaxes.
1)Usually occurs during latent phase of the 1st stage of labor
2)UCs increased frequency & varying intensity
3)May be cramp-like
4)Usually occurs before 4 cm dilation
5)Less common
6)Medical management: Oxytocin off, sedation and/or tocolytic drugs
7)Nursing care: support, comfort measures |
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Term
| Causes of ineffective maternal pushing |
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Definition
1)Does not understand technique
2)Loss of sensation due to regional anesthesia
3)Fear of injury
Nursing care:
1)Coaching
2)Exhausted woman -push q other contraction
3)Fearful woman –teaching it’s a normal feeling |
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Term
| Why may Macrosomia present a problem in delivering the fetus? |
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Definition
| Cephalopelvic disproportion=CPD. Essentially the fetal head is too large for the pelvic passageway |
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Term
| Types of abnormal presentations |
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Definition
1)OP:Rotate to OA
2)Face presentation
3)Compound presentation
4)Transverse lie
5)Breech presentation
1)Delivered cesarean
2)External version
3)Forceps |
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Term
| Nursing care for Macrosomia or abnormal presentations |
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Definition
Nursing care:
Positioning:
1)Lean forward
2)Pelvis rock
3)Side
Squatting
1)Lunges
2)Assist MD w/version OR |
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Term
| Problems associated with multifetal pregnancy |
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Definition
1)Over distended uterus
2)Poor quality contractions
3)Abnormal presentation
Nursing Care:
1)Each monitored separately during labor
2)Assess for hypotonic uterus
3)One nurse for each infant |
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Term
| Problems associated with fetal anomalies |
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Definition
1)Hydrocephalus -fluid within brain
2)Excessive amniotic fluid
Nursing Care:
1)Each monitored separately during labor
2)Assess for hypotonic uterus
3)One nurse for each infant |
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Term
| Typical passageway issues associated with pelvis and soft tissues |
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Definition
1)Pelvis small or abnormally shaped as in Platypelloid Pelvis
2)Soft tissue obstructions
A)Full bladder is most common
1)Empty q 1-2 hours or catheterize
B)Pelvic tumors, condylomata (HPV), fibroids, or scarred cervix |
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Term
| How is a prolonged or difficult labor quantified and what are the potential consequences? |
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Definition
Active: DILATION
1.2 cm per hour –nullipara
1.5 –multipara
Descent:
1.0 cm per hour –nullipara
2.0 –multipara
Results:
1)Potential infection for mom or baby
2)Maternal exhaustion
3)Postpartum hemorrhage
4)Anxiety and fear
Nursing care:
1)Help woman conserve energy = strength
2)Encourage mom |
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Term
| Abnormal Duration of Labor: Signs of infection for mom and baby |
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Definition
Signs of infection:
Mom:
Temp 100.4 or 38
Foul drainage
Cloudy amniotic fluid
Infant:
Temp 100 or 37.8
Lethargy
Irritability,
Poor feeding,
Just “doesn’t look right” |
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Term
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Definition
| A graph that illustrates dilation and descent on two axes |
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Term
| Precipitate labor occurs in less than 3hrs which is no problem when the tissues yield. What are the consequences of the tissues are unyielding and what is the nursing care? |
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Definition
If tissues unyielding:
1)Uterine rupture
2)Laceration
3)Hematoma
4)Fetal compromise
Nursing care:
1)Promote fetal oxygenation
2)Side-lying
3)Tocolytic drugs
4)Manage pain and assess after delivery as well… |
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Term
| What is the difference between PROM and PPROM and what are the complications? |
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Definition
PROM at term =/>37 weeks and no contractions…
PPROM < 37 weeks
Primary complications:
1)Infection
2)Umbilical cord compression or prolapse |
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Term
| What is the nursing care for PROM/PPROM? |
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Definition
Clinician may…
Admit woman to hospital
Wait-observe OR Induce-deliver
Monitor
1)Temperature
2)FHR
3)Abdominal pain
4)Infection –signs and symptoms in mother and fetus
5)Bed rest, pelvic rest, administer steroids & antibiotics |
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Term
| What are some risk factors for preterm labor? |
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Definition
1)African American(double risk)
2)<16yrs old and > 40yrs old
3)Low socioeconomic status
4)Alcohol or other drug abuse (cocaine)
5)Poor maternal nutrition |
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Term
| What are some medical interventions for preterm labor? |
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Definition
Medical intervention:
1)Identify and halt labor
2)Activity restriction
3)Treatment of infection
4)Hydration
Tocolytic drugs:
1)Terbutaline (Brethine)
2)Magnesium sulfate
3)Indomethacin (Indocin)
4)Nifedipine (Procardia) |
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Term
| What drugs are used to speed fetal maturation. What accompanying therapies would you employ? |
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Definition
Speeding fetal maturation
A)Dexamethasone
B)Betamethasone
1)Reinforce strict bed rest
2)Monitor UC status
3)Monitor fetal status
4)Emotional support |
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Term
| A prolonged or post term pregnancy is one >42 weeks in duration. What are the fetal risks and the medical treatment? |
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Definition
Risk to fetus:
1)As placenta ages it becomes less effective and typically will not tolerate labor well
2)Predisposition to hypoxia
3)Meconium may be expelled
4)Aspiration of meconium presents respiratory problems for newborn
5)Hypoglycemia
6)Potential fetal injury during birth due to large size
Medical treatment = Labor induction! |
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Term
| What types of prolapsed cord difficulties can occur and what is the remedy(s)? |
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Definition
1)Complete –visible at vaginal opening
2)Palpated –cannot be seen, can be felt
3)Occult –cannot be seen or felt
Medical Mgmt
1)Place in knee-to-chest or Trendelenburg to displace
2)Experienced person may push fetus up
3)Deliver quickly, usually by cesarean |
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Term
| Types of uterine rupture and risk factors |
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Definition
1)Complete –hole through uterine wall into abdominal cavity
2)Incomplete –tears into a nearby structure, i.e. ligament, not into abdominal cavity
3)Dehiscence –older scar separates
Risk factors:
1)Previous uterine surgery –Cesarean section (CS)
2)Many births -multipara
3)Intense labor
Blunt abdominal trauma:
1)MVA
2)Falls |
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Term
| Characteristics of uterine rupture and medical intervention |
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Definition
Characteristics:
1)Shock
2)Abdominal pain -severe
Pain:
1)Chest
2)Between scapulae on inspiration
3)Shoulders –referred
4)Back
5)Cessation of contractions
6)Abnormal or absent FHR
7)Palpate fetus outside uterus
8)Loss of fetal station |
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Term
| Medical intervention for uterine rupture |
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Definition
Medical intervention:
Surgery to deliver fetus and stop bleeding |
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Term
| What is uterine inversion and what is the medical intervention and nursing care? |
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Definition
Uterus turns inside-out after delivery of baby…
Occurs if uterus not firmly contracted, pulls on placenta or placenta adheres to uterine wall
Medical intervention:
Try to replace uterus under general anesthesia or hysterectomy
Nursing care:
1)Routine post op assessments –including pain
2)Assess fundus every 15 minutes,
3)I&O –especially urine output |
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Term
| What is an amniotic fluid embolism? |
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Definition
| It is a very rare event in which amniotic fluid containing particles of debris (e.g. hair, skin, vernix, or meconium) enters the maternal circulation and obstructs the pulmonary vessels causing respiratory distress and circulatory collapse. |
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Term
| What are the signs of an amniotic fluid embolism? |
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Definition
Signs:
1)Hypotension
2)Respiratory distress
3)Coagulation abnormalities
High mortality rate –50-80%
Assist with resuscitative measures! |
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Term
| What is shoulder dystocia? |
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Definition
Fetal head delivers but the shoulders become stuck in the boney pelvis
preventing the body from delivering |
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Term
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Definition
| This may occur in should dystocia cases where the fetal head appears and then retracts. The face will showing as flushed. |
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Term
| What is the McRobert's position and its purpose? |
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Definition
| The mother is lying on her back with knees drawn up to the chest with palms down on the bed. The purpose is to straighten the pelvic axis. |
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Term
| What are the risk factors for shoulder dystocia? |
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Definition
1)Gestational diabetes
2)Post dates pregnancy
3)Macrosomia
4)History of a “Tight Fit” |
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Term
| What are the maternal complications associated with shoulder dystocia? |
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Definition
Maternal Complications:
1)Lacerations
2)Episiotomy -extended
3)Hematomas
4)Uterine atony
5)Hemorrhage
6)Bladder injury
7)Rectal injury |
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Term
| What are the fetal complications associated with shoulder dystocia? |
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Definition
Fetal Complications:
1)Brachial plexus injury
2)Fractured clavicle or humerus
3)Asphyxia, brain damage, & possible death |
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Term
| Nursing care for shoulder dystocia? |
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Definition
Nursing Care:
1)Anticipate
2)Call for HELP!
3)No fundal pressure
4)Assist with maternal positioning
5)Prepare for STAT CS
6)Assess for crepitus
7)Assess for nerve damage |
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Term
| What issues are commonly associated with short umbilical cords? |
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Definition
| umbilical hernia, abruption placenta, cord rupture |
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Term
| If a fetus has a long umbilical cord, what possible issues can arise? |
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Definition
1)May become twisted and entangled
2)Rarely causes fetal death
3)May have one or more knots |
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Term
| What is a Velamentous cord insertion? |
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Definition
| Velamentous cord insertion is an abnormal condition during pregnancy. Normally, the umbilical cord inserts into the middle of the placenta as it develops. In velamentous cord insertion, the umbilical cord inserts into the fetal membranes (choriamniotic membranes), then travels within the membranes to the placenta (between the amnion and the chorion). The exposed vessels are not protected by Wharton's jelly and hence are vulnerable to rupture |
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Term
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Definition
| Vasa previa is an obstetric complication defined as "fetal vessels crossing or running in close proximity to the inner cervical os. These vessels course within the membranes (unsupported by the umbilical cord or placental tissue) and are at risk of rupture when the supporting membranes rupture. |
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