CH 32 Labor and Birth Complications

Anaphylactoid syndrome of pregnancy nursing care

-Summon emergency team -Positive pressure oxygen delivery -Large-bore IV -CPR as needed -Prepare for cesarean if birth has not occurred -Prepare for CVP line insertion -Administer blood -Support for family members

Forceps assisted birth

3 types outlet forceps: applied when fetal skill has reached perineum, fetal scalp is visible and sagittal suture is not more than 45 degrees from midline low forceps: applied when leading edge of fetal skill is at station of 2+ or more midforceps: applied when fetal head is engaged

Nursing Care Oligohydramnios

provide information and encourage questions evaluate EFM tracing for variable decels or non-reassuring fetal status reposition mother to relieve cord compression notify clinician of signs of cord compression evaluate newborn: anomalies, pulmonary hypoplasia, post-maturity

A shoulder dystocia is noted. What is the first priority? Deliver the posterior shoulder put the head of the bed flat perform/extend the episiotomy apply suprapubic pressure

put the head of the bed flat

Which clients are eligible for a trial of labor after c/s TOLAC. SATA a client with a history of three previous c/s. All uterine incisions were documented as low transverse A client with one previous c/s for breech presentation with a documented LTUI A client with a previous low transverse abdominal who labored to complete and pushed for three hours A client who had one c/s via LTUI with her last delivery due to fetal distress A client at 26 weeks who delivered in mexico. No prenatal records available a client whose last deliver was a c/s due to twin and breech. LTUI is documented in the OR record

A client with one previous c/s for breech presentation with a documented LTUI A client who had one c/s via LTUI with her last delivery due to fetal distress a client whose last deliver was a c/s due to twin and breech. LTUI is documented in the OR record

A client is scheduled to have and external cephalic version performed. What conditions are considered safest for this procedure? SATA the gestational age should be around 39-41 weeks EFM will be used before an directly after the procedure The client will receive an epidural for the procedure rhogam/rhophylac is administered directly after if indicated the amniotic membranes must be intact singleton gestation

EFM will be used before an directly after the procedure rhogam/rhophylac is administered directly after if indicated the amniotic membranes must be intact singleton gestation

Multiple gestation

Incidence- 33.4 per 1000 births, highest among african americans, higher incidence with: greater age and parity, family history of fraternal twins, women who are tall and over weight, dizygotic (two eggs and two sperm)-> fraternal, monozygotic (one egg/one sperm)->indentical 4/1000

Conditions associated with breech presentation

Preterm birth, Placenta previa, Hydramnios, Multiple gestation, Uterine anomalies - E.g. bicornuate uterus, Fetal anomalies (Anencephaly, Hydrocephaly)

Risks associated with breech presentation

increased perinatal morbidity and mortality rates, increased risk of prolapsed cord, increased risk of cervical spinal cord injuries due to hyperextension of fetal head during vaginal birth, increased risk birth trauma during any type of birth, increased risk of asphyxia and non-reassuring fetal status

tachysystolic labor

UC's >6 in 10 minutes lasting longer than 2 min or resting tone increases maternal risks: uterine muscle cell anoxia, fatigue, stress and poor coping strategies, dehydration and increase risk of infection, prolonged labor fetal/neonatal risks: non-reassuring fetal status (d/t increase uterine tone interferes with uteroplacental exchange), prolonged pressure on the fetal head (may result in cephalohematoma, caput succedaneum or excessive molding)

Maternal implications of multiple gestation

UTIs, threatened AB, anemia, gestational hypertension, preeclampsia/eclampsia, PLT and PTB, PROM, thromboembolism, placenta previa, placenta abruption, placental disorders

For which obstetrical emergency would a forceps delivery be considered preferable/safer to a vacuum placement? a client at 32 weeks gestation with fetal distress a client at 42 weeks who has bushed for 3 hours and is too fatigued to push effectively a client at 38 weeks with a pre-existing heart disease with a category I tracing who has been pushing with every other contraction for 30 minutes a client at 37 weeks with fetal distress and maternal fatigue

a client at 32 weeks gestation with fetal distress

Hypertonic labor

a condition in which frequent, painful, but poor-quality contractions fail to accomplish effective cervical effacement and dilation usually in latent phase of related to fetal malpresentation and cephalopelvic disproportion lack of relaxation between contractions may not allow optimal uterine artery filling that could lead to fetal anoxia-> late decels and hypoxia nursing care: hospitalize, assess uterine contraction pattern, provide rest, provide comfort measures, monitor maternal vital signs, frequently monitory fetal status, lateral position, administer oxygen by mask

cervical ripening misoprostol: X

absolute contraindications: presence of ctx 2/10min significant hx of maternal asthma, prior c/s or uterine scar, bleeding in pregnancy, placenta previa, non-reassuring FHR tracing cytotc guidelines: only third trimester usage, 25 mcg initial dose, no more than 3-6 hours, pitocin administration: 4 hours from last dose, continuous FHR monitoring inpatient, have terbutaline available

Care of mother with fetal macrosomia

after birth: fundal massage to prevent maternal hemorrhage from over-distended uterus, close monitoring of vital signs, administration of pitocin IV is common

An obese client is admitted at 39 weeks gestation for a scheduled c/s due to breech presentation. Her weight is documented at 650 pounds. What is the most important nursing implication for this client? tape the pannus back before prepping the incision assess the weight limit on the operating room bed ask the physician to perform a bpp as external fetal monitoring will not work on a client this size ask the anesthesiologist to consult with the client

ask the anesthesiologist to consult with the client

CPD nursing care

assess adequacy of pelvis, suspect: cervical dilation and effacement slow, engagement is delayed, lack of descent, head is not well applied to cervix, labor prolonged, continuous FHR monitoring, frequent position changes: squatting, sitting, rolling from side to side and knee chest, frequent vaginal exams to assess progress, keep woman and partner informed, expain procedures, support measures, prepare for c/s

Prolapsed umbilical cord nursing care

assess for non-reassuring fetal status- decels if a loop of cord is discovered, the examiner's gloved fingers must remain in vagina to provide firm pressure on fetal head until birth oxygen via face mask monitor FHR to determine whether cord compression is adequately relived moan assumes knee-chest position or bed is adjusted to Trendelenburg position transport to the delivery or operating room in this position

The nurse is caring for a client at 28 weeks with PPROM and suspects that chorioamnionitis is setting in. VSS and the client is afebrile. The FHR is a category I tracing. Which of the following interventions or assessments should the nurse implement for this client recommend the hcp start IV antibiotics recommend the HCP consider inducing the client assess the client for localized abdominal tenderness assess the fetus with a BPP

assess the client for localized abdominal tenderness

Nursing management of pitocin for induction/augmentation of labor

assessment: continuous FHR monitoring: FHR: baseline, variability and periodic changes, if FHR abnormality: DC pitocin, UC's: frequency, duration and strength I&O VS and pain level cervical exam teaching: explain purpose of procedure, procedure details, breathing and relaxation techniques and comfort measures implementation: P&P in each hospital will dictate frequency and amount of pitocin that is utilized: have terbutaline available

Vacuum extraction birth

assists birth by applying suction to fetal head usually not used before 34 weeks gestation should be progressive descent with first two pulls, procedure should be limited to prevent cephalohematoma: maximum time 8-10 minutes increases risk for sub-dermal hematoma, cephalohematoma and jaundice dur to reabsorption of bruising at cup attachment site

A client has suffered an apparent amniotic fluid embolism. She is not breathing and has no pulse. What is the priority? begin chest compressions and rescue breathing while manually displacing the uterus to the left turn the client flat on her back and begin chest compressions and rescue breathing prepare the client for an emergency c/s perform chest compressions and rescue breathing at a rate of 15:2

begin chest compressions and rescue breathing while manually displacing the uterus to the left

Post-term pregnancy nursing care

community care: education regarding post-term pregnancy, fetal kick counts hospital care: may induce at 41 weeks or continue with expectant management, continuous FHR monitoring, leopold maneuver, assess labor progression, support

While assessing a client in labor, the nurse notes the fetal heart rate pattern to be 130s with decelerations to the 110s that drop with contractions are return to baseline before the contraction ends. The contractions are occurring every 3-6 minutes and are moderate in intensity. The priority is continue to monitor reposition the client discontinue oxytocin decrease oxytocin

continue to monitor

External cephalic version

criteria: 36-38 weeks, reactive NST, breech is not engaged contraindications: maternal problems, complications of pregnancy, previous uterine surgery, multiple gestation, non-reassuring NST, fetal abnormalities

Polyhydramnios conditions

diabetes, rh sensitization, malformations of fetal swallowing, neural tube defects with exposed meninges, anencephaly, cardiac anomalies, esophageal or duodenal atresia, monozygotic, monochorionic twins, large placenta, result infections

A client is attempting a TOLAC at 39 weeks. The client is GBS+ and allergic to penicillin. The fetal monitor shows a category 1 tracing and contraction are every 5-7 minutes. The SVE is 5/100/+1. Which orders will the nurse question? SATA dinoprotone/cervidil oxytocin/pitocin amniotomy intermittent fetal monitoring ampicillin 6 gram IVMB now and then 2 gram every 6 hours clindamycin 900 mg IVMB every 8 hours

dinoprotone/cervidil intermittent fetal monitoring ampicillin 6 gram IVMB now and then 2 gram every 6 hours

While assessing a client in labor, the nurse notes the fetal heart rate pattern to be 130s with decels to the 110s that drop after the peak of the contraction and return to baseline after the contraction ends. The contractions are occurring every 3-6 minutes and are moderate in intensity. The priority is continue to monitor perform leopold maneuver discontinue oxytocin decrease oxytocin

discontinue oxytocin

The HCP asks the nurse to chaperone while an AROM is performed on a client being induced. The nurse assesses maternal and fetal assessment includes: sterile vaginal exam 1cm/40%/-3 station, FHR baseline is 150 and reactive; and contraction every 4-6 minutes and strong in intensity. What is the most appropriate nursing action place more absorbent pads under the client assist the HCP by providing an amnihook assess the FHR tracing before, during, and after the AROM discuss the client's SVE with the HCP

discuss the client's SVE with the HCP

Post-date infant

dry peeling skin, little old men look, minimal lanugo or vernix, deep creased on feet, prominent nipple and breast tissue

Indications for forceps

prolonged 2nd stage or need to shorten 2nd stage due to: maternal heart disease, maternal pulmonary edema, maternal infection, maternal exhaustion, non-reassuring fetal status, premature placental separation, heavy regional block with ineffective pushing

Dysfunctional labor

prolonged labor, tachysystolic labor, hypotonic labor, hypertonic labor

Forceps nursing care

explain procedure assure that adequate anesthesia is in place breathing techniques during application of forceps continuous FHR monitoring with UC's, provider applies downward, outward force on forceps instruct patient to push with UC's following birth, assessment of mom and babe for any complications

Prep c/s

explain procedure establishing IV lines FHR monitoring administer medications placing indwelling catheter performing abdominal prep and scrub may or may not obtain consent

Amniotomy nursing care

explain procedure and prepare, assess fetal presentation, position and station, position and pad patient, continuous FHR monitoring, note color, amount, odor, any blood or meconium, cleanse and dry perineal area, position of comfort, decreased number of cervical exams, reassure patient and family

Post-term pregnancy

extends >294 days or 42 weeks past the first day of the LMP

clinical therapy for breech presentation

external cephalic version prior to labor between 36-38 weeks EGA, probable cesarean if version unsuccessful, consider alternative methods of version, ACOG recommends c/s for breech presentation d/t sig increase in complications with breech births

Tachysystolic labor: nursing care

first stop pitocin if infusing, facilitate rest, administer pharmacologic agents as ordered: terbutaline sulfate, monitor maternal fatigue, monitor contractions and fetal status, provide information and support; encourage questions: cause implications, and treatment of dysfunctional institute supportive measures: position changes with pillow support, quiet, soothing environment, touch and massage techniques, personal hygiene, hydrotherapy, sedation if ordered by hcp, relaxation exercises, visualization music

Breech presentation

frank breech - flexed hips and extended knees complete breech - flexed hips and knees footing- single or double, extension at thighs and knees, foot or feet are presenting part kneeling- extension at thighs, flexion at knees, knees are presenting

Hypotonic labor nursing care

frequent monitoring of vital signs, FHR, and contractions, assess amniotic fluid for meconium, monitor I & O, assess bladder for distention and empty frequently: encourage voiding at least q2 hours, catheterize as needed with regional block, decrease risk of infection, may start pitocin per HCP order

Trial of Labor After Cesarean (TOLAC)

guidelines: 1 or 2 prev c/s and low transverse only, clinically adequate pelvis, obese and morbidly obese women have lower success rates (increased neonatal death rates; more anesthesia complications), absence of other uterine scare or uterine rupture, no prostaglandin agents (increased risk of uterine rupture) nursing care: IV, immediate access to OR, continuous FHR: may perform internal monitoring if high risk, clear liq, support for couple

PROM care

hospitalized on br cbc, crp, and cultures, monitor for s/s infection- fluid changes fetal surveillance no vaginal exams unless indicated maternal corticosteroid administration for fetal lung maturation per HCP MGSO4 for neural protection answer questions and anticipate birth provide psychological support for patient and family

A primigravida client presents to the ob triage area for the 4th time in a 24 hour period and is rating her pain at an 8 out of 10. She appears distressed and is crying and pacing. Her SVE is unchanged at 1cm/50cm%/-3. Her contraction are mild to palpation and recording every 2 minutes. The FHR is reactive with no decels. What is her likely diagnosis and the relevant plan of care? hypertonic labor; therapeutic rest hypotonic labor; oxytocin arrest of descent; peanut ball arrest of dilation and descent; c/s

hypertonic labor; therapeutic rest

A multigravida client is being admitted for augmentation at 41 weeks gestation. Her cervical exam is unchanged for the last four weeks at 5cm/80%/-2. Currently, she is contracting every 15 minutes. How do we classify her labor pattern and what is the appropriate treatment? hypertonic labor dysfunction: cervial foley bulb hypertonic labor dysfunction: therapeutic rest hypotonic labor dysfunction: amniotomy hypotonic labor dysfunction: oxytocin protocol

hypotonic labor dysfunction: oxytocin protocol

Precipitous labor nursing care

identify women at risk: accelerated cx dilation, intense UC's with little uterine relaxation between UC's, previous history of precipitous labor monitor closely if increased risk, prepare (have precip pack available), stay in attendance, monitor pitocin closely

Fetal/neonatal implications of multiple gestation

increase mortality rate, iugr, incidence of fetal anomalies, prematurity, abnormal presentations, cord accidents, cerebral palsy

Induction of labor

indications: DM, non-reassuring antepartum testing, preeclampsia/eclampsia, PROM, chorioamnionitis, post-term, IUFD, IUGR, alloimmunization contraindications: client refusal, placenta previa, floating presenting part, prior uterine incision that would preclude a TOL, active genital herpes, prolapsed umbilical cord, acute, severe non-reassuring fetal status, absolute CPD inductions prior to 39 weeks should be avoided

C/S

indications: complete previa, CPD, placental abruption, active genital herpes, umbilical cord prolapse, FTP, non-reassuring fetal status, previous classical c/s, obstruction of birth canal maternal medical conditions: cardiac disorders, severe respiratory disease, CNS disorders, HIV infection, mental disorders

Amniotomy

indications: induce or augment labor, apply internal fetal or contraction monitors, assess color and composition of amniotic fluids

Cervical ripening prostaglandin E2 agents

induction is indicated but not emergent, administered inpatient, monitor FHR for 2 hours after administration, remove insert if uterine hyperstimulation or non-reassuring FHTs occurs, terbutaline available for hyperstimulation contraindications: known sensitivity, non-reassuring FHTs, unexplained bleeding during pregnancy, CPD suspected, suspicion that vaginal birth is not anticipated, hx of c/s, uterine scarring or uterine rupture cautious use: hx of asthma or glaucoma, ORM, breech presentation

Maternal complications of PROM

infection- chorioamnionitis, endometritis abruption, retained placenta, maternal sepsis and death

Amnioinfusion

instilling saline into the amniotic cavity using an intrauterine catheter, ROM, warm sterile NS, infused with pump, infused through IUPC, continuous FHR monitoring, meconium, variable decelerations

Malposition nursing care

knee chest, side to side, pelvic rocking, support and coping mechanisms

Precipitous labor

labor lasting less than 3 hours, resulting in a rapid birth contributing factors: multiparity, large pelvis, previous precipitous labor, small fetus, recent cocaine use risks: maternal hemorrhage, vaginal and/or cervical tearing/laceration, infant intracranial hemorrhage from rapid change in pressure on head

Breech presentation nursing care

leopold maneuver, continuous FHR monitoring, assess for meconium amniotic fluid, potential for prolapse cord, if multip may labor under double set up, prepare for c/s if unable to turn baby, information and support

Factors that predispose women to episiotomy

lithotomy and other recumbent positions encouraging or requiring sustained breath holding during 2nd stage pushing arbitrary time limit placed by physician/cnm on length of 2nd stage macrosomic fetus, OP position, shoulder dystocia and forcep/vacuum assisted birth

Macrosomia risks

maternal risks: CPD, dysfunctional labor, soft tissue laceration, postpartum hemorrhage, 3 and 4 degree lacerations or extension of episiotomies fetal risks: meconium aspiration, asphyxia, shoulder dystocia, upper brachial plexus injury, fractured clavicle, hypoglycemia, polycythemia, hyperbilirubinemia

precipitous labor risks

maternal risks: loss of coping, lacerations of cervix, vagina and perineum d/t rapid descent and birth of fetus, postpartal hemorrhage d/t undetected lacerations or inadequate UC's after birth fetal risks: non-reassuring fetal status or hypoxia from decreased utero placental circulation d/t intense UC's, cerebral trauma, especially intracranial hemorrhage from rapid descent, pneumothorax, brachial plexus injuries

Hypotonic labor

maternal risks: maternal exhaustion, stress and poor coping abilities, prolonged labor, pp hemorrhage from insufficient UC's following birth, intrauterine infection fetal/neonatal: non-reassuring fetal status d/t prolonged labor pattern, fetal sepsis

Oligohydramnios

maternal- dysfunctional labor with slow progress, hypertensive disorders fetal deformation defects- adhesions, skin and skeletal abnormalities, pulmonary hypoplasia, umbilical cord compression, head compression

Polyhydramnios

maternal- shortness of breath, edema, greatly increased cesarean rate, uterine dysfunction, abruptio placentae, postpartum hemorrhage fetal-neonatal- malformations, preterm birth, increased mortality rate, prolapsed cord, malpresentation

Risks associated with forceps application

maternal: possible laceration of birth canal, extensions of midline episiotomy, increased bleeding, bruising, increased risk of infection PP, increased risk of PP hemorrhage, perineal edema, anal incontinence fetal: ecchymosis and edema along side of face where placement occurred, facial lacerations, brachial plexus, caput succedaneium, cephalohematoma, transient facial paralysis, cerebral hemorrhages, fractures, brain damage and fetal death

nursing care of polyhydramnios

provide information and emotional support, maintain absolute sterility during amniocentesis: will drain fluid- maybe more than once monitor FHR tracing after procedure collaborate with social services if fetal defect identified

Post-term pregnancy risks

maternal: probable labor induction, increased risk for LGA infant (increased risk of perineal trauma), increased incidence of forceps/vacuum assisted birth or c/s, increased psychologic stress as EDC passes, increased risk of infection risk factors: primigravidas, history of prolonged pregnancy, presence of fetal anencephaly or placental sulfatase deficiency infant: decreased placental perfusion, oligohydramnios ( increased risk of cord compression), meconium aspiration, low 5 minute apgar score, dysmaturity syndrome or LGA

Multiple gestations nursing care: hospital care

monitor for complications, continuous FHR monitoring, possible c/s, prepare for birth of two or more babies, advise neonatal staff, additional staff will be necessary, Baby a, b, c

Malposition

most common malposition is occiput posterior position: occurs d/t fetus not rotating, common in android pelvis, prolonged labor, c/s, lacerations/episiotomy, cephalohematoma, molding, edema and bruising of the face s/s: intense back pain, dysfunctional labor, hypotonic labor, arrest of dilation, arrest of fetal descent, FHR heard far laterally on abdomen, wide diamond-shaped fontanelle in anterior portion of pelvis

Fetal macrosomia

newborn weighing more than 4500g identification of fetal macrosomia is conducted through: palpation of fetus in utero, leopolds, ultrasound of fetus, x-ray pelvimetry more common with pre-pregnancy maternal obesity, excessive maternal weight gain, maternal diabetes, prior history of macrosomia, male fetus, grand multip, prolonged gestation and hispainc background

Multiple gestations nursing care: community care

nutrition counseling, 3500cal/day, PNV daily and additional 1-4mg folic acid daily, frequent rest periods, side-lying resting position, comfort measures, body mechanics while lifting

Cephalopelvic disproportion

occurs when fetus is larger than pelvis diameter- clinical and e-ray pelvimetry used to determine smallest diameter through which fetal head must pass (shortest ap diameter <10cm, diagonal conjugate <11.5cm, greatest transverse diameter <12 cm, above diameters determine that pelvis is "contracted", labor usually prolonged in presence of CPD, vaginal birth may be possible depending upon type of CPD

Preventative measures

perineal massage during pregnancy for nullips, natural pushing during labor, side-lying position for pushing, warm compresses on perineum and firm counterpressure, gradual expulsion of infant, avoid immediate pushing after epidural placement

A client at 28 weeks gestation diagnosed with PPROM calls out stating something just fell out of my vagina. The nurse visualizes the umbilical cord. The HCP is notified? What is the priority? perform a SVE and gently push the cord back up into the uterus cover the cord with warm sterile saline soaked gauze place the client in trendelenburg position prepare the client for an emergent forceps delivery

place the client in trendelenburg position

Oligohydramnios conditions

post maturity, maternal hypertensive disorders, IUGR secondary to placental insufficiency, major renal malformations: renal agenesis, dysplastic kidneys, lower urinary tract obstructive lesions

Anaphylactoid syndrome of pregnancy

presence of a small tear in the amnion or chorion high in the uterus, a small amount of amniotic fluid may leak into the chorionic plate and enter the maternal system as an amniotic fluid embolism sudden onset respiratory distress, acute hemorrhage , circulatory collapse, cor pulmonale, hemorrhage shock, coma and maternal death, fetal death if birth not immediate s/s: dyspnea, cyanosis, frothy sputum, chest pain, tachycardia, hypotension, mental confusion, massive hemorrhage

PROM nursing care

prevention of infection such as limiting vaginal exams and changing the bed pads frequently fetus monitored carefully

Prior to amniotomy, the EFM shows 145 with early decelerations. Following this procedure, the FHR is exhibiting variable decels. The nurse concludes that which of the following has occurred? Placental abruption amniotic fluid embolus prolapsed cord meconium aspiration

prolapsed cord

Retained placenta

retention of the placenta beyond 30 minutes after birth if not expelled must be manually removed, if unable to remove manually: will try curretage, not successful -> hysterectomy: prep for surgery, monitor blood loss, monitor VS, I&O, monitor emotional state

Fetal/Newborn complications of PROM

risk of respiratory distress syndrome, intraventricular hemorrhage and necrotizing enterocolitis, fetal sepsis, malpresentation, cord prolapse, non-reassuring FHT tracing, umbilical cord compression related to oligohydramnios, premature birth, perinatal morbidity and mortality- earlier gestational age- increased infant complications

c/s nursing care

routine post-partal care including, VS, fundal checks, assessment of lochia, care of incision, assessment of bladder status, monitoring I&O, maintaining IV access, assess pain level, assess homan's sign unless contraindicated, administer and teach about post-op and medications, assessment of heart and respiratory system, assessment of bowel sounds

Premature rupture of membranes (PROM)

rupture of membranes occurring before 37 weeks' gestation associated with infection, previous history of PPROM, polyhydramnios, multiple pregnancy, UTIs, amniocentesis, placenta previa, abruption placentae, trauma, cervical insufficiency, history of laser conization or LEEP and maternal tract abnormalities and reduced mean plt ct in 1st trimester

Maternal contraindications to oxytocin/pitocin administration

severe preeclampsia/eclampsia, predisposition to uterine rupture, cephalopelvic disproportion, malpresentation or malposition of the fetus, cord prolapse, more than one previous cesarean birth, preterm baby, rigid, unripe cervix, total placental previa, presence of non-reassuring fetal status

Methods of induction

stripping the membranes: mechanical method: gloved finger inserted into internal os and rotated 360 degrees twice: aparating amniotic membranes lying against lower uterine segment, does not require monitoring or other assessments- often done as outpatient, may not induce labor, may cause bleeding and cramping, cervical ripening, pitocin induction, complementary methods: intercourse, nipple/breast stimulation by self or partner, herbal use, mechanical dilation of cx with balloon catheters

The nurse begins an oxytocin drip for induction of labor at 40 weeks gestation. The bishops score is 4. The nurse will anticipate? SATA the labor may take longer than average the labor will occur rapidly the patient is likely to have a successful induction the patient is at a greater risk for needing a c/s the membranes will need to be artificially ruptured if the induction is unsuccessful, then the patient may rest overnight, and cervical ripening can be employed

the labor may take longer than average the patient is at a greater risk for needing a c/s if the induction is unsuccessful, then the patient may rest overnight, and cervical ripening can be employed

The nurse begins an oxytocin/pitocin drip for induction of labor at 40 weeks gestation. The bishops score is 10. The nurse will anticipate? the labor may take longer than usual the labor will occur rapidly the client is likely to have a successful induction the client is at a greater risk for needing a c/s

the labor will occur rapidly the client is likely to have a successful induction

A nurse is monitoring the effectiveness of an amnioinfusion for a client experiencing significant variable decels. How will the nurse know that the intervention is successful in this scenario? the resting tone is 20 mmhg and the fundus is soft between contraction the client reports a decrease in her pain rating there are acceleration noted on the strip and the variable deceleration are improving late deceleration are noted on the tracing

there are acceleration noted on the strip and the variable deceleration are improving

Pitocin infusion

usually effecting at producing contractions- may cause hyper-stimulation of the uterus (decreased palcental perfusion and non-reassuring fetal status, required small, precise dosage, maximum rate and dosing internal based on facility protocol, clinician order, individual situation and maternal-fetal response, palpating uterus essential, unless IUPC in place, may initially decrease blood pressure, may give pitocin after birth to control bleeding

Management of fetal macrosomia

•Cesarean birth performed if fetus is greater than 4500 g (4000-4500 birth option debatable) •Continuous FHR monitoring if labor is allowed to progress •Requires notification of physician for early decelerations, lack of fetal descent, labor dysfunction, or non-reassuring fetal status •Increased surveillance for shoulder dystocia •Assess infant closely after birth for problems