Shoulder Dystocia - OB
When anticipating a PPH, do we perform a fundal check?
Yes, but no pushing
How is suprapubic pressure administered?
apply pressure to top of pubis through a fist in dominant hand and support wrist with other hand
Do not give Hemabate to _________ patients
asthmatic
What should the nurse prepare for a shoulder dystocia?
be prepared with every deliver
What is an anticipated assessment variance following the administration of Misoprostol?
bowels typically affected along with abdominal pain
What is the route of Hemabate?
deep IM
Stage 3 labor time frame
delivery of placenta within minutes to 30 min
Stage 1 Labor time frame
dilation hours to days
What does a bladder shifted to side indicate?
full bladder
How is the Rubins Maneuver performed?
give suprapubic pressure and rotate the fetus for proper delivery - use two fingers inserted on each side and fold inwards
Postdates
greater than 40 weeks
What is the McRobert's position?
hyperflexing the mother's legs tightly to her abdomen
What are some of the common risk factors for postpartum hemorrhage?
multiple pregnancies prolonged labor forceps/vacuum delivery gestational hypertension retained placenta preeclampsia large fetus
Does the Zavanelli maneuver have good mortality rate?
no
When applying suprapubic pressure, where should you press?
on the baby's back
placenta acreta/increta/percreta
postpartum bleeding that does NOT respond to uterotonic agents
Stage 4 labor
recovery
"turtle sign"
retraction of the fetal head against the mother's perineum after it emerges
What is McRobert's Maneuver?
straightens out the sacrum of the mother, puts the fetus in a perpendicular position and therefore puts the most force on the baby to get it out
What specific documentation is necessary when caring for a patient who experienced a shoulder dystocia?
the time the head came out the time the body came out
What should be explained to the parents about the neonatal injuries presumably caused by the shoulder dystocia and the treatments provided?
these effects do not always last and that it is likely that their baby will show no effect of this later in life as 90% of babies will fully heal and show no signs later on
Why is documentation for a shoulder dystocia important?
they are more likely to have another labor with shoulder dystocia later on
What potential maternal complications could occur following a shoulder dystocia?
torn cervix, rectum, uterus, or vagina risk for postpartum hemorrhage
What is the role of the nurse in the Zavanelli maneuver?
try everything else, techniques, etc, before hand and assist physician
What is the dosage of Pitocin?
usually starts at 2 milliunits and increase every half hour as needed
What is the most common side effect associated with the administration of Hemabate?
vomiting/diarrhea
Macrosomia
when the baby is born significantly larger than the average newborn at their gestation age
What type of neonatal injuries should be anticipated following a shoulder dystocia?
- brachial plexus injury - fractured clavicle - anoxic injury
What interventions should a nurse anticipate when caring for a patient with a prolonged second stage of labor?
- discourage mom from further pushing and utilizing different maneuvers to ease baby out - prepare bedside stool - prepare fellow staff - inform NICU - get hemorrhage cart available
What intervention should the nurse anticipate to be ordered with a postpartum hemorrhage?
- medication - massage the fundus - check if bladder has shifted to side
Which women are at risk for shoulder dystocia?
- obese mom - obese baby - gestational diabetes - postdates - long second stage of labor - women with history of shoulder dystocia complication in past labor
What is the dosage of Methergine?
0.2mg PO or 1mL IM/IV
What does HELPERR stand for?
1) call for Help 2) evaluate for Episiotomy 3) Legs in mcroberts manuever 4) suprapubic Pressure 5) Enter internal maneuvers 6) Remove posterior arm from birth canal 7) Role patient to hands and knees
What is the dosage of Misoprostal for inducing labor?
25 mcg
What is the dosage of Hemabate?
250mcg in 1.5-3.5 time intervals
Macrosomia is typically >___________
4000g
What is the dosage of Misoprostal for abortion?
800mcg
Stage 2 labor time frame
Delivery 15 minutes to 3 hours
What assessment finding is a contraindication to the administration of Methergine?
HTN, toxemia, hypersensitivy
What is shoulder dystocia?
Head is born, but anterior shoulder cannot pass under pubic arch
What is the route of Pitocin?
IV
What is the Zavanelli maneuver?
Last resort for a shoulder dystocia: pushing baby back into uterine cavity followed by C-section
What is the route of Misoprostal?
PO, vaginally, or sublingually