chapter 14

Leopold Maneuvers

Abdominal palpations used to determine the fetal presentation, lie, position and engagement; supine position place both cupped hands over the fundus and palpate the determine fetal position;

. In general, the grief accompanying the loss of a fetus proceeds in the following order

Accepting the reality of the loss Getting over suffering from the loss Adapting to the new environment without the deceased Emotionally relocating the deceased and getting on with life

precipitate labor

An intense, unusually short labor (less than 3 hours).

external cephalic version

Turning a breech baby to cephalic presentation through the maternal abdominal wall

failure to progress

Woman has begun the birth process but it is taking longer than normal.

increment

(n.) an enlargement, increase, addition

Normal labor

-38-42 weeks -no complications -single vertex fetus -delivery generally within 18-24 hours (no longer true, now look at many varying factors) -regular progression of contractions -effacement and dilation of cervix -progressive descent we don't want baby at 37 weeks but we won't stop the labor then either starts with regular uterine contractions that are strong enough to result in cervical effacement and dilation.

Magnesium Sulfate Indications

-Torsades de pointes -Cardiac arrhythmias accoc. with hypomagnesmia -Eclampsia -Status asthmaticus

Dinoprostone (Cervidil)

-cervical ripening; produces contractions, dilation & effacement of cervix, initiate labor or expulsion of fetus. -S/E: abnormal contractions, warmth in vagina, back pain, amniotic fluid embolism, fever

Oxytocin

A hormone released by the posterior pituitary that stimulates uterine contractions during childbirth and milk ejection during breastfeeding.

Betamethasone (Celestone)

Antenatal steroids. Stimulate production of surfactant in fetus between 24 and 34 weeks gestation. Promotes fetal lung maturity in preterm labor when delivery is likely. Side effects: fluid retention and elevated BP. Interventions: administer 2 doses (usually IM) 24 hours apart (repeat doses not recommended). Provide emotional support to family.

subtle symptoms of preterm labor

Change or increase in vaginal discharge with mucous, water, or blood in it Pelvic pressure (pushing-down sensation) Low, dull backache Menstrual-like cramps Feeling of pelvic pressure or fullness GI upset: nausea, vomiting, and diarrhea General sense of discomfort or unease Heaviness or aching in the thighs Uterine contractions, with or without pain More than six contractions per hour Intestinal cramping, with or without diarrhea

The nurse is performing Leopold's maneuvers as part of the initial assessment. Which action would the nurse do first?

Feel for the fetal buttocks or head while palpating the abdomen.

umbilical cord prolapse

Initial action = elevate the presenting fetal part to reduce compression on cord -- can place in knee-chest or deep Trendelenburg position to further relieve compression

Leopold Maneuvers

Maneuver 1: What fetal part (head or buttocks) is located in the fundus (top of the uterus)? Maneuver 2: On which maternal side is the fetal back located? (Fetal heart tones are best auscultated through the back of the fetus.) Maneuver 3: What is the presenting part? Maneuver 4: Is the fetal head flexed and engaged in the pelvis

RISK FACTORS ASSOCIATED WITH PRETERM LABOR

Maternal age extremes (<16 years and >40 years old) Low socioeconomic status Alcohol or other drug use, especially cocaine Poor maternal nutrition Maternal periodontal disease Cigarette smoking Low level of education History of prior preterm birth (triples the risk) Uterine abnormalities, such as fibroids Low pregnancy weight for height Pre-existing diabetes or hypertension Multiple pregnancy Premature rupture of membranes Late or no prenatal care Short cervical length

Indomethacin (Indocin)

NSAID. Inhibit prostaglandin synthesis resulting in decreased inflammatory responses. Uses: provide rapid, symptomatic relief of inflammation and pain. Precautions/Interactions: hypersensitivity to aspirin or other NSAIDs, may increase the risk of MI and stroke.

passage

Natural mechanisms of labor favor efficient passage of the fetus through the mother's pelvis. The passage for birth of the fetus consists of the maternal pelvis and its soft tissues.

placental abruption

Premature separation of the placenta from the uterine wall after 20 weeks' gestation and before the fetus is delivered.

Passenger

Presentation and position further describe the relation of the fetus (passenger) to the maternal pelvis.

Shoulder dystocia risk factors

Previous should dystocia maternal obesity Prolonged second stage of labour fetal macrosomia

Misoprostol (Cytotec)

Prostaglandin E analog Used w/ NSAIDs to prevent gastric ulcers Can induce labor Can cause diarrhea, abdominal pain, dysmenorrhea, spotting Take w/ meals and at bedtime

umbilical cord prolapse

Protrusion of the umbilical cord alongside or ahead of the presenting part of the fetus

Passageway

The four basic types are gynecoid, anthropoid, android, and platypelloid

The nurse is discussing the various positions for delivery with a client and her partner. The client mentions she would like a position which speeds up the process, decreases stress to her baby, and reduces the possibility of needing an episiotomy. Which positions should the nurse point out will best meet the client's desires

The hands and knees position is documented to be one of the best delivery positions for easing delivery and improving outcomes

Powers

The two powers of labor are uterine contractions and the maternal pushing efforts. During the first stage of labor (onset through dilation) uterine contractions are the primary force moving the fetus through the maternal pelvis. During the second stage of labor (dilation through birth) the woman uses her voluntary pushing efforts to propel the fetus through the pelvis

decrement

To subtract a certain amount (often 1), once or many times

Nifedipine (Procardia)

Tocolytic. Side effects: hypotension, fatigue, nausea, flushing, uteroplacental perfusion complications. Monitor BP, avoid concurrent use with magnesium sulfate, monitor contractions and FHT, prevent complication with hypotension.

fetopelvic disproportion

also called cephalopelvic; the head of the fetus is larger than the pelvic outlet

Tocolytic drugs

are medications that are used to suppress uterine contractions in preterm labor

Face and brow presentations

are rare and are associated with fetal abnormalities (anencephaly), pelvic contractures, high parity, placenta previa, hydramnios, low birth weight, or a large fetus

preterm labor

cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy

Three parameters are evaluated during the transvaginal ultrasound

cervical length and width, funnel width and length, and percentage of funneling

The nurse is providing preoperative care for a client who will undergo a cesarean section. The nurse should.

confirm that consent has been provided by the client

dystocia

difficult labor and is the leading indicator for primary cesarean birth in the United States

protraction disorders

dilation or descent in active phase is slowed. -should be 1cm an hour

postterm pregnancy

gestation of the fetus that extends beyond 42 weeks

hypertonic uterine dystocia

high level of pain from contractions

acme

highest point; summit; the highest level or degree attainable

factors associated with an increased risk for dystocia

include epidural analgesia, excessive analgesia, multiple pregnancy, hydramnios, maternal exhaustion, ineffective maternal pushing technique, occiput posterior position, longer first stage of labor, nulliparity, short maternal stature (less than 5 ft tall), fetal birth weight (more than 8.8 lb)

Commonly used diagnostic testing for preterm labor risk

includes a complete blood count to detect infection, which may be a contributing factor to preterm labor; urinalysis to detect bacteria and nitrites, which are indicative of a urinary tract infection; and an amniotic fluid analysis to determine fetal lung maturity and the presence of subclinical chorioamnionitis.

Any presentation other than occiput anterior (head down and anterior facing)

increases the probability of dystocia

indications cesarean births

labor dystocia, abnormal fetal heart rate (FHR) tracing, fetal malpresentation, multiple gestation, and suspected macrosomia

gynecoid pelvis

most favorable pelvis for successful labor.

platypelloid pelvis

pelvis that is flat in its dimensions with a very narrow anterior-posterior diameter and a wide transverse diameter; this shape makes it extremely difficult for the fetus to pass through the bony pelvis

placenta previa s/s placental abrution s/s

previa - there is no pain, but there is bleeding abrution - there is pain, but no bleeding (board like abd)

uterine rupture risk factors

previous uterine surgery, breech extraction, obstructed labor, high parity

Corticosteroids

recommended for all pregnant women between 24 and 34 weeks of gestation who are at risk of preterm birth within 7 days.

Fetal lie

relationship of the long axis of the fetus to the long axis of the mother

Diastole

relaxation phase of the contraction

Prostaglandin gel is used to...

ripen or soften the cervix.

ischial spines in female

serve as landmarks and have been designated as zero station.

android pelvis

the typical male pelvis; in the woman, the heart shape of the android pelvis is not favorable to a vaginal delivery

hypotonic uterine dysfunction

too few contractions (usually due to big baby), admin pitocin or prepare for c/s major risk with this complication is hemorrhage after giving birth because the uterus cannot contract effectively to compress blood vessels

hypertonic uterine dysfunction

uncoordinated uterine activity. Contractions are frequent and painful but ineffective in promoting dilation and effacement.

Anthropoid pelvis

woman's pelvis that is elongated in its dimensions and is sometimes referred to as apelike