OB: shoulder dystocia
what is shoulder dystocia
birth injury that occurs when one or both of the baby's shoulders get stuck inside the mother's pelvis during labor
most common side effect of hemabate
diarrhea or vomiting
what assessment finding is a contraindication to administration of methergine
hypertension - do not give to patient with hypertension
dosage and route of methergine
-IM - 0.2 mg
what interventions should the nurse anticipate to be ordered with postpartum hemorrhage
-IV meds like pitocin or methergene -if fundus goes up need to call physician -find cause of bleeding and stop as soon as possible -massage uterus to stimulate contraction -ensure bladder is empty bc fundus can't contract if bladder is full
What is suprapubic pressure and how is it administered
-an attempt to manually dislodge the anterior shoulder behind the symphysis pubis during shoulder dystocia -make a fist and place it above maternal pubic bone and push fetal shoulder in one direction -pressure for more than 30 seconds -strong downward pressure
fetal macrosomia
-baby large for gestational age -birth weight greater than 8 pounds (4000 grams) regardless of gestational age
what is Zavanelli maneuver and what is the role of the nurse
-babys head rotated into position then flexed -doctor applies constant firm pressure and pushes head back into birth canal -nurse monitors baby and mother and observes any complications -replacement of the head so we can go back and do a c section - high mortality rate
what type of neonatal injuries should be anticipated following a shoulder dystocia emergency
-brachial plexus injury -fractured clavicle -fractured humerus -contusions -fetal asphyxia
what should be explained to the parents about neonatal injuries caused by shoulder dystocia
-depends on what injury occurred
what interventions are used for a patient with a prolonged second stage of labor
-forceps or vacuum -blood transfusion -2 IVs -McRoberts maneuver -bedside stool -call charge nurse -call NICU -notify OR techs -medication for postpartum hemorrhage
when should the nurse prepare for shoulder dystocia
-if there are any risk factors -with every delivery - be prepared for the possibility -turtling
what documentation is necessary when caring for a patient who experienced should dystocia
-need to know what maneuvers were performed and the duration bc of how the body is affected by the maneuvers
what women are at risk for shoulder dystocia
-often unpredicted -all women who give birth -previous shoulder dystocia -fetal macrosomia -maternal diabetes -instrumental delivery: forceps or vacuume -obesity ->4000 grams baby -long second stage/pushing stage of labor -turtling (head coming out and going back in)
common risk factors for postpartum hemorrhage
-placental abruption -placental previa -overdistended uterus (large baby) -multiple pregnancies -gestational hypertension -preeclampsia -prolonged labor -infection -retained placenta -long induction
potential maternal complications following shoulder dystocia surgery
-postpartum hemorrhage -cervicovaginal lacerations -4th degree lacerations of the rectum -bladder atony -uterine rupture -symphyseal separation -maternal femoral neurpathy
What is McRobert's Maneuver?
-procedure to release baby's impacted shoulder -mothers legs are held back in fixed position and pulled to her chest to further open her pelvis -allows babys shoulders to be released -head of bed down -knees to ears -suprapubic pressure
dosage and route of misoprostol
-rectally': 400-800 mcg -can give orally but takes too long to absorb
What is Rubins maneuver and how is it performed
-secondary rotational maneuver -rotate anterior shoulder under pubic symphysis -fold into a taco and fold shoulders together -used if McRoberts doesn't work
anticipated assessment variance following administration of misoprostol
-tachysystole -constipation -diarrhea -abdominal pain
what does HELPERR stand for
H: call for HELP E: evaluate for EPISIOTOMY L: LEGS and McRoberts P: suprapubic PRESSURE (push shoulder under pubic bone) E: ENTER rotational maneuvers R: REMOVE posterior arm R: ROTATE mom to hands and knees
dosage and route of hemabate
IM 100 mcg IM 250 mcg every 15-90 minutes
dosage and route of pitocin
IV/IM 10-30 units