childbirth at risk ii
dystocia
-abnormal/difficult labor- problems with the Powers -probs w passenger: OP malposition -face/brow and breech presentation -shoulder dystocia -cpd
(poly) hydramnios -how much amniotic fluid -can cause _________to fetus
-sometimes referred to as "hydramnios" ->2000ml of amniotic fluid -assoc w/fetal anomalies -preterm birth/dysfunctional labor possible -risk of prolapsed cord
clinical therapy, maneuvers for shoulder dystocia -what maneuver is first/most common?
-therapy: ID macrosomia before labor onset -maneuvers: -mcroberts -suprapubic pressure, NOT fundal pressure -rubins/wood's screw maneuver -hands/knees position, episiotomy, elective clavicle frcture, zavanelli maneuver
mcroberts maneuver
-very common for dystocia or birth -woman flexes thighs up (like birth I saw) to increase angle
Which patient is most at risk for uterine rupture? a- G3P2 with history of 2 prior LTCS b- G2P1 with history of 1 prior classical C/S c- G3 P1102 d- G3 P0030 with history of 3 elective abortions
b- g2p1 with history of 1 prior classical
oligohydramnios -how much amniotic fluid -fx on baby (lungs, cord, renal)
-<500ml amniotic fluid -assoc w/prevention of urine production or collection in amniotic sac -fx on baby: post-term GA, IUGR/placental insufficiency -fetal renal malformations -impaired mvmt for fetus -cord vulnerability -pulmonary hypoplasia
when prolapsed cord has already occurred, what do we do after? what will nurse do to support the baby until tx
-EMERGENCY! -remain calm, explain situation to patient -use SVE to maintain upward pressure on presenting part and off of cord -emergency c/s -notify anesthesia and NICU -woman on side, knees to chest
nursing assessment/management for polyhydramnios
-assessment: -disproportionate fundal height increases -difficulty palpating fetus/auscultating FHR -assist with AFI -management: -maternal dyspnea and pain -no AROM with amnihook
nursing assessment/management for oligohydramnios
-assessment: fundal height < than expected -NST/BPP/continuous EFM -assist with AFI -management: -amnioinfusion possible in labor -intrauterine resuscitation PRN -possible indication for IOL
turtling -what/what does it indicate
-baby's head pushes out, then back in -can indicate shoulder dystocia
post-term pregnancy -what is it -maternal risks -fetal risks
-beyond 42wks -maternal: IOL, FAVD/VAVD, perineal damage, c/s, hemorrhage -fetal: decreased uteroplacental circulation, macrosomia (should IOL in 41st week; NST/BPP to monitor)
precipitate labor/birth -causes -parameters
-entire labor and birth within 3 HOURS -causes: abnormally strong contractions, low resistance of soft tissue -causes: 5cm/hr primip -10cm/hr multip
nursing care for CPD
-fetopelvic relationships -trial of labor vs decision for c/s -EFM for fetal distress -reposition during labor to change angles
shoulder dystocia -definition -complications
-following birth of head, shoulders do not emerge -complications: brachial plexus injury, fractured clavicle
-maternal complications -fetal complications of uterine rupture
-maternal: -hemorrhage -pain, uterine tenderness -fetal: -anemia, hypoxia -fetal demise
maternal and fetal risks of precipitate labor/birth
-maternal: very few if adequate passageway; anxiety/fear, perineal lac risk, uterine rupture possible -fetal: non-reassuring FHR r/t UCs, head trauma
cephalopelvic disproportion (CPD)
-narrowing in any part of passageway (bony pelvis/soft tissue) -excessive fetal size for pelvis -implications: prolonged labor, uterine rupture
s/s of uterine rupture tx
-non-reassuring fetal hr -LOSS OF FETAL STATION* -can only be dx via surgical incision for sure -vaginal bleeding-- count pads, check wt loss -prep for emergency birth
uterine rupture -def -what is ruptured if complete rupture -risk factors
-nonsurgical disruption of uterine cavity -complete: endometrium, myometrium, and serosa separated -risk: previous uterine incision, operative vaginal delivery/uterine manipulation, abdominal trauma
precipitate birth: clinical therapy
-obtain history prenatally -stay calm -DON'T LEAVE PT!!! CALL OUT FOR HELP!!!!!! -support perineum -dry off baby, stimulate
clinical therapy for prolapsed umbilical cord -prevention -therapy -what does it look like on EFM
-prevention: minimal risk if presenting part is well engaged -after AROM, FHR monitored- bedrest possible -EFM: variable decels progressing to prolonged decel
prolapsed umbilical cord
-umbilical cord precedes fetal presenting part -presenting part not firmly against cervix-> cord trapped between presenting part and maternal pelvis
hypertonic uterine dysfunction -uterus/contractions -clinical manifestation -prolonged __________ phase in labor -complications -nursing mgmt
-uterus fails to relax between UCs (>1 uterine pacemaker) -uncoordinated, ineffectual, painful UCs -prolonged LATENT phase -increased fatigue/stress -increased risk of PPH -therapeutic rest w/pain mgmt
hypotonic uterine dysfunction -uterus/contractions -clinical manifestation -prolonged __________ phase in labor -complications -nursing mgmt
-weak contractions that become milder (overstretched uterus) -UCs with weak intensity that don't dilate/efface the cervix -prolonged ACTIVE phase -compl: to mother and baby -CPD? if not then proceed w/arom and pitocin
The nurse is caring for a multigravid client who speaks little English. As the nurse enters the client's room, the nurse observes the client squatting on the bed and the fetal head crowning. After calling for assistance and helping the client lie down, which of the following actions should the nurse do next? a- Tell the client to push between contractions. b- Provide gentle support to the fetal head. c- Apply gentle upward traction on the neonate's anterior shoulder. d- Massage the perineum to stretch the perineal tissues.
2- provide gentle support to fetal head
You are caring for a GDM A2 G2 P1001 who complains of severe dyspnea. At her 39 week prenatal visit, her AFI was determined to be 30. An induction of labor is scheduled for this patient. Which of the following is an appropriate plan of care? Select all that apply. a- Needle amniotomy with FSE b- Amniocentesis c- Administration of Indocin (Indomethacin) d- Amnioinfusion
A, B, C (AFI of 30 is very high) -can do amniotomy/amniocentesis but just not AROM
Which of the following clients is most at risk for cephalopelvic disproportion? a- G3 P2002 b- Fetus presenting in ROP c- Poorly controlled Type 2 DM d- Severe pre-eclamptic
C poorly controlled t2 DM
A client has just had a C/S for a prolapsed cord. In reviewing the client's history, which of the following factors places a client at risk for cord prolapse? Select all that apply. a -2 station at time of rupture b Prior elective abortion c Assisted rupture of membranes d Breech presentation e Low lying placenta
a, c, d
A client who is in labor is at risk for shoulder dystocia because she has a history of this event with her first delivery. Which of the following is an important nursing intervention? a- Assess for complaints of intense back pain in the first stage of labor. b- Anticipate possible use of forceps to rotate to anterior position at birth. c- Assist with positioning the woman in squatting position. d- Perform an emergency episiotomy.
c- assist with positioning woman in squatting position
protracted vs arrest labor
protracted: slower rate of dilation vs -arrest: no progression in dilation/descent -hypertonic uterine dysfunction: arrest -hypotonic uterine dysfunction: protracted
