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labor complications

BC3-maternity- labor complications

QuestionAnswer
dystocia (blank)
dystocia long, difficult , abnormal labor
causes of dystocia dysfunctional labbor, alteration in pelvic structure, fetal causes (size, position), maternal position (best squatting), phychological responses
when is dystocia suspected lack of progress in rate of cervical dilation, fetal decent, or problems with uterine contractions
dysfunctional labor abnormal uterine contractions that prevent dilation, effacement, descent
primary dysfunctional labor hypertonic contractions, anxious primagravida having painful contractions
management of primary dysfunctional labor theraputic rest, analgesics (morphine and demerol) to reduce pain
secondary uterine inertia hypotonic
secondary uterine inertia hypotonic contractions, that decrease in strength dropping uterine tone below normal contractions. occurs in active phase, secondary uterine inerita, most common
management of secondary uterine inertia R/O CPD, goal to increase quality of uterine contractions. rest, fluids for mom, amniotomy, oxytocin, if fetal distress, or CPD (head too big)or CS
stage 2 dystocia ineffective expulsive force- inability to push related to too much anesthesia, fatigue or pain
epidural window 3-7 cm
precipitous labor labor of 3 hours or less, related to lack of resistance in maternal tissue, large pelvis small baby, extra strong contractions, possible uterine rupture, lacerations, ppossible asphyxia to baby
alterations in pelvic structure d/t car wreck, genetic abnormality (rickets, neoplasm, MVA-C-section most often necessary
fetal causes of dystocia fetal size, malpresentation, position, leads to low forceps delivery, vacuum extraction, or c- section
hydrocyphallis water on brain (spinobifida)
rickets lack of vitamin D
CPD usually related to macrosomic infant. shoulder stuck after head born, shoulder dystocia. Mc roberts maneuver to deliver
fetal mal position ROP-LOP change moms position frequently, pressure on sacrum may reduce pain, hands and knee position, or lateral pushing may facilitate birth
fetal malpresentation breech (most common)
for Breech management C-section most often, greatest danger of vaginal delivery is prolapsed cord
brow and face presentations cause L and D complications and sometimes bonding problems if face bruised
multiple pregnancies early diagnosis to improve fetal outcome
macrosomic baby>8lbs 13 oz (bigger baby)
high risks associated with multiple pregnancies premature labor, PIH, abnormal presentation, hydramnios, uterine dysfunction
prenatal care for multiple pregnancies see dr. more often Q 2 weeks in 2nd trimester, Q 1 week in 3rd trimester.
position multipple preg. maternal position can enhance or impede the progress of labor. Having mom restricted to lying on her bed can work against her
psyche anxiety/ stress/ excessive labor result prolonged painful labor. Doulas, coaches, staff, help to relax and enhance positioning and support
external cephalic version attempt to convert fetal position to favorable one, externally, proceedure done under ultrasound, continual monitoring. Give Ritodrine (relax uterus), fetus meneuvered into vertex position, 35 to 38 weeks to turn
induction initiation of uterine contractions before their spontaneous onset for the purpose of bringing on birth
indications to induce PIH (pregnancy induced hypertension) DM, postterm gestation (old placenta) fetal distress, distance from hospital
bishop score compare 5 items, cervical dilation, effacement, position, consistency, station of fetal head
bishop scoring total of 13 possible, 9 or more good for nullipara, 5 or more for a multip
chemical & mechanicial methods of induction cervical ripening, amniotomy. oxytocin, augmentation, episiotomy, pitocin
prostaglandin gel (cervidil) ripening of cervix
amniotomy artificial rupture of membranes, assess fluid for color, consistancy, odor, quantity, record time of rupture, FHR assessed prior and after proceedure (checking for prolapsed cord) maternal temp monitored for infection
oxytocin administration goal to achieve contractions 2-3 min apart lasting 45 seconds. follow strict protocol nurse can give medication, MD responcible
pitocin discontinued if contractions longer than 90 seconds, abnormal fetal HR patterns, significant maternal blood pressure changes.
contraindications for induction of labor any situation in which delivery should not be accomplished or which would cause uterine rupture, or hem., activer herpes, placenta previa, fetal distress
augmentation stimulation of uterine contractions if progress unsatisfactory
episiotomy surgical incision of perineal body done to enhance birth of fetus
most commonm episiotomy midline, with medial-lateral helpful when a longer epis. is necessary. more comfortable , heals quicker
forceps delivery provide traction, rotation
low-forceps delivery facilitate outlet delivery
mid-forceps can deliver head at ischial spine, head must be totally engaged, membranes ruptured, vertex presentation, adequate maternal anesthesia
vacuum extraction suction used to deliver fetal head, intermittent suction
Cesarean Delivery delivery through abdominal uterine incision
indications for C section malpresentation, CPD, fetal distress, placental accidents
types of c sections skin incisions/ transverse (bikini)
Ritodrine med used to relax uterus
amniocentesis to test lung maturity L:S ratio, 35 weeks
induction done because PIH, and sometimes coonvenience
vertical incision transverse, thinnest, least blood loss, preferable for VBAC, best for twins, abnormal presentation, placenta previa, fetal distress, disadvantage, takes longer
Nursing care for c section provide information, support for breastfeeding, encourage and inform momm regarding PCA catheter, TEDS, breathing and coughing and diet
Created by: goryan on 2007-11-26



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