BC3-maternity- labor complications
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| dystocia | (blank)
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| dystocia | long, difficult , abnormal labor
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| causes of dystocia | dysfunctional labbor, alteration in pelvic structure, fetal causes (size, position), maternal position (best squatting), phychological responses
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| when is dystocia suspected | lack of progress in rate of cervical dilation, fetal decent, or problems with uterine contractions
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| dysfunctional labor | abnormal uterine contractions that prevent dilation, effacement, descent
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| primary dysfunctional labor | hypertonic contractions, anxious primagravida having painful contractions
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| management of primary dysfunctional labor | theraputic rest, analgesics (morphine and demerol) to reduce pain
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| secondary uterine inertia | hypotonic
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| secondary uterine inertia | hypotonic contractions, that decrease in strength dropping uterine tone below normal contractions. occurs in active phase, secondary uterine inerita, most common
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| 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
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| stage 2 dystocia | ineffective expulsive force- inability to push related to too much anesthesia, fatigue or pain
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| epidural window | 3-7 cm
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| 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
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| alterations in pelvic structure | d/t car wreck, genetic abnormality (rickets, neoplasm, MVA-C-section most often necessary
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| fetal causes of dystocia | fetal size, malpresentation, position, leads to low forceps delivery, vacuum extraction, or c- section
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| hydrocyphallis | water on brain (spinobifida)
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| rickets | lack of vitamin D
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| CPD | usually related to macrosomic infant. shoulder stuck after head born, shoulder dystocia. Mc roberts maneuver to deliver
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| 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
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| fetal malpresentation | breech (most common)
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| for Breech management | C-section most often, greatest danger of vaginal delivery is prolapsed cord
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| brow and face presentations | cause L and D complications and sometimes bonding problems if face bruised
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| multiple pregnancies | early diagnosis to improve fetal outcome
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| macrosomic | baby>8lbs 13 oz (bigger baby)
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| high risks associated with multiple pregnancies | premature labor, PIH, abnormal presentation, hydramnios, uterine dysfunction
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| prenatal care for multiple pregnancies | see dr. more often Q 2 weeks in 2nd trimester, Q 1 week in 3rd trimester.
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| 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
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| psyche | anxiety/ stress/ excessive labor result prolonged painful labor. Doulas, coaches, staff, help to relax and enhance positioning and support
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| 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
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| induction | initiation of uterine contractions before their spontaneous onset for the purpose of bringing on birth
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| indications to induce | PIH (pregnancy induced hypertension) DM, postterm gestation (old placenta) fetal distress, distance from hospital
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| bishop score | compare 5 items, cervical dilation, effacement, position, consistency, station of fetal head
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| bishop scoring | total of 13 possible, 9 or more good for nullipara, 5 or more for a multip
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| chemical & mechanicial methods of induction | cervical ripening, amniotomy. oxytocin, augmentation, episiotomy, pitocin
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| prostaglandin gel (cervidil) | ripening of cervix
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| 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
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| oxytocin administration | goal to achieve contractions 2-3 min apart lasting 45 seconds. follow strict protocol nurse can give medication, MD responcible
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| pitocin | discontinued if contractions longer than 90 seconds, abnormal fetal HR patterns, significant maternal blood pressure changes.
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| 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
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| augmentation | stimulation of uterine contractions if progress unsatisfactory
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| episiotomy | surgical incision of perineal body done to enhance birth of fetus
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| most commonm episiotomy | midline, with medial-lateral helpful when a longer epis. is necessary. more comfortable , heals quicker
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| forceps delivery | provide traction, rotation
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| low-forceps delivery | facilitate outlet delivery
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| mid-forceps | can deliver head at ischial spine, head must be totally engaged, membranes ruptured, vertex presentation, adequate maternal anesthesia
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| vacuum extraction | suction used to deliver fetal head, intermittent suction
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| Cesarean Delivery | delivery through abdominal uterine incision
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| indications for C section | malpresentation, CPD, fetal distress, placental accidents
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| types of c sections | skin incisions/ transverse (bikini)
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| Ritodrine | med used to relax uterus
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| amniocentesis | to test lung maturity L:S ratio, 35 weeks
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| induction done because | PIH, and sometimes coonvenience
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| vertical incision | transverse, thinnest, least blood loss, preferable for VBAC, best for twins, abnormal presentation, placenta previa, fetal distress, disadvantage, takes longer
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| Nursing care for c section | provide information, support for breastfeeding, encourage and inform momm regarding PCA catheter, TEDS, breathing and coughing and diet
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