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OB Exam 3
OB Chapter 21
| Question | Answer |
|---|---|
| Dystocia | abnormal progression of labor typically caused by problems or abnormalities involving the expulsive forces; fetal presentation, position, and development; the maternal bony pelvis, or birth canal; and psychological maternal stress |
| Precipitous labor | labor that is completed in less than 3 hours from the start of contractions to birth |
| Protracted disorders | series of events including protracted active phase dilation (slower-than-normal rate of cervical dilation) and protracted descent (delayed descent of the fetal head in the active phase) |
| Shoulder dystocia | obstruction of fetal descent and birth by the axis of the fetal shoulders after the fetal head has been delivered |
| Tocolytic therapy is | ordered if preterm labor occurs before completion of the 34th week of gestation in an attempt to delay birth and thereby reduce the severity of respiratory distress syndrome and other complications associated with prematurity |
| Vaginal birth after cesarean (VBAC) | giving birth vaginally after having at least one previous cesarean birth |
| Labor induction | involves the stimulation of uterine contractions by medical or surgical means before the onset of spontaneous labor |
| Hypertonic uterine dysfunction | occurs when the uterus never fully relaxes between contractions |
| Hypotonic uterine dysfunction | occurs during active labor (dilation more than 5 to 6 cm) when contractions become poor quality and lack sufficient intensity to dilate and efface the cervix |
| Dystocia is associated with | an increased risk of complications & CS: postpartum hemorrhage, infections, perineal lacerations, and anal sphincter injury |
| what is key with dystocia | Prevention is key – so must know risk factors! |
| risk factors for dystocia | weak or ineffective uterine contractions, LGA, malpresentation, malposition, a small or abnormal maternal pelvis, multiple gestation, polyhydramnios, maternal obesity, diabetes mellitus, advanced maternal age, and maternal exhaustion |
| dystocia can be caused by | problems with the Ps |
| problems with the Ps | powers passenger passageway position psyche |
| normal labor vs dystocia | normal labor: contractions cause progressive cervical changes dystocia: lack of progressive cervical change or fetal descent |
| problems with the powers aka | Hypertonic Uterus Hypotonic Uterus Inadequate Bearing Down |
| primary power: Hypertonic Uterus | No relaxation between contractions Contractions are erratic, poorly coordinated and ineffectual |
| Hypertonic Uterus only involve | a portion of the uterus and more than one uterine pacemaker is sending signals for contraction |
| tachysystole | uterus contracts more than 5 times in 10 minutes, averaged over 30 minutes |
| Hypertonic Uterus will compromise | placental perfusion |
| Hypertonic uterus will lead to | maternal exhaustion |
| management of hypertonic uterus | Pain and comfort Enhance rest and relaxation |
| primary power: Hypotonic Uterus is the most common cause of | protraction disorder |
| hypotonic uterus contractions lack | quality and intensity: cervical change is absent or slow |
| hypotonic uterus causes | CPD Fetal malposition |
| hypotonic uterus consequences | Infection Exhaustion |
| hypotonic uterus management | Pitocin Amniotomy Position changes, hydration, ambulation |
| Secondary Power: Pushing Efforts | Inadequate pushing May be related to analgesic medication administration |
| Secondary Power: Pushing Efforts management | Coach & support client Reposition Prepare for assisted-delivery Prepare for CS |
| Problems with the Passenger | Lie Position Presentation Size/Development |
| lie | oblique transverse |
| position | Occiput anterior is best! Occiput posterior is difficult |
| presentation | breech shoulder |
| Size/Development | Macrosomia Multiples Fetal abnormalities |
| Occiput anterior | baby faces the mother's back, with the back of the baby's head toward the front of the mother's pelvis |
| Occiput posterior | baby faces the mother's abdomen, so the back of the baby's head is toward the mother's back |
| Problems with the Passenger | Macrosomia can sometimes cause “shoulder dystocia” which is a mechanical problem and emergency! |
| McRobert's Maneuver | an emergency nursing intervention used to treat shoulder dystocia, when the baby's shoulder becomes stuck behind the mother's pubic bone during delivery |
| Problems with the Passageway | small or abnormally shaped maternal pelvis, cephalopelvic disproportion (CPD), pelvic tumors, a full bladder, and soft tissue obstructions of the birth canal |
| Problems with the Psyche | Reduced pain tolerance Anxiety/fear Fatigue/exhaustion |
| Nursing management for Problems with the Psyche | Continuous labor support, comfort measures, education, encouragement, relaxation |
| Precipitous labor lasts | ≤3 hours from start to finish |
| Precipitous labor can result in | maternal injury (e.g., uterine rupture, cervical lacerations, hemorrhage) and fetal injury (e.g., trauma, asphyxia) |
| Nursing Assessment & Management of Dystocia | Identify risks & watch for signs/sx of dystocia Promote labor progress Promote comfort (physical and emotional) Promote empowerment |
| Risk Factors for Dystocia Labor Patterns | Short stature Obesity Hydramnios Uterine abnormalities Fetal malpresentation CPD Too much oxytocin!! Maternal exhaustion Poor positioning in labor Maternal anxiety (fear) |
| Nursing Management 1. Promote Labor Progress | Assess Labor Progress Ensure hydration and elimination Encourage position changes Assist with therapeutic interventions |
| Assess Labor Progress | Cervical change Fetal station Contraction pattern Progress?? |
| Ensure hydration and elimination | IV fluids, hydration status Bladder status |
| Encourage position changes | Open the pelvis Reduce soft tissue swelling |
| Assist with therapeutic interventions | Membrane rupture - watch for proloapsed cord! Uterotonics (Pitocin) or Tocolytics (Terbutaline) |
| Nursing Management 2. Provide Physical & Emotional Comfort | Comfort measures – blankets/backrubs Lower lights, reduce noise, warm shower, pillows, frequent position changes Fluids / food as appropriate Analgesics as prescribed Empathetic listening |
| Nursing Management 3. Promote Empowerment | Educate about dysfunctional labor patterns Explain and Inform on therapies and interventions Advocate for patient wishes Acknowledge any anxieties/fears |
| Preterm labor risk factors | *** HX of preterm birth or labor Infection Use of assisted reproductive technologies smoking or substance use Stress High-risk conditions |
| Preterm labor physical assessment | assess pattern of contractions evaluate cervical dilation and effacement engagement of the fetal presenting part |
| Preterm labor Laboratory and Diagnostic Testing | cervical length Fetal fibronectin CBC Urinalysis Amniotic fluid analysis |
| Preterm Labor: Nursing & Therapeutic Management | High-Risk Patients: Progesterone Therapy Tocolytics: Magnesium sulfate, Indomethacin, Nifedipine Consider Antenatal Steroids |
Created by:
leh195