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68wm6 p2 Spe Sit Lab

Special Situations in Labor and Delivery

Define amniotomy (aka AROM): Artificial Rupture Of the Membranes (amniotic sac) by using a disposable plastic hook (Amnihook)
What is the purpose of an amniotomy? usually performed in conjunction with induction and augmentation of labor and to allow internal electronic fetal monitoring
What are complications of an amniotomy? *Prolapse of the umbilical cord *Infection *Abruptio placentae
What does green amniotic fluid indicate? the fetus passed the first stool (meconium)
Bishop score > 8 indicates what? vaginal birth more likely successful
When is labor induced? Labor is induced if continuing the pregnancy is more hazardous for mom and fetus than delivery
What are contraindications to induce labor? *Placenta previa, Vasa previa *Umbilical cord prolapsed *High station of the fetus *Active herpes *Abnormal size or structure of the mother’s pelvis *Abnormal fetal presentation *Previous classic cesarean incision
What are Induction / Augmentation Techniques to induce labor? Amniotomy. Cervical Ripening
What are medical methods of cervical ripening? *Prostaglandin gel (Prepidil) *Cytotec (Misoprostol
What is the mechanical method of cervical ripening? Laminaria
What is the most commonly used drug in oxytocin induction? Pitocin
What are the risks of Oxytocin induction/augmentation? *Hypertonic uterine activity *Uterine rupture *Maternal water intoxication
When is oxytocin DCed or reduced during induction? if the fetal heart rate is out of the normal range or if there are excessive uterine contractions
What drugs may be given to reduce uterine activity in the PT on oxytocin? terbutaline and magnesium sulfate
During oxytocin induction, how often must B/P pulse and respirations be taken? every 30-60 minutes
During oxytocin induction, how often must the temperature be taken? every 2-4 hours
What is an External Cephalic Version (ECV)? The care provider externally manipulates a breach baby into the proper postion through massage of the stomach/uterus
What is an Internal Version? Reaching through the cervix to manipulate fetal position
What can be used in malpresentation of twin gestations to position fetus correctly for birth? Internal Version
What are Version contraindications? *Uterine malformations that limit the room available to perform the version and may be the reason for the abnormal fetal presentation *Previous C section with a vertical uterine incision *Disproportion between fetal size and maternal pelvic size
What may result from a Version of a fetus in a woman with a previous c-section with a verticle uterine incision? May lead to uterine rupture
When is an External Cephalic Version (ECV) done? Breach babies after 37 weeks of gestation
How is an ECV done? *The procedure begins with nonstress test or biophysical profile. *Woman receives tocolytic medication (terbutaline) to relax uterus Using ultrasound to guide procedure, doctor pushes fetal butt upward outward, at same time pushes head toward pelvis
How long must a mother and fetus be observed after a version? 1-2 hours
Leaking of vaginal fluid after a version may indicate what? Ruptured membranes
What forceps are used to deliver fetal head during breach delivery? Piper forceps
When are vacuum extractors contraindicated? It is not used to deliver the fetus in a nonvertex presentation such as breech or face and also not used for very preterm fetus because the suction is more likely to injure the head
What are fetal indications for operative birth? *Nonreassuring FHR patterns *Failure of the fetal presenting part to fully rotate and descend in the pelvis *Partial separation of the placenta
What are maternal indications for operative birth? *Exhaustion *Inability to push effectively *Cardiac and pulmonary disease
When are cesarean births preferable? if maternal and fetal conditions mandate a more rapid birth than can be done with forceps or vacuum and if the procedure would be too traumatic, or maternal CHF
How many times may a vacuum be applied during childbirth before the use of it is DCed? Three
Where is the vacuum placed? on the fetal head in the midline of the occiput
What may facial asymmetry indicate in the child born from operative birth? injury to facial nerves
What is an episiotomy? the surgical enlargement of the vagina during birth
What degree of laceration are usually uncomplicated and heal quickly? 1st and 2nd degree
What degree of laceration extends to the rectal sphincter? 3rd degree
What degree of laceration extends completely through the rectal sphincter? 4th degree
What is the primary risk of episiotomy and laceration? Secondary? infection, blood loss
How is an episiotomy done? episiotomy is done with blunt-tipped scissors just before birth
What is the nursing interventions of a post-op episiotomy PT? *Place cold packs on perineum to reduce pain, bruising and edema during the first 12-24 hours *Followed by perineal heat; this increases blood flow and promotes healing *Provide mild PO analgesics for pain management
What is hypotonic labor? uterine contractions are too weak to be effective during labor
Who is hypotonic labor most likely to occur in? women with an over-distended uterus
Tx of hypotonic labor *The doctor may do an amniotomy *Augmentation of labor *IV or oral fluids
Nursing care of PT in hypotonic labor *Give the laboring woman emotional support *Help patient with position change to promote comfort and enhance progress *Have patient walk, if allowed, to enhance contractions
What is hypertonic labor? contractions that are frequent, cramp-like, and poorly coordinated
Tx of hypertonic labor *Mild sedation to allow the woman to rest *Warm showers and baths promote relaxation and rest *Tocolytic drugs (terbutaline) may be ordered to reduce the high uterine resting tone
What may lead to ineffective maternal pushing? *The woman does not understand which technique to use *The woman is afraid of tearing *Regional anesthesia may reduce the natural urge to push
Nursing care of PT demonstrating ineffective maternal pushing *Main focus is to coach the woman and teach her the proper pushing techniques *If the woman cannot feel her contractions the nurse must tell the patient when to push *Reduce anxiety
What is macrosomia? a large fetus, generally weighing over 4000 gm (8.8 pounds)
What fetal position may cause intense back and leg pain in the woman? Occiput posterior
Dysfunctional labor in a multifetal pregnancy may be due to what common causes? *Uterine overdistension --> hypotonic labor *Abnormal presentation of one or all of the fetuses
What is hydrocephalus? fluid collection on the brain, causes enlargement of the fetal head
What is spina bifida? hernial protrusion of the meninges of the spinal cord. Hernial sac contains CSF and sometimes nervous tissue
What pelvic shape is the most common and most favorable for vaginal birth, the pelvis inlet is round? Gynecoid
What pelvic shape is the anteroposterior diameter is equal to or greater than the transverse diameter. Not favorable for vaginal delivery? Anthropoid
What pelvic shape is the male type pelvis and not favorable for vaginal delivery? Android
What pelvic shape has a shortened anteroposterior diameter and a flattened, oval, transverse shape. Not favorable for vaginal delivery? Platypelloid
What are the four basic pelvis shapes? *Gynecoid *Anthropoid *Android *Platypelloid
What is the most common soft tissue obstruction during labor? Full bladder
What are forms of maternal soft tissue obstruction? *Full bladder most common *Fibroids *Cervical scar tissue
What is the average rate of cervical dilation? 1.2 cm/hr for a woman having her first baby, and 1.5 cm/hr for a woman that has had a baby previously
Prolongued labor increases the risks of what? *Maternal or fetal infection *Maternal exhaustion *Postpartum hemorrhage
What are the complications of PROM? *Chorioamnionitis: infection of the amniotic sac *Chance for infections greatly increased after 24 hours
What is the Tx of preterm labor? *Bed rest and hydration *Urinalysis is done to detect UTIs *Tocolytic drugs may be given to inhibit contractions *Ritodrine (Yutopar) *Because of the side effects of Ritodrine, other drugs are given to inhibit contractions
In the PT suffering preterm labor, what is given to speed fetal lung maturation? *Steroid drugs to increase fetal lung maturity *Dexamethasone and betamethasone.
What is prolongued pregnancy? Pregnancy that lasts longer than 42 weeks
What are the risks of prolongued pregnancy? *inefficient placental delivery of nutrients and oxygen.  *Fetus may lose weight or skin may peel *Meconium may be expelled in amniotic fluid *Low blood sugar likely at birth *If placenta functioning inefficiently fetus will not tolerate labor well
What is a prolapsed umbilical cord? the cord slips downward after the membranes rupture, subjecting it to compression between the fetus and pelvis
What is a complete prolapsed umbilical cord? the cord can be seen protruding from the vagina
What is an occult prolapsed umbilical cord? the cord is compressed between the fetal presenting part and pelvis but cannot be seen or felt during vaginal exam
What increases the risk of prolapsed umbilical cord? *Fetus is high in the pelvis when the membranes rupture *Very small fetus *Abnormal presentation (breech) *Hydramnios
Tx of prolapsed umbilical cord *Displace the fetus upward to stop the compression *The baby is usually delivered by cesarean section
In the event of a prolapsed umbilical cord, how is the fetus displaced? *Knee-chest position *Trendelenburg *The nurse or doctor may push the fetus upward from the vagina
What is complete uterine rupture? a direct communication between the uterine and peritoneal cavities
What is incomplete uterine rupture? a rupture into the peritoneum covering the uterus or into the broad ligament but not the peritoneal cavity
What is uterine dehiscence? a partial separation of an old uterine scar. Little or no bleeding may occur. No signs or symptoms may exist and the rupture may be found incidentally during a subsequent C section or other abdominal surgery
What can cause uterine ruptures? *Previous surgery on the uterus *Many previous births *Intense contraction, as with use of Pitocin *Blunt abdominal trauma
S/Sx of uterine rupture: *Asymptomatic *Shock *Abdominal pain *Pain in the chest *Cessation of contractions *Abnormal or absent fetal heart rates *Palpation of fetus outside uterus
What surgery may need to be done in the case of a large uterine rupture? Hysterectomy
What is uterine inversion? occurs when the uterus completely or partly turns inside out, usually during the 3rd stage of labor. Is uncommon but potentially fatal
What can cause uterine inversion? *Fundal pressure during birth *Pulling on the umbilical cord before the placenta detaches from the uterine wall *Fundal pressure on an incompletely contracted uterus after birth
What drug is used to cause the uterus to contract and reduce bleeding? Pitocin
What is necessary if the replacement of an inverted uterus is unsuccessful? Hysterectomy
What is an amniotic fluid embolism? when amniotic fluid, with its particles such as vernix, fetal hair, and sometimes meconium, enters the maternal circulation and obstructs pulmonary vessels
What adverse effect of an amniotic fluid embolism occurs early and what can it lead to? Failure of the right ventricle occurs early and can lead to hypoxemia, depressed cardiac function, and circulatory collapse
What is a boggy uterus? A uterus that is not firm or contracted.
What must be done if the umbilical cord is wrapped too tightly over the infants neck for it to be slipped over? It must be clamped in two places and cut.
Created by: Shanejqb
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