Birth Complications
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| ____ term for difficult labor | Dystocia - may arise due to incoordinate uterine activity, abnormal fetal lie (longitudinal axis of fetus and mother) or presentation (leading fetal part and pelvic inlet), or absolute or relative cephalopelvic disproportion.
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| Name 3 dysfunctional labor patterns | hypertonic labor, hypotonic labor, and precipitous labor
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| What type of dysfunctional labor pattern includes need to assess for CPD (cephalopelvic disproportion), pain and anxiety during latent phase and ineffective contractions | hypertonic labor
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| What causes stress hormones to release catacholamine which in turn makes rhythmetic conractions ineffective during hypertonic labor | pain and anxiety
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| What type of dysfunctional labor includes the need to access for CPD (cephalopelvic disproportion), have less than 3 contractions in 10 minutes, during active phase, and needs aminotomy (artificial rupture of membrane) and oxytocin (Pitocin) | Hypotonic labor
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| What type of dysfunctional labor lasts less than three hours, may cause maternal complications and fetal cerebral trauma | precipitous labor
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| What causes the fetus to have a hematoma during precipitous labor | change in pressure in a rapid amount of time
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| A woman with a history of ____ labor will have a scheduled induction | precipitous labor
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| what is the term for a pregnancy greater than 42 weeks gestation, increased risks for fetus, oligohydramnious (too little amniotic fluid) and meconium aspiration | post term pregnancy
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| When a fetus is over 40 weeks gestation, a ____ test and _____ are done | nonstress test and biopysical profile (BPP)
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| What would concern a physician for a possible ruptured uterus | vaginal birth after cesearean (VBAC) due to scar fibers
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| Which is ideal: occiput anterior or posterior | occiput anterior
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| When the occiput presents posterior what negative effects are on the baby and mother | baby: molding and trauma (cephelahematoma). mother: back labor due to occiput on sacral area
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| What position do you want to put the mother into when the occiut is posterior position | to side and lateral sims or knee chest
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| When the baby is in breech presentation an external version can be done before ____ weeks gestation | 38. first give a topalitic med to relax smooth muscles
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| What is a negative outcome of external version | cord can be entangled, painful to mother
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| ____ is a term for large baby | macrosomia - over 4000 grams (8lbs 13 oz)
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| What can cause a big baby (macrosomia) | obease during beginning of pregnancy and or gained too much weight during pregnancy
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| a macrosomia baby is at risk for | CPD cephlo-pelvic disporportion and shoulder dystocia
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| At what estimated weight of a fetus will a C-section be scheduled | over 4500 grams
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| At how many weeks is fetal demise considered intra uterine fetal death (IUFD) | after 20 weeks
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| What are the risks of disseminated intravascular coagulation (DIC) | thromboplastin from fetus (triggers external clotting), depletes fibrinogen and clotting in mother, massive maternal bleeding from low factors V & VII
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| what is the difference between placenta abruptio and placenta privia | placenta abruption is painful, DIC potential, can be caused from substance abuse. placenta previa is painless, if slight bleed during preturm give bedrest and try to get baby to term
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| With placenta abruptia, disseminated intravascular coagulation (DIC) is caused by what | potential amniotic fetal debri to enter maternal blood system and set up for coagulation.
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| what are the signs of DIC | lab values showing slow change in platelet being used up, low levels of fibrinogen, high levels of prothrombin/thromboplastin time (PTT)
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| Amniotic fluid embolism is caused from what | tear in amnion or chorion results in amniotic fluid/debris to enter the maternal vessels to the lungs
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| What are the signs and symptoms of amniotic fluid embolism | acute shortness of breath and hypotension, progressing to cardiac arrest then coma, the 50% that survive this may have severe shivering, coughing, vomiting and excessive bleeding due to loss of ability to clot.
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| What are the risks from amniotomy (artificial rupture of membranes AROM) | prolapsed cord and infection
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| which hormone causes cervical ripening | prostaglandins (Cervidil, Prepidil, cytotec) first assess for hypertension
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| which hormone induces labor | oxytocin (Pitocin)
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| what procedure is done to release cord compression | amnioinfusion (0.9% NaCl if too little amniotic fluid)
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| ____ is a procedure done to enlarge the outlet | episiotomy
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| When are forceps or vaccum used | inadauate pushing (exhusted), epidural, fetal distress (bradycardia), mother has heart disease (to prevent over exhusting)
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| When is VBAC (vaginal birth after cesarean) contraindicated | previous classical (vertical) uterine incision
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| when is vaginal delivery contraindicated | breech or shoulder presentation, placenta previa or herpes blisters
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| prior to an amniotomy the nurse must assess for | presentation (if breech umbilical cord could slip under buttocks) if vertex look at station (if high -2 cord could prolapse) FHR decelerations if variable could be cord compression
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| What do you do if you suspect prolapsed cord | vag exam, even if can't feel cord keep hand firmly against fetal head to push up and relieve pressure - yank call light to get help immediately
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| Potential side effects of oxytocin induction | more decelerations due to close contractions (hyperstimulation less than 2 min apart and 1 min rest between), effects of hypoxia begin 30 min b4 fetal distress,
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| What is placneta previa | placement of placenta in the lower uterine quandrant and or over the cervix itself (placenta pulls away and there is bleeding) - do not do vag exam, fingers may go through placenta, do ultra sound
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| abruptio placenta has a ____ uterine musculature due to bleeding behind the placenta | hard rigid uterine muscular - causes pain
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| Tamika Collins is a 23-year-old gravida 3 para 2 client at 35 weeks' gestation. She presents at the prenatal clinic with complaints of painless, bright red bleeding. What would be the medical diagnosis for Ms. Collins at this time? | Placenta previa.
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| Tamika Collins is a 23-year-old gravida 3 para 2 client at 35 weeks' gestation. She presents at the prenatal clinic with complaints of painless, bright red bleeding. What are three possible nursing diagnoses for Ms. Collins (actual or risk)? | Fluid volume deficit, risk for impaired fetal gas exchange, and anxiety.
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| Tamika Collins is a 23-year-old gravida 3 para 2 client at 35 weeks' gestation. She presents at the prenatal clinic with complaints of painless, bright red bleeding. What is the expected treatment for Ms. Collins? Hint. Refer to Figure 19-14. | Care depends on the week of gestation during which the first bleeding episode occurs and the amount of bleeding.
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| Tamika Collins is a 23-year-old gravida 3 para 2 client at 35 weeks' gestation. She presents at the prenatal clinic with complaints of painless, bright red bleeding. What are the appropriate nursing interventions for Ms. Collins? | Vaginal exam is contraindicated. The nurse assesses for blood loss, pain, and uterine contractions. The nurse monitors maternal vital signs frequently and FHR continuously. The nurse provides emotional support.
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| Tamika Collins is a 23-year-old G3 P2 cl @ 35 weeks gestation. She presents @ the prenatal clinic with complaints of painless, bright red bleeding.What are some appropriate ? for the nurse to ask Ms. Collins related to the bleeding? | It would be important to determine (a) when the bleeding began, (b) what Ms. Collins was doing when the bleeding started, and (c) how much bleeding has occurred.
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| The nurse is working in the hospital labor and delivery unit with an obese client who is experiencing a prolonged labor. It is determined that the fetus is large. Why is this position used for shoulder dystocia? | The McRoberts maneuver is thought to change the maternal pelvis angle and therefore reduce the force needed to extract the shoulders and decrease the incidence of brachial plexus stretching and clavicular fracture.
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| The nurse is working in labor & delivery unit w/ an obese cl who is experiencing a prolonged labor. It is determined that the fetus is large. What are the maternal risks associated with the birth of a fetus weighing more than 4000 g (8 lb. 14 oz)? | overstretching of the myometrial fibers, which may lead to dysfunctional labor and an increased incidence of postpartal hemorrhage. uterine rupture during labor. Vaginal birth - perineal lacerations & extensions of an episiotomy.
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| If the oversized fetus is not able to ____, the chance of uterine rupture during labor increases. Vaginal birth poses an increased risk of perineal lacerations and extensions of an episiotomy. | If the oversized fetus is not able to descend, the chance of uterine rupture during labor increases. Vaginal birth poses an increased risk of perineal lacerations and extensions of an episiotomy.
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| Distention of the uterus may cause overstretching of the myometrial fibers, which may lead to dysfunctional ___ and an increased incidence of postpartal ____. | Distention of the uterus may cause overstretching of the myometrial fibers, which may lead to dysfunctional labor and an increased incidence of postpartal hemorrhage.
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| The nurse is working in the hospital labor and delivery unit with an obese client who is experiencing a prolonged labor. It is determined that the fetus is large. What are the fetal risks associated with macrosomia? | Fetal prognosis is guarded. If unsuspected & labor is allowed to continue in the presence of disproportion, the fetus can receive cerebral trauma from intermittent forceful contact with the maternal bony pelvis.
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| Macrosomia: During difficult operative procedures performed at the time of vag birth, the fetus may become ___ or ____ damage from pressure exerted on its head. | During difficult operative procedures performed at the time of vag birth, the fetus may become asphyxiated/experience neurologic damage from pressure exerted on its head.
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| A nurse in L & D unit w/ an obese cl who is experiencing a prolonged labor. It is determined that the fetus is Lg. Following delivery of the head, the anterior shoulder doesnt deliver either spontaneously or w/ gentle pressure. What is this called? | Shoulder dystocia.
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| A nurse in L & D unit with an obese client who is experiencing a prolonged labor. It is determined that the fetus is large. The nurse recognizes this situation as an obstetric emergency. What position does the nurse assist the client to maintain? | The client is assisted to sharply flex her thighs up against her abdomen. This is known as the McRoberts maneuver.
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| The nurse must be knowledgeable & competent in reading the fetal heart monitors & responding to the contraction & FHR patterns. The nurse reviews the cl's admin hx & notes that the cl was born via c-section after a prolonged labor. Is this significant? | Yes; researchers have suggested that genetic factors may control normal physiologic processes of labor. Cesarean birth and operative vaginal birth tend to run in families.
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| A _____ uterine contraction has a pattern with contractions occurring every 7 minutes, with some uterine activity between contractions; duration is 50 seconds. | A hypotonic uterine contraction pattern with contractions occurring every 7 minutes, with some uterine activity between contractions; duration is 50 seconds.
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| The nurse is performing a pelvic exam on a laboring client and discovers a loop of cord in the vagina. What is the initial nursing action? | Leave gloved fingers in the vagina. Call for help. You will ride on cart with pt to surgery for an emergency C-section. You will keep your fingers in her vagina until the doctor starts cutting on pt
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| The nurse is caring for a prenatal client at 38 weeks' gestation whose ultrasound reveals approximately 3000 mL of amniotic fluid. She complains of SOB and has 2+ pitting edema in her lower extremities. What intervention should the nurse prepare for? | amniocentesis
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| The nurse is caring for a G3P2 laboring client with intact membranes and a breech presentation. What complication should the nurse anticipate at this time? | placenta previa and Hydramnios may be a complication.
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| A nurse is admitting a laboring client with a breech presentation to the birthing unit. Where is the most appropriate place for the nurse to auscultate for fetal heart tones? | above the umbilicus
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| The nurse is assessing a prenatal client at 30 weeks' gestation who was admitted to the hospital with complaints of severe nausea and vomiting, elevated alpha-fetoprotein, and a fundal height of 38. What diagnosis should the nurse anticipate? | multiple pregnancy
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| The nurse is providing prenatal care to a client pregnant with twins. How much weight should the nurse counsel this client to gain? | 40-50 pounds
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| The nurse is caring for a laboring client with a known history of cocaine abuse. What complication is most likely for this client? | abruptio placentae
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| The nurse is assessing a prenatal client diagnosed with possible placenta previa. What signs and symptoms should the nurse expect this client to demonstrate? | bright-red vaginal bleeding
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| The nurse is reviewing the complications of childbirth. Head injury is most likely to occur with which presentation? | Breech
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| Fetal-neonatal risks of face presentation include ___ of the face, ___ of the face and throat, and pronounced ___ of the head. | Fetal-neonatal risks of face presentation include cephalhematoma of the face, edema of the face and throat, and pronounced molding of the head.
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| Trauma may include cerebral and neck compression during birth with ___ presentation. | Trauma may include cerebral and neck compression during birth with brow presentation.
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| The nurse is caring for a third trimester prenatal client admitted with bright-red painless vaginal bleeding. What diagnosis should the nurse anticipate? | placenta previa
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| Pt G3P2 cl @ 41 weeks, admitted for labor induction. Dilated 2 cm., 40% effaced, anterior position, -2 station, cervix firm & membranes intact. hx last baby delivered @ 40 wks, 9 lbs. What are nurse considerations when preparing an oxytocin infusion? | Explain procedure, Apply fetal monitor & obtain a 15- to 20- minute tracing, & conduct a nonstress test to assess FHR before starting IV oxytocin.Start primary IV and piggyback secondary IV with oxytocin and infusion pump.
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| Ensure continuous monitoring of the fetus and uterine contractions.Monitor maternal BP and P every 30-60 minutes.Monitor contraction pattern every 15 minutes.Assess intake and output.Monitor for N/V, headache, & hypotension. When is all this done? | This is all done when giving Pitocin. Also Assess fetal status using electronic fetal monitoring. Monitor uterine tone.Follow agency protocol.
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| What tests might be performed prior to Pitocin induction? | A nonstress test & a contraction stress test to determine placental function & to eval fetal response to uterine contractions.
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| A ____ profile w/ ultrasound is indicated to determine fetal size, if last baby was Lg. If Baby is Larger than her last baby, induction may be contraindicated, depending on the size of the pelvis. | A biophysical profile w/ ultrasound is also indicated to determine fetal size, if last baby was Lg. Baby Larger than her last baby, induction may be contraindicated, depending on the size of the pelvis.
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| Norma Roberts, G3P2 cl @ 41 weeks gestation, is admitted for labor induction. Ms. Roberts' cervix is dilated 2 cm., 40% effaced, anterior position, -2 station, cervix firm, and membranes intact. Why does Ms. Roberts need an induction? | Ms. Roberts is postdue at 41 weeks' gestation.
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| Norma Roberts, G3P2 cl @ 41 weeks gestation, is admitted for labor induction. Ms. Roberts' cervix is dilated 2 cm., 40% effaced, anterior position, -2 station, cervix firm, & membranes intact. Last baby Lg. Is miss Roberts a good canidate for induction? | Ms. Roberts meets the minimum criteria of 5 for a multigravida.
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| The nurse is preparing the oxytocin infusion by adding 10 units of oxytocin to 1L of D5LR. The resulting mix will contain 10 mU of oxytocin per 1 mL. The order is to start the infusion at 1 mU/minute. At what rate will the nurse set the infusion pump? | 10 mU/mL = 1mU/0.1 mL = 0.1 mL * 60 minutes = 6 mL/hour or1ml/10mU x 1mU/min x 60min/hr = 6 ml/hr
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| The nurse is working the hospital labor and delivery unit with a client during the induction of labor. What are the most frequently used methods of labor induction? | The most frequently used methods of labor induction selected by physicians are stripping the amniotic membranes, amniotomy, intravenous oxytocin, nipple self-stimulation, and administration of misoprostol.
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| The nurse is working the hospital labor and delivery unit with a client during the induction of labor. Misoprostol has been ordered to induce labor. How is misoprostol administered? | Misoprostol is a vag insert. The cl is kept supine for 2 hrs, but then may ambulate. Dr, certified nurse-midwives, & birthing rooms nurses who have had special education & training may admin PGE products
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| The nurse is working the hospital labor and delivery unit with a client during the induction of labor. What are the maternal side effects of oxytocin administration? | Hyperstimulation of the uterus results in hypercontractility, which in turn may cause abruptio placentae, impaired uterine blood flow with fetal hypoxia, rapid labor with cervical lacerations, uterine rupture, and water intoxication.
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| The nurse is working the hospital labor and delivery unit with a client during the induction of labor. Oxytocin has also been ordered to induce labor. What does the nurse assess for to determine if oxytocin is effective? | The goal of oxytocin administration is to achieve 3 uterine contractions with a duration of 40-60 seconds in 10 minutes with good uterine relaxation and return to baseline tone between contractions.
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| Vacuum extraction is an obstetric procedure used to assist the birth of a fetus by applying suction to the fetal head. What is the most common indication for the use of the vacuum extractor? | The most common indication for the use of the vacuum extractor is a prolonged second stage of labor.
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| Vacuum extraction is an obstetric procedure used to assist the birth of a fetus by applying suction to the fetal head. What is the nursing care management associated with vacuum extraction? | The nurse should inform the cl about what is happening during the procedure. The FHR should be assessed q 5 min/continuously by electronic fetal monitoring. Cls need to be informed that the caput (chignon) on the baby's head will disappear w/in 2-3 days.
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| Vacuum extraction is an obstetric procedure used to assist the birth of a fetus by applying suction to the fetal head. What newborn complications does the nurse assess for? | The nurse should continue to assess the newborn for cephalhematomas, intracranial hemorrhage, and retinal hemorrhages.
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| A nurse is planning an educational seminar on natural methods of cervical ripening. Which of the following would be inappropriate to include? | misoprostol (Cytotec)-is considered to be an allopathic method. sexual intercourse, evening primrose oil, & blue/black cohosh herbs are all natural methods
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| A nurse is reviewing the charts of several clients in the birthing unit. Which client would be the best candidate for prostaglandin gel insertion? Also ___ & ___ are contrindications and prostaglandin gel should be used with caution in pts with ____. | client at 39 weeks' gestation with migraine headaches . placenta priva & oxytocin are contrindications and prostaglandin gel should be used with caution in pts with ashthma.
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| Transverse fetal lie, prolapsed umblical cord, & active herpes infection are all contraindications to an _____? | contraindication to an induction.
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| A nurse is caring for a client during an amnioinfusion. Which fetal heart rate (FHR) pattern would be an expected outcome of a successful amnioinfusion? | decrease in variable decelerations (you want to get the baby off the cord)
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| A nurse is caring for a client with an oxytocin infusion. What is the correct nursing action prior to increasing the oxytocin rate? A. Assess cervical dilation B. Monitor fetal heart tones C. Eval the need for analgesia D. Assess maternal temperature. | B. Monitor the fetal heart tones
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| A nurse is reviewing the charts of four cls in the L&D. Which client is at increased risk for having an episiotomy? A. 27-yr-old cl laboring in a lithotomy position B. 22-yr-old cl w/ an occiput-anterior position C.31-yr-old cl w/ an abruptio placentae | 27-year-old client laboring in a lithotomy position
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| A nurse is assisting the physician with a forceps-assisted birth. When should the nurse indicate for the Dr to apply the forceps? A. when the cl is pushing B. prior to a contraction C. after a decrease in fetal heart rate D. during a contraction | D. during a contraction
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| A nurse is caring for a postpartum client after a cesarean birth. What nursing action is appropriate in the immediate postpartal period? | Assess the client's vital signs every 5 minutes. The dressing must be checked every 15 minutes for the first hour.Coughing and deep breathing must be done q2 hrs for at least 24 hours. Massage is appropriate only when the fundus is not firm.
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| A nurse is preparing a prenatal cl w/ a breech presentation for an external version. What criterion must be met prior to this procedure? A. 1000 mL of amniotic fluid B. 36 wks of gestation C. nonreactive nonstress test D. fetal breech must be engaged | 1000 mL of amniotic fluid...The fetus must be at 38 weeks' gestation or more. The nonstress test must be reactive. The fetal breech must not be engaged.
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| A nurse in the birthing unit is caring for a client following an amniotomy. What is an appropriate nursing intervention? A. Assess cervical dilation q 2 hrs B. Monitor temp q 2 hrs C. Encourage ambulation q 1-2 hrs D. Replace fluids & e- q 1-2 hrs. | Monitor temperature every 2 hours. Vag exams kept at a minimum to reduce risk of infection; Bed rest is maintained unless presenting part is engaged.This is not necessary as amniotic fluid is constantly produced.
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