Complicated Labor&Delivery

Question 1

How is Labor Dystocia Characterized as?

Answer 1

1. 4+ hours with less than 0.5cm/hr
2. > 1hr of pushing but no descent

Protractions: slowed, delayed
Arrest: stopped, arrest, failure

Question 2

Risk Factors that can contribute to Labor Dystocia

Answer 2

• Overweight
• Short
• AMA
• Infertility
• Prior ECV
• Uterine abnormals
• CPD
• Maternal condition (fatigue, dehydration)
• Improper use of analgesics

Question 3

[Power] What is Hypertonic and Hypotonic

Answer 3

Hypertonic: sides contractions, or not in sync
Hypotonic: insufficient intensity, failed dilation, d/t uterus distension, fetal malposition

Question 4

[Power] What is Inadequate Voluntary Expulsive Forces

Answer 4

• Lack of urge
• Analgesics/Epidural
• Lead to OVD

Question 5

[Power] What is Precipitous Labor?

Answer 5

< 3hrs
- Perineal Tissues, Rapid Fetal descent

Complications: lacerations, hemorrhage, newborn bruising

Question 6

[Passenger] What is External Cephalic Version and Risks?

Answer 6

When baby is in breech presentation
Turning of the Baby
Done at 36 weeks gestation

Risks: can induce labor, and baby can flip back before due date

Management: NST before and after, concurrently with u/s

Question 7

[Passenger] Occiputposterior positioning

Answer 7

Occiputposterior: baby is looking towards the sky

Must rotate 135 degrees

Nursing Interventions: Keep bladder empty, change position q15-30mins, good pain control (for back pain)

Question 8

[Passenger] Shoulder Dystocia
- Risk Factors?
- Complications?

Answer 8

Shoulder/Arm presentation

Risks Factors:
- Macrosomia
- Previous SD
- Maternal Obesity
- Arrested descent
- Prolonged labor
- Short
- OVD

Complications:
- Fetal death
- Hypoxia
- Fractured/Birth injuries
- Brachial Plexus Palsy
- Maternal (PPH, uterine rupture0

Question 9

[Passage] What is Cephalopelvic Disproportion

Answer 9

Fetus’ head is larger than pelvic diameters

Question 10

[Passage] What are the indications for having an Operative Vaginal Delivery (OVD)

Answer 10

• Stuck at station +2, +3
• FHR increased/compromised
• Exhaustion
• Prolonged

Question 11

[Passage] What are the contraindications for having an Operative Vaginal Delivery (OVD)

Answer 11

• Breech, shoulder, face, or brow presentation
• Unengaged vertex
• CPD
• Premature

Question 12

[Passage] Vacuum Assisted Delivery
- Role?
- Complications?

Answer 12

Role of the nurse:
- Anticipate
- Prepare equipment, patient
- Coach (3 pulls with 3 contractions)

Complications:
- Cephalic, subdural, vaginal hematoma
- Scalp, perineal, vaginal, cervical lacerations

Question 13

[Passage] Forceps Assisted Delivery (Types of Applications)

Answer 13

• Outlet: at perineum
• Low: at +2 stations
• Mid: between 0-2 station

Question 14

[Passage] What is the care of a newborn following OVD

Answer 14

Subgaleal Hemorrhage
Scalp swelling crosses suture line
Hypovolemic shock:
- Cap refill
- Modelling
- Pale
- Increased HR, RR
- Sunken fontanelles (dehydration)

Question 15

What are the types of Caesarean Section?

Answer 15

Elective: choosing
Emergent: ER, FHR dropping
Urgent: labor dystocia

Question 16

What is the nursing care for C-section?

Answer 16

Pre-op: labs, psychosocial, education, fetal wellbeing

Intra-op: support team

Recovery: v/s, cardiac, assessment, pain, dermatomes. bonding/feeding, newborn care

Postpartum: incision care, s/s of infection, pain, psychosocial, education on limitations

Question 17

TOLAC (trial of labor after C-section)
- Qualifications?
- Risks?
- Nurse Role?

Answer 17

Qualify if:
- Reason for previous c/s
- Type of previous c/s
- Maternal Health

Risks:
- Hemorrhage
- Uterine rupture
- Scar opening
- Infant death/neuro-complications

Role:
- EFM, contractions
- IV fluids
- NO PROSTAGLANDINS (cervidil)
- Support
- Epidural
- Prepare c/s
- Cross match
- Pre-op blood work

Question 18

[Passage] Prolapsed Umbilical Cord

Answer 18

What it is:
- Portion of umbilical cord falls in front of, lies beside, or hangs the fetal presenting part following ROM

Types
1. Occult/Hidden: Alongside presenting part
2. Overt: precedes presenting part

Question 19

Amniotic Fluid Embolism
- What it is
- Interventions

Answer 19

Fluid goes into blood flow like an embolism, treated like a foreign body
S/s: immediate change in v/s , signature cough

Interventions:
- Cardiac resuscitation
- c/s
- ICU care