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Womens Health Exam 2 > Labour Related Complications > Flashcards

Labour Related Complications Flashcards

1
Q

What is dystocia

A

Abnormal labor pattern due to problems with:

Power
-uterine contractions
-maternal expulsion forces

Passenger
-Fetal size
-Fetal position
-Fetal presentation

Passage
-Soft tissue
-pelvis

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2
Q

What is typical for active labor?

A

3 to 5 contractions in a 10 minute period

Uterus relaxed for at least 1 minute between contractions

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3
Q

What is tachysystole

A

More than 5 contractions in a 10 minute period

Less than 60 seconds of relaxation between contractions

Or with individual contractions lasting longer than 2 minutes

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4
Q

What is hypotonic labour

A

Decreased frequency, possibly irregular.

Decreased intensity

Slow progress of labor

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5
Q

What are the risk factors for tachysystole?

A

Oxytocin use

Cocaine

Uterine rupture

Placental abruption

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6
Q

What is the nursing care for tachysystole

A

First, stop oxytocin and reposition patient

Begin continuous fetal monitoring if not already in use

Empty the patient’s bladder

Notify HCP

If accompanied by non-reassuring FHR tracing, also:
- Left side
-02 by facemask at 10L/min
- IV bolus

Support and comfort measures for patient

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7
Q

What causes hypotonic labor?

A

False labor

Early labor

Induction with unripe cervix

Cephalopelvic disproportion (CPD)

Passenger problems:
-Marcosomia
- malpresentation
-Malposition

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8
Q

Nursing care for hypotonic labor pattern

A

Monitor:
- maternal vital signs
- Contraction pattern
- Fetal heart rate
- Color of amniotic fluid
- Intake and output

Manage oxytocin protocol if ordered

Teach and support patient

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9
Q

What is post term pregnancy?

A

It extends more than 294 days or 42 completed weeks past the first day of the last menstrual period (LMP)

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10
Q

What is post term pregnancy associated with?

A

Deterioration of the placenta and related problems for baby, such as reduced blood supply, decreased fetal oxygenation and reduced nutritional supply

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11
Q

What is the clinical therapy for post term pregnancy?

A

Specialized monitoring of fetus once the woman completes the 40th week of gestation

Non-stress test

Biophysical profile: fetal breathing movements, body movements, tone, amniotic fluid volume (by sonogram), and FHR accelerations

If problems discovered, induction of labor may be recommended

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12
Q

Nursing care for post term pregnancies

A

Assess estimate date of birth and the criteria that were used to establish the date

Evaluate FHR as part of non-stress test

Be prepared to intervene for a non-reassuring FHR tracing

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13
Q

What is fetal malposition?

A

Position abnormal - typically persistent occiput posterior

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14
Q

Nursing care for fetal malposition

A

Recognize that complaints of intense back pain during first stage may indicate OP presentation

Assess position of head by feeling fontanelle during vaginal exam and with Leopold maneuvers

Encourage alternate positioning during labor to facilitate possible rotation

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15
Q

What are the different cephalic malpresentations?

A

Military

Brow

Face

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16
Q

What causes breech malpresentations?

A

Placenta implantation problems

Uterine anomalies

Fetal anomalies such as anencephaly or hydrocephaly

Multiple gestation

17
Q

What happens in a breach malpresentations?

A

Once membranes have ruptured, umbilical cord prolapse more likely, because presenting part may not fill outlet completely

Higher morbidity and mortality rates

Head entrapment possible during second stage

18
Q

Problems with malpresentations?

A

Malpresentations can slow, endanger, or stop progress of labor

19
Q

What is transverse lie malpresentation

A

Also known as shoulder presentation, the infants long access, lies perpendicular to mom spine

20
Q

What is macrosomia?

A

Fetal macrosomia is defined as a weight of more that 4000 grams (8 pounds and 13 ounces)

More common for mothers who are obese, or who have diabetes

21
Q

What are some complications for marcosomia?

A

Shoulder dystocia (a medical emergency)

Possible brachial plexus injury

22
Q

If vaginal delivery results in shoulder dystocia, possible interventions include:

A

McRoberts maneuver

Suprapubic pressure

Episiotomy

Woods screw maneuver

Breaking the babies clavicle

23
Q

Nursing care for macrosomia

A

Monitor for dysfunctional labor pattern, and report to HCP

Note excessive molding or caput during vaginal exams

24
Q

What is cephalopelvic disproportion (CPD)

A

A narrowing or contracture of any part of the pelvis or maternal tissues that cause the size of the birth passage to be inadequate for the baby

25
Q

What is non-reassuring fetal status

A

Non-reassuring fetal status is caused by insufficient oxygen supply to meet the needs of the fetus

26
Q

What are the most common signs of non-reassuring fetal status?

A

Meconium stained amniotic fluid

Changes in the fetal heart rate

27
Q

What is the clinical therapy for non-reassuring fetal status?

A

Relieve the hypoxia

Minimize effects of anoxia on fetus

If fetal status remains non reassuring and deliver is non imminent, cesarean birth is indicated

28
Q

Nursing care for non-reassuring fetal status

A

Be alert for:
-Risk factors
-Meconium stain fluid
-Fetal heart rate changes

Intervene:
-Position
-Correct maternal hypotension
-Discontinue oxytocin or Pitocin
-Administer O2
-Assess for prolapsed cord
-Notify HCP

29
Q

What is placenta malformations?

A

Succenturiate placenta - may lead to retained placenta fragments and bleeding

Circumvalllate placenta- may cause miscarriage, IUGR, preterm labor

Battledore placenta- may cause preterm labor, and bleeding

30
Q

What is a prolapsed umbilical cord

A

An umbilical cord that precedes the fetal presenting part and becomes trapped and compressed against the bones of the pelvis- an emergency

Can be obvious at opening of vagina, or occult (hidden)

Incidence highest with abnormal lie, such as footling breach or shoulder presentation

Can seriously affect oxygen supply to baby

31
Q

Clinical therapy for a prolapsed umbilical cord

A

Prevention is preferred approach

Once a membranes rupture, bedrest usually indicated until engagement of the presenting part occurs

If prolapse occurs, relieving pressure on the cord is essential

32
Q

Nursing care for a prolapsed umbilical cord

A

Observe perineum once rupture of membranes occurs to look for cord

Listen for FHR decelerations or bradycardia

33
Q

Nursing interventions if cord is prolapsed

A

Call for help stat

Used gloved hand to lift presenting part away from cord

Knee- chest or trendelenburg position may help

Administer oxygen

Prep for emergent delivery

Womens Health Exam 2 (9 decks)

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