chapter 33

Question 1

dysfunctional labor

Answer 1

does not result in normal progress of cervical dilation, effacement or descent
(so no progress but could have normal contractions)

Question 2

dystocia

Answer 2

any difficult labor or birth

Question 3

powers =

Answer 3

uterine contractions

Question 4

ineffective uterine contractions

Answer 4

A) Hypotonic dysfunction- Secondary Inertia

B) Hypertonic dysfunction- Primary Inertia

Question 5

Hypotonic dysfunction- Secondary Inertia

Answer 5

more common, mom starts labor and does good until gets to 4cm and stays there (active phase)
“falls out of labor”
decrease frequency - intensity of contractions, decrease to 2-3 contractions/10 min
causes: cephalapdric dysportion (baby cant get through), positions of body, over distention of uterus, exhaustion, infection risk
if baby not born in 24 hrs then c-section

Question 6

Hypertonic dysfunction- Primary Inertia

Answer 6

occurs during early phase of 1st stage so 0-3 cm
contractions are uncoordinated
in a lot of pain, never really goes away
want to stop labor and give analgesic to knock her out of labor
within 2-3 hours labor starts normally
get pt to rest while contractions stop

Question 7

SECONDARY POWERS–INEFFECTIVE MATERNAL PUSHING; may result from

Answer 7

Incorrect pushing (if pushing correctly will see bulging of peritoneum)
Fear 
Decreased/absent urge to push
Exhaustion
Analgesics/anesthesia
Psychologically unready

Question 8

with secondary powers want to

Answer 8

promote effect pushing, make sure pt hydrated, don’t wast energy between contractions,relax, may need forceps or vacuum

Question 9

using what graph for abnormal labor patterns

Answer 9

friedman graph

Question 10

causes of abnormal labor patterns

Answer 10

contractibility, prob with fetus (too big), fetal presentation, med to knock out of labor

Question 11

prolonged labor

Answer 11

Active phase- dilation should proceed at a minimum rate of 1.2cms./hr. (prima) or 1.5 cms./hr. in the multipara
Descent at a minimum of 1 cm/hr. in prima or 2cm/hr in the multipara
(don’t mem numbers)

Question 12

precipate labor

Answer 12

birth occurs within 3 hours of onset
hard/fast labor - babies can have damage from it
mom more likely to have birth traumas, in a lot of pain but can’t give meds

Question 13

passenger problems

Answer 13

I. FETAL SIZE
II. ABNORMAL FETAL PRESENTATION OR POSITION
III. MULTIFETAL PREGNANCY
IV. FETAL ANOMALIES

Question 14

fetal size -

Answer 14

Macrosomia can cause Shoulder Dystocia

more likely if mom diabetic

Question 15

abnormal fetal position/presentation

Answer 15

Rotation Abnormalities
Face Presentation
Breech (more difficult to deliver, more likely to have meconium/prolapsed cord)

Question 16

multifetal preg

Answer 16

more likely preterm or mal presentations

Question 17

fetal anomalies

Answer 17

big head baby, breech

Question 18

PROBLEMS WITH THE PASSAGE

Answer 18

I. PELVIS
II. MATERNAL SOFT TISSUE OBSTRUCTION
(full bladder can be a problem)

Question 19

gynecoid pelvis

Answer 19

50% of all women have

Question 20

anthropoid pelvis

Answer 20

25% of all white, 50% of nonwhite

Question 21

android pelvis

Answer 21

30%, heart shaped, narrow diameter, difficult to deliver

Question 22

PROBLEMS WITH THE PSYCHE

Answer 22

STRESS - tense, decrease blood flow to muscles = increase pain, decrease contractility (increase hypoxia)
ANXIETY
FEAR
can affect ability to tolerate pain

Question 23

intrauterine infection

Answer 23

Signs/symptoms: fetal HR >160, maternal
temp. > 100.4 F, elevated pulse (above 90)/respirations (above 20), foul smelling amniotic fluid
REDUCED THE RISK BY:
Limiting vaginal exams, maintaining aseptic technique, keeping bed pads dry, cleaning perineum

Question 24

other interpatum complications

Answer 24

I. intrauterine infection
II. obesity
III. premature rupture of membranes
IV. preterm labor

Question 25

obesity -

Answer 25

ultrasound may not work

Question 26

Premature Rupture of membranes (PROM)-

Answer 26

rupture before the onset of labor may increase infection 24 hr period to have baby

Question 27

Preterm Premature Rupture of Membranes (PPROM)-

Answer 27

rupture of membranes before the 37th week of gestation

Question 28

Premature Rupture of membranes (PROM) causes -

Answer 28

a lot of times dont know, infections, chorioamnionitis - can cause rupture

Question 29

Premature Rupture of membranes (PROM) complications -

Answer 29

preterm labor - broad spectrum antibiotic, compressed umbilical cord

Question 30

Premature Rupture of membranes (PROM) management -

Answer 30

Gestation Near Term | Preterm Gestation - watch for s/s and sac

Question 31

Premature Rupture of membranes (PROM) nursing considerations -

Answer 31

if sent home then no sex if contractions/ elevated temp - notify physician take temp 4 times a day modified bed rest

Question 32

preterm labor

Answer 32

33% of infant mortality associated with preterm birth 12.3% of all births in 2008 Labor that begins after the 20th week but before the 37th week of gestation causes - preclampsia, small babies, placenta problems, cognitive malformation

Question 33

MANIFESTATIONS OF PRETERM LABOR

Answer 33

``` Uterine contractions Baby “balling up” Low back pain Pelvic pressure (baby "dropping") Pain, discomfort, pressure vulva/thighs Change in vaginal discharge - increase amount, more watery, bloody/brown “feeling bad” ```

Question 34

EDUCATING ABOUT PRETERM LABOR

Answer 34

TEACH HOW TO RESPOND IF S/S OCCUR: Drink 3 glasses of water - dehydration can cause contractions Empty the bladder- full bladder cause contractions Lie down - on left side for at least 1 hour Palpate contractions for one hour Notify medical personnel if more than 4 contractions in an hour CALL IMMEDIATELY IF—fluid leaking from vagina, vaginal bleeding, foul odor of vaginal discharge

Question 35

STOPPING PRETERM LABOR

Answer 35

THERAPEUTIC MANAGEMENT INCLUDES: 1. Identifying preterm labor early 2. Delaying birth 3. Accelerating fetal lung maturity if preterm birth is likely

Question 36

IDENTIFYING PRETERM LABOR

Answer 36

``` Frequent prenatal visits Check for S/S Ultrasound/cervical exams Identify infections and treat Biochemical marker- fetal fibronectin (FFN) - protein found in amniotic fluid, found in vagina can swab to see if preterm ``` Home Uterine Activity Monitoring

Question 37

Stopping Preterm Labor Initial measures

Answer 37

Identifying and treating infections Identifying other causes for preterm contractions Limiting activity Hydrating woman - to make sure she doesn't release oxytocin on ovum

Question 38

Stopping Preterm Labor Tocolytics

Answer 38

Beta-adrenergic drugs - uterine relaxant, stop contractions Magnesium sulfate Prostaglandin synthesis inhibitors Calcium antagonists

Question 39

Bethine

Answer 39

beta antagonist injection every 4 hours subq once contractions stop and decrease eventually put them on bethine PO and go home antidote - inderal

Question 40

mg sulfate -

Answer 40

tropolic, CNS depressant relaxes smooth muscle calcium glutamate flushing/hot

Question 41

ACCLERATING FETAL LUNG MATURITY

Answer 41

Betamethasone 12 mg IM for 2 doses 24 hrs apart