Exam 4: Ch 32 Labor & Birth Complications Flashcards
(30 cards)
Oxytocin (Pitocin)
Oxytocin: stimulates uterine contractions and aids in milk let down
Pitocin: synthetic form
Indication of Oxytocin
labor induction and augmentation and control postpartum bleeding
Dose of oxytocin
IV: secondary line
- 10 units in 1000 ml of fluid
- 20 units in 1000 ml of fluid
- 30 units in 500 ml of fluid
goal of oxytocin
produce uterine contractions:
- consistent achievement 200-220 MVUs or
- conssitent pattern of one contraction every 2-3 min, lasting 80-90 sec, strong to palpation
Maternal Adverse effect of oxytocin use
- uterine tachysystole
- plancental abruption
- uterine rupture
- unplanned cesarean birth caused by abnormal FHR and patterns
- postpartum hemmorage
- infection
- death from water intoxication
Fetal adverse effect to oxytocin
hypoxemia and acidosis
abnormal FHR
Signs of uterine tachysytole r/t oxytocin use
- more then 5 contractions in 10 min
- single contractions lasting >2 min
- contractions of normal duration occurring within 1 min of each other
Interventions with abnormal FHR during oxytocin
- discontinue oxytocin
- reposition mother
- admin bolus 500mL LR
- Consider giving 10L/min O2
- if nothing: 0.25 terbutaline following protocol
- Notify Dr
When to resume Oxytocin
less then 20 -30 min: resume at no more than half the previous rate
more than 30-40 min: resume at same rate
Mazzanti technique:
- want suprapubic pressure
- suprapubic pressure can be applied to the anterior shoulder in an attempt to push the shoulder under the synthesis pubis.
Rubin technique
➢ Pressure is applied oblique and posterior against the anterior shoulder to get shoulder to deliver
McRobert’s Maneuver
➢ Hyperextend her legs- take legs and bring them up to her head to open pelvis
➢ The womans legs are flexed apart, with her knees on her abdomen
Signs that indicate shoulder dystocia
o Slowing of the progress of the second stage of labor and formation of a caput succedaneum that increases in size
o The nurse should observe for the “turtle sign” which is retraction of the fetal head against the perineum immediately following its emergence (early sign)
o The most serious complication is brachial plexus (Erb palsy)
o The major maternal complications associated w/ shoulder dystocia are PP hemorrhage and rectal injury.
Signs of prolapsed cord
o Variable or prolonged decelerations during UC
o Woman reports feeling the cord after ROM
o Cord is seen or felt in or protruding from vagina
always do what to oxytocin
Discontinue it !
Precipitate labor
less than 3 hour labor
very fast
Precipitate birth
− Maternal risks: cervical, vaginal, or rectal laceration and hemorrhage
− Fetal risks: hypoxia, intracranial hemorrhage, or injury
− Nursing care:
• Sterile gloves and place hands on presenting part and guide and support baby and instruct mom to push with contractions
Uterine rupture
EMERGENCY
− During labor and birth the major risk factors for uterine rupture is a TOL for attempted VBAC
− Could occur with put pitocin induction and giving a lot of pitocin and not paying attention
s/s of uterine rupture
o (most common) abnormal (nonreasuring) FHR tracing, including bradiacardia, and absent or minimal variability
o Constant abdominal pain, uterine tenderness, change in uterine shape, and cessation of contractions
o May also show signs of hypovolemic shock caused by hemorrhage • Hypotension • Tachycardia • Pallor • Cool, clammy skin
TOLAC
o Bring on contractions and see how baby tolerates trial
- they will see if the baby engages into the pelvic inlet
VBAC
o Indications for primary cesarean birth, such as dystocia, breech presentation, or fetal distress, are often nonrecurring
o Must have an adequate pelvic size and uterine incision is a low transverse incision and baby in right position, presentation
o Problem for primary c-section was the baby was not tolerating labor- nothing to do with pelvic size
o Classic incision: not a candidate
Pelvic Dystocia
o Abnormal size of pelvis , contractures that reduce the diameters of boney pelvis, including the inlet, the midpelvis, the outlet, or a combination of any of these
Trial of Labor
o add pitocin and have contractions; see if labor will start and see if baby can move down pelvis
o observance of a woman and her fetus for a reasonable period (4-6 hrs) of spontaneous active labor to assess safety of vaginal birth for the mother and infant
o A woman who has had a previous cesarean birth w/ a low transverse uterine incision may be a candidate for a TOL.
o During TOL, the woman is evaluated for the occurrence of active labor, including adequate contractions, engagement and descent of the presenting part, and effacement and dilation of the cervix
o The nurse assess maternal V/S and FHR and pattern and is alert for signs of potential complication
Cephalopelvic Disproprotion
o presenting part of the baby in the inlet is disprortional; may not be able to engage into inlet or may get stuck in inlet pelvis
o is disproportion between the size of the fetus and the size of the mothers pelvis
o fetus cannot fit through the maternal pelvis to be born vaginally
o problem is malposition of the fetal presenting part rather than true CPD
oIf the maternal pelvis is too small, abnormally shaped, or deformed, CPD may be of maternal origin.
