High Risk Labor and Birth

Question 1

What are two cause dystocia?

Answer 1

1. Lack of progressive cervical dilation.
2. Lack of descent of the fetal head.

Question 2

Define

Hypertonic dystocia

Answer 2

Contractions are frequent and painful, but ineffective in promoting dilation and effacement.

Question 3

Define

Hypotonic dystocia

Answer 3

Decreased frequency, strength, and duration of contractions causing ineffective cervical change (dilation, effacement).

Question 4

Which pregnant women are most at risk for hypertonic contractions?
Which phase of labor?

Answer 4

Nulligravida in the early phase of labor

A person who has never been pregnant or given birth.

Question 5

Which pregnant women are most at risk for hypotonic contractions?
Which phase of labor?

Answer 5

Multigravida in the active phase of labor

Multiple pregnancies

Question 6

What is second-stage arrest?

Answer 6

Inability for the baby to fully descend into the pelvis after certain period of time has passed.

Question 7

What effects does hypertonic contractions have on the fetal heart rate?

Answer 7

Potential for category II or III FHR.

possibly leading to lack of oxygenation (hypoxia).

Question 8

What maternal complications may occur due to precipitous labor?

Answer 8

Hemorrhage and lacerations

Question 9

What should the nurse do during precipitous labor?

Answer 9

Stay in the room since birth may occur rapdily.

Question 10

Nursing Intervention (5)

Hypertonic contractions

Answer 10

1. Promote relaxation and rest.
2. Stopping pitocin
3. Tocolytics
4. Pain med (morphine ↓ labor contractions)
5. IV administration (possible dehydration)

after sleep possible for woman to return to normal labor pattern.

Question 11

Extreme fear may cause what type of dystocia?

Answer 11

Hypotonic contractions

catecholamine release may interfere w/ contractility. Provide support.

Question 12

What are the fetal risks for precipitous labor?

Answer 12

Fetal risk of hypoxia and CNS depression

Question 13

What is suspected to be occurring?

1. Hypertonic contractions occuring every 2 mins
2. Cat II or III FHR
3. Rapid cervical dilation

Answer 13

precipitous labor

Question 14

Fetal macrosomia parameter

Answer 14

> 9 lbs or 4500 g

Question 15

Malpresentation such as brow, breech, or face is an example of what type of dystocia?

Answer 15

Fetal dystocia

Question 16

What is suspected to be occurring?

Delayed descent of fetal head

Answer 16

Pelvis dystocia

Question 17

What are the three induction interventions?

Answer 17

1. Cervical ripening (balloon, prostaglandins)
2. Oxytocin (Pitocin titration)
3. Aminotomy (AROM)

artifical rupture of membranes

Question 18

What is the requirement of induction of labor?

Answer 18

Must be medically necessary

Question 19

What is the most important predictor of sucessful labor induction?

Answer 19

cervical status

Question 20

A Bishop score of < 6 puts the patient at risk for (?) if labor is induced.

Answer 20

cesarean delivery

Question 21

What is a favorable Bishop score for induction?

Answer 21

≥ 6

6 or more, 8 being very favorable

Question 22

What are the 5 cervical status that effect Bishop scores?

Answer 22

1. Position
2. Consistency (firm, medium, soft)
3. Effacement (%)
4. Dilation (cm)
5. Station

Question 23

When a Bishop score is unfavorable cervical ripening may be considered by what methods?

normal process of softening and opening the cervix before labor starts

Answer 23

1. Mechanical (balloon)
2. Pharmalogical (prostaglandins)

Question 24

What is Pitocin?
What are its effects?
How is it adminstered?

Answer 24

1. Analog of Oxytocin
2. Induce contractions and decrease risk of PPH in PP
3. IV

Question 25

What is the difference b/w prostaglandins (*cervidil/misoprostol*) and oxytocin (*Pitocin*)?

Answer 25

**Prostaglandins** are used to **induce labor** by softening the cervix, but they may also cause contractions. **Oxytocin** is used to **augment labor** during vaginal delivery by causing contractions.

Question 26

What are the **operative vaginal delivery** methods?

Answer 26

Vaginal birth assisted by either: 1. vacuum extraction 2. Forceps

Question 27

What are the advantages of vacuum over forceps delivery? | (4)

Answer 27

1. Easier application 2. Less anesthesia 3. Less material soft tissue damage (pelvis) 4. Fewer fetal injuries

Question 28

Cup detachment during vacuum delivery is a warning sign of what?

Answer 28

**too much pressure** or **ineffective force** is being exerted on the fetal head.

Question 29

What should the nurse expect after three failed attempts of vacuum delivery?

Answer 29

cesarean birth

Question 30

What are the fetal risks of vacuum delivery? | (3)

Answer 30

1. Cephalohematoma (15%) increases risk of jaundice 2. Intrancranial and/or retinal hemorrhage 3. Scalp lacerations or bruising (10%)

Question 31

When/why are operative **vaginal delivery** methods are used?

Answer 31

To shorten second stage labor or due to prolonged second stage labor.

Question 32

What is the first sign of shoulder dystocia?

Answer 32

The first sign is a **retraction of the fetal head** against the maternal perineum after delivery of the head, sometimes referred to as **turtle sign**.

Question 33

What is the first intervetion if shoulder dystocia has occurred?

Answer 33

McRoberts maneuver

Question 34

What pressure should be applied during McRoberts maneuver? |What pressure should be avoided?

Answer 34

Suprapubic pressure | Avoid fundal pressure

Question 35

# What would the nurse anticipate next? If both McRoberts maneuver and suprapubic pressure has been unsuccessful

Answer 35

The Woods corkscrew maneuver

Question 36

# Nursing actions Hypotonic Contractions (3)

Answer 36

1. Ambulate and change posiitions 2. Augment labor w/ oxytocin as per protocol 3. Hydrate w/ IV or Po as per order

Question 37

First Stage Arrest

Answer 37

**Not reaching full dilation** after assessing for adequate contractions

Question 38

What are different malpresentation of the fetus? | 5

Answer 38

1. Occiput posterior 2. Face 3. Brow 4. Shoulder 5. Breech (Frank, Complete, Footling)

Question 39

When is augmentation indicated?

Answer 39

**Frequency of contraction is < 3 contractions per 10 minutes** and/or **intensity of contraction is less than 25 mmHg above baseline**

Question 40

What are the contraindications to augmentation? | (5)

Answer 40

1. Prior uterine scarring 2. Placenta abnormalities 3. Active genital herpes 4. Pelvic structural deformities 5. Invasive cervical cancer | similar to induction of labor

Question 41

**Maternal** Risks for shoulder dystocia | (4)

Answer 41

1. Lacerations (*additionally: sphincter, pelvis injury, peripheral neuropathy*) 2. Postpartum Hemorrhage 3. Infection 4. Bladder injury

Question 42

**Fetal** risks from shoulder dystocia (3)

Answer 42

1. Compression of fetal neck (hypoxia) 2. Brachia plexus injuries (nerve damage) 3. fractures of clavicle and humerus.

Question 43

What is umbilical cord prolapse?

Answer 43

occurs when the cord drops through the open cervix into the vagina before your baby moves into the birth canal.

Question 44

What is **disseminated intravascular coagulation**?

Answer 44

A syndrome that occurs when the body is breaking down blood clots faster than it can form a clot. Can lead to maternal death

Question 45

# Define Effacement

Answer 45

Effacement is the thinning and shortening of the cervix.