High risk labor & birth Flashcards
(24 cards)
S&S of tachysystole
More than 5 uterine contractions in 10 min period over 30 min window
Do not allow for gas exchange
Tetanic contractions
Really long ones → 120 sec or more
Resting tone
What the uterus feels like between contractions
Increase in tone → little rest; not enough gas exchange (acidotic baby)
Causes/ risk factors for tachysystole
Cervical ripening
Oxytocin induction
Endogenous → nipple stimulation; prostaglandins
Abruptions, uterine rupture
Interventions for tachysystole
Pull cervical ripening agent
Discontinue oxytocin
Administer a fluid bolus (at least 500 mL of LR)
Administer Terbutaline (Stops contractions)
If the cause of tachysystole is abruption or uterine rupture what is the cure?
Surgery
Interventions for shoulder dystocia
- Call for help
- Flatten HOB
- McRobert’s maneuver
- Apply suprapubic pressure
- Gaskin maneuver
- Zavanelli procedure
McRobert’s Maneuver
Flex legs back towards the abdomen
→ provider will attempt to deliver posterior shoulder, may use corkscrew maneuver & turn baby 180°
Suprapubic pressure
Downward & lateral → press down on mom’s pubic bone & try to turn baby a little to dislodge the shoulder
Ask provider which side
What is a turtle sign?
Sign that baby has shoulder dystocia
Rest of baby fails to deliver
What is a cord prolapse
The cord “escapes” before the presenting part
A life threatening emergency for a baby → you only have minutes!!
Risk factor of cord prolapse
PROM
Amniotomy when baby is not engaged in pelvis
Unknown in some cases
Signs of cord prolapse
- variable/ prolonged decelerations, usually deep
- visible loop of cord outside vagina
- cord palpable with vaginal exam
- mother states, “I felt something come out of me”
Cord prolapse interventions
- Call for help
→ sterile gloved hand in vagina
→ apply pressure to head
→ don’t let go until baby’s out - avoid manipulating cord
- if cord is protruding, use moistened NSS
- position mom in knees-chest or trendelenburg
- immendiate C-section
Preciptious delivery → delegation of roles
Call out from room, “We’re having a baby”
Assign roles as people arrive
→ get warmed blankets, check warmer
→ delivery instruments
→ someone capable of neonatal resuscitation
→ get any OB or midwife to attend if possible
ISBAR
Communication is key!
Main points → keep brief, pertinent, focused
Actions/ care of the nurse during eclamptic seizure
Side rails up, padded is best
Do NOT shove anything in patient’s mouth
Have suction & O2 available
Lateral “recovery” position
Look at FHR, S/S of abruption
Delivery → usually c-section
Given Magnesium sulfate bolus
What to know about CPR in pregnant mom who is experiencing cardiac arrest?
Uterine displacement is not a bad idea → manually maneuver/ physically move uterus to the left side of her body
How many weeks is considered post-dates pregnancy
Technically 42 weeks → but providers will induce around 41 weeks
What can happen with post-dates pregnancies?
Babies grow too big to fit thru vagina
Placenta gets old & starts to die → calcifications & infarcts can result in fetus death
Interventions for post-dates pregnancy
- NSTs twice a week after 40 wks
- BPP if NST is non-reactive
- Fetal movement counts
- Induction of labor at 41 weeks (mostly)
What is Dystocia?
Labor that won’t progress
Dystocia:
How do you get labor to pick back up again?
Manipulate the 5 P’s
1. widen the passage
2. help the passenger route
3. encourage ambulation/ upright position for stronger powers
4. decrease anxiety & control fear, tension, pain
Techniques when working with the 5 P’s:
Assist with positioning
Use of rebozo, birth ball, peanut ball, CUB chair or other aids
Encourage coping → prepared childbirth techniques
Allow mom choices & respect culture & personal identity
