Labor at Risk Flashcards
List the interventions for shoulder dystocia (7)
1) Call for help: “Shoulder in room 6”
2) Flatten the HOB
3) McRoberts maneuver → flex the legs back – may injure the mom
4) Provider will attempt to deliver posterior shoulder, may use wood’s (corkscrew maneuver) → turn the baby 180°
5) Suprapubic pressure → downward & lateral – press down on moms pubic bone & try to turn baby a little to dislodge the shoulder
6) Gaskin maneuver → all fours (most effective but ONLY on unmedicated mom)
7) Zavanelli → C section is last resort
what is turtle sign?
Sign that baby has a shoulder dystocia → the rest of baby fails to deliver
List the interventions for tachysystole (3)
1) Pull cervical, discontinue oxytocin → very short half life; should see response in 10 minutes
2) Fluid bolus → at least 500 mL of LR of NSS; decreases oxytocin concentration & relaxes uterus
3) Terbutaline→ tocolytic; stops contractions; give 0.25 mg via subq
when do we withhold terbutaline? (2)
1) if mom or baby has tachycardia
2) Any respiratory issues → can increase risk of pulmonary edema
why do we use terbutaline with caution in pts with cardiac issues?
it can increase BP & HR for mom & baby
what should nursing assessments include for a pt on terbutaline & why?
Assess pt & watch for signs of increased respiratory rate and heart rate because this medication can potentially create tachycardia. The heart rate can go as high as 110 bpm
if the cause of tachysystole is abruption or uterine rupture, what is cure ?
surgical
how can we be careful with induction for TOLAC/VABC? (3)
1) No cervidil or misoprostol
2) Assess with palpation frequently
3) Avoid tachysystole
list the contraindications for TOLAC/VBAC (5)
1) Vertical uterine incision
2) Short intervals between pregnancies (< 6 mos)
3) Fetal macrosomia
4) Over 40 weeks gestation
5) More than one cesarean section
what is the worst that can happen with TOLAC/VBAC?
uterine rupture!!
how does uterine rupture present? (10)
1) “Ripping” pain in low abdomen
2) Referred pain in shoulders
3) Sudden development of fetal bradycardia
4) Maternal hypotension
5) Maternal tachycardia
6) Loss of contractions
7) Loss of fetal station
8) Vaginal Bleeding
9) Tenderness to palpation
10) Fetal parts palpable externally
what are the interventions for uterine rupture?
1) C-Section, possibly under general anesthesia
2) Possible hysterectomy
3) Volume replacement
4) Massive Transfusion Protocol
