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MATERNAL-CARE FOR AT RISK > PROBLEMS WITH THE POWER > Flashcards

PROBLEMS WITH THE POWER Flashcards

1
Q

What are the 4P’s affecting Labor?

A

1) Power
2) Passenger
3) Passage
4) Psyche

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2
Q

Power refers to what?

A

Uterine Contractions & Maternal Pushing Efforts

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3
Q
  • Is the primary force of labor.
  • Rhythmic tightening & relaxing of the uterus that dilates the cervix and pushes the fetus downward
A

Uterine Contractions

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4
Q

Why do uterine contractions occur?

A

Interplay of different enzymes, hormones (oxytocin), mechanical factors (fetal pressure on the cervix, uterine stretching)

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5
Q

Uterine Contractions is assessed or measured in terms of?

A
  • Frequency
  • Duration
  • Intensity
  • Interval (Resting time)
  • Resting Tone
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6
Q

Refers about the time from the start of one contraction to the start of the next

A

Frequency

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7
Q

Refers to how long each uterine contraction lasts (in secs)

A

Duration

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8
Q

Refers to the strength of the uterine contraction (measured by IUPC)
- By palpation : (mild = cheek, moderate = chin, strong = forehead)

A

Intensity

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9
Q

Refers to the time between the end of one contraction & the start of the next.
- ensures O2 supply to the fetus; allows the mother to prep for the next contraction

Time between contractions

A

Interval (Resting Time)

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10
Q

Refers to the tension in the uterus between contractions (soft, non-tender, or firm, tense uterus)

Measured using palpation & IUPC

A

Resting Tone

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11
Q

IUPC of less than or equal to 20 mmHg refers to?

A

Normal (soft uterus)

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12
Q

IUPC of greater than or equal to 20 mmHg indicated what?

A

High (firm uterus)

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13
Q

A high resting tone would indicate that?

A

Uterus is not relaxing enough → decreased blood flow → fetal distress

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14
Q

What happens if the uterus is not relaxing enough in between contractions

A

Decreased fetal blood flow → fetal distress

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15
Q

Is the secondary force of labor.
- Becomes important during the second stage of labor

A

Maternal Pushing Efforts (Bearing Down)

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16
Q

Why must maternal pushing efforts be coordinated with uterine contractions?

A

To assist with fetal descent (continuous downward movement of the fetus)

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17
Q

Problems with the POWER (abnormal contractions)
TYPES OF INEFFECTIVE UTERINE CONTRACTIONS

A
  • Hypotonic
  • Hypertonic
  • Tachysystole
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18
Q

Refers to labor patterns that fail to progress effectively, leading to prolonged or difficult labor.

A

Dysfunctional Labor (Labor Dystocia)

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19
Q

Refers to weak contractions ; infrequent ; slow or no cervical dilation

A

Hypotonic

Intensity-Based Issue

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20
Q

Refers to strong, frequent contractions but uncoordinated or irregular pattern ; ineffective in dilating cervix; uterus does not relax completely between contractions

A

Hypertonic

Uterine-Tone Issue

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21
Q

Refers to excessive contractions
- > 5 contractions in 10 mins that are too long / strong

A

Tachysystole

Frequency-Based Issue

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22
Q

CHARACTERISTICS OF NORMAL UTERINE CONTRACTIONS

Frequency of a normal uterine contraction

A

4-5 contractions in 10 mins

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23
Q

CHARACTERISTICS OF NORMAL UTERINE CONTRACTIONS

Normal intensity of a uterine contractions

A

30-70 mmHg or higher (strong)

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24
Q

CHARACTERISTICS OF NORMAL UTERINE CONTRACTIONS

Normal Resting Tone of a uterine contraction

A

10-15 mmHg

IUPC - Intrauterine Pressure Catheter

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25
# CHARACTERISTICS OF NORMAL UTERINE CONTRACTIONS Describe the pain in a normal uterine contraction
Increasing in intensity as labor progresses
26
# CHARACTERISTICS OF NORMAL UTERINE CONTRACTIONS Cervical dilation of a normal uterine contraction
Progressive
27
CHARACTERISTICS OF A HYPOTONIC UTERINE CONTRACTIONS - Frequency - Intensity - Resting Tone - Phase of Labor - Pain
- Frequency : Infrequent uterine contractions **(2-3 contractions / 10 mins)** - Intensity : **Less than or equal to 25 mmHg** - Resting Tone : Normal - Phase of Labor : **ACTIVE** (6-10cm dilation) - Pain: Limited / mild | **CONCLUSION**: INFREQUENT, LOW STRENGTH, AND RESTING TONE IS NORMAL
28
Causes of Hypotonic Uterine Contractions
- **O**verstretching of the uterus (large baby, multiple gestation, polyhydramnios or multiparity) - **B**owel or bladder distention, preventing fetal descent - **E**xhaustion due to prolonged labor
29
Interventions for Hypotonic Uterine Contractions
**O**xytocin **N**ipple Stimulation **E**nema **A**mbulation **A**mniotomy - (AROM)
30
# Interventions for Hypotonic Uterine Contractions Why administer oxytocin?
To strengthen the uterine contractions further
31
# Interventions for Hypotonic Uterine Contractions Why stimulate the nipple?
Stimulate oxytocin release, thus increasing uterine contractions
32
# Interventions for Hypotonic Uterine Contractions What is Enema for?
Relieve bowel distention
33
# Interventions for Hypotonic Uterine Contractions Why is ambulation an intervention?
Increases the intensity of contractions ; fetal descent
34
# Interventions for Hypotonic Uterine Contractions What is amniotomy for?
Triggers prostaglandin release → stimulate stronger uterine contractions; ↑ pressure on cervix
35
CHARACTERISTICS OF HYPERTONIC UTERINE CONTRACTIONS - Frequency - Intensity - Resting Tone - Phase of Labor - Pain
- Frequency : **frequent** uterine contractions ; **uncoordinated**; **ineffective** - Intensity: **moderate-strong** but uncoordinated - Resting Tone : **>20-25 mmHg** - Phase of Labor: **Latent** (0-5 cm dilation) - Pain: Painful | CONCLUSION: Frequent with stronger contractions ## Footnote However uterus does not sufficiently relax after each contraction.
36
Causes of Hypertonic Uterine Contractions
- **M**aternal Stress - **U**terine Irritability - **D**ehydration
37
Complications of hypertonic uterine contractions
- **Fetal anoxia** due to decreased oxygenation - **Prolonged labor** due to ineffective cervical dilation
38
Interventions for Hypertonic Uterine Contractions
- Provide comfort measures - Bed Rest/Position Changes - Hydration - Pain relief/mild sedation - Tocolytics - Cesarean section
39
# Interventions for Hypertonic Uterine Contractions What is the purpose of hydration?
Promotes coordinated contractions
40
# Interventions for Hypertonic Uterine Contractions Purpose of pain relief / mild sedation
Reduces maternal stess , prevent exhaustion
41
# Interventions for Hypertonic Uterine Contractions Purpose of Tocolytics
To relax the uterus
42
# Interventions for Hypertonic Uterine Contractions When is a Cesarean section considered?
If hypertonic contractions do not resolve and pose risks to the mother or fetus.
43
Characteristics of Tachysystole Uterine Contractions
- Frequency: **too frequent** ; **excessive** contractions - Intensity : normal - strong but too frequent - Resting tone: **normal or elevated** - Phase of Labor : can occur at any stage - Pain : **severe**, **frequent pain**, **persistent** | "Constant uterine tightness" or "cramping that doesn't go away"
44
Causes of Tachysystole Uterine Contractions
Medically-induced - **Excessive oxytocin** infusion - **Prostaglandin** (misoprostol , dinoprostone) use for labor induction Spontaneous causes -**Placental abruption** (irritation from placental separation) -**Chrioamnionitis** - Hypertonic uterine contractions can lead to tachysystole - **Dehydration** - can trigger uterine contractions
45
Management for tachystole uterine contractions if it is due to oxytocin infusion
- Stop or reduce oxytocin infusion **(first-line of action)** - **Administer IV fluids** to dilute oxytocin in the maternal blood stream - Reposition the mother **(LLD)** - Provide **oxygen inhalation** esp if fetal distress is present - Administer **tocolytics** (terbutaline, nifedipine, MgSO4) to relax the uterus.
46
Management for tachystole uterine contractions if spontaneous tachysystole
- **Hydration** - **Pain management & sedation** - Monitor for fetal distress (tachycardia, decelerations or decrease in FHR)
47
Common Causes of Dysfunctional Labor
- CPD - Primigravida - Fetal malposition - Macrosomia - Polyhydramnios - Multiple pregnancy / twins - Unripe cervix - not effaced & not dilated - Full bladder / rectum - Exhaustion from labor - Analgesia / administration of sedatives
48
Two phases of the 1st stage of labor
1) **Latent Phase** : Onset of labor - 5 cm dilation 2) **Active Phase** : 6-10 cm dilation
49
Upper normal limit of a nullipara mother for the latent and active phase
Latent : **20 hrs** Active : **12 hrs**
50
Upper normal limit of a multipara parent for latent and active phase
- Latent : **14 hrs** - Active : **6 hours**
51
This stage full dilation to birth of the baby happens
2nd stage
52
For a nullipara mother , how long does the 2nd stage last, with or w/o epidural
Without : less than 2 hrs With : Less than 3 hrs
53
For a multipara mother , how long does the 2nd stage last, with or w/o epidural
Without : less than 1 hr With : less than 2 hrs
54
What happens on the 3rd stage of a normal labor
Delivery of the placenta
55
How long is the delivery of the placenta normally
30 mins
56
Causes of a prolonged Latent Phase (0-5 cm dilation)
**Hypertonic contractions**
57
Managment for Prolonged Latent Phase
- Pain relief & Hydration - If persistent : Amniotomy & C-section
58
Management of Prolonged Active-Phase Dilation
- **Amniotomy** if membranes are intact - **Oxytocin augmentation** - if CPD is not present - **C-section**
59
Causes of a Prolonged Active-phase dilation
- Hypotonic contractions - CPD - Malpresentation ; multiple gestation
60
Management of Prolonged Active-Phase Dilation
- **Amniotomy** if membranes are intact - **Oxytocin augmentation** - if CPD is not present - **C-section**
61
This phase happens when the cervix is almost fully open (8-10 cm) but slows down before reacing 10 cm.
Deceleration phase
62
Normal Deceleration Phase of a nullipara
2-3 hrs
63
Normal Deceleration Phase of a multipara
Less than or equal to 1 hr
64
Causes of Prolonged / Protracted Deceleration Phase
- Hypotonic contractions - Malpresentation, malposition, CPD - **Uterine exhaustion**
65
Management of a Prolonged / Protracted Deceleration Phase ## Footnote -
- Amniotomy - Oxytocin augmentation - C-section
66
Means that the fetus takes too long to descend after cervix has fully dilated. Fetal station does not advance at least: - Nullipara : <1cm/hr - Multipara : <2cm/hr
Prolonged Descent
67
Causes of Prolonged Descent
- Hypotonic contractions & inadequate maternal pushing - Malposition - macrosomia - CPD - full bladder
68
Management of prolonged descent
- AROM if membranes are intact - Oxytocin augmentation - Semi-fowler's, squatting, kneeling & effective pushing may speed up descent
69
Nullipara: no descent has occured for 2 hrs Multipara : no descent has occured for 1 hr
Arrest of Descent
70
Most common cause of arrest of descent
CPD
71
Management of Arrest of Descent
- **Cesarean delivery** : if CPD is present - **Oxytocin**
72
When expected descent of fetus does not begin. - Engagement **beyond 0 station** does not occur
Failure of Descent
73
Common causes of failure of descent
- CPD - Malposition
74
Extremely rapid labor & delivery. -contactions are so stong & duration is very fast.
Precipitate Labor
75
Maternal Risks of Pripitate Labors
- Premature placental separation - Perineal laceration - Uterine rupture - PP Hemorrhage - Emotional & Psychological trauma
76
Fetal Risks of Precipitate labor
- Hypoxia & distress - MAS - Infection - Birth injuries like : clavicle fracture & brachial plexus injury
77
Non-pharmacological labor management techniques
- Positioning & Movement - Breathing Techniques & Dilation - Continous Labor support - Nipple stimulation
78
Used when labor does not naturally despite medical necessity
Labor Induction
79
Induction is done only when:
- Cephalic presentation - No CPD - Longitudinal lie - maturity 39 weeks - cervix is flavorable
80
Change in cervical consistentcy from firm to soft, so dilation & coordination of conractions will occur.
Cervical ripening
81
Methods of Cervical Ripening
- **Prostaglandins** (Misoprostol, Dinoprostone) - **Evening Primrose Oil** -:not advised in PROM - **Mechanical METHODS** - **Oxytocin** - **Amniotomy (arom)**
82
Involves the doctor sweeping a finger between the membranes of the amniotitac sac the uterus to help separate the sac from ther uterine leaning.
Stretch & Sleeping
83

MATERNAL-CARE FOR AT RISK (24 decks)

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