Therapeutic Management & Nursing Care: Complications of Labor and Delivery Flashcards
(27 cards)
INEFFECTIVE UTERINE FORCE: HYPOTONIC CONTRACTION: Therapeutic Interventions
a. Ambulation
b. Nipple Stimulation – release of endogenous Pitocin
c. Enema – warmth of enema may stimulate contractions
d. Amniotomy – artificial rupture of the membranes
e. Augmentation of labor with Pitocin
Amniotomy
a. Amniotomy is the artificial rupture of the amniotic sac with a tool called the amniohook (a long crochet type hook, with a pricked end) or an amnicot (a glove with a small pricked end
on one finger).
b. One of these will be placed inside the vagina, where the
caregiver will rupture the amniotic sac or membrane.
WHY WOULD AN AMNIOTOMY BE PERFORMED INSTEAD OF
STARTING PITOCIN?
Advantages of doing this before Pitocin
a. Contractions are more similar to those of spontaneous
labor
b. Usually, no risk of rupture of the uterus
c. Does not require close surveillance
Disadvantages of an Amniotomy
a. Delivery must occur
b. Increase danger of prolapse of umbilical cord
c. Compression and molding of the fetal head (caput)
Nursing Care: Amniotomy
Check the fetal heart tones
a. Assess color, odor, amount
b. Provide perineal care
c. Monitor contractions
d. Check temperature every 2 hours
WHEN IS AN AMNIOTOMY CONTRAINDICATED?
a. When the head is NOT engaged and the inlet is NOT occluded
- The umbilical cord could prolapse
Cervical Ripening
a. Cervical ripening
- Softening and effacing of the cervix
- Prostaglandin acts on cervical collagen → dilation
and ripening of cervix
b. Prostaglandin E1 Medication
- Cytotec
c. Prostaglandin E2 Medications
- Prepidil gel
- Cervodil
Nursing Care: Cervical Ripening
a. Monitor maternal vital signs, cervical dilatation and effacement
b. Monitor fetal status for presence of reassuring fetal heart rate
c. Remove medication if hyperstimulation occurs
Hyperstimulation
a. Remove the medication
b. Turn patient to side-lying position
▪ To prevent supine hypotension syndrome → it can
compromise the fetus
c. Provide oxygen via face mask
d. Give Terbutaline (delay preterm labor)
Pitocin (Augmentation of Labor)
a. Assess first to make sure CPD is not present, then start procedure: Give 10 units/1000 cc fluid and hang as a secondary infusion, never as primary
Nursing Care: Pitocin
a. Assess contractions if increasing but not tetanic
b. Assess dilation and effacement
c. Monitor vital signs and FHT’s
d. Make sure no signs of hyperstimulation before increasing dose
INEFFECTIVE UTERINE FORCE: HYPERTONIC CONTRACTION: Treatment
a. Goal: Relieve pain and promote normal labor pattern
b. Provide comfort measures
- Warm shower
- Mouth care
- Imagery, music therapy
- Back rub, therapeutic touch
c. Mild sedation
d. Bedrest or position changes
e. Hydration
f. Tocolytics to reduce high uterine tone
Ineffective Maternal Pushing: Treatment
Teaching
INEFFECTIVE UTERINE FORCE: UNCOORDINATED CONTRACTION:
DYSFUNCTIONAL LABOR: 1ST STAGE
1ST STAGE: PROLONGED LATENT PHASE: Nursing Intervention
a. Change the linen and woman’s gown
b. Darken room lights
c. Decrease noise stimulation
INEFFECTIVE UTERINE FORCE: UNCOORDINATED CONTRACTION:
DYSFUNCTIONAL LABOR: 1ST STAGE
1ST STAGE: PROLONGED / Protracted Active Phase: Nursing Intervention
Oxytocin may be prescribed
INEFFECTIVE UTERINE FORCE: UNCOORDINATED CONTRACTION:
DYSFUNCTIONAL LABOR: 2ND STAGE:
2ND STAGE: PROLONGED DESCENT: Nursing Intervention
a. Rupturing of membranes
b. IVF with Oxytocin
Complications with the Passenger
Prolapse of the Umbilical Cord: Nursing Care
a. Get the pressure of the cord
- Place in Trendelenburg or knee-chest position or elevate
part with sterile gloved hand
b. Palpate FHT
- NEVER ATTEMPT TO REPLACE CORD!
c. Give O2 mask at 10 liters
d. Cover exposed cord with sterile wet gauze
e. Stay with the patient and offer support
Amnioinfusion
a. Warmed, sterile normal saline or RL is introduced into the
uterus through an intrauterine pressure catheter (IUPC)
b. Used to treat:
- Oligohydramnios
- Meconium-stained amniotic fluid
- Cord compression and variable decelerations
Amnioinfusion: Nursing Care
a. Assess maternal and fetal vital signs
b. Assess contractions
c. Provide comfort measures
d. Measure intake and output of the fluid
Treatments for complications of the passenger
a. Positioning
- Hands and knees, lunge to side
b. Version
- Alteration of fetal position by abdominal or intrauterine manipulation
c. Amnioinfusion
- Infusion into the uterine cavity
d. Forceps
- Low forceps or outlet forceps usually applied after
crowning
- Used to shorten the second stage of labor and assist the woman’s pushing efforts
e. Vacuum extraction
- Disk shaped cup placed over vertex of head and vacuum applied
- Used to shorten the second stage of labor and assist the woman’s pushing efforts
f. Episiotomy
- Surgical incision of perineal body to enlarge the outlet
g. External version procedure
- A version is a procedure used to change the position of the fetal presentation by abdominal manipulation
External Version Procedure
a. Criteria
- Fetus is not engaged
- A reactive NST
- 36+ weeks gestation
b. Contraindications
- Complicated pregnancy
- Multiple pregnancy
- Non-reassuring FHR
c. Nursing Care
o Administer Terbutaline prior to start
o Monitor maternal and fetal vital sign
o Post – assess for contractions and kick counts
Episiotomy
a. Factors that predispose
o Primigravida
o Large baby, macrosomia
o Posterior position of baby
o Use of forceps or vacuum extractor
b. Preventive Measures
o Perineal massage
o Side-lying for expulsion
o Gradual expulsion
c. Nursing Care
o Provide comfort and patient teaching
o After delivery – apply ice and assess site
Forceps - Assisted Delivery
a. Risks
- Fetus
▪ Facial edema or lacerations
▪ Caput succedaneum or cephalohematoma
o Maternal
▪ Lacerations of birth canal
▪ Perineal bleeding, bruising, edema
b. Nursing Care
o Preventive measures to decrease need for forceps
o Patient teaching
o After – assessment of newborn and assessment of
woman’s perineum
Vacuum Extraction
a. Risk
- Cephalohematoma or caput succedaneum
b. Nursing Care
- Keep woman and partner informed during the procedure
- After – assess newborn
Cesarean Delivery
a. Operative procedure in which the fetus is delivered through an incision in the abdomen
b. Mother may feel less than normal, so may need support
c. May have option of a VBAC (vaginal birth after cesarean) the next time
d. Nursing Care
o Frequent monitoring of woman and fetus
e. Complication: Uterine rupture
