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Variations of Spontaneous Labor Flashcards

1
Q

What are some indications for labor induction?

A

PROM, preeclampsia, GHTN, infection, fetal demise, postterm pregnancy, fetal compromise, mild abruptio placentae, logistics

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2
Q

What are some contraindications for induction of labor?

A

Breech/transverse, severe HTN, significant heart dz, umbilical cord prolapse, hx of uterine surgery, vasa previa, complete placenta previa, active genital herpes

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3
Q

What is Bishop’s score?

A

Group of 5 factors to determine favorability of induction based on cervical ripeness & probability of success of induction

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4
Q

What is a favorable Bishop score?

A

> 6

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5
Q

What is an unfavorable Bishop score?

A

<5

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6
Q

What Bishop score indicates likelihood of vaginal birth similar to spontaneous labor?

A

> 8

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7
Q

What are the 5 factors included in the Bishop score?

A

Position, consistency, effacement, dilation, fetal station

*All scored 0-3

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8
Q

What are risks associated w/ induction?

A

Uterine tachysystole/hyperstimulation, uterine rupture, maternal water intoxication, greater risk for chorioamnionitis and/or C-section

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9
Q

How might induction lead to maternal water intoxication?

A

Oxytocin has an antidiuretic effect

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10
Q

What is problematic about uterine tachysystole?

A

Can reduce placental perfusion & fetal oxygenation due to excess frequency/duration/intensity of contractions or insufficient relaxation between contractions

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11
Q

What might be done if a birthing person is to be induced but their Bishop score is too low?

A

Prostaglandins to promote ripening

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12
Q

What positions are included in the Bishop score?

A

Posterior, midposition, anterior

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13
Q

What consistencies are included in the Bishop score?

A

Firm, medium, soft

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14
Q

What is the purpose of cervical ripening?

A

To increase cervical readiness for labor by promoting softening, dilation, & effacement

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15
Q

Techniques for cervical ripening

A

Prostaglandins, mechanical

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16
Q

What are advantages of cervical ripening?

A

Reduce dose or eliminate need for oxytocin

*Low dose oxytocin is used for cervical priming

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17
Q

What are some mechanical techniques of cervical ripening?

A

Balloon catheter in the intracervical canal (inflated w/ 30 cc saline)

Osmotic/hygroscopic dilators absorb body fluids and expand (e.g. seaweed (laminaria tents), Mg sulfate-based)

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18
Q

Disadvantage of balloon catheters

A

Causes pressure on the cervix

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19
Q

Disadvantage of osmotic dilators

A

Increased infection risk

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20
Q

Advantages of mechanical methods

A

Low cost, stable at room temp, reduced risk of uterine tachysystole

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21
Q

How are PGs administered?

A

Oral, vaginal suppository/gel

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22
Q

Cytotec

A

Misoprostol (PE1)

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23
Q

Cervidil

A

Dinoprostone (PE2)

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24
Q

Prepidil

A

PG gel

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25
Complications of cervical ripening
Uterine tachysystole, fetal distress
26
Nursing action for uterine tachysystole
Subq terbutaline
27
Nursing actions for fetal distress
O2 via face mask at 10 L/min Left side-lying position Increase rate of V fluid admin Notify provider
28
Nursing actions for cervical ripening
Assess for urinary retention, rupture of membranes, uterine tenderness/pain, contractions, vaginal bleeding, fetal distress
29
Nursing interventions for cervical ripening
``` Informed consent Baseline fetal and maternal data Void before procedure Document number of dilators used Side-lying position Assist w/ procedure Monitor FHR, uterine activity Notify provider of complications Monitor for AEs (N/V/D, fever, tachysystole) ```
30
Maternal precaution conditions w/ PG use
Asthma - known hypersensitivity Glaucoma Ischemic heart disease Pulmonary, hepatic, renal disease
31
PG mechanism of action
PGE2 sensitizes to PGF2 which sensitizes myometrium to endo-/exogenous oxytocin & ripens cervix *Used in conjunction w/ oxytocin
32
PG contraindications
``` Known allergy Fetal distress w/o imminent delivery Unexplained bleeding Cephalopelvic disproportion CI of oxytocic drugs Prior C-section, major uterine surgery Prior IV oxytocic admin Multipara w/ 6+ prior term pregnancies ```
33
Non-pharmacologic methods of induction
Membrane stripping, amniotomy, nipple stimulation, intercourse?
34
What gestational age is required for elective induction?
39 weeks
35
Induction indications
``` Postterm pregnancy (>42 weeks) Dystocia Prolonged ROM IUGR Maternal medical complications - Rh isoimmunization, DM, pulm dz, GHTN Fetal demise Chorioamnionitis (infection) ```
36
What is membrane stripping?
Provider inserts finger into internal cervical os & rotates 360 degrees twice
37
Requirement for membrane stripping
Cervical dilation >1 cm
38
Benefit of membrane stripping
Increases PGF/PGE release from membranes and cervix
39
What fetal engagement and station are required before oxytocin admin?
Engagement in birth canal & minimum station of 0
40
Maternal assessments w/ oxytocin
BP, HR, RR q30-60mins & w/ dose change
41
FHR monitoring w/ oxytocin
1st stage - q15mins 2nd stage - q5mins Every dose change
42
Maintain dose of oxytocin when contraction...
``` Frequency - 2-3 min Duration - 80-90 sec Intensity - 40-90 mmHg/strong Uterine resting tone - 10-15 mmHg Dilation - 1 cm/hr Reassuring FHR 110-160 bpm ```
43
Clinical findings of uterine tachysystole
``` Frequency <2 min Duration >90 sec Intensity >90 mmHg Resting tone >20 mmHg No relaxation between contractions ```
44
Characteristics of nonreassuring FHR
Abnormal baseline <110 or >160 bpm Loss of variability Late/prolonged decelerations
45
Define amniotomy
Artificial rupture of membranes (AROM)
46
Indications for AROM/amniotomy
Labor induction, stimulation, internal electronic fetal monitoring
47
Major risks of amniotomy/AROM
Umbilical cord prolapse Chorioamnionitis Placental abruption
48
How is amniotomy performed?
Amnihook perforates amniotic sac
49
Amniotomy considerations
Fetal engagement to prevent cord prolapse Monitor FHR before & after Assess/document fluid characteristics
50
Amniotomy nursing interventions
Document time or rupture Obtain temp q2hrs Comfort measures
51
Amniotomy contraindications
Fetal presenting part high in pelvis | Non-cephalic presentation
52
How do nipple stimulation & sex promote labor?
Nipple stim releases oxytocin Semen has PGs in it Orgasms could stimulate contractions
53
Oxytocin (Pitocin) administration
IV piggyback Inserted into primary line at closest port to patient Start at low dose, increase q20-30mins until regular contractions Continuous FHR & contraction monitoring (chart q15mins in 1st stage, q5mins in 2nd stage)
54
What should you never use Pitocin w/o?
IV pump
55
Pitocin risks
``` Tachysystole Hypertonic uterus/increased resting tone Uterine rupture Non-reassuring FHR Increased risk of uterine atony PP ```
56
Non-reassuring FHR nursing interventions
``` Reduce/stop Pitocin Increase IV fluids to 200 mL/hr Side-lying position 100% O2 at 8-10 L/min via face mask Continue assessing FHR, contractions Monitor maternal BP, HR q30mins Administer subq terbutaline ```
57
Caput succedaneum
Newborn scalp swelling, resolves in 3-5 days
58
C-section indications
``` Malpresentation (breech) Cephalopelvic disproportion Dystocia Non-reassuring FHR Placental abnormalities Placenta previa Abruptio placentae Prior C-section Multiple gestations Maternal and/or fetal distress Umbilical cord prolapse Failed induction Macrosomia Congenital malformations Maternal cardiac/respiratory dz High risk pregnancy - HIV+, HTN (preeclampsia, eclampsia), DM, active genital herpes ```
59
C-section risks
``` Infection Hemorrhage UTI, UT trauma VTE Ileus Atelectasis Anesthesia complications Transient newborn tachypnea Persistent pulm HTN of newborn Newborn injury (lac, bruising, fracture) ```
60
C-section pre-op nursing interventions
``` Last oral intake Allergies Current meds & last dose Informed consent Labs - CBC, blood type/Rh Pre-op teaching Start IV and bolus Clip abdominal hair Administer GI meds - Bicitra, pepcid Insert catheter Assist pt onto table, hip wedge Grounding pad for electrocautery Sterile prep of abdomen Fetal monitoring ```
61
Types of assisted deliveries
Vacuum, Forceps
62
Assisted delivery indications
``` Need shortened 2nd stage Exhaustion Ineffective pushing Cardiac, pulm dz Infection Fetal cord compression Premature placental separation Non-reassuring FHR ```
63
Assisted delivery risks
Maternal - lac, vaginal hematoma, perineum, large episiotomy Fetal - ecchymoses, facial/scalp lacs, facial nerve palsy, cephalohematoma, intracranial hemorrhage
64
Assisted delivery nursing considerations
``` Empty bladder (straight catheter) Assess FHR (report <100 bpm) Assess for trauma of mom/baby Cold application to perineum/vagina for 12 hours after Fundus tone ``` Fetal assessment - skin breaks, facial asymmetry, seizures, scalp edema, facial bruising

OB Nursing (7 decks)

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