Week 5: In-Labour Complications

Question 1

What hormone is used to induce labour?

Answer 1

Oxytocin

Question 2

How does oxytocin work to induce labour?

Answer 2

Stimulates uterine contractions, synthetic use can induce and augment labour via IV administration

Question 2

How does the dosage of oxytocin work?

Answer 2

Dosage is increased per protocol until an adequate contraction pattern is established

Question 2

What are the maternal risks for oxytocin admin?

Answer 2

Placental abruption, uterine rupture, C-section, PPH and infection

Question 2

After the birth, what should we check for on the baby of the amniotic fluid is stained with meconium?

Answer 2

resp efforts, HR, muscle tone

Question 3

What should you monitor for when using an IV oxytocin drip?

Answer 3

Uterine tachysystole (hyper stimulated)

Question 3

What do we assess amniotic fluid for following ROM?

Answer 3

Meconium

Question 3

T/F: Routine suctioning of the mouth and nose in babies born with meconium stained amniotic fluid

Answer 3

False. Suctioning MAY be required of mouth, nose, or trachea if they aren’t breathing, but it is no longer routine.

Question 3

Describe meconium aspiration syndrome

Answer 3

Often in term or post-dates, severe form of aspiration pneumonia, give the baby IV antibiotics

Question 4

External Cephalic Version- when do you use this?

Answer 4

If the baby is in breech position at 36-37 weeks.

Question 4

How do you perform external cephalic version?

Answer 4

US, manually rotate the baby, in hospital as there is a risk of ruptured membranes, cord prolapse, and fetal distress

Question 5

What does it mean if a patient presents with shoulder dystocia?

Answer 5

The anterior shoulder cannot pass under the pubic arch

Question 6

What are some risk factors for shoulder dystocia?

Answer 6

Fetopelvic disproportion, macrosomia, previous Hx

Question 7

What are some interventions for shoulder dystocia ?

Answer 7

position changes, apply suprapubic pressure, turtling

Question 8

T/F you should apply fundal pressure as a method of relieving shoulder dystocia

Answer 8

FALSE. You can apply suprapubic pressure though!

Question 9

Describe Mcroberts maneuver

Answer 9

Hold mom’s legs flexed in the air 45 degrees. Grab behind the knees.

Question 10

Forceps Birth

Answer 10

Use of forceps in childbirth. This is less common.

Question 11

TI forceps birth

Answer 11

Prolonged second stage, maternal exhaustion, abnormal FHR, abnormal fetal presentation, arrest of rotation, extraction of head in breech

Question 12

What are the maternal risks of forceps birth?

Answer 12

Vaginal and cervical lacerations, hematoma, injuries to uretrha and bladder

Question 13

What are the risks to the baby in a forceps birth?

Answer 13

Subdural hematoma, bruising, abrasions, facial palsy

Question 14

T/F A forceps birth is more safe than a vacuum birth

Answer 14

False. A vacuum carries less risk

Question 15

Describe a vacuum assisted birth

Answer 15

Attachment of a vacuum cup to the fetal head with negative pressure

Question 16

What are the maternal risks associated with vacuum assisted birth?

Answer 16

These are less common, but perineal, vaginal, or cervical lacerations and hematoma

Question 16

WWYD: A patient presents fully dilated, ruptured membranes, engaged head, vertex presentation, and is greater than 34 weeks gestation. What type of birth would we administer?

Answer 16

Vacuum assisted

Question 17

What are the newborn risks associated with vacuum assisted birth?

Answer 17

Cephalohematoma, scalp lacerations, subdural hematoma, hyperbilirubinemia

Question 18

When administering a vacuum assisted birth, what would you tell a patient to do and how would you proceed?

Answer 18

Count times vacuum is applied and pt must remember to help bear down and push. We want the baby in RLOA or RLOP position

Question 19

Can you elect for a caesarean birth? Is this still a birth at all?

Answer 19

yes and yes

Question 20

What type of incision is made in a caesarean?

Answer 20

Transabdominal incision of the uterus

Question 21

What are the maternal-fetal indications for C-section?

Answer 21

Placenta previa, placental disruption, dysfunctional labour, active herpes lesions

Question 22

What are the maternal indications of c-secion

Answer 22

2+ previous Hx, specific medical conditions

Question 23

What are the fetal indications for a C-section

Answer 23

Abnormal FHR, malpresentation, congenital abnormalities, maternal HIV with high viral load

Question 24

What are the risks of C-section with respect to the mom?

Answer 24

Aspiration, hemorrhage, atelectasis, endometritis, And wound dehiscence, bladder and bowel injury, anaesthesia complications

Question 25

Fetal risks of C-section

Answer 25

Injuries from scalpel, poor placental perfusion if maternal hypotension

Question 25

As a nurse, how would you engage in prenatal preparation in order to provide a family-centred approach? This is during preoperative care for a C-section.

Answer 25

Informed consent, lab tests, vitals, foley catheter, spinal or epidural, emotional support

Question 26

As a nurse, how would you provide family-centred care during the intraoperative process in a C-section birth?

Answer 26

Circulating, newborn care

Question 27

What are the strongest predictors for successful vaginal birth following a previous C-section?

Answer 27

Previous vaginal birth, spontaneous labour

Question 27

How would you engage in postoperative care with patients to provide family centred care in the post-operative phase of a C-section?

Answer 27

Skin to skin, frequent vitals, assess loch and funds, assess incisional dressing, pain relief, breastfeeding support

Question 28

What are the Pros and cons of a vaginal birth following a C-section?

Answer 28

Pros: Lower risk of hemorrhage, infection, shorter recovery Cons: Uterine rupture

Question 29

What are the CIs for a trial of Labour following a C-section

Answer 29

Previous uterine rupture, major uterine surgery, classic uterine incision or inverted T-incision