NCM 109 Midterms Quiz 3

Four Components of Labor Process

• The power - the force that propels the fetus (uterine contractions)

• The passenger - the fetus

• The passageway - the birth canal

• The psyche - the woman and family perception of the event

Uterine Inertia

Sluggishness of contractions

Primary (hypertonic) uterine dysfunction

Relaxations are inadequate and mild, thus are ineffective

Secondary (hypotonic) uterine dysfunction

Contractions have been good but gradually become infrequent and of poor quality and cervical dilatation stops

Hypertonic Contractions

Are marked by an increased in resting tone

Hypotonic Uterine Contraction

The number of contractions is usually low or infrequent

Postmature Pregnancy

• Defined as those pregnancies lasting beyond the end of the 42nd week

• Fetus at risk due to placental degeneration and loss of amniotic fluid

Prolapsed Umbilical Cord

• Displacement of cord in a downward direction, near or ahead of the presenting part, or into the vagina

• May occur when membranes rupture

Fetal Distress

• Cord compression

• Placental abnormalities

• Preexisting maternal disease
  
  Assessment findings:

  • Decelerations in FHR

  • Meconium-stained amniotic fluid with a vertex presentation

Dystocia

• Any labor/delivery that is prolonged or difficult

• Usually results from a change in the interrelationships among the 4 P's that is the factors in labor and delivery

Shoulder Dystocia

happens when after delivery of the head the anterior shoulder is trapped and arrested behind symphisis pubis

Fetal complications for Shoulder Dystocia

• Erbs palsy

• Fracture humerus and clavicle

• Abnormal neurologic examinations

Mc Robert's maneuver

flexing legs of the parturient sharply over the abdomen

Wood's Corkscrew maneuver

rotating anterior shoulder 180 degrees to dislodge it

Cleidotomy

cutting the clavicles

Rubin's maneuver

rocking the shoulders from side by side by applying force over the abdomen

Management of shoulder dystocia

• Mc Robert's maneuver

• Wood's Corkscrew maneuver

• Cleidotomy

• Rubin's maneuver

• Suprapubic pressure

• Strong fundal pressure

Precipitous Labor and Delivery

• Labor less than 3 hours

• Emergency delivery without client's physician or midwife

Precipitate delivery can lead to

• Extensive lacerations

• Abruptio placenta

• Hemorrhage due to sudden release of pressure, leading to shock

Prolonged labor

In primis, labor lasting more than 18 hours and in multis, more than 12 hours

• Can lead to:

  1. Maternal exhaustion

  2. Uterine atony

  3. Caput succedanum

  4. Cephal hematoma

Uterine Rupture

Occurs when the uterus undergoes more straining that is capable of sustaining

Uterine Rupture Causes

• Scar from a previous classic cesarean section

• Unwise use of oxytocin

• Overdistention

• Faulty presentation

• Prolonged labor

Uterine Inversion

Fundus is forced through the cervix so that the uterus is turned inside out

Crowning

encirclement of largest head diameter by vulvar ring

Ritgen Maneuver

gloved hand exerts pressure on fetal chin through perineum. controlled delivery of fetal head

Amniotic Fluid Embolism

Occurs when amniotic fluid enters maternal blood circulation

Trial Labor

for women with borderline adequate pelvic measurements but good fetal position

Premature Labor and Delivery

Uterine contractions before 38th week of gestation

Ritodrine

a muscle relaxant given orally

Bricanyl

a known bronchodilator

Steroids

(glucocorticoids) are given to the mother to help in the maturation of the fetal lungs by hastening the production of surfactants

Induction of Labor

Deliberate stimulation of uterine contractions before the normal occurrence of labor

Amniotomy

the deliberate rupture of the membrane

Indication for Induction of Labor

• Postmature pregnancy

• Preeclampsia/eclampsia

• Diabetes

• Premature rupture of membranes

Ruptured Uterus

is characterized by a tearing or splitting of the uterine wall during labor it is usually a result of a thinned or a weakened area that cannot withstand the strain and force of uterine contraction

Intrauterine fetal death

Absence of FHR and fetal movement