The woman with an intrapartum complication

The main causes of dysfunctional labor are problems with

powers and passengers

what are the problems of the powers causing dysfunctional labor

ineffective contractions

uterine overdistention - hydramnios

hypotonic/hypertonic labor dysfunction

ineffective maternal pushing

what are the problems with the passenger causing dysfunctional labor

fetal size

macrosomia

shoulder dystocia

abnormal fetal presentation or position

multifetal pregnancy

fetal anomalies

shoulder dystocia is a

true emergency

what are the methods associated with relief of shoulder dystocia

mcroberts maneuver

suprapubic pressure

the hands and knees position is used to

flip a breech baby

breech position is a major emergent risk because of potential

cord compression

what are some problems associated with passage that cause dysfunctional labor

pelvis

maternal soft tissue obstructions

what are the more favorable pelvic shapes for vaginal birth

gynecoid and anthropoid shapes

what are the poor pelvic shapes for vaginal birth

android and platypelloid shapes

what are some problems associated with psyche that cause dysfunctional labor

perceived threat caused by fear, pain, or ones situation

stress response of fight or flight

what are the two kinds of abnormal labor duration

prolonged labor

precipitate labor

what can cause prolonged labor

maternal infection

neonatal infection

maternal exhaustion

higher levels of anxiety and fears

what is the intervention for prolonged labor

administration of pictocin

a rapid birth that occurs within 3 hours of onset of labor

precipitate labor

hypertonic contractions occur in

precipitate labor

irregular, painful contraction

may/ may not change cervix

leads to fetal hypoxia

precipitate labor

what are the signs associated with intrapartum infection

fetal tachycardia

maternal fever

puritic amniotic fluid (foul smelling/cloudy)

rupture of the sac before the onset of true labor (water breaks too soon)

premature rupture of membranes (PROM)

rupture occurs before 37 weeks of gestation and associated with preterm labor

preterm premature rupture of membranes (PPROM)

PPROM is associated with

preterm labor

infection of chorion and amnion (membranes of the placenta)

chorioamnionitis

can be the cause and a result of PROM

chorioamnionitis

labor that begins after the 20th week but prior to the end of the 37th week gestation

preterm labor

complaints of preterm labor s/s are often

vague

prompt identification of preterm labor enables

the most effective therapy to delay preterm birth

what S/S do you need to diagnose preterm labor

gestation between 20-37wks

uterine activity

cervix changes

what is the effective tx of preterm birth

steroids given to mom to stimulate baby surfactant development

what is the number 1 thing to prevent pre-term birth is

prenatal care

term birth occurs between

37-41 weeks

late preterm birth occurs between

34-36 weeks

moretality for late preterm infants is

3x higher than term infants

for mothers at risk of late preterm birth we

educate

give progesterone

what are signs that predict preterm birth

cervical length

fetal fibronectin

infections

if there is no fetal fibronectin noted, this means

low risk of early delivery

if there is fetal fibronectin noted, this means

higher risk of early delivery

how do we stop preterm labor

mag sulfate and terbutaline to relax uterine

tocolytics to prevent contractions

steroids to accelerate fetal lung maturity

one that lasts longer than 42 weeks

prolonged pregnancy

what are the complications of prolonged pregnancy

insufficiency of placental function

meconium aspiration

dysfunctional labor due to continued fetal growth

what are the intrapartum emergencies

placental abnormalities

umbilical cord prolapse

risk for hemorrhage during the antepartum or intrapartum period

placental abnormality

starts to grow into the uterine wall

placenta accreta

grows into the uterine wall

placenta increta

grows on/in and through the uterine wall

placenta percereta

what happens during umbilical cord prolapse

the umbilical cord slips infront of the fetus and becomes compressed between fetus and pelvis, causing fetal hypoxia

what is the primary intervention regarding umbilical cord prolapse

relieve pressure on the cord without compression of blood vessels

what are the risk factors for prolapsed umbilical cord

ruptured membranes

fetal presenting part at high station

fetus that poorly fits pelvic inlet

excessive volume of amniotic fluid (hydramnios)

variable decelerations are caused by

variable decelerations

cord is compressed between fetal presenting part and pelvis but cannot be seen or felt during vaginal exam

occult (hidden) prolapse

cord cannot be seen but can be felt as a pulsating mass during vaginal exam

cord prolapsed in front of fetal head

cord can be seen protruding from the vagina

complete cord prolapse

how do we alleviate pressure on a prolapsed cord

push the fetus upward and off the cord

reposition mom into knee-chest position or elevate hips with two pillows and trendelenberg

S/S:

extreme abdominal pain/tenderness

chest pain or referred scapular pain

hypovolemic shock

abnormal FHR patterns

absent FHR

abrupt stop of contractions

palpation of the fetus outside the uterus

uterine rupture

what puts you at risk for uterine rupture

risk increases with every CS, traumatic delivery, twins/triplets

occurs when the uterus completely or partly turns inside out

uterine inversion

what is uterine inversion often accompanied by

massive blood loss or shock

when does uterine inversion normally occur (quite uncommon)

third stage of labor

what is the recovery care regarding uterine inversion

promoting uterine contraction

maintenance of adequate circulating volume

uterine inversion is uncommon but

potentially fatal

anaphylactoid syndrome is

often fatal

anaphylactoid syndrome is also known as

amniotic fluid embolism (AFE)

amniotic fluid is drawn into the maternal circulation and carried to the womans lungs

anaphylactoid syndrome

what is the management of anaphylactoid syndrome

cardiopulmonary resuscitation

O2 with mechanical ventilation

correction of hypotension

blood component therapy

most often caused by MVA, assault or suicide causing separation of the placenta or hemorrhage, or injury to the fetus

trauma

treatment of trauma is similar to that in a

nonpregnant person

save mom first

how do we treat traumatic incidents

cardiopulmonary support

controlling bleeding

careful evaluation of the uterus and fetus

the nurse should assist the laboring woman into a hands and knees position when

the occiput of the fetus is in a posterior position