DR - HIGH RISK CONDITIONS DURING LABOR AND DELIVERY

Fetal Malposition

• Slackness of uterine (after previous pregnancies)

• Abnormal shape and size of the pelvis

• Multiple pregnancy

• Excess amniotic fluid

are abnormal positions of the vertex of the fetal head (with the occiput as the reference point) relative to the maternal pelvis.

Cause: (SAME)

• Premature rupture of membranes

• Abdominal pain

• Vaginal bleeding

• Unsatisfactory progress of labor

Fetal Malposition S/Sx

(PAVU)

1. fetal heart rate

2. contraction

3. full minute

4. 30 minutes

5. active phase

6. 5 minutes

7. second stage

8. less than 100

9. more than 180

10. fetal distress.

Fetal Malposition Diagnosis

Listen to the (1)__ immediately after a (2)__: count the (1)__ for a (3)__ at least once every (4)__ during the (5)__ and every (6)__ during the (7)__; if there are fetal heart rate abnormalities ((8)__ or (9)__ beats per minute), suspect (10)__.

1. Oxytocin

2. obstruction; fetal heart rate; caesarean section

3. 1/5 and 3/5; symphysis pubis; 0 station and -2 station; vacuum extraction, symphysiotomy.

4. Craniotomy

5. Episiotomy

Fetal Malposition Medical / Surgical Management

1. __ administration

2. If there are signs of __ or the __ is abnormal at any stage, deliver by __.

3. The fetal head is between __ above the __ or the leading bony edge of the head is between __ station. Deliver by __ and __.

4. C__

5. E__

1. Nursing Management

dilated; descent; expulsive phase; obstruction

2. Prognosis

morbidity; mother and infant

Fetal Malposition

1. Nursing Management

If the cervix is fully __ but there is no __ in the __ phase, assess for signs of __

2. Prognosis

Fetal malposition is associated with increased __ of both __and __ if not treated accurately.

Fetal Distress

• Forceps and vacuum extractor misuse

• Placental abruption

• Prolonged and arrested labor

• Umbilical cord problems

is an emergency pregnancy, labor and delivery complication in which a baby experiences oxygen deprivation (birth asphyxia).

Cause: (FPPU)

Decreased movement felt by the mother

Abnormal fetal heart rate

Fetal hyperactivity

Fetal metabolic acidosis

Fetal Distress S/Sx

(DAFF)

1. Clinical examination; antenatal visit; fetal heart sound, fetal size, fundal level, & amount of amniotic fluid.

2. Fetal scalp Blood sampling

Fetal Distress Diagnosis

1. __ in each __ is the primary and main assessment of fetal well-being. This includes detection of F__, F__, F__, and A__.

2. F__ B__

Medical / Surgical Management

1. Tocolytics

2. Cesarean delivery

Nursing Management

1. oxygen at 8-10 / min via face mask

2. oxytocin

3. lateral position, elevate legs

4. maternal and fetal status

5. Intrauterine

6. Amniotic

Fetal Distress

Medical / Surgical Management

1. T__

2. C__

Nursing Management

1. Administer __ at __ /min via __

2. Discontinue __

3. Place patient in a __, __

4. Monitor __ and __ status

5. __ resuscitation

6. __ infusion

1. Fetal bradycardia

2. less than 100 per minute

3. meconium staining

4. vertex presentation

5. slowing of the fetal heart

Fetal Distress Prognosis

Determination of the prognosis in fetal distress has always been difficult for the obstetrician. Compounding the problem is the variation in opinion as to what clinical findings actually comprise fetal distress. (1)__ with a persistent fetal heart rate of (2)__ per minute has been widely accepted as the cardinal sign of fetal difficulty in utero. Many authors have considered (3)__ of the amniotic fluid in (4)__ presentation in association with (5)__ as suggestive of fetal distress. Others have shown willingness to regard meconium staining alone in a vertex presentation as a sign of impending fetal difficulty.

Umbilical Cord Prolapse

• Premature delivery of the baby

• Delivery more than one baby per pregnancy (twins, triplets, etc.)

• Breech delivery

• umbilical cord that is longer than usual

It is a complication that occurs prior to or during delivery of the baby. The umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. The cord can them become trapped against the baby’s body during delivery.

Cause: (PDBU)

1. Umbilical cord seen or felt during vaginal examination; Fetal bradycardia; Client reports feeling the cord within the vagina

1. fetal heart

2. pelvic

3. palpate; fingers

Umbilical Cord Prolapse

1. S/Sx (UFC)

Diagnosis

1. __ monitoring

2. A __examination

3. __ the cord with his or her __

Medical / Surgical Management

1. tocolysis (e.g Terbutaline)

2. Amnioinfusion

3. caesarean section

Nursing Management

1. cord

2. elevate; presenting part

3. Knee chest

Umbilical Cord Prolapse

Medical / Surgical Management

1. Consider __ (e.g., __)

2. A__

3. Delivery is usually via emergency __

Nursing Management

1. Avoid handling the __

2. Manually __ the __

3. __ position

1. 41.3%

2. 5 minutes

3. 9.8%

4. umbilical cord prolapse

5. childbirth

6. delivery mode

7. small birth

Umbilical Cord Prolapse Prognosis

The fetal prognosis was bad; neonatal mortality was (1)__ at (2)__ minutes of life against (3)__ in the control group. The factors aggravating the fetal prognosis were the long delay between the occurrence of the (4)__ and (5)__, the (6)__ and the (7)__.

Cephalopelvic Disproportion

• Large baby due to hereditary factors

• Diabetes

• Post-maturity

• Abnormal shape and small pelvis

It occurs when a baby’s head or body is too large to fit through the mother’s pelvis. It is believed that rue CPD is rare, but many cases of “failure to progress” during labor are given a diagnosis of CPD. When an accurate diagnosis of CPD has been made, the safest type of delivery for mother and baby is a cesarean.

Cause: (LDPA)

1. Prolonged labor, Fetal distress, Polyhydramnios, Large fundal height

Diagnosis

1. Ultrasound; fetal size; fetal weight.

2. Physical examination; pelvic size

3. MRI; head; pelvis

Cephalopelvic Disproportion

1. S/Sx: (PFPL)

Diagnosis

1. __ is used in estimating __ but not totally reliable for determining __.

2. __ that measures __ can often be most accurate method for diagnosing CPD.

3. __ to visualize the baby’s __ and your __

Medical / Surgical Management

1. Symphysiotomy

2. Caesarean section

Nursing Management

1. open your pelvis; changing positions; nurse, doula, or partner.

2. sitting, squatting, changing sides or going on your hands and knees; forceps or a vacuum

Cephalopelvic Disproportion

Medical / Surgical Management

1. S__ (the surgical division of pubic cartilage)

2. C__

Nursing Management

1. During the trial of labor, you can help to __ and move the labor along by __ with the help of your N__, D__, or P__.

2. You can try: S__, S__, C__ or going on your H__. If labour continues, __ may be needed to help deliver the baby.

(PROM) premature rupture of membranes

Cephalopelvic Disproportion Prognosis

CPD is uncommon and complications are even rarer. But when a baby is too big to get through the mom’s pelvis or labor is very long and obstructed, it can lead to delivery problems and birth injuries. Some of the complications of cephalopelvic disproportion are __

Premature Labor

• interval of less than 12 months – or of more than 59 months- between pregnancies

• Pregnancy with twins, triplets or other multiples

• Stressful life events (e.g., death of a loved one)

• polyhydramnios

It occurs when regular contractions result in the opening of your cervix AFTER week 20 and BEFORE week 37 of pregnancy.

Cause: (IPSP)

1. Constant low, dull backache; Vaginal spotting; Flu-like symptoms; watery, mucus-like or bloody vaginal discharge

1. Pelvic examination

2. trans-vaginal ultrasound

3. Uterine

Premature Labor

1. S/Sx:(CVFW)

Diagnosis

1. __ to see if your cervix has started to change.

2. A __ exam may be done to measure the length of your cervix

3. __ monitoring

1. Corticosteroids

2. Magnesium sulfate

3. Tocolytics

4. Cervical cerclage

Premature Labor

Medical Mgmt:

1. __ can help promote your baby’s lung maturity.

2. Your doctor might offer __ if you have a high risk of delivering between 24 and 32 of pregnancy

3. Your health care provider might give you a medication called a __ to temporarily slow your contractions.

4. C__ c__.

1. warning signs and symptoms, healthy diet and lifestyle

2. chronic conditions

1. bed rest; 24 weeks

Premature Labor

Nursing Mgmt:

1. Educate patient and caregivers regarding __, __ to help prevent repeat preterm labor.

2. Encourage patient to properly manage __ to prevent further labor symptoms.

Prognosis

1. Some women with premature labor and early dilation of the cervix are put on __ until the pregnancy progresses. Most babies born prior to __ weeks have little chance of survival. Only about 50% will survive and the other 50% may die or have permanent problems.

Precipitate Labor and Birth

• History of precipitate labor

• Baby who is smaller than the average size

• When prostaglandin is used to induced labor

• Conceived using fertility treatments

• is defined as giving birth after less than 3 hours of regular contractions. Sometimes it’s also called precipitous labor if labor lasts anywhere under 5 hours. Although it might seem like a good thing, rapid labor can also carry risks and drawbacks.

• also called rapid labor

Cause: (HBWC)

1. Sudden pattern of strong contractions that are very close to one another and don’t let you rest or recover between each one; Pain that feels like one long contraction; Sudden feeling or having to push down like a bowel movement

2. medical history; risk factors

Precipitate Labor and Birth

1. S/Sx: (SPS)

2. Diagnosis: Review __ and __ for preterm labor and evaluate your signs and symptoms

Medical /Management

1. Tocolytics

Nursing Management

1. Lie down; back or side

2. clean space

3. deep breaths; calming things

Precipitate Labor and Birth

Medical /Management

1. __ temporarily slow your contractions.

Nursing Management

1. __ either on your __ or __

2. Remain in a __

3. Take __ and think about __

vaginal and/or cervical tearing or laceration

Precipitate Labor and Birth

Prognosis

Although very fast labor might initially sound appealing, there are some difficulties with it, as well as some potential problems. Physically, precipitous labor can cause: increased risk of __

Uterine Rupture

• Pressure buildup (this pressure can cause the mother’s uterus to tear)

• Previous cesarean delivery scar (it tears along the site of a previous cesarean delivery scar)

Is a rare, but serious childbirth complications that can occur during vaginal birth. It causes a mother’s uterus to tear so her baby slips into her abdomen. This can cause severe bleeding in the mother and can suffocate the baby.

Cause: (PP)

1. Sudden pain between contractions, Contractions that become slower or less intense, Recession of the baby’s head into the birth canal, Bulging under the pubic bone

1. Abdominal

2. Vaginal bleeding

3. fetal heart

4. hypovolemic shock

5. fetal parts; skin

Uterine Rupture

1. S/Sx: (SCRB)

Diagnosis

1. __ pain

2. V__ B__

3. Non-reassuring __ pattern

4. Signs of __ (with complete uterine rupture)

5. Palpation of __ under the __

Medical / Surgical Management

1. Blood transfusion

2. Oxygen therapy

3. Hysterectomy

4. Laparotomy

Nursing Management

1. uterine rupture

2. rapid intervention

3. complications

4. physical and emotional

Uterine Rupture

Medical / Surgical Management

1. B__

2. __ for the baby at birth

3. H__

4. L__ with cesarean delivery

Nursing Management

1. Monitor for possibility of __

2. Assist with __

3. Prevent and manage __

4. Provide __ and __ support

1. critical care

2. oxygen

3. 6.2%

4. 14-33%

5. hysterectomy.

6. 0%

Uterine Rupture

Prognosis

Doctors will improve the baby’s chances of survival by administering (1)__, such as (2)__. (3)__% of uterine ruptures are associated with perinatal death. (4)__% of women with uterine rupture require an emergency (5)__. In a systematic review of VBAC the maternal mortality rate recited to spontaneous uterine rupture was (6)__%. Similarly, in a Dutch nationwide study there were no pregnancy-related deaths due to uterine rupture.

Uterine Prolapse

• Chronic cough or bronchitis

• Repeated heavy lifting

• Multiple pregnancies

• Lower estrogen level after menopause

It occurs when pelvic floor muscles and ligaments stretch and weaken and no longer provide enough support for the uterus. As a result, the uterus slips down into or protrudes out of the vagina. __ can occur in women of any age. But it often affects postmenopausal women who`ve had one or more vaginal deliveries.

Cause: (CRML)

1. Sensation of heaviness or pulling in your pelvis, Tissue protruding from your vagina, Trouble having a bowel movement, Urine retention

1. Pelvic examination

2. Bearing down

Uterine Prolapse

1. S/Sx: (STTU)

Diagnosis:

1. __. During the exam your doctor is likely to ask you: to bear down as if having a bowel movement

2. __ can help your doctor assess how far the uterus has slipped into the vagina. To tighten your pelvic muscles as if you`re stopping a stream of urine. This test checks the strength of your pelvic muscles.

1. Analgesics

2. Blood transfusion

3. Oxygen

4. uterine prolapse

5. Hysterectomy

Uterine Prolapse

Medical / Surgical Management

1. __for pain

2. B__

3. __ therapy

4. Repair __

5. H__

1. constipation

2. heavy lifting; lift correctly

3. coughing

4. weight gain

5. Self-care measures; (1)Kegel exercises

6. Pessary

Uterine Prolapse

Nursing Mgmt:

1. Treat and prevent __

2. Avoid __ and __ correctly

3. Control __

4. Avoid __

5. __. If your uterine prolapse causes few or no symptoms, simple __ measures may provide relief or help prevent worsening prolapse. __ include performing (1)__ to strengthen your pelvic muscles, losing weight and treating constipation.

6. A vaginal __ is a plastic or rubber ring inserted into your vagina to support the bulging tissues. A __ must be removed regularly for cleaning.

strengthening exercises

Uterine Prolapse

Prognosis

Minor prolapse of the uterus or bladder can be corrected with __ of the pelvic floor muscles. Once prolapse has progressed to a more advanced stage, it will continue and worsen without surgical treatment or pessary support.