labor delivery

Tachysystole

>5 contractions in 10 minutes. UC frequency more often than every 2 mins, lasting longer than 90 sec, increased resting tone or no relaxation of uterus between UCs

Hypertonus:

contractions lasting longer than 2 minutes in duration (will be discussing later in this lecture

Relaxation Time:

▪Time between contractions.  Measured from the end of one contraction to the beginning of another.

in increased Resting Tone

Risk for uterine rupture increases (especially with prior uterine scar)

Hypertonus: Why is it bad?

• Fetal hypoxia

• Fetal acidemia

• Nonreassuring FHR patterns

Tachysystole: Why is it bad?

• Decreased placental perfusion

• Reduced oxygen delivery to fetus

• Fetal hypoxia

• Late decelerations may occur

• Increased risk for fetal distress

tocolytics used to stop contractions a smooth muscle relaxant

true

external version contraindications

▪Uterine anomaliesshape weird

▪Previous C/Sprevius c section)

▪CPD( sperolevic dispoportion ) head to big narrow hips

▪Placenta previa(placenta grew on wrong spot) risk of bleeding

▪Multiple gestation Twins, triplets, etc

▪Oligohydramnios(low fluid)

▪3^rd trimester bleeding(unusual bleeding)

at 37 to 38 weeks we can do what procedure if consent provided

external version

xternal version does what

flip fetsu externally from breech to vertex

nurse responsibilites for external version

▪Gather equipment (ultrasound etc)

▪Perform a NST prior (non stress test should be good)

▪If pt is Rh (-), asses if Rho(d) immune globulin was given at 28 weeks.

▪Ensure the patient is not in labor

▪Tocolytics

▪Risk of procedure: with external version

▪Abruption

▪Umbilical cord prolapse

▪Emergency C/S

how to promote cervical ripening

▪Balloon Catheter: Inserted into the cervix to dilate the cervix(pushes pressure on cervix)

▪Stripping of the membranes

Hygroscopic dilators: inserted vaginally, absorbs fluid and expands

when they don’t go into labor naturally

•Administer Terbutaline 0.25mg subcus

•Tachysystole: greater than 5 UCs in 10 mn averaged over a 30 min window

can occur from cervical ripening

tx fetal distress after cervical ripening

•Apply O2 @10L via face mask

•Position left lateral

•IV bolus

•Notify HCP

cervical ripening medications

Misoprostol (prostaglandin E1):

Dinoprostone (prostaglandin E2):

Misoprostol (prostaglandin E1):

Given PO or vaginal. Must void prior. Can re dose every 6 hours.

Dinoprostone (prostaglandin E2):

•given vaginally, must void prior, stays in place for up to 24 hrs