Ch. 33 Labor and Birth Complications

StudyBlue printing of Ch. 33 Labor and Birth Complications html, body, div, span, applet, object, iframe, h1, h2, h3, h4, h5, h6, p, blockquote, pre, a, abbr, acronym, address, big, cite, code, del, dfn, em, font, img, ins, kbd, q, s, samp, small, strike, strong, sub, sup, tt, var, b, u, i, center, fieldset, form, label, legend, table, caption, tbody, tfoot, thead, tr, th, td { margin: 0; padding: 0; border: 0; outline: 0; font-size: 100%; background: transparent; } body { line-height: 1; } blockquote, q { quotes: none; } blockquote:before, blockquote:after, q:before, q:after { content: ''; content: none; } /* remember to define focus styles! */ :focus { outline: 0; } /* remember to highlight inserts somehow! */ ins { text-decoration: none; } del { text-decoration: line-through; } /* tables still need 'cellspacing="0"' in the markup */ table { border-collapse: collapse; border-spacing: 0; } /* end RESET */ .header { min-width:800px; } .logo { padding:6px 20px 2px 20px; margin:0; font-size:25px; 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} ul li { list-style: disc; } ol li { list-style: decimal; } img { border: 0; } table { clear: both; width: 100%; border: 1px solid #c5c5c5; border-width: 1px 0; margin: 0; page-break-after: always; } table#page { page-break-after: auto; } td { text-align: center; font-size: 12px; border-bottom: 1px dashed #c5c5c5; height: 1.75in; width: 50%; padding-left: 15px; } .leftside { border-right: 1px solid #cccccc; padding: 0 15px 0 0; } .bottom td { border-bottom: none; } .clearfix { clear:both; line-height:1px; height:1px; } img { max-width:80%; max-height:150px; margin:20px; } @media print {.header { display: none; } .content .header{ display:inherit; } table { border: 1px dashed #bbb; border-width: 1px 0; } .theNote{ background-color:white; } } amniotomy - AROM, place several pads, elevate hips, assess FHR, assess fluid, watch temp. every 2 hrs, document time of rupture, color, odor and consistency of fluid, FHR and pattern before and after, and how well the procedure was tolerated anaphylactoid syndrome of pregnancy (ASP) - amniotic fluid embolism: sudden onset of hypoxia, hypotension, or cardiac arrest and coagulaopathy, unknown cause, maternal death is 61%, 50% neonates have neuro impairment, maternal risk factors include advanced age, minority race, placenta previa, preeclampsia, forceps, c/s, rapid labor and meconium staining, interventions include oxygenating and maintaining cardiac output and placing fluid loss Bishop score - rating system used to evaluate inducibility. a score of 8 or more on the 13 pt scale indicates that cervix is soft, anterior, 50% and dilated 2cm or more and presenting part is engaged, 8+ usually indicates successful labor cephalopelvic disproportion (CPD) - disproportionate size between fetus and pelvis, usually baby is too big, but mom could have small pelivs cesarean birth - birth of fetus though transabdominal incision of uterus. indications for cesarean include cardiac disease in mom, Guillian barre syndrome, obstruction, history of c/s. fetal indications include abnormal FHR, breech or transverse lie, active maternal herpes lesions, HIV, congenital anomalies. dysfunctional labor, placental abruption, previa, elective c/s chorioamnionitis - bacterial infection of the amniotic cavity, occurs after membranes rupture. risk factors inlucde long labor, multiple vag exams, use of internal monitoring. women with this are more likely to have dysfunctional labor and need a c/s. neonatal risks include pneum, bacteremia, and sepsi. treatment of GBS in the intrapartum period has decreased the incidence. external cephalic version (ECV) - used to attempt to turn the fetus from a breech or shoulder presentation to a vertex presentation for birth. accomplished by exertion of gentle, constant pressure on the abdomen. tocolytic agent may be given to relax uterus forceps-assisted birth - one in which instrument with two curved blades is used to assist in birth of fetal head. used in prolonged second stage. cervix must be dilated to prevent lacerations and hemorrhage, bladder should be empty, presenting part must be engaged. document as forceps assisted birth induction of labor - chemical or mechanical initiation of uterine contractions before their spontaneous onset for the purpose of bringing about birth. may be elective or indicated. IUGR - i ntrauterine growth restriction late preterm - occur between 34-36 wks LBW - describes only weight at birth posterm pregnancy - extends beyond end of 42 wks, manifestations : maternal weight loss, decreased uterine size, meconium in amniotic fluid, hard fetal skull precipitous labor - labor that last less than 3 hrs from onset of contractions to time of birth PROM - premature rupture of membranes preterm birth - any birth that occurs before completion of 37 wks of pregnancy preterm labor - cervical changes and uterine contractions occurring between 20-37 wks PPROM - premature preterm rupture of membranes shoulder dystocia - uncommon obstetric emergency that increases the risk for fetal and maternal morbidity and mortality during attempt to accomplish birth vaginally. condition in which the head is born but the anterior shoulder cannot pass under the pubic arch. trial of labor - observance of a woman and her fetus for a reasonable period (4-6hrs), of spontaneous active labor to assess the safety of vaginal birth for mother and infant. vaccuum-assisted birth - birth involving attachment of vacuum cup to fetal head, using negative pressure to assist in birth of head. generally not used <34 wk births. must have completely dilated cervix, ruptured membranes, engaged head, vertex presentation and no suspicion of CPD. document as vacuum assisted. VBAC - criteria include: one previous low-transverse c/s birth, clinically adequate pelvis, no other uterine scars or history of previous rupture, physician immediately available, anesthesia personnel ready for emergency c/s. very preterm birth - born before 32 wks Signs and symptoms of preterm labor uterine activity: contractions occurring more frequently then every 10 mins lasting 1hr or more, may be painful or painless lower abd cramping, dull back pain, painful menstrual like cramps, pevlic pressure, urinary frequency vaginal discharge that is thicker (mucoid) or thinner (watery), bloody, brown or colorness, increased amount, odor, rupture Treatment for preterm labor effects of prolonged bed rest physical (weight loss; indigestion, loss of appetite, weakness, risk for DVT, sleep disturbance, prolonged postpartum recovery) psychosocial (dysphoria, guilt, boredom, lonely, increased stress, mood swings, role reversal) support system (role reversal, financial strain, fear for mother and fetus) Suppression of uterine activity tocolytics medications given to arrest labor after uterine contractions and cervical changes have occurred contraindications: mom = HTN, vaginal bleeding, cardiac disease; baby = 36 + wks, fetal demise, chorioamnionitis nursing care: explain, place on side to enhance placental perfusion and reduce pressure of cervix, VS, watch I&Os closely, limit fluid intake to 2500-3000 ml/day medication guides (magnesium, terbutaline and antenatal glucocorticoids) magnesium CNS depressant that relaxes smooth muscles including uterus it is essential to frequently assess respiratory status (pulmonary edema), DTR and LOC to identify toxicity, also urine output must be greater then 30ml/hr adverse effects include: hot flushes, burning at IV site, n/v, lethargy (flu-like feeling), SOB therapetic dose is 4-8mg/dl, calcium gluconate to reverse terbutaline relaxes smooth muscles, inhibiting uterine activity and causing bronchodilation subQ, may cause tachycardia, HA, n/v, hypotension toxic: >130bpm, bp < 90/60, chest pain contraindicated in women with diabetes, HTN, cardiac disease antenatal glucocorticoids stimulates fetal lung maturation, 24-34 wks adverse effects: pulmonary edema, could worsen maternal condition (diabetes, HTN) give deep IM in ventral gluteal or vastus lateralis, teach signs of pulmonary edema, assess blood glucose and lung sounds Dysfunctional labor long, difficult or abnormal labor caused by conditions with 5 Ps of labor causes: ineffective UCs or maternal bearing-down efforts (powers) - most common cause alterationss in pelvic structure (passageway) fetal causes: abnormal presentation/position, anomalies, excessive size, # of fetuses maternal position during labor and birth psychologic response of the woman hypertonic vs. hypotonic contractions hypertonic: often axious first-time mom in latent phase of 1st stage (<4cm dilation) hypotonic: contractions stop in active phase 4-7 cm, often due to CPD or malpresentation, insert IUPC, labor augmentation may be implemented abnormal labor patterns progress in 1st or 2nd stage is prolonged or stopped back labor with OP position reducing pain: counterpressure, heat or cold, double hip squeeze, knee press facilitating rotation of fetus: lateral abd stroking, hands and knees position, squatting, pelvic rocking, stair climbing, lie on same side as fetal spine, lunges Induction of Labor indicated if continuing pregnancy is dangerous for mom or baby cervical ripening methods: chemical agents (prostaglandin to ripen and soften cervix, cervidil can be removed in case of tachysystole, cytotec cannot be removed.) mechanical (balloon catheter), sweeping membranes, alternative methods include castor oil or acupunture, amniotomy is used to induce if cervix is ripe but monitor for signs of infection oxytocin is produced by pituitary to stimulate contractions, starts or audments labor by increasing UCs. maternal hazards include placental abruption, uterine rupture, abnormal FHR and patterns, infection. if contractions are too strong this could lead to hypoxemia, use lowest dose possible, tocolytics available, aggressive use so woman delivers <12 hrs requires 1:1 nurse: patient but this never happens Augmentation of Labor stimulation of UCs after labor has started spontaneously but progress is unsatisfactory Prolapsed Umbilical cord variable decelerations or prolonged decelerations can mean cord compression, many causes from position of mom or baby, to amount of amniotic fluid if the cord is seen or felt this is case for emergency call for assistance, do not leave mom alone, glove up and move presenting part off of cord, do not remove hand, if cord is protruding do not attempt to replace, administer oxygen, IV fluid, prepare for immediate birth if cervix is dilated or cesarean if it is not.