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Dystocia - correct answer ✅abnormal labor pattern in which abnormalities occur with:
o Power (uterine contractions or maternal expulsion forces)
o Passenger (size, position or presentation)
o Passage (soft tissue or pelvis)
Dystocia - Cervical dilatation
o < 0.5 cm/hr over 4 hrs during active phase of 1st stage
o or < 1 cm/hr of fetal descent during the 2nd stage
- *Most common = dysfunctional (or uncoordinated) uterine contractions prolonged labor
Risk Factors for Dystocia - correct answer ✅• > Maternal age
- Maternal obesity
- Nulliparity
- < Maternal height
- Post term or LGA
- Labor induction
- Mal presentation
- Premature rupture of membranes
- Prolonged latent phase
- Epidural anesthesia
- Chorioamnionitis
Tachysystole: Nursing Diagnosis - correct answer ✅Pain, Acute, related to the woman's inability to relax secondary to tachysystole uterine contractions
Coping, Ineffective, related to ineffectiveness of breathing techniques to relieve discomfort•
Anxiety, related to frequency of contractions and lack of an adequate uterine relaxation period
Nursing Evaluations for Tachysystole - correct answer ✅The woman's labor pattern expected with contractions of frequency duration, and intensity.
- The woman and her partner are able to cope with the abnormal labor pattern and interventions.
Delivery must occur Increase danger of prolapse of umbilical cord Compression and molding of the fetal head (caput)
Amniotomy: Nursing Care - correct answer ✅# 1-Check the fetal heart tones; Assess color, odor, amount
Provide with perineal care; Monitor contractions Check temperature every 2 hours
Dangers of Inadequate Progress: Constriction Ring - correct answer ✅• Develops around a depression in the fetus
- Related to hyperstimulation of the uterus
- Keeps the fetus from descending
o Ring may be felt abdominally & doesn't move
o Uterus below the ring is often loose and floppy
o Head does not move down at all with contractions
- Uterus becomes tender but will not rupture
- Labor does not progress
- May occur in any stage of labor
Dangers of Inadequate Progress: Bandl's retraction ring - correct answer
✅• Develops after excessive retraction of the upper segment
o "Hallmark of neglected labor"
- Above the ring is THICK; lower segment below is paper-thin and can rupture
- As the lower segment thins the ring rises
- Generally occurs late in the second stage
Post Term Pregnancy and Predisposition: Definition and Association - correct answer ✅is one that extends more than 294 days or 42 completed weeks past the first day of the last menstrual period.
Associated with: primiparity, previous postterm pregnancy, placental sulfatase deficiency, fetal anencephaly, male fetus, maternal obesity, and genetic predisposition
Post Term Risks: Maternal - correct answer ✅Discomforts of preg
Implications: > Time 1st and > 2nd state- severe back pain
Mal-Presentations of the Fetus: Face
Description
Implications - correct answer ✅Description: Fetal head in extension
Implications: > Time pushing and labor
Mal-Presentations of the Fetus: Brow
Description
Implications - correct answer ✅Description: Between full flexion and > extension (largest diameter of head)
Implications: > Time 2nd stage
Mal-Presentations of the Fetus: Breech - complete
Description
Implications - correct answer ✅Description: Thighs alongside body, feet close to head
Implications: Dystocia, fetal injury
Mal-Presentations of the Fetus: Footling Breech
Description
Implications - correct answer ✅Description: 1 or 2 feet descending
Implications: CS usually occurs unless 2nd twin
Persistent Occiput posterior position - correct answer ✅The occiput posterior -> > length of labor >back discomfort predisposes vaginal & perineal trauma and lacerations
Precipitous Birth Outside Normal Setting: Nursing Care - correct answer ✅- mom is frightened, angry, feels cheated
Nursing Care:
- Do NOT leave the mother alone
- Try to make the place clean, (don't break down table)
- Try to get the mother in control -- Have mom pant < push
- Apply gentle pressure to the fetal head as it crowns
to prevent rapid change in pressure in the fetal head which can cause subdural hemorrhage or dural tears.
- Deliver the baby BETWEEN contractions to control delivery
- Suction or hold baby's head low place on mom/s abdomen,
tie off cord & - Allow to breast feed, Document!
Precipitious Labor: Risk because of Macrosomia
Birth
Postpartum - correct answer ✅• Maternal Obesity - 2X's more likely
Pregnancy weight gain
- Type 1 or 2 or gestational diabetes → > glucose
- Post term pregnancy, Multiparity or grand multiparity
- Previous macrosomic infant, shoulder dystocia
- Male sex
- Birth: dysfunctional labor patterns, CPD, lacerations, operative birth
- Postpartum: hemorrhage & infection
Birth Risks: Maternal and Infant - correct answer ✅Maternal
- CPD
- Dysfunctional labor pattern
- Perineal lacerations
- Extension of episiotomy
- C-section or operative birth
Infant
- Shoulder dystocia: nerve & brachial plexus, Erb's
- Fractured clavicles
o No risk factors
Shoulder Dystocia: Complications
Fetal and Maternal - correct answer ✅Fetal
- Nerve Injury to shoulder, arms & hands -> shaking or paralysis (usually self- limiting in 6 - 12 months)
- < oxygen to brain -> R/T brain damage or death
Maternal
- Heavy bleeding PP
- Tearing of uterus, vagina, cervix or rectum
HELPERR - correct answer ✅• "H" stands for help
- "E" stands for evaluate for episiotomy
- "L" stands for legs
- "P" stands for suprapubic pressure
- "E" stands for enter maneuvers
- "R" stands for remove the posterior arm from the birth canal
- "R" stands for roll the patient
Management of Nonreassuring Fetal Status - correct answer ✅• Deep, repetitive variable decelerations
- Prolonged decelerations
- Ongoing late decelerations
- Begin intrauterine resuscitation measures:
- Change maternal position
- Correct maternal hypotension
- Discontinue Pitocin
- Administer medications, i.e. terbutaline to < uterine activity
- Increase IV fluid rate or begin IV immediately if not already established
- Assess for prolapsed cord via vaginal exam
- If abnormal patterns resolve, continue with EFM
- If patterns do not resolve and vaginal birth is imminent, proceed as quickly as possible.
- If birth not imminent and bradycardia persists, or if a scalp pH level is < 7.20, perform a C Section
Fetal-Neonatal Implications - correct answer ✅Description: A doublefold of chorion and amnion form a ring around the umbilical cord, on the fetal side of the placenta
Maternal Implications: Increased incidence of late abortion, antepartum hemmorhage and preterm labor
Fetal-neonatal Implications: Intrauterine growth restriction, prematurity, fetal death
Placenta Variation: Battledore Placenta
Description
Maternal Implications
Fetal-Neonatal Implications - correct answer ✅Description: The umbilical cord is inserted at or near the placental margin
Maternal Implications: > incidence of preterm labor and bleeding
Fetal-Neonatal Implications: Prematurity and fetal stress
Placenta Variation: Velamentous Insertion of the Umbilical cord - correct
answer ✅Description: The vessels of the umbilical cord divide some distance from the placenta in the placental membranes
Maternal Implication: Hemorrhage if one of the vessels is torn
Fetal-Neonatal Implications: Fetal stress, hemorrhage
Prolapse of the Umbilical Cord: Description, Etiology, Goal, Treatment - correct answer ✅Umbilical cord passes through the cervical canal ahead or alongside of the presenting part
Etiology: inlet is not occluded, Fetus is not engaged
Goal: Relieve pressure off the cord- NEVER REPLACE CORD
Treatment:
Uterine Rupture - correct answer ✅Complete separation of the: endometrium, myometrium & serosa
Incomplete or Partial not all layers, but some, have been disrupted
- Early: initial tearing along previous scar
- Late: blood flowing out into endometrium
Cephalopelvic Disproportion: Factors - correct answer ✅• Fetal size, presentation, and position
- Size and shape of the maternal pelvis
- Quality of the uterine contractions
- Factors prevent fetal descent through the maternal pelvis
- Results: C section
Clues to contractures of Maternal pelvis - correct answer ✅• Diagonal conjugate inlet <11.5 cm (contracture of inlet); outlet less than 8 cm (contracture of outlet)
- Unengaged fetal head in early labor in primigravidas (?? inlet, malpresentation, or malposition)
- < uterine contraction pattern (? contracted pelvis)
- Deflexion of fetal head (not flexed on chest; ?OCP)
urge push prior complete dilatation of cervix (?OCP)
- < descent (? contracture of inlet, midpelvis, or outlet)
- Edema of anterior portion (lip) of cervix (obstructed labor at the inlet)
Types of Complications of 3rd and 4th stages of Labor - correct answer ✅- Retained Placenta
- Lacerations
- "Welcome to our World"
Retained Placenta: Description, Treatment and Types - correct answer
✅Retention of the placenta beyond 30 minutes after birth
TRX: manual removal of the placenta
- May be r/t attachment of the placenta:
- Placenta Acreta: placental villi extend beyond the endometrium and attach to the superficial aspect of the myometrium
