Problems with Labor and Birth Flashcards Preview

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Flashcards in Problems with Labor and Birth Deck (10)
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1
Q

Premature Rupture of Membranes

A
  • spontaneous rupture of the amniotic membranes before the onset of labor.
  • when happens before term, birth will be delayed and infection becomes a risk.
  • amount, color, consistency, and odor of fluid need to be assessed.
  • fetal monitoring is necessary, tachycardia in the fetus may indicate maternal infection.
  • Avoid vaginal examinations because of the risk of infection and adm ATB as prescribed.
2
Q

Prolapsed Umbilical Cord

A
  • umbilical cord is displaced causing compression of the cord and compromising fetal circulation.
  • client has a feeling that something is coming through the vagina.
  • umbilical cord may be visible or palpable.
  • FHR is irregular and slow.
  • fetal heart monitor shows variable decelerations or bradycardia after rupture of the membranes.
  • if fetal hypoxia is severe, violent fetal activity may occur and then cease.
  • elevate the fetal presenting part that is lying on the cord by applying finger pressure with a gloved hand.
  • place the client in extreme trendelenburg’s or modified sims or a knee-chest position.
  • adm 8-10L/min by face mask.
  • prepare for immediate birth.
  • nurse stays with client and ask someone else to contact the PHCP.
  • NEVER attempt to push the cord into the uterus. If cord is protruding from the vagina, wrap loosely a sterile towel saturated with warm saline
  • is an emergency and delivery must occur, usually via c-section.
3
Q

Supine Hypotension (Vena Cava Syndrome)

A
  • occurs when the venous return to the heart is impaired by the weight of the uterus on the vena cava.
  • the syndrome results in partial occlusion of the vena cava and aorta and in reduced cardiac return, cardiac output, and blood pressure.
  • assessment: palllor, faintness, dizziness, tachycardia, hypotension, sweating, cool and damp skin, fetal distress.
  • position the client on her side to shift the weight of the fetus of the vena cava. Avoid supine position.
  • monitor VS and FHR.
4
Q

Preterm Labor

A
  • occurs after the 20th week but before the 37th week.
  • risk factors: history of medical conditions, present and past obstetric problems, infection, and social and environmental factors (including substance abuse). Multifetal pregnancy, anemia (decreases oxygen supply to uterus), age < 18 or > 40 years.
  • focus on stopping the labor (identify and treat infection, restrict activity, and ensure hydration), maintain bed rest and a lateral position, monitor fetal status, adm fluids and meds as prescribed and monitor for side effects of tocolytes.
  • use of 17 alpha-hydroxyprogesterone caproate known as 17P injection to decrease risk of preterm delivery.
5
Q

Precipitous Labor and Delivery

A
  • labor lasting less than 3 hours
  • ensure that a precipitous delivery tray is available (hemostats, scissors, and cord clamp).
  • prepare for rupturing membranes when the head crowns (if not already).
  • do not prevent the fetus from being delivered.
6
Q

Dystocia

A
  • is a difficult labor that is prolonged or more painful
  • occurs because of problems caused by uterine contractions, the fetus, or the bones and tissues of the maternal pelvis.
  • fetus may be excessively large, malpositioned, or in an abnormal presentation.
  • contractions may be hypotonic (short, irregular, weak) or hypertonic (6 or more in a 10 min time period, uncoordinated).
  • can result in maternal dehydration, infection, fetal injury, or death.
7
Q

Amniotic Fluid Embolism

A
  • the escape of amniotic fluid into the maternal circulation.
  • the debris-containing amniotic fluid deposits in the pulmonary arterioles and is usually fatal to the mother.
  • assessment: abrupt onset of respiratory distress and chest pain, cyanosis, fetal bradycardia and distress if delivery has not occurred.
  • adm oxygen with face mask 8-10L/min or resuscitation bag at 100%. Prepare for intubation and MV.
  • position client on her side
  • adm fluids, blood products, and medications as prescribed.
  • monitor fetal status and prepare for emergency delivery if necessary.
8
Q

Fetal Distress

A
  • FHR < 110 or >160 bpm
  • meconium-stained amniotic fluid
  • fetal hypo or hyperactivity
  • progressive decrease in baseline variability
  • severe variable decelerations or late decelerations
  • discontinue oxytocin if infusing
  • place client in lateral position
  • adm IV fluids and oxygen via face mask at 8-10l/min
  • monitor maternal and fetal status
  • prepare for emergency delivery
9
Q

Rupture of the Uterus

A
  • complete or incomplete separation of the uterine tissue as a result of a tear in the wall of the uterus from the stress of labor.
  • risk factors: labor after previous c-section, overdistended uterus (multiples or hydramnios), abdominal trauma.
  • assessment: abd pain or tenderness, chest pain, contractions may stop or fail to progress, rigid abd, absent FHR, signs of maternal shock, fetus palpated outside the uterus.
  • interventions: monitor for signs of shock, prepare for cesarean delivery (with possible hysterectomy).
10
Q

Uterine Inversion

A
  • uterus completely or partly turns inside out.
  • can occur during delivery or after delivery of placenta
  • risk factors: fundal implantation of the placenta, manual extraction of the placenta, short umbilical cord, uterine atony, leiomyomas, and abnormally adherent placental tissue.
  • assessment: depression in the fundal area, interior of the uterus may be seen through the vagina, severe pain, hemorrhage, and signs of shock.
  • interventions: monitor and prepare the client for a return of the uterus to the correct position (via vagina or laparotomy).