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50 Cards in this Set
- Front
- Back
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difficult labor
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dystocia
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dystocia: ——can arise from any of the four main components of the labor process:
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(a) the power, or the force that propels the fetus (uterine contractions), (b) the passenger (the fetus), (c) the passageway (the birth canal), or (d) the psyche (the woman's and family's perception of the event).
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Inertia is a time-honored term to denote that sluggishness of contractions, or the force of labor, has occurred. A more current term used is
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dysfunctional labor
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the number of contractions is unusually low or infrequent (not more two or three occurring in a 10-minute period). The resting tone of the uterus remains less than 10 mm Hg, and the strength of contractions does not rise above 25 mm Hg
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hypotonic uterine contractions,
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When would HYPOtonic contractions occur?
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-Active Phase
-after the adm of analgesia, especially if the cervix is not dilatated to 3 to 4 cm or if bowel or bladder distention prevents descent or firm engagement. -occur in a uterus that is overstretched by a multiple gestation, a larger-than-usual single fetus, hydramnios, or in a uterus that is lax from grand multiparity |
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In the 1st hour after birth following a labor of hypotonic contractions, what is the Nursing implication?
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, palpate the uterus and assess lochia every 15 minutes to ensure that postpartal contractions are not also hypotonic and therefore inadequate to halt bleeding
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contractions are marked by an increase in resting tone to more than 15 mm Hg
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Hypertonic uterine
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HYPERtonic contractions occur b/c of?
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the muscle fibers of the myometrium do not repolarize or relax after a contraction, thereby “wiping it clean” to accept a new pacemaker stimulus. They may occur because more than one pacemaker is stimulating contractions.
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What is the danger of hypertonic contractions?
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the lack of relaxation between contractions may not allow optimal uterine artery filling; this could lead to fetal anoxia early in the latent phase of labor
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a latent phase that is longer than 20 hours in a nullipara or 14 hours in a multipara.
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Prolonged latent phase
-This may occur if the cervix is not “ripe” at the beginning of labor and time must be spent getting truly ready for labor. It may occur if there is excessive use of an analgesic early in labor |
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What is the management of a prolonged latent phase in labor that has been caused by hypertonic contractions?
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involves helping the uterus to rest, providing adequate fluid for hydration, and pain relief with a drug such as morphine sulfate. Changing the linen and the woman's gown, darkening room lights, and decreasing noise and stimulation can also be helpful
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A contraction ring is a hard band that forms across the uterus at the junction of the upper and lower uterine segments and interferes with fetal descent. The most frequent type seen is termed a
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PATHOLOGIC RETRACTION RING (Bandl's ring). The ring usually appears during the second stage of labor and can be palpated as a horizontal indentation across the abdomen (Fig. 23.4). It is a warning sign that severe dysfunctional
P.630 labor is occurring as it is formed by excessive retraction of the upper uterine segment; the uterine myometrium is much thicker above than below the ring |
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CPD:
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cephalopelvic disproportion or fetal malposition
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Usually cause Precipitate labor, not prolonged labor?
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HYPERtonic contraction (ati)
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occur when uterine contractions are so strong that a woman gives birth with only a few, rapidly occurring contractions.
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PRECIPITATE LABOR and birth
- It is often defined as a labor that is completed in fewer than 3 hours. Precipitate dilatation is cervical dilatation that occurs at a rate of 5 cm or more per hour in a primipara or 10 cm or more per hour in a multipara |
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artificial rupture of the membranes
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Amniotomy
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means that labor is started artificially.
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Induction of labor
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refers to assisting labor that has started spontaneously but is not effective.
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Augmentation of labor
-may be necessary if the contractions are hypotonic or too weak or infrequent to be effective |
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or a change in the cervical consistency from firm to soft, is the first step the uterus must complete in early labor. Until this has occurred, dilatation and coordination of uterine contractions will not occur
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Cervical ripening,
-score is 8 or greater, the cervix is considered ready for birth and should respond to inductio |
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*How is oxytocin admin?
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Use infusion pump, always admim IV, so that, if hyperstimulation should occur, it can be quickly discontinued. B/c the half-life of oxytocin is approx 3 minutes, the falling serum level and effects are apparent almost immediately after d/c of IV admim
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a loop of the umbilical cord slips down in front of the presenting fetal part
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umbilical cord prolapse
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*Prolapse may occur at any time after the membranes rupture if the presenting fetal part is not fitted firmly into the cervix. It tends to occur most often with:
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Premature rupture of membranes
Fetal presentation other than cephalic Placenta previa Intrauterine tumors preventing the presenting part from engaging A small fetus Cephalopelvic disproportion preventing firm engagement Hydramnios -Multiple gestation |
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the addition of a sterile fluid into the uterus to supplement the amniotic fluid.
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Amnioinfusion
-The technique neither shortens nor prolongs labor; it just prevents additional cord compression |
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oversized fetus?
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Macrosomia
>4000-4500g(approx 9 -10 lbs) |
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methods to determine position, presentation and engagement of fetus.
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Leopold’s Maneuvers
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the fetal position is posterior rather than anterior, means?
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That is, the occiput t(assuming the presentation is vertex) is directed diagonally and posteriorly, either to the right (ROP) or to the left (LOP
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the turning of a fetus from a breech to a cephalic position before birth. It may be done as early as 34 to 35 weeks, although the usual time is 37 to 38 weeks of pregnancy
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External cephalic version
-For the procedure, FHR and possibly ultrasound are recorded continuously. A tocolytic agent may be administered to help relax the uterus |
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*What agent may be admin to help relax the uterus during an external cephalic version?
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Tocolytic agent
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prolonged or ineffective labor, usually resulting from hypotonic contractions
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. Dysfunctional labor
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. If contractions are hypertonic, their resting tone will be above average. A usual resting tone is
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A normal resting tone is 15 mm Hg.
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The danger of a resting tone that is too high (hypertonic) is that
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lack of relaxation prevents optimal uterine artery filling.
- It is important that uterine arteries fill between contractions to supply enough oxygen to the fetus. |
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risks for uterine rupture.
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A previous cesarean birth, multiple birth, prolonged labor, oxytocin induction, and an abnormal presentation (occipitoposterior position)
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If a fetus is in a breech position, it can be turned to a cephalic position by external cephalic version just before or during labor. An important assessment to make immediately following this would be
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Assessthe fetal heart rate
- It would assure the fetal cord was not compressed by the maneuver. |
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. The degree of Molly’s cervix ripening is rated as 9 on a Bishop Scale. Based on this, you would
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rate her as an acceptable person to have oxytocin induction
-A score of 8 to 10 indicates a cervix is “ripe” or soft and ready for dilation. |
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*What is a good technique to follow when infusing oxytocin to ensure safe administration during labor?
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Begin the infusion as a “piggyback” to a primary IV solution.
-Piggybacking allows you to immediately discontinue oxytocin if contractions become too frequent or too intense. Always use a pump to decrease the possibility of oxytocin overdose. |
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A side effect of oxytocin administration is water intoxication. A signal that this is occurring for which you would assess is
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Water intoxication means fluid is pooling in interstitial spaces.
-This increased tension leads to Headache, Vomiting and Mental confusion. -Urine flow would be decreased. |
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If a fetus is determined to be a face presentation, what would be most important to observe for in the newborn after birth?
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Signs of dehydration
-The baby's face is extremely edematous following birth, so much so that sucking can be ineffective |
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Labor is said to be precipitous if
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the total length is under 3 hours
-such labors can be so abrupt that a fetus experiences sudden pressure changes to the head, possibly resulting in tearing of cranial vessels. |
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means amniotic fluid has entered the maternal bloodstream. This can cause a pulmonary embolism that could be fatal.
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Amniotic embolism
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Common Causes of Dysfunctional Labor:
-Inappropriate use of analgesia (excessive or too early administration) -Pelvic bone contraction that has narrowed the pelvic diameter so that a fetus cannot pass such as could occur in a woman with rickets -Poor fetal position (posterior rather than anterior position) |
-Extension rather than flexion of the fetal head
-Overdistention of the uterus, as with multiple pregnancy, hydramnios, or an excessively oversized fetus -Cervical rigidity (unripe) Presence of a full rectum or urinary bladder that impedes fetal descent Woman becoming exhausted from labor -Primigravida status |
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problem occurs at the second stage of labor, when the fetal head is born but the shoulders are too broad to enter and be born through the pelvic outlet.
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Shoulder Dystocia
This is hazardous to the woman because it can result in vaginal or cervical tears. It is hazardous to the fetus if the cord is compressed between the fetal body and the bony pelvis. The force of birth can result in a fractured clavicle or a brachial plexus injury for the fetus. |
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*narrowing of the anteroposterior diameter to less than 11 cm, or of the transverse diameter to 12 cm or less. It usually is caused by rickets in early life or by an inherited small pelvis
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Inlet contraction
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If a woman has a borderline (just adequate) inlet measurement and the fetal lie and position are good, her physician may allow her a
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“trial” labor to determine whether labor can progress normally.
A trial labor continues as long as descent of the presenting part & dilatation of the cervix continue to occur. Monitor FHR & contractions -Urge the woman to void every 2 hr ( allowing the fetal head to use all the space available) After rupture of the membranes, assess FHrR; if the fetal head is still high, there is an increased danger of prolapsed cord & anoxia to the fetus |
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a forceps outlet procedure in which the forceps are applied after the fetal head reaches the perineum.
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Forceps birth
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The term Low forceps birth may be used to indicate:
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that the fetal head is at a +2 station or more.
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If the fetal head is engaged but at less than +2 station, the procedure is called a
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Midforceps birth. This type of forceps extraction is rarely justified
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What assessment should be done before forceps application and immediately after application?
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Record FHR b/c there is a danger that the cord could be compressed b/w the foceps and the fetal head
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Before the forceps can be applied, what must take place?
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Membranes must be ruptured.
CPD must not be present. The cervix must be fully dilated. The woman's bladder must be empty. |
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Vacuum extraction has advantages over forceps birth in what ways?
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-little anesthesia is necessary (leaving the fetus with less respiratory depression at birth) -fewer lacerations of the birth canal occur
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major disadvantage of Vacuum extraction?
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causes a marked caput on the newborn head (may be noticeable up to 7 days after birth) Tentorial tears from extreme pressure may occur
-caput swelling is harmless to her infant & will decrease rapidly. -not for Preterm infants b/c of softness of skull -don't use if fetal scalp blood sample was used |
