Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
94 Cards in this Set
- Front
- Back
|
Labor Dystocia
|
long, difficult or abnormal labor
|
|
|
Problem in progression of labor result from
|
dysfuctional labor
alteration in pelvic structure fetal causes maternal position psychological response of the mother inadequate pain relief/ coping |
|
|
dysfunctional labor
|
ineffective uterine contractions
|
|
|
Factors that increase risk of dysfunctional labor
|
body build
uterine abnormalities malpresentation cephalopelvic disproportion pitocin maternal fatigue, dehydration, fear inappropriate timing of analgesics |
|
|
Hypertonic Uterus
|
latent phase of labor
contractions are uncoordinated manage with therapeutic rest |
|
|
Hypertonic uterus is common in
|
first pregnancy
|
|
|
therapeutic management consists of
|
pain management
hot shower sleep |
|
|
hypotonic uterus
|
progress to active phase
CTXs become weak and inefficient augment labro |
|
|
What is a pelvic dystocia?
|
contractures of the pelvic diameters
|
|
|
What is a soft tissue dystocia?
|
anatomic abnormalities
full bladder or rectum cervical edema |
|
|
What are possible fetal causes of a dysfunctional labor?
|
fetal anomalies
cephalopelvic disproportion Malpresentation suboptimal fetal position |
|
|
What are malpresentations?
|
Face
Shoulder Breech |
|
|
What is a complete breech?
|
legs and knees flexed and come out first
|
|
|
What is a frank breech?
|
butt first
|
|
|
What is a risk with any type of mal presentation?
|
Cord prolapse
|
|
|
What technique is used to turn a breech baby?
|
External cephalic Version
|
|
|
What are the risks of a external cephalic version?
|
nuchal cord
fetal death or distress ROM placental obruption maternal/ fetal bleeding |
|
|
External cephalic version is done at week?
|
36-37
|
|
|
What is given to the mother (if she needs it) before doing a external cephalic version?
|
Rogham
|
|
|
Who can do a external cephalic version?
|
Fetal Maternal neonatologist
|
|
|
What is Friedman's classification?
|
progress monitored in terms of cervical dilation and fetal descent
monitor for expected progress and change based on phase of labor and parity |
|
|
What is a precipitous labor?
|
total labor process completed in less then 3 hours
|
|
|
Precipitous labor is associated with
|
significantly increased risk of maternal and fetal complications
|
|
|
Precipitous labor is common in woman
|
high on cocaine
|
|
|
Precipitous labor can lead to
|
uterine rupture
laceration amniotic fluid embolism postpartum hemorrhage |
|
|
What is "trial of labor"?
|
allowance of "reasonable period" of spontaneous active labor to determine the safety
|
|
|
What is considered a "reasonable period"?
|
4-6 hours as long as there are no other problems
|
|
|
What are indications for "trial of labor"?
|
maternal pelvis is a questionable size/shape
VBAC abnormal presentation |
|
|
Induction of labor before spontaneous labor is done with
|
pitocin
amniotomy |
|
|
success of IOL is greater if
|
cervix is favorable
|
|
|
What is bishop scoring
|
method of evaluating the favoriability of a cervix
|
|
|
Bishop scores for dilation
|
0 = 0points
1-2 = 1 point 3-4 = 2 points 5-6 = 3 points |
|
|
Bishop scores for effacement
|
0-30%
40-50% 60-70% 80%-100% |
|
|
Bishop scores for station
|
-3
-2 -1/0 +1 |
|
|
Bishop scores for cervical consistency
|
firm = 0
med =1 sof =2 |
|
|
Bishop scores for cervical position
|
posterior = 0
midline = 1 anterior = 2 |
|
|
High bishop score is associated with
|
a favorable cervix
|
|
|
low bishop score is associated with
|
a failed induction
|
|
|
For a nuliperous women you want a Bishop score of
|
9 or better
|
|
|
For a multip you want a Bishop score of
|
5 or better
|
|
|
What chemical agents are used to ripen the cervix?
|
prostaglandins (prepidil, cervidil)
misoprostol (cytotec) |
|
|
Cervical Ripening results in
|
higher sucess of induction
lower doses of pitocin shorter induction times |
|
|
When inducing with pitocin monitor FHR and contraction pattern....
|
q15m
|
|
|
Reasons for induction of labor
|
suspected fetal jeopardy
PROM Postterm Chorioamnionitis maternal medical problems PIH Fetal demise |
|
|
Risk with induction of labor
|
fetal distress
failed induction uterine rupture water intoxication hyperstimulation |
|
|
Hyperstimulation with pitocin
|
contractions q2m x >90
|
|
|
What do you do when you observe hyperstimulation with pitocin
|
turn off pitocin
increase IVF O2 Notify provider |
|
|
What is the normal uterine resting tone?
|
20 mmHg
|
|
|
Half life of pitocin is?
|
2-4 minutes
|
|
|
Augmentation of labor is done when?
|
labor has begun spontaneously and then stops or has an abnormal pattern
|
|
|
Symptoms of preterm labor?
|
pelvic pressure
low, dull backache menstrual like cramps change or increase in vaginal discharge intestinal cramping with or without diarrhea contraction less then 10 minutes apart |
|
|
Causes of preterm labor
|
unknown and multifactorial
|
|
|
contributing factors to preterm labor
|
bacterial vaginosis
chlamydia gonorrhea UTI |
|
|
If a mother has bacterial vaginosis
|
she is 50% more likely to have a PTL
|
|
|
How many babies are born premature in the US each year
|
1 in 8
|
|
|
Risk factors for preterm labor?
|
infection
long distance traveling on feet more then 50% of time stress poor nutriotion late or no prental care lower ses or education ETOH, tobacco, durgs pre-existing or pregnancy complications |
|
|
Preterm labor is diagnosed by
|
measuring contractions
documented cervical change effacement 80% dilation more then 1cm |
|
|
Predictors of Preterm Labor and Birth
|
Salivary Estriol
Fetal Fibronectin Transvaginal Ultrasound Home uterine activity monitorin |
|
|
Salivary Estriol and Fetal fibronectin are best at
|
identifying who WILL NOT experinece PTL
|
|
|
both Salivary Estriol and Fetal Fibronectin have a
|
high negative predictive value
|
|
|
Fetal Fibronectin is present
|
in the cervical canal early and late in labor
|
|
|
The presence of fetal fibronectin between ______ & ______ weeks can indicate _________
|
24-34 weeks
preterm labor |
|
|
Accuracy of fetal fibronectin in diagnosing PTL
|
25-40%
|
|
|
Accuracy of fetal fibronectin in giving a negative result
|
95%
|
|
|
Salivary estriol is produced
|
in maternal saliva
|
|
|
Levels of salivary estriol increase
|
before preterm birth
|
|
|
A positive salivary estriol indicator is right
|
7-25% of the time
|
|
|
A negative salivary estriol indicator is right
|
98% of the time
|
|
|
How is preterm labor managed
|
tocolytic therapy
administation of glucocorticoids |
|
|
what is tocolytic therapy?
|
suppression of uterine activity
|
|
|
What tocolytic agents are used?
|
Ritodrine- relaxes smooth muscle
Terbutaline -relaxes smooth muscle Magnesium sulfate- CNS depressant |
|
|
a betamimetic does what
|
relaxes smooth muscle
|
|
|
indomethacin does what?
|
prostglandin inhibition
|
|
|
nifedipine does what?
|
calcium channel blocker
|
|
|
Side affects of terbutaline?
|
tachycardia
dysrhythmia termors headache NV Hyperglycemia Hypokalemia pulmonary edema myocardial ischemia hypotension jitters |
|
|
Side affects of magnesium ?
|
decreased RR
absent or decrease deep tendon reflexes muscle weakness decreased urine output |
|
|
Nursing care for a patient on tocolytic tx
|
position on L lateral
Vital Signs notify if maternal HR is greater then 120 pulmonary edema urinary output q1h ketonuria limit fluids 2500-3000 mL psychosocial support |
|
|
With pulmonary edema you hear?
|
crackles at the base of the lungs
|
|
|
What is the antidote for magnesium overdose?
|
calcium gluconate
|
|
|
What are glucocorticoids used for ?
|
accelerate fetal lung maturity
|
|
|
Glucocorticoids can be given again
|
in 7 days if birth has not occurred
|
|
|
Contraindication for stopping preterm labor
|
preeclampsia
vaginal bleeding infection cardiac disease actue fetal distress chronic IUGR |
|
|
Preterm labor cannot be stopped if dilation is over
|
4cm
|
|
|
Preterm labor could be aloud to continue if continuation of pregnancy is impractical as with
|
fetal demise
lethal fetal anomaly EG is greater 37 weeks EFW greater than 2500gm |
|
|
PROM stands for
|
premature rupture of membranes
|
|
|
PPROM stands for
|
preterm premature rupture of membrances
|
|
|
Management of PPROM
|
prevent preterm birth and maternal fetal complications
biweekly testing of NST, BPP and amniotic fluid |
|
|
Criteria for home care with PPROM
|
PPROM > 72 hours
Cervical dialtion < 3cm no infection no PTL client comply with rules no breech or transverse presenation |
|
|
Home care self assesment
|
temp q4h
monitor s &s of infection assess uterine contractions daily fetal movement counting |
|
|
activity modification for PPROM patients
|
bed rest
NPV proper hygiene no tub baths take antibiotics |
|
|
Complications of PPROM and PTL
|
infection
preterm birth cord prolapse |
|
|
Choriamnionitis is
|
intramniotic infection with risks for mother and fetus
|
|
|
Signs and symptoms of
|
fetal tachycardia
elevated maternal temp uterine tenderness decreased contractions |
|
|
with a premature newborn its important to
|
maintain body temp
organ systems respiratory distress syndrome L/S ratio to check for maturity |
