High Risk Labor and Delivery (Final)

41 terms by lscheema 

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Hypertonic labor

resting tone of the myometrium increases - contractions are more frequent but intensity may decrease = painful and ineffective contractions. This can cause maternal exhaustion and fetal intolerance to labor, decreased placental perfusion and asphyxia

What pain medication is prescribed for hypertonic labor

demerol and morphine

Hypotonic Labor

less the 2-3 contractions in 10 min. generally occurs in the active phase of labor. These are really weak contractions that dont result in dilation or effacement = maternal exhaustion and infection. and fetal intolerance of labor and asphyxia

who does hypotonic labor effect most?

those who have already had children

how is hypotonic labor managed?

with admin of pitocin, encouraging voiding, preventing dehydration, position changes, limit vag exams if ROM

Precipitous labor

labor lasting less then 3 hours. Sudden, unexpected and often unattended birth. Not really any pushing - baby just slides out in second stage of labor

what are risks to the mother in precipitous labor

hemorrhage and laceration

fetal risks of precipitous labor

hypoxia and CNS depression

Postterm Labor

pregnancy extends beyond 42 weeks. usually induce by 41 weeks

assessing postterm labor

NST 2-3 times a week and assess for fetal distress

Malpresentation of the fetus includes

persistent occipital posterior, brow, face, breech, shoulder

what does malpresentation of the fetus result in

dysfunctional labor patterns, arrest of descent or dilation, pain

what position should the baby be in for labor

occiput anterior

fetal dystocia

difficult labor due to fetal malposition, excessive size multiples, fetal anomaly. vaginal birth is difficult if not impossible

Pelvic dystocia

presence of contractions in one or more of the three planes of the pelvis (inlet, midpelvis, outlet)

what is a favorable pelvis for child birth

genecoid or anthropoid

cephalopelvic disproportion

fetus is larger than the pelvic diameter. This can be caused by abnormal position/ presentation and may occur as the presenting part tries to pass through the pelvis

what position change is best for cephalopelvic disproportion

squatting

Shoulder dystocia

the anterior shoulder or both shoulders become impacted above the pelvic rim after the delivery of the head

what are the signs of shoulder dystocia

turtle head retraction of the fetal head back into the vaginal canal

what are complications of shoulder dystocia

brachial plexus injury, broken clavicle, neurological injury, asphyxia, death

management of shoulder dystocia

suprapubic pressure (downward traction of the fetal head) (get on patient and push really hard). midline episiotomy. McRoberts maneuver (pull legs up to chest), empty bladder, anticipate neonatal resuscitation.
Last resort: push babies head back in and do a C-section.

What should never happen when shoulder dystocia occurs

applying fundal pressure

Prolapsed cord

umbilical cord precedes the presenting part. pressure from presenting part and maternal pelvis compress cord and decrease blood flow to the fetus.

risk factors to cord prolapse

malpresentation, presenting part not engaged, preterm or small fetus, multiple gestations

management of cord prolapse

relieve pressure of the cord ASAP! lift the presenting part of the cord and hold it this way until pt is in the OR. admin O2 and IV bolus. DC oxytocin and admin a tocolytic to decrease uterine activity

Anaphylactoid Syndrome (Amniotic Fluid Embolism)

leaking of amniotic fluid into maternal circulation/ immune response to fluid. This is an EMERGENCY!

signs of Anaphylactic syndrome

acute dyspnea, hypoxia, cyanosis, hypotension, cardiac and respiratory arrest, uterine atony, massive hemorrhage, coagulopathy-disseminated intravascular coagulation

Uterine Rupture

tearing of the uterine muscles either partial or complete. caused from: weakened uterine scar, mismanagement of pitocin, obstetric trauma

signs of uterine rupture

tearing sensation, vaginal bleeding, fetal compromise or loss of fetal heart time, maternal hemorrhage, hypovolemia, shock

1st degree lacerations

vaginal mucose membranes and perineal skin - just skin and mucous membranes

2nd degree lacerations

same as 1st + tear to underlying fascia and muscle of perineal body

3rd degree lacerations

same as 1st and 2nd + anal sphincter and anterior wall of the rectum

4th degree lacerations

same as 1st, 2nd and 3rd + rectal mucosa and lumen of the rectum

when can a sitz bath be initiated

24 hrs after labor

placenta percreta

myometrium penetrated by chorionic villi

Placenta increta

myometrium in invaded by chorionic villi

Placenta Accreta

chorionic villi attach directly into the myometrium = hemorrhage-placenta fail to separate... hysterectomy

Uterine inversion

Uterus comes through vagina inside out. can occur both at the time of birth or later in life.

management of uterine inversion

must be replaced manually or surgically

DIC

associated with lots of complications of pregnancy: preeclampsia, post partum hemorrhage, sepsis, anaphylactic shock

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