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41 terms

High Risk Labor and Delivery (Final)

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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