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Main Components of Dysfunctional labor
- Problems with powers
- Problems with passenger
- problems with passageway
- problems with Psyche
What does the word dystocia mean? prolonged labor, power, passageway, pathway
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Complications with Power:
Hypertonic Uterine Dysfunction
- Clinical Manifestation: lots of contractions but the cervix doesn't change. the uterus doesn't relax between contraction
- Occurs: when the contraction cannot relax. Prolonged latent phase. happens early in labor
- Maternal risk: could mess with mom psyche in which she can tighten up. mom gets exhausted. mom in pain and no process
- Fetal risk: placental profusion becomes compromised- reducing oxygen
- Therapeutic management: hydration, sedative to relax, promote relaxation,
- Nursing management: continous monitoring of the baby
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Complication with powers:
Hypotonic Uterine dysfunction
- Clinical manifestation: when contractions are slow. contractions are not strong enough to dilate/efface
- occurs: during active phase 4-7cm
- maternal risk: hemorrahage after labor bc not contracting
- therapeutic management: might do an infusion of oxytocin to augment the labor, AROM if head is engaged
- Nurse management: +96
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comparision of hypotonic and hypertonic
- Criteria Hypertonic Hypotonic
- Phase of labor latent active
- symptoms painful painless
- meds
- Oxytocin no yes
- sedation helpful little value
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Complication of powers:
Precitious labor
- Clinical manifestation: fast labor completed in less than 3hrs onset to delivery of baby
- occurs: soft tissue that strench quickly
- maternal risk: risk for tissue damage, trauma to mom peritineal.painful no rest between contractions
- fetal risk: bc baby isn't supported during delivery- hypoxia, intracranial pressure hemmorahage, head trauma, nerve damage
- Therapeutic management: pain management, have health team in place for delivery
- Nursing management: frequent updates, keeping mom calm, reassurance about her condition
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complication with passager:
persistent occiput posterior position
- diagnosis: dont know why it happens
- clinical manifestion: head pushing against mom's backbone coccoxy, poorly flexed head
- maternal risk: backpain,
- fetal:
- therapeutic manage: counterpressure, no epidural then warm packs (based on hospital policy), change position-sitting, rocking, sidelying to turn baby
- nursing management: same as above encourage empty bladder, IV glucose replacement if tired, LR, sometimes moms get stressed caused prolonged
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Face and brow presentation
- look at past notes
- makes it difficult for the baby to come out bc head is not tucked.
- difficult for them to come thru pelvis
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Breech presentatin
- footling, frank position
- risk largest part coming out last cause the cervix may start to close around the neck
- c-section
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External Cephalic Version
- External cephalic version is performed before the birth to turn the infant into a vertex position (head down)
- manually try to manipulate very uncomfortable
- done 36-37
- risky
- Nursing management:
- FHR and ultrasound should be recorded continously- monitor baby
- tocolytic agent may be administered- to relax
- admin RH to patient who are RH negative
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External cephalic version:
contraindications
- mulitple gesation
- severe oligohydraminos- bc not enough fluid to move around
- contraindications to vaginal birth
- nuchal cord
- unexplained 3rd trimester bleeding (possible placenta previa
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Shoulder dystocia
- Diagnosis: incre due to increase in birth weight
- Clinical manifestation: baby's head is delivered but shoulders get stuck
- Occurs:
- fetal risk: baby heart can go down, if shoulders can't make it thru md may have to break shoulder- brachial plexus, where is the cord
- maternal risk: postpartum hemmorhage, uterine atony, laceration
- therapeutic management:
- nursing management: Mcroberts- butterfly moms legs as far back as it can go or subrapubic pressure light pressure is applied
- scary
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Mulitple gestation
- Dx:
- clinical manifestion: spontaneously, fertility meds
- occurs: hearing one than one hr, mother measuring large, leopold manevers, confirmed by u/s
- fetal risk:
- maternal risk: postpartum hemmorage, uterine atony
- therap manag:
- nursing manage:
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excessive fetal size and abnormalities
Macrosomia
- big babies
- excess fetal weight 4,000-4500g (8.13-9.15lb
- can cause problem with vag delivery
- sometimes mom has a hx of having big babies- so md may recommend mom having c-section if not could end up with shoulder dystocia
- mom risk- shoulder wont fit
- baby risk: shoulder dystocia, brachial plexus injury, nerve damage
- hydrocephalic baby- big headed baby
- she be indentify a head of time thru ultrasound*
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Passway complication:
pelvic dystocia
- contraction of one or more of the three planes of the pelvis causing a disproportion between the fetal head and pelvic diameters known as cephalic pelvic disproportion (CPD)
- Contracted pelvis:
- pelvic shape other than gynecoid
- decrease of anterior-posterior diameter and transverse
usually will do a measurement
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Soft tissue dystocia
- birth passage is obstructed by an anatomical abnormality other than that involving the bony pelvis
- prevents fetus entering the bony pelvis
- bandl ring (pathological retraction ring); develops between the upper and lower uterine segments
- - associated with protracted labor, prolonged rupture of membranes, and in increase risk of uterine rupture
- fibriods tumors can prolong labor
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Problems with pysche
Emotions can lead to psychological stress which indirectly can cause dystocia
- dx: baby has decel (has to stay put), mom who wants natural childbirth but baby gets fresh u need a c-section, no meds but pain is so much
- clinical manifestion:fear, anxiety, helpness, being alone, weariness
- occurs:hormones can be released to cause dystocia
- fetal risk:
- maternal risk:
- thera manage: a little nubain so mom can relax
- nurse manage: patience, physical and emotional support
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Nursing assessment for dystocia
- Hx of risk factor mom: tear, anxiety
- assessing VS: BP
- uterine contractions
- fetal HR, fetal position
- amniotic fluid: time odor, color
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Nursing management for dystocia
- promoting labor progress
- - 1 cm/hr for cervical dilatin
- - when membranes are ruptured- fetal HR and cord prolapse
- - assess fluid balance status, monitor bladder for distention
- - monitor fetal well being
- prepare to admin oxytocin for hypotonic labor
- provide emotional/physical comfort
- promoting empowerment
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Common causes of dysfunctional labor
- inapproriate use of analgesia- assess pain
- pelvic bone contracture that has narrowed the pelvis
- poor fetal position- breech
- extension rather than flexion of the fetal head- attitude
- overdistention of the uterus
- cerivical ridigity (unripe)- bishop score to access if ready for labor based on thin, soft, dilated) ready for induction
- presence of full rectum/bladder- will stop
- exhausted- let them down rest bc it gives
- them strength. if mom and baby looks good
- primigravida
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