Birth at Risk

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  1. 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
  2. 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
  3. 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
  4. comparision of hypotonic and hypertonic
    • Criteria            Hypertonic       Hypotonic
    • Phase of labor   latent               active 
    • symptoms         painful             painless
    • meds      
    • Oxytocin           no                       yes
    • sedation            helpful               little value
  5. 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
  6. 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
  7. 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
  8. Breech presentatin
    • footling, frank position
    • risk largest part coming out last cause the cervix may start to close around the neck
    • c-section
  9. 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
  10. External cephalic version:
    • mulitple gesation
    • severe oligohydraminos- bc not enough fluid to move around
    • contraindications to vaginal birth
    • nuchal cord
    • unexplained 3rd trimester bleeding (possible placenta previa
  11. 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
  12. 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:
  13. excessive fetal size and abnormalities
    • 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*
  14. 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
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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
Card Set
Birth at Risk
poor mama and baby
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