indications for induction of labor
history of rapid or silent labors, precipitate birthcoexisting medical disordersPROM (24 hr before labor)congenital anomalypostterm pregnacy with nonreactive NSTintrauterine fetal death
nursing care for induction of labor
amniotomy (breaking water)oxytocininternal fetal monitoring
when performing assess?
"taco" Time Amount Color Odor
dystocia
abnormal labor pattern in which abnormalities occur with the power, the passenger, or the passage
causes of dystocia
dysfunctional labor (or uterine ctx's) alterations in passage fetal causes ineffective pushing psychological responses
dysfunctional labor (hypertonic)
usually occurs before 4cm dilation most often in primipara, fearful, anxious pain out of proportion to intensity and effectiveness frequent, uncoordinated, poor resting tone
potential maternal problems with hypertonic labor
maternall loss of control and fatigue stress in coping abilities dehydration and increased risk of infection if labor is prolonged
potential fetal problems with hypertonic labor
fetal asphyxia cephalhematoma, caput succedaneum, or excessive molding
hypertonic nursing care
provide comfort and supportsupportive measures (shower, position change, walking, mouth care, relaxation exercises and meds)education
Hypotonic dysfunctional labor
usually occurs after 4cm dilation following normal latent/early active labor causes may be CPD, malpresentation/position, overdistention of uterus CTX's infrequent; normal resting tone
potential maternal problems with Hypotonic labor
maternal loss of control and exhaustion
fetal problems with hyptonic labor
infection of amniotic sac
medical management of hypotonic labor
rule out CPD
nursing management for hypotonic labor
rest, analgesia if no CPD or ROM often normal labor will resume after sleep or rest
problems with powers include
abnormal patterns lax abdominal wall ineffectice pushing (secondary)
abnormal patterns r/t problems with powers
prolonged latent protracted active secondary arrest protracted descent, arrest of descent, failure of descent precipitous labor
lax abdominal wall
displaces fetal head; prevents engagement sculteus binder
ineffective pushing
anesthesia, exhaustion, malpresentation/position may require forceps or vacuum extraction
alterations in pelvic structure
pelvic dystocia soft-tissue dystocia
pelvic dystocia
pelive size and/or shape midplane most common problem
soft-tissue dystocia
any tissue other than bone that impedes descent placenta previa, fibroids, adipose tissue
fetal factors affecting normal labor
anomalies CPD malposition malpresentation multifetal pregnancy shoulder dystocia
postterm pregnancy - maternal risk
perineal damage due to the increased size of the fetus maternal hemorrhage cesarean birth
postterm pregnancy - fetal risk
decrease in uterine-placental-fetal circulation (due to placental changes) oligohydramnios meconium staining SGA or LGA
precipitous labor
labor and birth that last less than 3 hrs; hypertonic, tetanic CTX
potential problems with precipitous labor
uterine rupture, abruptio placenta post partal hemorrhage fetal hypoxia and deathtrauma (laceration of cervix, vagina and perineum)
what to do in shoulder dystocia
implement McRoberts maneuver place woman's legs in exaggerated flexion into abdomen (apply suprapubic pressure - NEVER apply fundal pressure) be prepared to place woman in knee chest or lateral position
breech presentation (most common malpresentation)
frank breech presentation
fetal thighs flexed at the hips, legs extended, feet close to face
complete breech presentation
fetal thighs and hips are flexed
incomplete breech presentation
one or both htighs are not flexed; knee, foot or feet is/are presenting part
episiotomy
surgical incision reduces possibility of laceration portects fetal head from pressure exerted by resistant perineum midline, mediolateral
indications for forceps and vacuum assited birth
fetal distress maternal needs
criteria for forceps or vacuum assisted birth
engaged fetal head ruptured membranes full dilation absence of CPD anesthesia empty bladder
types of forcep/vacuum assisted birth
criteria for vaginal breech delivery
frank or complete breech withouth hyperextension of the head fetal weight less than 3500gms adequate pelvic size gestational age of 36-42 wks experienced birth attendant and pediactric support
crieria for c-section
absence of labor when fetal status requires prompt delivery premature fetus whose condition requires minimal stress previous hx of perinatal death or child with birth injury inadequate pelvis
problems with cord
cord prolapse congenital of absence with artery (associated with other anomalies) abnormal insertions abnormal lengths
abnormal cord length
umbilical hernias, abruption, cord rupture transient variables, true knots
cord prolapse
occult, in front of head, complete
presenting part at high station small fetal size or abnormal presentation hydramnios
interventions for cord prolapse
relieve pressure on cord - push head off cord - knee chest position - elevate hips deliver expediently - C-section - vaginally
problems with membranes and fluid
chorioamnionitis fluid imbalance (poly and oligohydramnios) amniotic embolism/anaphalactoid syndrome
chorioamnionitis
infection of membranes and fluid fetal tachycardia, maternal fever, amniotic fluid abnormalities medical and nursing care depends on Sx, maternal and fetal response
hydramnios (polyhydramnios)
over 2000 ml cause unknown, associated with fetal anomalies - may be associated with increased placental function chronic and acute SOB, LE edema d/t VC compression fetal anomalies, preterm birth
management of polyhydramnios
hospitalization Arom, indomethacin
arom
needle amniotomy, amniocentesis abruption, prolapsed cord,
indomethacin used to
decrease fetal urine output = <amniotic fluid
oligohydramnios
less than normal fluid; AFI of <500cc (measure on US) risks of skin, muskuloskeletal abnormalities, pulmonary hypoplasia reduced cushioning effect during labor may lead to cord compression
Pregnancy induced hypertension
occurs in 5-8% of all pregnancies (most common hypertensive disorder in pregnancy/second leading cause of maternal death) preeclampsia and eclampsia
preeclampsia
defined as increase BP after 20 wks gestation accompanied by proteinuria 140/90 or diff of 15 from norm
eclampsia
occurance of a seizure in a woman with preeclampsia who has no other cause for a seizure
maternal risks with pregnancy induced HTN
most organ systems, causing serious complications hyperreflexia, headache, eclamptic seizure rare complication, but is the most common cause of death in women with severe preeclampsia and eclampsia
fetal risks with HTN
preterm birth (15% of all preterm births are a result of preeclampsia) small for gest age placental abruption may be over sedated at birth d/t maternal meds may have hypermagnesmia d/t maternal tx w/ mag sulfate
nursing care for PIH
urine dipsticks for protein q shift blood pressure eval q 1-4 hrs daily weight bed rest corticosteroids anticonvulsants assess deep tendon reflexes and clonus assess for HA, blurred vision and epigastric pain if on mag sulfate chek urine output q 1 hr (should be more than 30cc/hr)
first sign of mag toxicity
decrease DTR
changes in fetal heart rate baseline:
baseline greater than 160 bpm for at least a 10 min period
Which comment made by a client would indicate the client's ability for safe care during the last trimester of pregnancy with mild preeclampsia?A. report any SOB to my MD B. limit my fluid intake after 3 pm C. report any HA or blurr vision to MD D. limit my salt intake during this time
C.
non-reassuring FHR pattern
severe variable deccelerations late deccelerations of any magnitude absence of variability, bradycardia (70 or less) prolonged decceleration lasting 2 min but less than 10 min
severe variable deccelerations consist of
FHR below 70 lasting 30-45 sec accompanied by a rising baseline or decreasing variability
interventions for non-reassuring tracing
document and report findings accurately and promptly to MD continuous monitroing of mom/fetus change position provide O2 increase IV fluids provide information to mom/family admin tocolytic if ordered prepare for immediate delivery
variable deccelerations
occur anytime withing the ctx due to cord compression
with variale decceleration you should do what first
change position to move fetus off of chord 1. give O2, 2. give fluid, 3. amnion fusion
interventions for variable decelerations
d/c pitocin change position perform vag exam O2 per face mask amnionfusion if uncorrected, deliver
late decelerations
occur after the beginning, peak, and end of ctx due to placental insufficiency
late deceleration interventions
D/C pitocin put in side lying position give O2 maintain or increase IV fluids if hypotensive, correct fetal pH sampling
early decelerations
simultaneously with ctx vagal nerve stimulation caused by the fetal head
interventions for early decelerations
position change
shock associated with pregnancy related complications
hypvolemic septic cardiogenic neurogenic
hypvolemic shock
loss of volume
ectopic pregnancy previa and abruption uterine rupture PP hemorrhage obsteteric surgery
septic shock
decreased blood vessel function
cardiogenic shock
decrease pump function
cardiac tamponade PE thrombophlebitis
neurogenic shock
overwhelmed neuro regulatory capacity
uterine inversion electroyte imbalance drug toxicity aspiratino
S/S hypovolemic shock
tachypnea, tachycardia, weak thready pulse hypotn increased cap refill (>4 sec) oliguria (<30cc/hr) cool, clammy skin pallor, peripheral cyanosis hypothermia anxiety, restlessness, thirst, feeling chilled, disorientation
S/S of Septic shock
tachycardia; hyperdynamic pulse tachypnea, resp alkalosis hypotn cerebral ischemia polyuria hyperthermia (early) palpitations, faintness, apprehension, stupor, disorientation
OB emergency interventions
large bore IV O2 admin floey cath admin of blood, blood products, tx coaglopathy, DIC promote fetal/newborn well-being prepare, assist with emergency delivery assess, monitor for changes, fluid overload CPR if necessary w/n 4 min
