Labor and Birth at Risk

1
Chapter 21

• Labor and Birth at Risk

2
Dystocia

• Disruption of labor
• Emotional factors
• Contractions
• Fetus
• Pelvis
• Relation between pelvis and fetus

3
Contractions

• Hypertonic (latent) labor- irregular in strength
  and timing
• Do not change cervix. Tx- augmentation
• Hypotonic (active) labor-less than 2-3 ucs in 10
  minutes.
• Due to overdistention

4
Nursing Assessment

• Contractions
• FHT
• Coping
• Dehydration
• Fluid
• Infection

5
Malposition

• OP common malposition -most rotate
• May visualize depression in maternal abdomen
  above symphysis
• Change positions- pelvic rocking, hand knees
• Assess for extreme back pain

6
Malpresentation

• Brow-widest diameter.
• Face
• Breech-ECV _at_ 36-38 wks
• Heart tones high
• Risk for prolapse
• T-lie- r/t multiparity, ECV
• Compound presentation

7
Macrosomia

• Greater than 4000 gms, risk for dystocia
• McRoberts, suprapubic pressure
• Greater than 4500 plan C/S
• Assess for Erbs, motor problem
• Maternal risk for PPH
• Falling off the labor curve

8
Multiple Gestation

• High risk, type of multiple gestation determines
  risk
• Associated with PIH, PTL, previa, malpresentation
• Need NST, BPP, serial UTZ
• Many need bed rest

9
Problems with Psyche

• Fear-Anxiety-Pain
• Release of catecholamines increases sensation of
  fear, inhibits perfusion
• Nsg- provide info, comfort measures, praise
• Assessment- FHTs, emotions, bladder, coping
• Interventions- comfort, pain control, info

10
Post term Pregnancy

• Past 42 wks
• Associate with LGA, assisted delivery, oligo, mec
  aspiration, decrease perfusion
• After 40 weeks need NST, BPP X2 q week

11
Cervical Ripening

• To soften and efface
• May need less pitocin
• Reactive NST
• Assess for hyperstimulation and fetal response

12
Labor Induction

• Indications and contraindications for induction
• Confirm dates by LMP and UTZ
• Cervical readiness will determine type of
  medication

13
Pitocin

• Use closest port
• Goal is 3 ucs x 40-60 secs
• Need relaxation in between ucs
• Need maternal and fetal baseline data
• Holistic induction

14
Amniotomy

• May accelerate or induce labor
• Head must be engaged
• Assess FHT before and after
• Color and odor
• Monitor vital signs
• Give pericare

15
IUFD

• Perinatal death after 20 weeks
• Can cause DIC.
• Thromboplastin activates clotting system
• FIB., and factor V and VII are depleted
• DX confirmed by Spauldings sign, estriol levels,
  no heart tones

16
Parents of Stillborn

• Protest, refuse to believe.
• Disorganization
• Reorganization- time frame varies
• Use checklist
• Give mementos

17
Prolapsed Cord

• Cord presents before fetus, vessels occluded
• Monitor FHT following SROM or with amniotomy X
  1min
• If feel cord push up head to relieve pressure
• Knee chest-Trendelenburg to OR
• Preventative- make sure head is engaged

18
Abruptio Placentae

• Cause may be decrease in blood flow.
• Marginal- at edges, may bleed vaginally
• Central-separates centrally, concealed
• Complete- massive bleed total separation
• S/S include rigid abdomen, constant pain

19
Amniotic Fluid Emboli

• Break in chorion or amnion can allow amniotic
  fluid to enter maternal system
• Uterus forces emboli from circulation to lung
• S/S
• Give 02, CPR, ABO

20
Instrumental Assisted Delivery

• Forceps used for traction or rotation
• Risk for facial bruising, lacerations, caput,
  cephalahematoma
• Maternal tissue trauma
• Need adequate pain control
• Vacuum assisted - not on fontanelle
• Evaluate descent

21
Cesarean Section

• Higher rates of infection, reaction to
  anesthesia, clots, bleeding
• Transverse vs. Classical
• Respect preferences and educate
• Assess previous experience
• Emergency C/S