OB February 4, 2020- Finals o High intrauterine pressure but with erratic

Intrapartum Complications pattern

Nursing care of women with complications during pregnancy o Resting uterine tone is high, no resting phase
for the uterus
 Happens during process of labor and can affect outcome of o Usually in the latent phase
pregnancy through delivery route  25-50- Mild (ideal mercury)
 50-75- Moderate
Components of labor (power,passenger,passage,psyche)  75-100 mmHg- Strong contraction
Problems with Power o Management: pain management
 Capacity of uterus to expel fetus o Terbutaline or any tocolytic meds may be
 Capacity of the mother to bear down prescribed (help relax the muscles, until a
Ineffective contractions pattern is achieved)
 Intensity is good (mild, moderate, strong)
 Duration is within normal levels (Does not exceed 90 Ineffective pushing
seconds) Usually caused by:
 Frequency and interval is good  Ineffective techniques for positioning
 Causes:  Fear
o Fatigue  Decreased or absent urge
o Inactivity  Exhaustion
o Fluid and electrolyte imbalance (labor for quite a  Psychological unreadiness
longtime) Management
o Excessive analgesia/ anesthesia  Maternal and fetal VS stable: Maximum duration of 2nd
o Catecholamines secreted in response to stress stage of labor (Stage where baby should come out of
o CPD (Cephalo pelvic disproportion) vaginal opening)
o Uterine overdistention (multiple pregnancy,  Compromise maternal and fetal well-being: Operative
polydhyramnios) delivery
 Hypotonic labor dysfunction  Delayed pushing
o Coordinated (has a pattern) but weak contractions  Upright positioning
with increasing pain (on active)  Mc Robert’s maneuver
o Secondary arrest  Accurate information
o Slow labor at 4cm and dilatation even decreases  Rest
o Measures
 Amniotomy Problems with passenger
 Induction or augmentation of labor by  Fetal size: 8lb or 4kg
oxytocin Shoulder dystocia
 Caution for Bandl’s ring  Difficult delivery of shoulder because it is impacted above
 Labor induction symphysis pubis (+ turtle sign)
o Use of artificial method to star uterine contration  Management
o Most common method is oxytocin drip, 10 mins o Mc Robert’s maneuver _ suprapubic pressure
in a 1L IV solution on slow frequency (not IV o Anticipate surgical delivery
push) Abnormal fetal position
 Labor augmentation  Rotational abnormalities- OP or OT instead of OA
o Use of artificial method to improve uterine
 Prevents cardinal movements
contractions
 Labor is longer and more painful
o Either intensity, duration of frequency have
 Change maternal position
already started
Deflexion/ fetal attitude
 Poorly flexed fetal head presents larger dimeter to pelvis
Multiple pregnancy/ fetal abnormalities
 Overdistention of uterus
 Fetal malposition
 Risk for pp hemorrhage
Breech presentation
 Bandl’s ring  Cervical dilatation is slower
 Fundic  Risk for fetal injury, cord prolapse
area  External cephalic version to rotate fetus at 37-39 weeks
contraction thickens and the lower segment of the before labor
uterus thins; thus, pressure is decreased
 Uterine muscles expand instead. Instead of globular Placental defects
uterus or fundic area, an indentation appears Placenta succenturiate
 Danger sign for ruptured uterus  An extra placenta separates from the main placenta
 Management: Cut the oxytocin drip, monitor fetal Placenta circumvallate
heart and report to the doctor  Double fold of amnion and chorion form a ring around the
 Hypertonic dysfunction umbilical cord
o Painful but ineffective (no pattern)  Prone to abruptio placenta
Kristen Azusano
Battledore placenta Operative birth
 Cord at or near edge of placenta  Amniotomy
Placenta vellamentosa o Artirical uprtuing of the membrane during labor
 Vessels of the cord divide some distance from the placenta to allow fetal head to contact cervix
o Position in dorsal recumbent
Problems with passage o Uses amniohook (amniotome)
Pelvis o Risk: Cord prolapse, infection
 Gynecoid: most favorable o Monitor FHT closely
 Anthropoid: possible for vaginal birth but OP  Episiotomy
 Android: heart/ narrow pubic arc; poor chance of vaginal o Surgical incision of the perineum to prevent
birth tearing of the perineum
 Platypoid: wide transverse diameter; poor change of o Release pressure on fetal head and possibly
vaginal birth shorten 2nd stage of labor
 Maternal-fetal race difference poses CPD o Uses blunt-tipped scissors
Maternal soft tissue obstruction o Usually right mediolateral episiotomy or midline
 Bladder distention o Median- less blood less, heals faster
 Nursing responsibility o Mediolateral- teraing beyond incision will not be
o Encourage to void q 2 hours directed towards rectum
o Cathether as ordered if urge to void is depressed  Forceps delivery
o Used if the client cannot bear down properly
Problems with psyche o Outlet forceps delivery- crowning
Factors of excessive stress o Low forceps delivery with traction
 Pain
 Fear  Vacuum extraction
 Non-support system o The gentle but effective M-style to suction the
 Personal situation infant out
Response to stress  Cesarean section
 Increased to glucose consumption o 2 types: Scheduled or emergency
 Epinephrine and norepinephrine o Indication
Nursing responsibility  Cephalopelvic disproportion
 Establish rapport  Active genital herpes
 Relaxation techniques  Previous uterine surgeries
 Provide accurate information  Fetal malpresentation
 Placenta previa
Abnormal labor duration Signs of fetal compromise
Prolonged labor  Non reassuring FHR
 Duration of labor is longer than the normal  Fetal acidosis
o Normal: 1.2-1.5cm/ hour cervicacl dilatation and  Meconium passage
1-2cm/ hour fetal descent Maternal compromise
 Complications:  Exhaustion
o Infetion  Infection
o Exhaustion  Cardiovascular compromise
o Negative birthing experience
 Interventions:
o Assess for infection
o Promote comfort
o Conserve energy
o Emotional support
Precipitate labor
 Birth occurs within 3 hours of its onset
Precipitate delivery/ birth
 Rapid, spontaneous expulsion of the infant
 Labor occurs at any length
 Complications:
o Maternal: cervical laceration, hematoma, uterine
rupture
o Fetal: direct trauma, hypoxia, intracranial
hemorrhage, nerve damage
 Intervention:
o Promote fetal oxygenation
o Promote maternal comfort
o *Side lyring position
o *Oxygenation
Dystocia

Kristen Azusano
Pre cesarean section care
 Informed consent
 Hygiene
 GI prep
o Adequate NPO
o Metoclopramide to speed stomach emptying
o Ranitidine to decrease stomach secretion
 Hydration
 Pre Op medications (anti allergies, antibiotics)

Post cesarean section care

 Pain management with analgesics as ordered
 Close monitoring of signs of excessive blood loss
 Monitor for signs of infection
 Keep on NPO until bowel movement returns
 Monitor urine output (catheterized 1st 24 hours)

Kristen Azusano