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What are these abbreviations:
- G = Gravida or # of pregnancy; P = Parity or # of deliveries
- IUP = intrauterine pregnancy
- BOW = bag of waters
- FM = fetal movement
What are the 4 P's for dysfunctional labor?
This P of dysfunctional labor refers to ineffective contractions or ineffective maternal pushing
(this multiple choice question has been scrambled)
Is Hypertonic dysfunction a latent phase of dysfunctional labor or an active phase?
Is this hypertonic or hypotonic dysfunction:
- UC's uncoordinated and erratic, painful but ineffective
- Loss of downward pressure
- Increased uterine resting tone
T or F: Hypertonic dysfunction is when UC's are coordinated but too weak for labor
List nursing management of Hypertonic contractions
- Promote rest
- ID contributing factors: CPD, fetal malpresentation
- Tocolytics to decrease uterine irritability
List nursing management of HYPOtonic contractions
- Change positions, ambulate
- Pain management
- Amniotomy (amniotic sac is deliberately ruptured)
- Augment labor (Pitocin)
- Consider C-sec
This is characterized by labor that can last as little as 3 hours and is typically less than 5 hours. How do you manage it?
- Precipitous Labor:
- Monitor closely for fetal distress
- DC pitocin
- Optimize uteroplacental profusion by positioning on left side
- Guard perineum and prevent rapid decent
This term refers to when a baby's head or body is too large to fit through a mother's pelvis
Cephalopelvic Disproportion (CPD)
How can these hormones complicate delivery: Catecholamines, cortisol, Epinephrine, Beta-endorphrine?
Release of these stress hormones interfere with uterine contractility and lower placental perfusion.
For normal labor, dilation should be __a__ cm/hr for nullip and __b__ cm/hr in multip
For normal labor, normal descent is _a__ cm/hr for nullip and __b__ cm/hr in multip
This med can inserted directly into the vagina or cervix to induce Labor, where the action is to produce cervical changes
What are implications of induced labor from prostaglandin?
- Might cause abnormal or execssive contractions which diminish baby's O2 and HR
- Increased risk that uterine muscles won't properly contract after birth, causing serious bleeding
What is Terbutaline used for during complicated deliveries?
For induced labor complications that ause achysystole of the uterus resulting in fetal bradycardia and possible hypoxia
Is this augmentation or induction:
This intervention is intended to increase the intensity of labor, usually when labor is not progressing or progressing too slowly
What are indications of Augmentation? What is its intended goal?
If contractions have become weak, not coordinated (or irregular), far apart, not lasting long enough or have ceased.
It is aimed at strengthening, coordinating and/or increasing frequency of contractions until cervix is fully dilated and baby is born
Is this augmentation or induction:
When labor does not naturally start on its and and delivery needs to happen soon.
What are some indications for induced labor?
- Pregnancy has gone 1-2 weeks past due date
- A condition that may threaten your or your baby's health if pregnancy continues
- Amniotic sac has broken but no active labor contractions starte
- Baby has a condition that needs treatment
State if augmentation or induction
1. Stimulates uterine contractions before the onset of spontaneous labor
2. Enhances ineffective contractions after labor has begun
- 1. Induction
- 2. Augmentation
What is a sufficient Bishop score for fetal readiness?
7 or higher
Amniotomy (AROM) is indicated if dilation is only __a__ and there is a bulging BOW.
What are the risks of AROM?
- Prolapse of the ubilical cord
- Prolonged rupture leading to risk of infection
- Need for augmentation
What are some near-term tests for fetal well being?
- Sonograms (placenta, cervix, fetus and fluid)
- Fetal movement (10 kick counts over 3hr period)
- FHR patterns (NST, CST, BST (breast stimulation test))
- AFI (amniotic fluid index)
What is the normal range of the AFI (amniotic fluid index)?
Normal = >5cm and <20cm of fluid
What are the components of the Biophysical profile (5)
- 1. fetal breathing movements
- 2. fetal muscle tone
- 3. gross body movement
- 4. amniotic fluid volume
- 5. reactive FHR NST
What could these findings mean:
FHR = persistent fetal tachycardia
Maternal temp >100.4
Maternal pulse high
foul smelling amniotic fluid
What are some causes of PROM?
- infection of vagina or cervix
- Chorioamnionitis - intraamniotic infection
- Hydramnios - excess of amniotic fluid
- Poor nutrition
- Overdistention of uterus
Define these infection complication risks for PROM:
- 1. Also known as intra-amniotic infection, it is an inflammation of the fetal memranes due to a bacterial infection.
- 2. an inflammatory condition of the lining of the uterus, usually d/t an infection.
What two ways to dx if there is a PROM?
- Nitrazine paper
- Ferning test
What do you look for during a fern test?
A detection of a "fern" like pattern of cervical mucus when viewed under a microscope
List the therapeutic management of PROM (5)
- 1. avoid digital cervical exam
- 2. assess gestational age and fetal well being
- 3. Assess s/s of infection
- 4. Hospitalized and put on bed rest
- 5. Induction if signs of sepsis develop
T or F: If someone with PROM shows signs of sepsis, you would use induction
What does the Fetal Fibronectin test? When is it taken?
20-34 weeks: This is something that leaks into the vagina if a preterm delivery is likely to occur.
If a fFN test is positive, it is an inconclusive test.
T or F: If an fFN test is positive, it means that she is about to go into labor.
False: It can indicate that she will go into preterm labor soon, but may or may not go into labor for weeks.
List three medications that an help stop preterm labor
- 1. Mag Sulfate
- 2. Terbutaline
- 3. Nifedipine
This corticosteroid therapy drug can accelerate Preterm Fetal Lung Maturity. When should it be used?
Betamethasone: If gestational age is >24 weeks and <34 weeks to reduce risk of RDS and IVH
T or F: You would delay delivery of a preterm labor if giving Betamethasone
What is the dose of Betamethasone? What is it for?
Given in two doses of 12mg, 24 hours apart.
Given for preterm labor: accelerates fetal lung maturity and prevent respiratory distress syndrome
List interventions for Preterm Labor
- 1. avoid pelvic exams
- 2. Monitor temp and labs if PROM
- 3. Bedrest
- 4. Hydration
Why do you want to avoid pelvic exams during preterm labor?
It stimulates UC
T or F: You do not want to restrict liquids if a mom is on MagSulfate
What are complications of a prolonged pregnancy?
- Insufficient placental function
- Decreased amniotic fluid
- Large fetus
- Harder labor or birth injury
What is Velamentous Insertion?
When the umbilical cord inserts into the fetal membranes, then travels within the membranes to the placenta.
This means that the blood vessels of the umbiliccal cord are unprotected by the Wharton's jelly and may rupture during anytime of the pregnancy.
Fill in: When cord prolapse is diagnosed, goal is __a__ off of cord and __b__ in __c__ position
Fill in: When cord prolapse is diagnosed, goal is elevation of presenting
off of cord and emergent delivery
in knee chest
- a. Elevation of presenting
- b. emergent delivery
- c. knee chest position
What is amniotomy?
Artificial rupture of membanes
T or F: an Amniotomy is performed during a prolapsed cord delivery
How much pressure do you use with a vacuum extractor?
How long do you use it for? When should u d/c it?
- 50-60 mmHg of pressure
- No more than 10 minutes
- after , should be d/c3 pop-offs
T or F: If placenta isn't delivered after 10 minutes the baby is born, it should be manually removed.
False: if it is longer than 30 minutes