Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
N113 Risky Labor
N113 - High risk labor & delivery
| Question | Answer |
|---|---|
| Types of dysfunctional labor | Hypertonic, hypotonic, prolonged, precipitous |
| Hypertonic labor pattern | Usually occurs during early stage of labor, less 4cm dilated. Contractions are frequent and resting time between & intensity is decreased. Pain > effectiveness of contractions = lactic acid cycle. |
| Goal of hypertonic labor | Stop or slow down contractions, with the hope of establishing more effective uterine activity. |
| Hypertonic labor treatment | Bedrest & sedation, IV fluids, may use oxytocin &/or ROM if pattern continues |
| Hypotonic labor pattern | Infrequent contractions, occurs after 4 cm dilation, mild to moderate intensity, fetal descent & cervical dilation slows, less intense & less productive. |
| Hypotonic labor causes | Overstretched uterus, sedation, CPD - cephalopelvic disproportion |
| Hypertonic labor treatment | Pitocin, steadily increase dosage until contractions are 2-4 min apart lasting 40-60 seconds |
| Pitocin half-life | 2-3 minutes |
| Pitocin uses | To induce labor or regulate contractions |
| Pitocin side effects | Contractions closer than 2 minutes, intensity >90 mm Hg (Mercury), duration >90 seconds, resting tone >20 mm Hg, either felt by palpation or intrauterine catheter. Fetal tachycardia, bradycardia, late decels, altered variability |
| Prolonged labor | Lasting longer than 24 hrs, failure of cervix to dilate, need to prevent maternal & fetal complications |
| Prolonged labor causes | Cephalopelvic disproportion, fetal malposition |
| Prolonged labor complications | Maternal - uterine atony, exhaustion, risk for uterine rupture, infection, hemorrhage Fetal - reduced fetal perfusion, fetal asphyxia |
| Prolonged labor treatment | Identify cause &/or complications, stimulate with oxytocin or ROM, birth by c-section if severe maternal/fetal distress |
| Precipitous labor & delivery | Rapid labor that lasts less than 3 hours |
| Precipitous labor causes | Rapid cervical dilation & fetal descent, exceptionally strong contractions, multiparity, large pelvis, small fetus in favorable position |
| Precipitous labor risks | Uterine rupture, postpartum hemorrhage, amniotic fluid embolism, cervical & perineal tears, rapid change in pressure on fetus can lead to cerebral trauma |
| Precipitous labor treatment | May use MgSO4 (magnesium sulfate) to slow contractions. Can occur with oxytocin overdose |
| Preterm labor | 20-37 weeks, documented uterine contractions 4 in 20 minutes &/or ruptured membranes, documented cervical change or effacement of 80%, dilation of 2 cm |
| Preterm labor contributing factors | Infection, placenta previa, abruptio, history of abortion, abdominal surgery, PIH, incomplete cervix, smoking, maternal age, multiple gestation |
| Preterm labor risks | Maternal - Psychological - concern for baby, Infection r/t PROM, risks r/t tocolytics & bedrest. Fetal - Immaturity of organs, Intraventricular hemorrhage, high mortality |
| Preterm labor management | Early detection is key. Stop labor if - no cervical dilation, fetus is viable, no s/s of fetal distress, no medical or obstetrical disorders |
| Preterm labor - other managing factors | Bedrest, hydration - dehydration will cause uterus to constrict, medications |
| When preterm labor that shouldn't be stopped | Severe PIH, fetal anomalies that are incompatible with life, chorioamnionitis - infection in amnionic fluid, hemorrhage, fetal death, severe abruptio placenta, severe fetal growth restriction |
| When it might be okay to stop preterm labor | Dilation of 5 cm or more, mild chronic hypertension, stable placenta previa, uncontrolled DM, maternal cardiac disease, fetal distress, fetal anomaly |
| Ritodrine - Yutopar | Beta adrenergic tocolytic - not used very often due to severe and numerous side effects |
| Terbutaline sulfate - Brethine | Used more commonly, off label use if beta adrenergic drug - bronchodilator. Better tolerated, few side effects. |
| Terbutaline sulfate, Brethine dosage | Started subq then given PO or IV |
| Magnesium sulfate | Fewer side effects than beta adrenergics, given IV at lowest rate |
| Magnesium sulfate side effects | Loading dose can cause flushing, warmth, headache, nausea, dizziness, nystagmus. Must watch for decreased deep tendon reflexes - clonus |
| Magnesium sulfate contraindications | Respiration rate must be greater than 12/min, urine output must be at least 100ml/q4hr. |
| Calcium gluconate | Given to reverse side effects of magnesium sulfate. |
| Magnesium sulfate fetal effects | Hypotonia - sluggish, floppy baby |
| Betamethasone celestone | Steroid given to increase lung maturity. Given only if labor can be delayed 24-48 hours. |
| Betamethasone celestone contraindications | Inability to delay birth, maternal infection, DM, hypertension. May increase risk of pulmonary edema if used with tocolytics. |
| Prolapsed umbilical cord | Cord falls or is washed through cervix into vagina. Risk increased with breech birth, small fetus, long cord, hydraminos, multiple gestation |
| Prolapsed umbilical cord treatment | 1-Reposition-knee chest position or Trendelenburg, 2-give O2, 3-Gloved finger in vagina to lift fetal head off cord. |
| Post-term pregnancy, labor & birth | Extends beyond 42 weeks or 294 days |
| Post-term risks | Maternal-dysfunctional labor r/t macrosomia, lacerations, labor induction, forceps or vacuum assist, c-section. Fetal-birth trauma, asphyxia r/t birth trauma, effects r/t aging placenta, cord compression r/t decreasing amniotic fluid volume |
Created by:
jrb265
Popular Nursing sets