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L&D Intrapartal
L & D Care of Intrpartal client by Lucy
| Question | Answer |
|---|---|
| Premonitory signs of Labor | Braxton-Hicks, Backache, Lightening, Cervical ripening, Bloody show, and GI symptoms. |
| S & Sx of False Labor | Irregular contractions, walking relieves contractions, bloody show no present, and no change in effacement/dilation of cervix. |
| S & Sx of True Labor | Contractions develop a regular pattern, contractions become stronger and more effective w/walking, discomfort in lower back/abdomen, Bloody show, and progressive effacement/dilation of cervix. |
| Physiology of Labor | Hormonal changes, fetal hormone production, uterine distention, oxytocin receptors increase, and Fern and Nitrazine tests. |
| Preterm Labor | Labor that starts after the 20th week but before the end of the 37th week. |
| Etiology of Preterm Labor | Associated/risk factors, but ~50% may not exhibit these factors: Maternal medical conditions, use of reproductive technologies, obstetric conditions, maternal or fetal, social/environmental factors, and demographics. |
| S & Sx of Preterm Labor | Often subtle, uterine contractions that are "cramping," low backache, pelvic pressure, abdominal cramps, Increase of vaginal discharge, cervical changes, and no feeling good. |
| Determining Preterm Labor | Diagnostic evaluation, physical assessment, labs, sterile speculum exam, ultra sound, fetal fironectic (fFN): protein present in fetal tissue, usually absent ~22-37 weeks; if positive, increased risk preterm birth, cervical length, and infections w/PROM. |
| Stopping Preterm Labor | Ascertain maternal/fetal contraindication, for stopping labor, treat infections, restrict activity, & hydration: may contribute to uterine irritability-dehydration activates pituitary to secrete ADH and may cause release of oxytocin. |
| Preterm Labor/Management | Use of Tocolytics. |
| Magnesium Sulfate | Quiets uterine contraction:decrease muscular excitability.Unlabeled use for preterm labor. Excreted in urine so must have adequate U/O. Assess deep tendon reflexes,respiratory status,U/O. Criteria to continue:UO 30 mL/hr presence of DTR,min 12 resp/min. |
| Beta-Adrenergics (Ritodrine & Terbutaline) | Side effects: increase HR(often hold >120, or per protocol). Breath sounds: SOB, c/o of chest pain. Metabolic changes: check blood glucose levels, restlessness, tremors, and nervousness. |
| Calcium Channel Blockers | Nifedipine (Procrdia) calcium needed for muscle contraction. |
| Prostaglandin Synthesis Inhibitors | Indothethicine: prostaglandin stimulate UC. |
| Fetal Lung Maturity Acceleration | Corticosteroids before birth to decrease severity of complications of respiratory system. |
| Components of Labor | 4 "P"s Psyche, passage, passenger, and powers. |
| Psyche | Labor can be experienced as loss of control, factors influencing response, childbirth prepartion, gather information on woman's expectations; help identify stressors. |
| Passage | Consists of hard passage(bony pelvis), soft tissue structures(stretching of cervix, vagina, perineum).4 Types pelvis shapes with gynecoid considered ideal-~50% have other shapes may cause fetus to enter pelvis in position not conducive to labor progress. |
| Problems with Passage | Dystocia:any labor deviation from normal labor pattern, difficult, prolonged, or abnormal labor. Pelvic Dystocia:Pelvis too small or of abnormal shape, and often increase risk for mal-presentation,cord prolapse. Maternal & fetal risks. |
| Passenger | Fetus, placenta, umbilical cord, and amniotic fluid and membranes. |
| Passenger - Fetus | 1. Fetal lie:relationship of long axis of fetus to long axis of mother(longitudinal). 2. fetal attitude:pose assumed within the uterus(flexion). 3. Presentation:portion of the fetus coming first (cephalic, breech, shoulder). |
| Problems with Passenger | Can be R/T fetal anomalies, presentation, position, size, multiple gestation, and cord. |
| Fetal Anomalies | Anything that affects the relationship of fetal anatomy to maternal pelvic capacity. |
| Mal-Presentation | 1) Face/brow 2) Transverse lie 3) Breech |
| Breech | Maternal Risks. Fetal Risks. Treatment: external version and C-section. |
| Fetal Size | Macrosmia. Often leads to dephalopelvic disproportion (CPD). Maternal and fetal risks. Treatment. |
| Prolapsed Cord (nursing intervention) | Stop Pitocin if running. Intervention to relieve pressure:change position (modified sims or knee/chest position, extreme trendelenburg). Call for help. Oxygen (mother). Monitor FHR. Tocolytic as ordered. Support parents. |
| Powers - Uterine Contractions | The upper two-thirds of the uterus contracts actively.The lower third and the cervix are passive.During labor, the upper segment of the uterus becomes thicker.The lower segment and the cervix become thinner & are pulled upward. |
| Problems with Powers-Hypotonic uterine contractions | Hypotonic uterine contractions:UC become infrequent, decrease in intensity and become ineffective;labor progress slowed. Usually seen in active phase.R/T exhaustion,infection,psychological. Result:fetal infection or death.May need ultrasound. |
| Problems with Powers-Hypertonic Uterine Contractions | Seen in latent phase.Increased frequency and resting tone, but may see decrease intensity cervix dilated <4. Result:Ineffective force to dilate cervix.Decreased utero-placental perfusion.Increased pain:myometrium hypoxic,exhaustion,aspiration of meconium. |
| Mechanisms of Labor | Descent of the presenting part through true pelvis. Engagement, Flexion, Internal rotation, extension, and expulsion. |
| Indications for Cesarean Birth | Abnormal labor, inability of the fetus to pass through pelvis, maternal conditions, such as GH & DM, active maternal herpes virus, previous surgery on uterus, fetal compromise, & placenta previa or abruptio placentae. |
| Cesarean Delivery | Aware of possibility of C-section. Routine pre-op:emergency, consider time frame to comprehend situation;not much time to teach.Psychological impact for parents;increased anxiety.Feelings of dependency/lack of control.Support mom. Emphasize care for baby. |
| Risks of Cesarean Birth (mom) | Mother:Anesthesia, respiratory complications, hemorrhage, DVT, injury to urinary tract, delayed intestinal peristalsis, and infection. |
| Risks of Cesarean Birth (neonate) | Neonate: Inadvertent preterm birth, respiratory problems because of delayed absorption of lung fluid, and injury. |
| Pitocin Use in Induction | Induction: Initiating labor by artificial means with use of drugs. |
| Pitocin Use in Augmentation | Augmentation: Stimulate UC in presence of spontaneous but ineffective labor. Protocols vary by facility. Goal: UC every 2-3 min, 45-90 sec, resting interval of at least 30 sec. |
| Warning Signs of Pitocin Use | Warning signs: Uterine contractions > 90 sec, . 90 mmHg, resting tone >20 mmHg, <2 min apart, signs of fetal distress. |
| Nursing care during Pitocin Use | Close observation: UC pattern, FHR, hypertonic UC, fluid I/O, VS. |
| Baseline Fetal Heart Rate | Parameters: 120 - 160 bpm Interpretation: Normal |
| Tachycardic FHR- Moderate, Marked | Parameters (monderate): 161-180 bpm Interpretation: non reassuring. Parameters (marked): >180 bpm Interpretation: Abnormal |
| Bradycardic FHR- Moderate, Marked | Parameters (moderate): 100-119 bpm Interpretation: Non reassuring Parameters (marked): <100 bpm Interpretation: Abnormal |
| Accelerations in FHR | Parameters: >15 bpm for >15 sec. Interpretation: Stimulation, maternal fever. |
| Decelerations FHR- Early, Late, & Variable | Parameters (early): 10-40 bpm Interpretation: head compression Parameters (late): 5-60 bpm Interpretation: Hypoxia/Acidosis Parameters (variable): 10-60 bpm Interpretation: Cord compression, non-reassuring. |
| Interventions for Late or Variable Decelerations | Lasting >60 sec. Reposition patient, administer O2 by face mask, discontinue oxytocin, IV fluids to increase maternal volume, notify physician, vaginal exam to check for prolapsed cord, and prepare for emergency C-section. |
Created by:
tiniekittie12
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