NR 222 -Maternity Health Assignment

NR 222 -Maternity Health Assignment

NR 222 -Maternity Health Assignment

Dystocia

Abnormal or difficult labor
Progress of labor deviates from normal
Influenced by several maternal/fetal factors
Apparent in active phase

Leading cause of C-sections

dystocia

Dystocia risk factors

-Epidural/excessive analgesia
-Multiple gestation
-Ineffective maternal pushing technique
-Occiput posterior position
-Nulliparity, short maternal stature
-Fetal birth weight over 8.8 lb.
-Shoulder dystocia
-Maternal age over 35 years
-Overweight
-Gestational age over 41 weeks
-Chorioamnionitis
-Ineffective uterine contractions
-High fetal station at complete cervical dilation
-Abnormal fetal presentation or position
-Fetal anomalies

Occiput posterior position -SIGN = backpain of mother could get stuck – nursing action?

massage mother’s back

Shoulder dystocia – shoulders get stuck – head is out but shoulders stuck- nursing action

– grab patient’s leg and do suprapelvic pressure – this will release one shoulder and you grab the baby – if doesn’t work, fracture baby’s clavicle, if doesn’t work, need to fracture the pelvis

High fetal station at complete cervical dilation

means baby not engaged, mom is fully dilated, so could have cord prolapse

Hypertonic uterine dysfunction

give magnesium sulfate to reduce number of contractions.

Hypotonic uterine dysfunction
-ex early phase should be 2 every 10 min, but then if she has 1 every 10 min this is hypotonic – less contractions than when you expect – if she switches suddenly from 2 in 10 to 1 in 10- treatment:

Pitocin – med to inc contractions (active shd be 3-4, transition should be 4-5)

Protracted disorders:

slower cervical dilation and/or descend of the fetal head – maybe try to rotate baby

Arrest disorders:

no progress in cervical dilation and/or failure of descent – usually ends in C section

Precipitate labor (labor complete in less than 3 hrs)

aggressive labor- could lead to complications – hemorrhage or lack of oxygen to baby -trauma, can have lacerations, hematoma of baby.

NR 222 -Maternity Health Assignment

Causes of dystocia- problems with powers

Hypertonic uterine dysfunction
Hypotonic uterine dysfunction
Protracted disorders: slower cervical dilation and/or descend of the fetal head
Arrest disorders: no progress in cervical dilation and/or failure of descent
Precipitate labor (labor complete in less than 3 hrs)

dystocia- problems with passageway

Pelvic contraction
Obstructions in maternal birth canal (swelling of the soft pelvic tissues)

dystocia- probs with passenger

Occiput posterior position
Breech presentation and shoulder dystocia
Multifetal pregnancy
Macrosomia
Structural abnormalities

dystocia- probs with psyche

psychological distress

dystocia assessment

vital signs, contractions, fetal position and presentation, SROM

dystocia management

Evaluate labor progress
Provide emotional and physical support
Back massage in case of occiput posterior position
Promote relaxation and reduce stress

Intrauterine Fetal Demise nursing assessment

Inability to obtain fetal heart sounds
Ultrasound to confirm absence of fetal activity
Labor induction

In utero NEED TO DOCUMENT

THAT YOU DID NOT FEEL THE FETAL HEART RATE

Labor Induction

stimulating contractions via medical or surgical means before the onset of spontaneous labor

no signs of true labor but you need to start labor -after 42 weeks by definition – start because placenta is aging

Labor Augmentation

enhancing ineffective contractions after labor has begun
-Stimulation of uterine contractions after labor has started but progress is unsatisfactory
-Implemented for management of hypotonic uterine dysfunction

for hypotonic problems – may occur from:
Epidural
Topolytics
Some other reason
Want to enhance contractions

indications for labor induction/augmentation

Prolonged gestation
Prolonged premature
Rupture of the membranes
Gestational hypertension
Cardiac disease
Renal disease,
Chorioamnionitis
Dystocia
Intrauterine fetal demise,
Isoimmunization
Diabetes

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contraindications for labor induction/augmentation

Complete placenta previa
Abruptio placentae
Transverse fetal lie
Prolapsed umbilical cord
Prior classical uterine incision or uterine surgery

If mother has term baby and mother has infection, she has ruptured membranes, would you induce labor right away?

mother has chorioamnionitis – do C section

Premature baby and chorioamnionitis treatment?

Try to give
Corticoids and antibiotics and wait 48 hours so corticoids give lung maturity and then take baby out – via C section

Common Induction Methods – nonpharm

herbs, castor oil, hot baths, nipple stimulation, sexual intercourse

Common Induction Methods – pharm

Prostaglandins: Labor induction
Dinoprostone gel (prepidil), dinoprostol inserts (cervidil) and misoprostol (Cytotec)
Oxytocin: Labor Induction and Augmentation

drug of choice for labor induction and augmentation

misoprostol (Cytotec) – pill normally for GI problems – put with vaginal exam – the pill in the os – causes dilation and effacement – they have never created formal pil- just same GI pill -be careful it can fall out

patient unstable – can give induction/agumentation?

If unstable, do not give induction or augmentation

nursing assessment for labor induction and aug.

Relative indications; gestational age determination
Fetal status; maternal status

nursing management for labor induction and aug.

Explanations
Oxytocin administration
Pain relief and support

can pitocin and epidural go together?

YES