nursing management of labor and birth at risk
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Nursing Management of Labor and Birth at Risk. Dystocia. Abnormal or difficult labor Vast number of maternal and fetal factors Problems with powers: hypertonic uterine dysfunction, hypotonic uterine dysfunction, precipitous labor - PowerPoint PPT PresentationTRANSCRIPT
Nursing Management of Labor and Birth at Risk
Dystocia
Abnormal or difficult labor Vast number of maternal and fetal factors Problems with powers: hypertonic uterine
dysfunction, hypotonic uterine dysfunction, precipitous labor
Problems with passenger: occiput posterior position, breech presentation, multifetal pregnancy, macrosomia and CPD, structural abnormalities
Problems with the passageway: pelvic contraction, obstructions in maternal birth canal
Problems with psyche: psychological distress
Dystocia (cont’d) Nursing Assessment
History of risk factors Vital signs Uterine contractions Fetal heart rate, fetal position
Nursing Management Promoting labor progress Providing physical and emotional comfort Promoting empowerment
Preterm Labor
Regular uterine contractions with cervical effacement and dilation between 20 and 37 weeks’ gestation
One of most common obstetric complications Therapeutic management
Risk prediction Tocolytic drugs: magnesium sulfate,
terbutaline, indomethacin, nifedipine Corticosteroids Antibiotic prophylaxis for women with group B
streptococcus
Preterm Labor (cont’d) Nursing Assessment
Risk factors Subtle signs Contraction pattern (4 contractions every
20 minutes or 8 contractions in 1 hour) Laboratory and diagnostic testing: fetal
fibronectin, cervical length via transvaginal ultrasound, salivary estriol, home uterine activity monitoring
Preterm Labor (cont’d)
Nursing Management Tocolytic administration Client education Psychological support
Question
Is the following statement True or False?
Psychological stress in the woman can contribute to dystocia.
Answer
True.
Emotions such as fear, anxiety, helplessness, being alone, and weariness can lead to psychological stress, indirectly causing dystocia.
Postterm Labor
Pregnancy continuing past end of 42 weeks’ gestation
Unknown etiology Maternal and fetal risks Nursing Assessment: estimated date of birth; daily
fetal movement counts, nonstress tests twice weekly, amniotic fluid analysis, weekly cervical examinations
Nursing Management: fetal surveillance; decision for labor induction; support; education, intrapartal care
Labor Induction and Augmentation
Induction: stimulating contractions via medical or surgical means; Augmentation: enhancing ineffective contractions after labor has begun
Indications Therapeutic management
Cervical ripening (Bishop’s score): nonpharmacologic methods; mechanical methods; surgical methods; pharmacologic agents
Oxytocin
Labor Induction and Augmentation (cont’d)
Nursing Assessment Relative indications; gestational age
determination Fetal status; maternal status; Bishop’s
score Nursing Management
Explanations Oxytocin administration Pain relief and support
Question
Is the following statement True or False?
Oxytocin is an important agent used to ripen the cervix for labor induction.
Answer
False.
Oxytocin is used to induce or augment labor once the cervix is ripe.
Intrauterine Fetal Demise
Numerous causes Devastating effects on family and staff Nursing Assessment
Inability to obtain fetal heart sounds Ultrasound to confirm absence of fetal
activity Labor induction
Nursing Management Assistance with grieving process Referrals
Umbilical Cord Prolapse
Obstetric emergency Pathophysiology: partial or total occlusion
of cord with rapid fetal deterioration Nursing Assessment
Prevention; risk factors Continuous assessment of client and fetus
Nursing Management Prompt recognition Measures to relieve compression
Placental Abruption Obstetric emergency involving premature
separation Risk factors Management dependent on gestational age,
extent of hemorrhage and maternal-fetal oxygenation perfusion
Maintenance of maternal cardiovascular status Prompt delivery of fetus Cesarean birth if fetus still alive; vaginal birth if
fetal demise
Uterine Rupture Obstetric emergency; onset marked by
sudden fetal bradycardia Nursing Assessment
Risk factors Onset of sudden fetal distress; other signs
Nursing Management Preparation for urgent cesarean birth Continuous maternal and fetal monitoring
Amniotic Fluid Embolism Obstetric emergency Sudden onset of hypotension, hypoxia, and
coagulopathy due to breakage in barrier between maternal circulation and amniotic fluid
Nursing Assessment: difficulty breathing, hypotension, cyanosis, seizures, tachycardia, coagulation failure, DIC, pulmonary edema, uterine atony with subsequent hemorrhage, ARDS, cardiac arrest
Nursing Management: supportive measures to maintain oxygenation and hemodynamic function and to correct coagulopathy; critical care monitoring
Question
Which of the following assessment findings would lead the nurse to suspect an amniotic fluid embolism?
A.Respiratory distress B.HypertensionC.Acute abdominal pain D.Sudden fetal distress
Answer
A.
Amniotic fluid embolism should be suspected in any pregnant woman with an acute onset of respiratory distress and hypotension. Sudden fetal distress and acute abdominal pain are associated with uterine rupture.
Amnioinfusion Indications
Severe variable decelerations due to cord compression
Oligohydramnios due to placental insufficiency Postmaturity or rupture of membranes Preterm labor with premature rupture of
membranes Thick meconium fluid
Nursing management: teaching, maternal and fetal assessment, preparation for possible cesarean birth
Forceps- or Vacuum-Assisted Birth Application of traction to fetal head Indications: Prolonged second stage of labor,
nonreassuring FHR pattern, failure of presenting part to fully rotate and descend, limited sensation or inability to push effectively, presumed fetal jeopardy or fetal distress, maternal heart disease, acute pulmonary edema, intrapartum infection, maternal fatigue, infection
Risk of tissue trauma to mother and newborn. Prevention as key
Cesarean Birth
Classic or low transverse incision Major surgical procedure with
accompanying risks Nursing Assessment: history and
physical examination for maternal and fetal indications
Nursing Management Pre-operative care Post-operative care
Question
Is the following statement True or False?
An amnioinfusion is appropriate for a pregnant woman experiencing a prolonged second stage of labor.
AnswerFalse.
Amnioinfusion is indicated for severe variable decelerations due to cord compression, oligohydramnios due to placental insufficiency, postmaturity or rupture of membranes, preterm labor with premature rupture of membranes, and thick meconium fluid. A forceps- or vacuum-assisted birth would be indicated for a prolonged second stage of labor.
Vaginal Birth After Cesarean (VBAC) Controversy related to risk of uterine rupture
and hemorrhage Contraindications Special areas of focus: consent,
documentation, surveillance, and readiness for emergency
Nurses as advocates for clients; expertise in reading fetal monitoring tracings to identify nonreassuring pattern and instituting measures for emergency delivery