topic 4 high risk labor & delivery

8/7/2019 topic 4 HIGH RISK LABOR & DELIVERY

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HIGH RISK LABOR AND

DELIVERY


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Intrapartum Care


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III. True Signs of Labor

1. Cervical dilation & effacement

a. Primi

b. multi

2. Uterine contractions

3. Show

4. Rupture of membranes

Nitrazine paper

Advantage

Disadvantage


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True False

1. Pain localization

2. Walking

4. Show

5. Duration

6. Frequency

7.Contractions

8. Cervical Dilation

& effacement

9. Fetus


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IV. 5 Ps of Labor

1. Passage

2. Passenger

3. Power4. Position

5. Psyche


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A. Passage

1. Types of Pelvis

2. Pelvic Measurements

3. Softening of tissuesa. Cervix

b. vagina


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Problems w/ Passage

1. Inlet Contraction AP diameter < 11cm

2. Outlet Contraction Transverse diameter


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B. Passenger

1. Fetal head

a. Bones of skull

b. Sutures

c. Fontanel


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d. Areas of the skull

1) Occiput

2) Vertex

3) Sinciput/brow

4) face


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2. Fetal attitude

Attitude Presenting Parts

a. Complete Flexion

b. Moderate flexion

c. Partial Flexion

d. Poor Flexion

e. Very poor flexion


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3. Fetal Lie

4. Fetal Presentationa. Cephalic

b. Breech

Types of Breech

c. shoulder


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5. Fetal Position

a. Maternal Landmarks

b. 4 fetal parts as landmarks (OMSA)

6. StationLOA ROA LOP ROP


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C. Power

1. Characteristics of uterine Contraction

a. Duration

b. Frequencyc. intensity

2. Phases of Uterine Contraction

3. Cervical dilation & effacement


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FHR Deceleration

1. Early deceleration

2. Late deceleration

Interventions

a. Maternal position

b. Oxygen

c. Stop Oxytocin

d. notify

3. Variable deceleration


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D.Position

E.Psyche


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V. Mechanism of Labor

(EDFIREREE)


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V. Mechanism of Labor

1. Engagement

2. Descent

3. Flexion

4. Internal Rotation

Factors to consider

POP


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5. External Rotation

a. Episiotomy

b. 2 nursing responsibilities

c. Ritgens maneuver

d. crowning

6. Extension


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7. expulsion


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VII. Stages of Labor

A. 1st stage

B. 2nd stage

C. 3rd stageD. 4th stage


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A. 1st stage

Stages Dilation Station Duration

(Sec)

Interval

(min)

Intensity

1.Latent

2. Active

3.Transi-

tional


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A. 1st stage

1. Latent

Nursing interventions

a. Assess

b. Teach

c. Encourage walking

d. Ask to void


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2. Active Phase

Nursing Interventions

a. Meds ready

1)Meperidine HCl

2)Nubain

3)Morphine SO4

4)Valium

5)Laminariab. Advise to go to hospital

c. Assess FHR q 15 min. and v/s q 30

min.


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3. Transitional Phase

Nursing Interventions

a. Supportive care

b. Encourage and praise efforts


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B. 2nd Stage

Nursing responsibilities when baby is out

(ASWCL)C. 3rd stage

Placental expulsion

Signs of Placental expulsion Types of Placental delivery

Abnormal placental implantations

Nursing Interventions AssessTwo-vessel cord & Unusualcord length

D. 4th Stage

Episiorraphy


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VII. Comfort and Pain Relief

1. Focusing and Imagery

2. Support from a coach

3. Breathing techniques

4. Analgesia reduces pain or decreasesawareness of it

5. Anesthesia partial or complete loss ofsensation

Primis should be 5cm before analgesics


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Comfort and Pain Relief

Regional Anesthesia

Epidural Anesthesia

Subarachnoid


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VIII. Danger Signs of Labor

A. Fetal danger signs

1. High or low FHR

2. Meconium stain3. Fetal acidosis

4. hyperactivity


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B. Maternal Danger signs

1. Rising or falling BP

2. Increase HR3. Inadequate contractions may be due

to uterine exhaustion (inertia)


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IX. Immediate Care of the New

Born

1. Airway

2. Body temp.

3. APGAR

4. Care of the umbilical cord5. Care of the eyes

6. Identification

7. Vit. K8. Inspect for abnormalities

9. attachment


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Complications of Labor and

Delivery


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I. Dystocia

Types of Uterine Dysfunction1. prolonged or arrested labor > 24 hours after

regular contractions onset

Criteria Hypertonic Hypotonic

Phase of Labor Latent Active

Symptoms Painful Painless

Medication

Oxytocin Unfavorable Favorable

Sedation Helpful Little value


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2. precipituous delivery very rapid, 2 -4

hours may cause trauma to repro. organs &

fetal hypoxia

Collaborative Mgt

a. treat underlying cause

b. adequate hydration

c. Prophylactic antibiotics


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II. Dysfunctional Labor

1. Prolonged Latent Phase Longer than 20 hrs(nullipara), and 14 hrs (multipara)

Signs & Symptoms

a. Hypertonic uterusb. Ineffective contractions

Collaborative Mgt

a. Rehydrationb. Morphine

c. C/S as necessary


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2. Protracted Active Phase MC cause

CPD

a. C/S if w/ CPDb. Augment labor if (-) CPD


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3. Secondary

Arrest of dilatation

4. Prolonged

Descent

5. Arrest of

Descent

No cervical dilatation

in 2 hrs

Descent < 1cm/hr No descent

Collaborative Mgt

1. Semi-fowlers

2. Squatting

3. Kneeling position

4. Effective Pushing

1. C/S

2. Oxytocin


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III. Contraction Rings

A. Bandis Ring B. Constriction RingCause

Excessive retraction of

upper uterine segment

Obstetric Manipulation

OxytocinHorizontal indention on

abdomen (2nd stage)

Occurs anytime

Collaborative Mgt1. morphine Sulfate

2. Amyl nitrite inhalation

3. CS birth


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High maternal mortality

Risk factors

1. multiparity2. improper pitocin use

3. weakened or old CS scar

IV. Ruptured Uterus


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Signs and Symptoms

Weak uterus

Lower uterus ballooning

pathological retraction ring

Ruptured uterus

Sudden abd. pain

Vaginal bleeding

Fetal distress

Fetal death


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Collaborative Mgt

1. treat hemorrhage

2. oxygen as prescribed

3. laparotomy4. hysterectomy


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amniotic fluid enters maternal circulation

Poor prognosis

Pathophysiology

V. Amniotic Fluid Embolism


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Dislodged thrombus

Pulmo. Artery obstruction

Blood vessel ruptures Poor gas exchange

hemoptysis

heart dyspnea

o RR Chest paino HR


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Collaborative Mgt

1.bed rest

2.Position

3.oxygen as prescribed

4.Medsa.morphine sulfate

b.thrombolytics

c.anticoagulants


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VI. Prolapsed Cord

Risk factors

1. shoulder

presentations

2. footling or breechpresentations

3. small size of fetus


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Signs & Symptoms

1. cord on birth canal

2. visualization of the cord

Collaborative Mgt

1. gloved finger & lift fetal head

2. oxygen as prescribed

3. knee-chest position or trendelenburgs

position4. moistened prolapsed cord

5. if dilation is incomplete _______________


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VII. Inversion of Uterus

A rare condition in which the uterus turns

inside out

Signs & Symptoms

1. sudden gush of blood from the vagina

2. Unpalpable fundus3. Signs of blood loss


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Collaborative Mgt

1. Placenta removal

2. Oxytocin prevent relaxation of uterus

3. general anesthesia prevent continuousuterine contraction

4. Tocolytic closure of cervix

5. antibiotic administration6. CPR


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THATS ALL

FOLKS!!!


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topic 4 high risk labor & delivery

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