NURS 4500: Midterm Material > Class 6: Postterm Labor > Flashcards

Class 6: Postterm Labor Flashcards

(60 cards)

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1
Q

what is considered postterm

A
  • pregnancy extends beyond the end of week 42 of gestation
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2
Q

postterm pregnancy is more common in…

A
  • primiparous people
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3
Q

what maternal risks are associated w postterm pregnancy (4)

A
  • perineal injury during birth due to macrosomia
  • hemorrhage (d/t macrosomia)
  • infection
  • interventions
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4
Q

what weight is considered macrosomia

A

> 4000 g

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5
Q

what interventions cause maternal risks w postterm pregnancy (3)

A
  • induction
  • instrument assisted birth
  • c-section
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6
Q

what fetal risks are associated w postterm pregnancy (5)

A
  • injury due to macrosomia
  • placenta begins to age = increased infarcts
  • oligohydramnios
  • meconium stained amniotic fluid
  • postmaturity syndrome
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7
Q

what is meconium

A
  • the 1st stool of a newborn or fetus
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8
Q

meconium can occur?

A
  • in utero or out of utero
  • anytime after 38 weeks
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9
Q

describe the appearance of meconium stained amniotic fluid

A
  • tar-like substance
  • dark green
  • sticky
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10
Q

meconium can be naturally passed after…

A
  • 38 weeks
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11
Q

meconium can be expected w… (2)

A
  • post-date pregnancy
  • if breech (d/t compression of abdomen)
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12
Q

meconium can mix with ____, causing ??

A
  • can mix with amniotic fluid
  • can interfere w first breath
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13
Q

meconium can be a sign of?? how??

A
  • of fetal hypoxia
  • causes sphincters to relax –> meconium passed
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14
Q

if there are changes in FHR and meconium, what is the concern?

A
  • fetal hypoxia
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15
Q

what are the characteristics of post-maturity syndrome (4)

A
  • greenish maconium staining
  • dry
  • flaking skin
  • long nails
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16
Q

what is included in collab care for postterm pregnancy

A
  • induction of labor between 41+0 and 42+0 weeks gestation
  • ongoing assessments of fetus
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17
Q

w postterm pregnancy, the pregnant person is usually placed on the induction list at…

A
  • 41+3 weeks gestation
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18
Q

induction of labor between 41 and 42 weeks gestation may.. (2)

A
  • reduce perinatal mortality
  • reduce meconium aspiration syndrome without increasing c-section birth rate
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19
Q

what is included in ongoing assessments of the fetus w postterm pregnancy & L&D (5)

A
  • daily fetal mvmt counts
  • NST
  • amniotic fluid index
  • BPP
  • doppler flow
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20
Q

if any of the postterm fetal assessments indicate fetus is not tolerating postterm, what happens?

A
  • moved to top of priority list for induction
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21
Q

what is dystocia

A
  • abnormally slow progress of labor
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22
Q

what is defined as dystocia (2)

A
  • greater than 4hrs of less than 0.5 cm per hour of cervical dilation in active labor
  • or greater than 1 hr of active pushing with no descent
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23
Q

dystocia can occur..

A
  • in either 1st or 2nd stage of labor
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24
Q

dystocia can be caused by.. (4)

A
  • abnormal uterine activity
  • ineffective pushing ***(most common)
  • alterations in pelvis structure (passageway)
  • fetal causes (passenger)
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25
what are fetal causes of dystocia (7)
- abnormal presentation/position --> malpresentation - anomalies - excessive size - number of fetuses - maternal position during L&D --> malposition - psychological response - cephalopelvic disproportion (CPD)
26
dystocia is dysfunctional labor from abnormal uterine contractions preventing normal progress of... (3)
- cervical dilation - effacement - descent
27
what is considered abnormal uterine activity w dystocia (4)
- hypertonic uterine dysfunction - hypotonic, uncoordinated, or infreq uterine contractions - alteration in secondary powers - abnormal labor patterns
28
what is the most common abnormal uterine activity that causes dystocia
- hypotonic
29
what does hypotonic uterus mean
- weak, inefficient contractions
30
what can cause hypotonic uterus (2)
- cephalic pelvis disproportion - malposition of the fetus (ex. OP)
31
what should be assessed w hypotonic uterus (2)
- FHR (EFM) - infection due to prolonged labor
32
what are interventions for hypotonic uterus (4)
- alter positions (esp. if malposition of fetus is present) - AROM - physical removal of membranes from cervix w finger - augmentation w oxytocin
33
how can AROM help w hypotonic uterus
- prostagloandins in amniotic fluid can help promote labor
34
how can removal of membranes help w hypotonic uterus
- can increase pressure on servic
35
when is the most common time for hypertonic uterine dysfunction
- early or latent phase
36
what does hypertonic uterine dysfunction lead to? (2)
- early exhuastion - poor psychological state of birther (due to it occuring in early/latent phase)
37
what is included in interventions for hypertonic uterus (2)
- morphine to help mother relax & keep energy - promote rest
38
describe contractions w hypertonic uterus
- contractions radiate from midpoint instead of fundus = not very effective
39
what is included in interventions for alterations in 2ndary powers (2)
- lithotomy position exhausts mother, do not have them in this position for more than 2 hrs - encourage them to work w their body
40
what is considered alteration in pelvic structure (passageway) r/t dystocia (2)
- pelvis dystocia - soft tissue dystocia
41
what is pelvic dystocia
- contractures of pelvic diameter that reduce capacity of bony pelvis, inlet, midpelvis, or outlet
42
what is soft tissue dystocia
- results from obstruction of birth passage by an anatomical abnormality other than bony pelvis
43
what can cause soft tissue dystocia (6)
- tumors - full bladder - full rectum - nutrition - placenta previa - STIs (impact cervical effacement & dilation)
44
what impact can psychological responses have on dystocia
- hormones and neurotransmitters released in response to stress can cause dystocia
45
what impact can position of the pregnant person have on dystocia (3)
- with OP position, get mother on hands and knees to encourage transition to OA - position changes throughout 1st and 2nd stage (ex. sitting, rocking, etc.) - do not want pushing on back too much
46
what can cause increased risk for dystocia (5)
- maternal fatigue (impacts 2ndary powers) - dehydration - electrolyte imbalance (impacts muscle contractions) - fear - inappropriate timing of analgesic or anaesthetic admin (ex. epidural too early)
47
what are fetal causes of dystocia (passenger) (6)
- anomalies (ex. acites) - fetal size --> macrosomia - cephalopelvic disproportion (CPD) - malposition - malpresentation - multiple fetuses
48
what is CPD
- considers the relationship between the fetus head to pelvis ex. head too big for pelvis or vice versa
49
what is malposition of the fetus ? whats an example
- abnormal position of the fetus ex. direct OP
50
what is malpresentation? examples (2)?
- abnormal presentation ex. breech, face or brow
51
what is the criteria for a vaginal breech delivery (4)
- frank or complete breech - fetal weight between 2000-3800 g - need to see good progress - flexed fetal head
52
what are concerns w a footling breech (3)
- umbilical cord prolapse (since foot does not take up entire cervical opening) - infection - head might get stuck
53
what type of delivery is done w a footling breech
- no vaginal birth
54
what is included in nursing care for dystocia (4)
- EFM - US to determine fetal positioning - risk assessment (continuous) - prevention
55
interventions for dystocia depend on... (2)
- the cause (which P) - and timing of the dystocia (1st or 2nd stage)
56
what are possible interventions for dystocia (4)
- external cephalic version - augmentation of labor/induction of labor - forceps or vacuum assisted birth (operative procedures) - c-section
57
what is external cephalic version
- turning of fetus from one presentation to another ex. from breech to cephalic/vertex presentation
58
operative procedures for dystocia are considered when?
- in second stage
59
what is included in prevention of dystocia (2)
- positioning - proper diagnosis of active phase of labor
60
what should be monitored after ECV (4)
- monitor FHR - monitor for vaginal bleeding - NST - monitor for labor (may induce)
NURS 4500: Midterm Material
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