Problems with Labor and Delivery

Question 1

Premature rupture of the membranes

Answer 1

Spontaneous rupture of the membranes prior to the onset of labor. Infection risk.

Question 2

Interventions for prolapsed umbilical cord

Answer 2

1. Trendelenberg’s position
2. Administer 02
3. Monitor for fetal hypoxia
4. Elevate presenting part if it is on top of cord
5. Prepare for immediate birth

Question 3

Placenta Previa

Answer 3

When the placenta adheres to the lower uterus - marginal, partial or total blockage of cervix.

Question 4

Symptoms of placenta previa

Answer 4

1. Bright red vaginal bleeding
2. Painless
3. Uterus is soft and relaxed
4. Fundal height is larger than expected for gestational age

Question 5

Interventions for placenta previa

Answer 5

1. Ultrasound
2. Avoid vaginal examinations
3. Maintain side lying bedrest
4. Monitor bleeidng
5. Administer fluid and blood products as required

Question 6

Abruptio placentae

Answer 6

Premature separation of the placenta from the uterine wall after 20 weeks gestation and before delivery.

Question 7

Symptoms of abruptio placentae

Answer 7

1. Abdo pain
2. Dark red vaginal bleeding
3. Uterine pain/tenderness
4. Uterine rigidity
5. Fetal distress
6. Possible maternal shock

Question 8

Interventions for abruptio placentae

Answer 8

1. Assess for excessive bleeding, enlargement of fundal height and pain
2. Bed rest
3. Administer fluids/blood products
4. Prepare for birth (vaginal if possible)

Question 9

Supine hypotension (vena cava syndrome)

Answer 9

Occurs when venous return to the heart is impaired by the weight of the fetus on the vena cava.

Question 10

Symptoms of supine hypotension

Answer 10

1. Dizziness
2. Hypotension
3. Pale
4. Tachycardia
5. Sweating, cool damp skin
6. Fetal distress

Question 11

Placenta accreta

Answer 11

Abnormally adherent placenta

Question 12

Placenta increta

Answer 12

Placenta penetrates the uterus

Question 13

Placenta percreta

Answer 13

Placenta perforates the uterus. Intervention for hemorrhage and shock. Prepare for possible hysterectomy.

Question 14

Preterm labor

Answer 14

Between 20 and 37 weeks gestation.

Question 15

Precipitous Labor

Answer 15

Labor which lasts less than 3 hours

Question 16

Dystocia

Answer 16

Difficult, prolonged or excessively painful labor. Occurs due to problems with contractions, fetus, bones or tissues of the maternal pelvis. Can result in maternal dehydration, infection, fetal injury or death.

Question 17

Recognizing dystocia

Answer 17

1. Excessive abdo pain
2. Labor which does not progress
3. Fetal distress
4. Maternal and fetal tachycardia
5. Abnormal contraction pattern.

Question 18

Amniotic fluid embolism

Answer 18

Escape of the amniotic fluid into maternal circulation. Debris from the fluid can lodge in the maternal pulmonary arterioles and be fatal.

Question 19

Recognition of amniotic fluid embolism

Answer 19

1. Respiratory distress
2. Cyanosis
3. Fetal bradycardia

Question 20

Intervention for amniotic fluid embolism

Answer 20

1. A-E assess and treat
2. Administer fluids & blood products
3. Stabilize the patient
4. Prepare for delivery after stabilized

Question 21

Fetal distress

Answer 21

• FHR 160 bpm
• Meconium stained amniotic fluid
• Fetal hyperactivity
• Progressive decline in baseline FHR variability
• Severe, variable decelerations in FHR

Question 22

Interventions for fetal distress

Answer 22

1. Mothering lateral position
2. Provide 02
3. Discontinue pitocin
4. Monitor vitals

Question 23

Recognizing intrauterine fetal demise

Answer 23

1. Loss of movement
2. Undetectable FHR
3. Lowered Hb, hematocrit and platelet levels
4. Prolonged bleeding and clotting time

Question 24

Ruptured uterus

Answer 24

Can be partial or complete tear due to the stress of labor.

• abdo pain
• contractions stop
• rigid abdome
• absent FHR
• signs of shock

Question 25

Interventions for ruptured uterus

Answer 25

1. Monitor and treat for shock | 2. C-section & possible hysterectomy

Question 26

Uterine inversion

Answer 26

Uterus which is partially or completely turned inside out.

Question 27

Symptoms of uterine inversion

Answer 27

1. Fundal depression 2. Signs of shock 3. Severe pain 4. Hemorrhage evident

Question 28

Interventions for uterine inversion

Answer 28

1. Monitor for hemorrhage and signs of shock | 2. Return uterus to correct position (may require laparotomy)