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Chapter 14

Chapter 14 . Caring for the Woman Experiencing Complications During Labor and Birth Catherine Marin, MSN/Ed(c), WHCNP, RN. Dystocia. Long, difficult, or abnormal labor May arise from Powers Passenger Passageway. Dysfunctional Labor Pattern: Hypertonic.

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Chapter 14

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  1. Chapter 14 Caring for the Woman Experiencing Complications During Labor and Birth Catherine Marin, MSN/Ed(c), WHCNP, RN

  2. Dystocia • Long, difficult, or abnormal labor • May arise from • Powers • Passenger • Passageway

  3. Dysfunctional Labor Pattern: Hypertonic • Strong, painful, ineffective contractions • Contributing factor—maternal anxiety • Occiput-posterior malposition of fetus • Management • Rest, hydration, sedation • Facilitate rotation of the fetal head

  4. Dysfunctional Labor Pattern: Hypotonic • Contractions decrease in frequency and intensity • Maternal and fetal factors that produce excessive uterine stretching • Management • Walking, position changes • Augmentation of labor

  5. Precipitate Labor and Birth • Rapid intense contractions • Nursing considerations • Careful examination for dilation and effacement • Reassure woman and support person • Breathing to avoid pushing and prevent tearing • Careful examination of maternal soft tissue and placenta

  6. Pelvic Structure Alterations • Pelvic dystocia • Soft tissue dystocia • Trial of labor • To assess safety of vaginal birth

  7. Obstetric Interventions—Amnioinfusion • Risks: infection, overdistention of uterus, increased uterine tone • Nursing • Careful monitoring of infusion, intensity and frequency of contractions, and maternal vital signs • Educate • Pharmacological induction of labor • Nonpharmacological stimulants of labor

  8. Obstetric Interventions—Amniotomy • Artificial rupture of membranes • Augment or induce labor • Nursing • Careful monitoring of vital signs, cervical effacement/dilation, station, FHR, contractions • Document regarding amniotic fluid

  9. Induction of Labor • Indications for induction • Bishop score • Cervical ripening agents • Mechanical methods • Oxytocin • Augmentation of labor

  10. Induction—Nursing Considerations • Informed consent • Careful monitoring of labor • Discuss pain relief measures • Position changes • Keep patient and support person informed of progress

  11. Instrumentation Assistance of Birth • Forceps • Vacuum extraction

  12. Maternal Complications—Hypertensive Disorders • Preeclampsia-eclampsia, HELLP syndrome • Nursing • Careful assessments • Monitor lab values • Administer platelets as appropriate • Ongoing education

  13. Maternal Complications—Diabetes • Fetal lung maturity • Intrapartum management—maternal hydration and blood glucose levels • Labor: normal progression of labor • Upright or side-lying position • Encourage breastfeeding

  14. Preterm Labor and Birth • Careful maternal monitoring • FHR monitoring *** • Identify and report symptoms suggestive of fetal hypoxia • Assess psychological status

  15. Labor and Birth Complications—Fetal • Fetal malpresentation • Version: external or internal • Shoulder dystocia- McRoberts Maneuver • Cephalopelvic disproportion • Multiple gestation • Non-reassuring FHR patterns

  16. Amniotic Fluid Complications • Oligohydramnios • Hydramnios • Meconium • Nuchal cord

  17. Complications—Placental Problems • Placenta previa • Placental abruption • Disseminated intravascular coagulation

  18. Other Complications • Uterine rupture • Obstetric emergency • Uterine inversion • Umbilical cord prolapse

  19. Variations—Umbilical Cord and Placenta • Velamentous cord insertion • Fetal vessels separate at distal end and insert into placenta away from the margin • Vasa previa • fetal blood vessels, unsupported by either the umbilical cord or placental tissue, traverse the fetal membranes (bag of waters) across the lower segment of the uterus between the baby and the cervical opening

  20. Placental Variations • Circumvallate placenta • Succenturiate placenta • Battledore placenta • Placenta accreta • Placenta increta • Placenta percreta

  21. Amniotic Fluid Embolism • Rapidly deteriorating maternal condition • Acute dyspnea, severe hypotension • Rapid delivery after stabilizing mother • Ethical conflict • Save mother versus fetus

  22. Collaboration in Perinatal Emergencies

  23. Perinatal Fetal Loss • Nursing considerations • What to say • What not to say

  24. Cesarean Birth • Indications • Health of mother or fetus is jeopardized • Ethical considerations • Surgical procedures • Surgical and postoperative care • Vaginal birth after cesarean

  25. Postterm/Prolonged Pregnancy • Postterm—extends beyond 42 weeks • Risk for fetal/neonatal problems • Increased maternal risk • Management—labor induction • Nursing implications

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