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Questions and Answers
Which hormone's drop is associated with the start of labor?
Increased oxytocin sensitivity influences the onset of labor.
True
What is cervical ripening?
Cervical ripening is the softening and thinning of the cervix in preparation for labor.
Uterine stretch due to ________ and ________ can trigger the onset of labor.
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Match the following labor factors with their descriptions:
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Which client is most likely to achieve a successful vaginal birth?
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Client C has a Bishop score of 0.
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What is the purpose of administering oxytocin during labor?
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The total Bishop score for Client B is ______.
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Match the clients with their respective Bishop scores:
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Which of the following is NOT a side effect of oxytocin?
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Define 'category 1 strip' in fetal heart tracing.
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Contractions occurring every 7 minutes that last 30 seconds are considered stable.
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Cephalic presentation refers to a fetus whose head enters the pelvic inlet first.
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Which of the following is NOT a type of fetal presentation?
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What are the 3 letters used to denote fetal position?
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Shoulder dystocia can occur due to maternal risk factors such as __________ and __________.
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Which cardinal movement refers to the tilting of the fetus as it moves through the birth canal?
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Match the following fetal presentations with their characteristics:
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In assessing labor, nurses also look for signs of __________ and __________ in the fetal monitor.
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Persistent occiput posterior positions are considered a normal presentation during labor.
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What term describes the assessment of the strength of uterine contractions through palpation?
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Tocolytic therapy can prolong pregnancy by 10-14 days.
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What is one common complication associated with preterm labor?
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Amniotic fluid that is __________ may suggest meconium staining.
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Match the labor support techniques with their classifications.
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Which of the following is a non-pharmacologic labor support technique?
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Only external electronic monitoring can be used to assess uterine contractions.
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What is the purpose of using indomethacin with preterm labor?
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What physical condition can result from a breakage in the barrier between maternal circulation and amniotic fluid during labor?
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Intrauterine fetal demise occurs after 20 weeks of gestation.
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Name one nursing management strategy for a patient experiencing hypotension and coagulopathy during labor.
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Prolonged deceleration in fetal heart rate can result in a category ____ strip.
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Which of the following symptoms is associated with amniotic fluid embolism?
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Match the following nursing assessments with their descriptions:
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Sensitivity to loss while caring for a family experiencing intrauterine fetal demise is unnecessary.
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What should the nurse do next if a fetal heart tracing shows a prolonged deceleration?
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Study Notes
What Causes Labor to Start
- Progesterone levels decrease, oxytocin and prostaglandin levels increase.
- Uterine stretch from a large fetus, polyhydramnios, or multiple gestation can trigger labor.
- Changes to the myometrium, decidua, and cervix occur gradually over days or weeks.
Cervical Ripening
- The cervix softens and thins out, allowing it to open.
Conditions That Increase Preterm Labor Risk
- Conditions that cause uterine stretch can increase the risk of preterm labor.
Fetal Presentation
- Cephalic presentation: The head of the fetus is the first part to enter the pelvic inlet
- Breech presentation: The buttocks or feet are the first part to enter the pelvic inlet
Fetal Position
- First letter: Describes the presenting part's tilting, either left or right.
- Second letter: Represents the presenting part, with options like O for occiput, S for sacrum, and M for mentum.
- Third letter: Indicates the presenting part's relation to the pelvis, with A for anterior, P for posterior, and T for transverse.
Cardinal Movements
- These are the positional changes the fetus goes through as it moves through the birth canal.
Problems with the Passenger
- Persistent occiput posterior: The baby's head is facing rearward, making labor more challenging.
- Face or brow presentation: The baby's face or forehead enters the pelvic inlet first.
- Breech presentation: The baby's buttocks or feet are the first to enter the pelvic inlet.
- Shoulder dystocia: The baby's shoulder gets stuck behind the mother's pubic bone after the head is born.
- Multiple pregnancy: Having twins, triplets, or more can create challenges for labor.
- Fetal size or abnormalities: Macrosomia (large baby) or fetal abnormalities can complicate labor.
Nursing Assessment and Management for Labor Complications
- Assess labor progress: Evaluate if contractions are strong and regular, and if dilation is progressing.
- Identify risk factors: Assess for potential complications, like a large baby or fetal malposition.
- Provide labor support: Offer encouragement and comfort to the mother during labor.
- Assess for fetopelvic disproportion: Check if the baby's head is too large for the mother's pelvis.
- Explain fetal malposition and management: Inform the mother about the baby's position and possible interventions like external version.
- Evaluate fetal monitor for signs of fetal hypoxia: Watch for signs of the baby not getting enough oxygen.
Shoulder Dystocia
- Risk factors: Maternal short stature, obesity, hydramnios (too much amniotic fluid), uterine abnormalities, fetal presentation issues, cephalopelvic disproportion, overstimulation with oxytocin, maternal exhaustion, ineffective pushing efforts, excessive fetal size, maternal fear and anxiety.
Nurse Assessment for Shoulder Dystocia:
- Assess maternal frame of mind: Understand the mother's emotional state, as she may be distressed.
- Assess vital signs, contractions, fetal heart rate patterns and fetal position: Monitor these closely, as they can indicate problems during labor.
Nursing Management for Shoulder Dystocia
- Promote labor progress: Help the labor along by evaluating progress, administering oxytocin, and supporting the mother's efforts.
- Provide physical and emotional comfort: Reduce environmental stimulation, offer physical comfort, and encourage frequent position changes.
- Promote empowerment: Educate the mother and family about dystocia and possible interventions.
Bishop Score:
- Assesses factors that indicate how ready the cervix is for labor:
- Dilation
- Effacement
- Fetal station
- Cervical consistency
- Position of cervix
Oxytocin (Pitocin)
- Purpose: To stimulate uterine contractions for labor induction or augmentation.
- Side effects: Uterine hyperstimulation, fetal compromise, impaired oxygenation, antidiuretic effect (reduced urine flow and potential for water intoxication), nausea, headache, and hypotension.
- Administration: Infused into a main IV line through the most proximal port, usually added to Lactated Ringer's solution.
- Nurse Management: Monitor for fetal heart rate changes, uterine contractions, and side effects of oxytocin.
- Titration: Adjust dosage, infusion rates, and frequency based on facility protocol.
- Contraction Monitoring: Monitor for regular contractions every 2-3 minutes, lasting 40-60 seconds, with resting tone decreasing below 20 mm Hg.
Fetal Heart Rate Monitoring:
- Category 1: Baseline 110-160 bpm, moderate variability, accelerations present, no decelerations.
- Category 2: Fetal heart rate shows variations that require close monitoring and further assessment.
- Category 3: Represents fetal distress; marked absence of variability, recurrent late or variable decelerations.
Maternal and Fetal Assessment and Management During Labor
- Vaginal Examination: To assess cervical dilation and effacement, as well as fetal position.
- Assessing Uterine Contractions: Performed subjectively (palpation) or electronically (external or internal monitoring).
- Amniotic Fluid Evaluation: Check amniotic fluid for spontaneous or artificial rupture, infection, or meconium.
- Evaluation of Fetal Heart Rate: Use fetal monitoring to assess and monitor fetal wellbeing.
- Labor Support: Provide non-pharmacological and pharmacological support, promoting comfort and relaxation.
- Risk Assessment: Identify any risks and perform appropriate interventions.
- Preparation, Communication: Prepare for potential interventions and maintain clear communication with the medical team and family.
Leopold Maneuvers
- Used to determine the fetal presentation, position, and lie by palpating the abdomen.
Preterm Labor
- Regular contractions with cervical change before the end of the 37th week of gestation (20 weeks to 36 weeks 6 days).
Preterm Labor Facts
- Preterm birth affects one in ten infants born in the US and is on the rise.
- It is one of the most common obstetric complications.
- African Americans experience preterm birth rates twice as high as other demographics.
- The annual cost of premature birth in the US is $820 million.
Therapeutic Management of Preterm Labor
- Risk Prediction: Help identify potential preterm birth risks, enabling timely interventions.
- Tocolytic Therapy: Medications used to delay labor and give time for other interventions. They can prolong pregnancy for 2-7 days.
- Corticosteroids: Administered to the mother to promote fetal lung development.
- Prophylaxis Antibiotics: Given to prevent infections, especially if Group B Strep is detected.
Indomethacin for Preterm Labor
- A medication used to suppress preterm labor.
Amniotic Fluid Embolism (AFE)
- Occurs when amniotic fluid enters the maternal circulation.
- It can cause a sudden onset of hypotension, hypoxia, and coagulopathy (blood clotting problems).
- Nursing assessment: Difficulty breathing, hypotension, cyanosis (bluish skin), seizures, tachycardia (fast heart rate), coagulation failure, disseminated intravascular coagulation (DIC), pulmonary edema, uterine atony (lack of uterine muscle tone), hemorrhage, acute respiratory distress syndrome (ARDS), and cardiac arrest are all possible signs.
- Nursing management: Provide supportive care to maintain oxygenation, hemodynamic function, and correct coagulopathy.
- Critical care monitoring is essential.
Intrauterine Fetal Demise (IUFD)
- Causes can be diverse, but often remain unknown.
- Occurs between 20 weeks of gestation and prior to birth.
- A devastating loss for the mother and family, often leading to post-traumatic stress disorder (PTSD).
- It can also affect staff emotionally.
- Nursing care for families should be compassionate and sensitive to their loss.
- Offer support, grieving guidance, and referrals to social work and chaplains.
- Provide resources like SHARE, a support group for pregnancy and infant loss.
- Confirm fetal demise with ultrasound and lack of fetal heart tones.
- Initiate labor induction and pain management for the mother.
Procedures During Labor (Interventions)
- Provide information and understanding about different labor procedures and interventions.
Forceps or Vacuum Assisted Birth
- Instruments used to assist in delivering the baby if the mother is unable to push effectively.
Cesarean Section Birth
- Surgical procedure to deliver the baby through an incision in the abdomen.
- Reasons for Cesarean: Fetal distress, failure to progress in labor, and maternal complications.
Nursing Actions for Contractions and Fetal Heart Patterns
- Contractions occurring every 1.5 minutes, lasting 60 seconds for the past 30 minutes: Indicates uterine hyperstimulation, which requires immediate intervention.
- Fetal heart tracing with minimal variability, no accelerations, and prolonged decelerations: Category 3 fetal heart tracing, suggestive of fetal distress and requiring immediate intervention.
Intervention for Category 3 Fetal Heart Tracing
- Immediate intervention: Notify the doctor, discontinue oxytocin, change maternal position, administer oxygen, and prepare for potential cesarean section or other interventions to address fetal distress.
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Description
Explore the triggers for labor, including hormonal changes and conditions leading to preterm labor. Understand cervical ripening and the significance of fetal presentation and position in the birthing process.
