Labor Augmentation and AROM Quiz

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Questions and Answers

What is a significant risk associated with a vaginal birth after cesarean (VBAC)?

Higher risk of uterine rupture (correct)

Enhanced chance for maternal bonding

Increased likelihood of premature birth

Lower incidence of fetal distress

Which symptom is characteristic of an anaphylactoid syndrome caused by amniotic fluid embolism?

Abrupt respiratory distress (correct)

Gradual onset of pain

Slow fetal heart rate

Prolonged labor

What is a primary management strategy for amniotic fluid embolism?

Scheduled cesarean delivery

Immediate surgical intervention

Early identification of signs and symptoms (correct)

Increased fluid intake

Which condition can increase the risk of amniotic fluid embolism?

Meconium-stained amniotic fluid Signup and view all the answers

What is a key feature of vaginal birth after cesarean (VBAC) monitoring?

Internal pressure monitor to assess uterine stress Signup and view all the answers

Which of the following statements about amniotic fluid embolism is true?

Fetal particles can obstruct pulmonary vessels. Signup and view all the answers

Which of the following is a sign of decreased cardiac function in a patient experiencing amniotic fluid embolism?

Depressed cardiac function Signup and view all the answers

What is an expected finding in a case of incomplete placental detachment?

Slower bleeding Signup and view all the answers

What is the primary goal of labor augmentation?

To stimulate ineffective contractions after labor has begun Signup and view all the answers

Which of the following is a risk associated with amniotomy (AROM)?

Risk of infection Signup and view all the answers

What is a common contraindication for performing a version procedure?

Unlikely to deliver vaginally Signup and view all the answers

What is the purpose of an internal pressure catheter during labor monitoring?

To measure contraction strength Signup and view all the answers

Which complication is associated with the use of Pitocin for labor augmentation?

Increased risk of postpartum hemorrhage Signup and view all the answers

What characteristic defines dysfunctional labor or dystocia?

Ineffective dilation, effacement, or descent Signup and view all the answers

What is a common symptom of premature rupture of membranes (PROM)?

Pooling of fluid in the vaginal vault Signup and view all the answers

Which condition can result from ineffective uterine contractions during labor?

Fetal distress or hypoxia Signup and view all the answers

What is the significance of performing an amnioinfusion?

To decrease cord compression Signup and view all the answers

What technique is used to monitor the fetus's heart rate accurately by placing an electrode on the scalp?

Fetal scalp electrode monitoring Signup and view all the answers

What potential complication could arise from a breech version attempt?

Uterine rupture Signup and view all the answers

Which parameter is monitored continuously during the administration of Pitocin?

Fetal heart rate and uterine contractions Signup and view all the answers

What is a major consideration when caring for a laboring woman with a history of uterine surgery?

Risk of uterine rupture Signup and view all the answers

What should be done following an amniotomy procedure to ensure fetal well-being?

Frequent monitoring of fluid color and odor Signup and view all the answers

What is the primary risk factor for preterm labor?

Infection Signup and view all the answers

Which medication is used as a tocolytic to relax smooth muscle during preterm labor?

Indomethacin Signup and view all the answers

What symptoms could indicate signs of preterm labor?

Pelvic pressure and discharge Signup and view all the answers

What is a common complication of prolonged pregnancy beyond 42 weeks?

Oligohydramnios Signup and view all the answers

What intervention should be taken first in the event of a cord prolapse?

Relieve cord pressure by positioning Signup and view all the answers

Which test can help identify proteins indicating labor within two weeks?

Fetal fibronectin swab Signup and view all the answers

What are the side effects of administering Betamethasone for fetal lung development?

Temporary glucose intolerance Signup and view all the answers

What distinguishes complete uterine rupture from incomplete rupture?

It does not involve the peritoneal cavity Signup and view all the answers

Which of the following maternal conditions is a risk factor for uterine rupture?

Previous uterine surgery Signup and view all the answers

What action is crucial for ensuring maternal stability during a suspected uterine rupture?

CV (cardiovascular) stabilization Signup and view all the answers

What is the recommended positioning for a mother experiencing cord prolapse?

Knee-chest position Signup and view all the answers

Which medication should be held if the mother experiences tachycardia exceeding 120 bpm?

Terbutaline Signup and view all the answers

What is the effect of prolonged pregnancy on the placenta?

Ageing, leading to insufficiency Signup and view all the answers

Study Notes

Augmentation of Labor

Stimulation of ineffective uterine contractions after labor has begun
Pitocin (oxytocin) is the most common method
Diluted in isotonic solution (e.g., normal saline) and administered IVPB
Start slowly and titrate to uterine contractions and fetal response
Monitor fetal heart rate (FHR) baseline and throughout labor
Watch for signs of hyperstimulation/tachysystole
Monitor for uterine rupture, maternal water intoxication (oxytocin is an antidiuretic), and increased risk of postpartum hemorrhage (PPH)

AROM (Amniotomy/Artificial Rupture of Membranes)

Risks include:
- Cord prolapse
- Infection
- Abruption (especially with polyhydramnios)
Post-procedure interventions:
- Monitor FHR for reassuring patterns
- Assess and document amniotic fluid (color, odor, amount)
- Monitor fetal temperature every 2 hours
- Administer antibiotics for ROM lasting 18+ hours
- Minimize upright positions/walking until head is engaged
- Monitor for abnormal fluid (blood, meconium)
- Notify neonatology team and pediatrician for anticipated deep suction at delivery

Internal Monitoring

Fetal scalp electrode (FSE) for accurate beat-to-beat variability
- Sterile technique required, within RN scope
- Avoid sutures/fontanels
Internal pressure catheter for accurate contraction strength
- Can be used to monitor and titrate Pitocin
- May be used with amnioinfusion
- Helps minimize uterine rupture risk

Version

Changing fetal presentation to cephalic for vaginal delivery (prevents c-section)

Dysfunctional Labor: Dystocia

Difficult labor due to ineffective dilation, effacement, and descent
- Problems with the powers (uterine contractions), passenger (fetus), passage (birth canal), position, and psyche
Types:
- Hypotonic: ineffective, exhausting uterine contractions (more common in active labor)
- Hypertonic: uncoordinated, painful contractions (more common in latent labor)
- Multifetal pregnancy: increase risk

Secondary Powers/Position/Psyche

Risk factors
- Ineffective pushing technique or position
- Fear of pain or injury
- Insufficient urge to push
- Exhaustion and psychological distress
Interventions:
- Provide assistance and guidance during pushing
- Provide comfort and support
- Encourage the use of upright positioning as tolerated to aid in pushing

Passenger/s

Large for gestational age (LGA)
- Shoulder dystocia is a risk

Prolapsed Cord

Umbilical cord displaces between presenting part and the amniotic sac, or protrudes through the cervix.
Symptoms: cord visible or reported by mother. Bradycardia, variable decelerations in FHR, and/or decreased fetal activity from cord pressure.
Risk factors: Polyhydramnios, small fetus, fetus at high station (-2 or -3).
Interventions: relieve cord pressure (positioning, placing sterile gloved hand under the presenting part to keep it off the cord).

Uterine Rupture

Separation of uterine tissue due to a tear in the uterine wall.
Risk factors: Previous uterine surgery (e.g., c-section), polyhydramnios, multifetal pregnancy, abdominal trauma, large or multiple pregnancies.
Symptoms: Severe abdominal pain (possibly between shoulder blades or radiating to the chest), possible hypovolemic shock (internal hemorrhage) and/or sudden absence of fetal heart tones and contractions.

Amniotic Fluid Embolism

Amniotic fluid enters maternal circulation.
Possible cause: uterine hyperstimulation/trauma, large-for-gestational-age fetus, previous pregnancy complications.
Risk factors: hyperstimulation of uterus, molar pregnancy, large fetus, presence of meconium in fluid.
Immediate management: CV stabilization, CPR, oxygen, fluid replacement, possible blood products like packed red blood cells (PRBCs) and/or fresh frozen plasma (FFP) as needed.

Other

Preterm labor: Weeks 20-37 of gestation, infection primary risk. Assessment of uterine activity, cervical change, pain, discharge, and rupture of membranes.
Prolonged Pregnancy after 42 weeks gestation. Aging placenta/interruption of nutrition and oxygenation to fetus with potential fetal distress and oligohydramnios/cord compression.
Variable, late decelerations in fetal heart rate monitoring and interpretation.

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Description

Test your knowledge on labor augmentation techniques, including the use of Pitocin and the procedures surrounding amniotomy. This quiz covers risks, monitoring, and important interventions related to uterine contractions during labor. Perfect for nursing students and healthcare professionals.