Podcast
Questions and Answers
Which characteristic defines hypertonic contractions during labor?
Which characteristic defines hypertonic contractions during labor?
- Contractions that become ineffective, leading to a prolonged latent phase.
- Stronger contraction intensity, high frequency, and increased resting tone above 15 mm Hg. (correct)
- Decreased resting tone less than 10 mm Hg with infrequent contractions.
- Weak contraction intensity with normal frequency.
A nulliparous woman is in active labor. At what rate of cervical dilation would her labor be considered protracted?
A nulliparous woman is in active labor. At what rate of cervical dilation would her labor be considered protracted?
- Exactly 1.5 cm per hour.
- Greater than 2 cm per hour.
- Less than 1.2 cm per hour. (correct)
- Greater than 1.5 cm per hour.
What is the criterion for diagnosing arrest of descent in a multiparous woman during the second stage of labor?
What is the criterion for diagnosing arrest of descent in a multiparous woman during the second stage of labor?
- Descent less than 2.0 cm per hour.
- Descent less than 1.0 cm per hour.
- No descent for 1 hour. (correct)
- No descent for 3 hours.
What is the primary distinction between induction and augmentation of labor?
What is the primary distinction between induction and augmentation of labor?
A Bishop score greater than what value suggests that the cervix is ready for induction?
A Bishop score greater than what value suggests that the cervix is ready for induction?
Which placental anomaly involves the fetal side of the placenta being partially covered with chorion?
Which placental anomaly involves the fetal side of the placenta being partially covered with chorion?
In velamentous insertion of the cord, what is the primary risk associated with the umbilical vessels?
In velamentous insertion of the cord, what is the primary risk associated with the umbilical vessels?
Which of the following factors related to the 'Passenger' can lead to complications during labor and birth?
Which of the following factors related to the 'Passenger' can lead to complications during labor and birth?
A woman is experiencing a dysfunctional first stage of labor. Besides hydration and pain relief, what is another intervention that may be beneficial?
A woman is experiencing a dysfunctional first stage of labor. Besides hydration and pain relief, what is another intervention that may be beneficial?
A laboring woman is experiencing infrequent contractions with a resting uterine tone of less than 10 mm Hg and a contraction strength that does not exceed 25 mm Hg. This indicates:
A laboring woman is experiencing infrequent contractions with a resting uterine tone of less than 10 mm Hg and a contraction strength that does not exceed 25 mm Hg. This indicates:
What is the primary focus when assessing a family experiencing complications during labor and birth?
What is the primary focus when assessing a family experiencing complications during labor and birth?
Which of the following is a 2020 National Health Goal related to reducing cesarean births?
Which of the following is a 2020 National Health Goal related to reducing cesarean births?
Which of the following factors relates to the 'Passage' that can lead to complications during labor and birth?
Which of the following factors relates to the 'Passage' that can lead to complications during labor and birth?
A prolonged labor is noted. The contractions started out strong, but have weakened considerably. This is an example of:
A prolonged labor is noted. The contractions started out strong, but have weakened considerably. This is an example of:
A woman is in active labor. The fetal heart rate tracing shows late decelerations. What should the nurse prioritize in the assessment?
A woman is in active labor. The fetal heart rate tracing shows late decelerations. What should the nurse prioritize in the assessment?
A patient had a prior cesarean birth. What is the 2020 National Health Goal related to the number of cesarean births for this population?
A patient had a prior cesarean birth. What is the 2020 National Health Goal related to the number of cesarean births for this population?
A patient in labor is diagnosed with a prolonged rupture of membranes. Which nursing diagnosis is MOST relevant to this situation?
A patient in labor is diagnosed with a prolonged rupture of membranes. Which nursing diagnosis is MOST relevant to this situation?
Which of the following reflects a revised outcome for a laboring woman who initially planned for a natural birth but now requires medical interventions?
Which of the following reflects a revised outcome for a laboring woman who initially planned for a natural birth but now requires medical interventions?
A nurse is caring for a laboring patient and implements interventions based on QSEN competencies. Which action BEST demonstrates the 'Safety' competency?
A nurse is caring for a laboring patient and implements interventions based on QSEN competencies. Which action BEST demonstrates the 'Safety' competency?
During labor, a nurse identifies an umbilical cord prolapse. What is the priority nursing intervention?
During labor, a nurse identifies an umbilical cord prolapse. What is the priority nursing intervention?
A woman in labor with a multiple gestation is expressing anxiety due to the number of healthcare providers in the room. What is an appropriate nursing intervention?
A woman in labor with a multiple gestation is expressing anxiety due to the number of healthcare providers in the room. What is an appropriate nursing intervention?
A newborn is diagnosed with a two-vessel umbilical cord. Besides VATER association, which of the following complications should the nurse assess for?
A newborn is diagnosed with a two-vessel umbilical cord. Besides VATER association, which of the following complications should the nurse assess for?
A patient is diagnosed with placenta accreta. Which intervention should the nurse anticipate being part of the plan of care?
A patient is diagnosed with placenta accreta. Which intervention should the nurse anticipate being part of the plan of care?
A patient is experiencing a prolonged second stage of labor, and the physician suspects cephalopelvic disproportion. Which intervention is LEAST likely to be considered initially?
A patient is experiencing a prolonged second stage of labor, and the physician suspects cephalopelvic disproportion. Which intervention is LEAST likely to be considered initially?
What is the primary nursing intervention when caring for a patient with vasa previa?
What is the primary nursing intervention when caring for a patient with vasa previa?
A laboring woman is diagnosed with a right occipitoposterior (ROP) position. Which intervention is MOST likely to help facilitate fetal rotation?
A laboring woman is diagnosed with a right occipitoposterior (ROP) position. Which intervention is MOST likely to help facilitate fetal rotation?
A laboring patient is identified as having an oversized fetus (macrosomia). What initial assessment is MOST critical?
A laboring patient is identified as having an oversized fetus (macrosomia). What initial assessment is MOST critical?
A nurse is providing education to a woman with a multiple gestation pregnancy. What information is MOST important to emphasize?
A nurse is providing education to a woman with a multiple gestation pregnancy. What information is MOST important to emphasize?
Which intervention BEST addresses the nursing diagnosis of 'Risk for maternal and/or fetal injury related to a labor complication'?
Which intervention BEST addresses the nursing diagnosis of 'Risk for maternal and/or fetal injury related to a labor complication'?
A patient in labor begins to experience premature separation of the placenta. What is the nurse's PRIORITY action?
A patient in labor begins to experience premature separation of the placenta. What is the nurse's PRIORITY action?
What intervention is MOST appropriate for a patient experiencing anxiety related to uncertainty of pregnancy outcome?
What intervention is MOST appropriate for a patient experiencing anxiety related to uncertainty of pregnancy outcome?
When preparing for an induction of labor with oxytocin, what is the most important reason for using a piggyback intravenous setup?
When preparing for an induction of labor with oxytocin, what is the most important reason for using a piggyback intravenous setup?
A patient with a breech presentation is in labor. Prior to full dilation, what assessment finding would MOST immediately necessitate a cesarean birth?
A patient with a breech presentation is in labor. Prior to full dilation, what assessment finding would MOST immediately necessitate a cesarean birth?
A laboring patient is diagnosed with a persistent face presentation. Which of the following is the MOST significant risk associated with vaginal delivery in this situation?
A laboring patient is diagnosed with a persistent face presentation. Which of the following is the MOST significant risk associated with vaginal delivery in this situation?
During the second stage of labor, a patient with transverse lie is being evaluated. What is the MOST appropriate course of action?
During the second stage of labor, a patient with transverse lie is being evaluated. What is the MOST appropriate course of action?
Following a forceps-assisted vaginal delivery, the nurse observes a steady trickle of bright red blood and a boggy uterus despite fundal massage and administration of oxytocin. What is the MOST likely cause?
Following a forceps-assisted vaginal delivery, the nurse observes a steady trickle of bright red blood and a boggy uterus despite fundal massage and administration of oxytocin. What is the MOST likely cause?
Which element of the VATER association poses the greatest immediate respiratory risk to a newborn?
Which element of the VATER association poses the greatest immediate respiratory risk to a newborn?
In the context of a two-vessel umbilical cord, which potential fetal growth issue is MOST likely to necessitate immediate postnatal intervention?
In the context of a two-vessel umbilical cord, which potential fetal growth issue is MOST likely to necessitate immediate postnatal intervention?
A laboring patient who initially desired no monitoring is now being closely monitored due to emerging complications. Which fetal heart rate (FHR) pattern would necessitate the MOST urgent intervention?
A laboring patient who initially desired no monitoring is now being closely monitored due to emerging complications. Which fetal heart rate (FHR) pattern would necessitate the MOST urgent intervention?
In a case of uterine inversion, why should the placenta NOT be removed in the initial management?
In a case of uterine inversion, why should the placenta NOT be removed in the initial management?
During the acute phase of uterine inversion, which intervention is MOST critical in stabilizing the patient?
During the acute phase of uterine inversion, which intervention is MOST critical in stabilizing the patient?
If manual replacement of the uterus fails in a case of uterine inversion, what is the MOST likely next step in management?
If manual replacement of the uterus fails in a case of uterine inversion, what is the MOST likely next step in management?
A laboring patient with a known CS scar suddenly reports excruciating pain and a 'tearing' sensation. What complication is MOST likely occurring?
A laboring patient with a known CS scar suddenly reports excruciating pain and a 'tearing' sensation. What complication is MOST likely occurring?
In a complete uterine rupture, what physical finding would the nurse expect to observe upon abdominal examination?
In a complete uterine rupture, what physical finding would the nurse expect to observe upon abdominal examination?
Following a uterine rupture, besides hemorrhage, what is the MOST immediate threat to the fetus?
Following a uterine rupture, besides hemorrhage, what is the MOST immediate threat to the fetus?
Which of the following factors increases the risk of uterine rupture during labor?
Which of the following factors increases the risk of uterine rupture during labor?
After a complicated delivery involving a CS hysterectomy, what key information should the nurse be prepared to communicate to the patient?
After a complicated delivery involving a CS hysterectomy, what key information should the nurse be prepared to communicate to the patient?
A pregnant woman carrying triplets is recommended to have a cesarean delivery. What is the primary rationale for this recommendation?
A pregnant woman carrying triplets is recommended to have a cesarean delivery. What is the primary rationale for this recommendation?
A client's fetus is in the occiput posterior position. How does this presentation typically influence the labor experience compared to an anterior presentation?
A client's fetus is in the occiput posterior position. How does this presentation typically influence the labor experience compared to an anterior presentation?
A laboring woman is diagnosed with hypotonic uterine dysfunction. After ensuring adequate hydration, which intervention should the nurse prioritize?
A laboring woman is diagnosed with hypotonic uterine dysfunction. After ensuring adequate hydration, which intervention should the nurse prioritize?
A multiparous woman is in active labor. At what rate of cervical dilation suggests a protraction disorder?
A multiparous woman is in active labor. At what rate of cervical dilation suggests a protraction disorder?
Which of the following findings would lead a nurse to suspect vasa previa during labor?
Which of the following findings would lead a nurse to suspect vasa previa during labor?
What is the primary difference between labor dystocia related to 'powers' versus 'passenger'?
What is the primary difference between labor dystocia related to 'powers' versus 'passenger'?
A primiparous woman at 41 weeks gestation is admitted for induction of labor with a Bishop score of 5. Which intervention should the nurse anticipate?
A primiparous woman at 41 weeks gestation is admitted for induction of labor with a Bishop score of 5. Which intervention should the nurse anticipate?
Flashcards
Oxytocin Administration
Oxytocin Administration
Administer oxytocin through a secondary IV line for safety during labor induction.
Optimal Labor Position
Optimal Labor Position
A side-lying position optimizes fetal oxygenation and avoids vena cava syndrome during labor.
Fetal Monitoring Methods
Fetal Monitoring Methods
Continuous monitoring is preferred over episodic monitoring with a fetoscope, as it provides comprehensive data on uterine contractions and fetal heart rate.
Induction Duration
Induction Duration
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Breech Presentation
Breech Presentation
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The Three P's
The Three P's
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Ineffective Uterine Force
Ineffective Uterine Force
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Passenger Problems
Passenger Problems
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Passage Problems
Passage Problems
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Dysfunctional Labor (Inertia)
Dysfunctional Labor (Inertia)
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Primary Inertia
Primary Inertia
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Secondary Inertia
Secondary Inertia
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Hypotonic Contractions
Hypotonic Contractions
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Prolonged Latent Phase
Prolonged Latent Phase
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Protracted Active Phase
Protracted Active Phase
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Prolonged Deceleration Phase
Prolonged Deceleration Phase
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Secondary Arrest of Dilatation
Secondary Arrest of Dilatation
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Prolonged Descent
Prolonged Descent
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Arrest of Descent
Arrest of Descent
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Induction of Labor
Induction of Labor
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Cesarean Delivery (C-section)
Cesarean Delivery (C-section)
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IV Oxytocin
IV Oxytocin
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Hysterectomy
Hysterectomy
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Cord Prolapse
Cord Prolapse
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Placental Separation
Placental Separation
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Occiput Posterior Position
Occiput Posterior Position
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External Cephalic Version
External Cephalic Version
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Forceps/Vacuum Extraction
Forceps/Vacuum Extraction
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VACTERL
VACTERL
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Uterine Inversion
Uterine Inversion
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Cause of Uterine Inversion
Cause of Uterine Inversion
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Symptoms of Uterine Inversion:
Symptoms of Uterine Inversion:
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Initial Uterine Inversion Response
Initial Uterine Inversion Response
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Uterine Rupture
Uterine Rupture
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Causes of Uterine Rupture
Causes of Uterine Rupture
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Signs of Uterine Rupture
Signs of Uterine Rupture
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Complications of Uterine Rupture
Complications of Uterine Rupture
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Fetal distress during uterine rupture
Fetal distress during uterine rupture
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Fatigue (Labor Complication)
Fatigue (Labor Complication)
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Risk for Ineffective Tissue Perfusion
Risk for Ineffective Tissue Perfusion
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Risk for Deficient Fluid Volume
Risk for Deficient Fluid Volume
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Risk for Maternal/Fetal Injury
Risk for Maternal/Fetal Injury
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Anxiety (Labor Complication)
Anxiety (Labor Complication)
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Umbilical Cord Prolapse Intervention
Umbilical Cord Prolapse Intervention
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Multiple Gestation Intervention
Multiple Gestation Intervention
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Macrosomia Intervention
Macrosomia Intervention
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Cephalopelvic Disproportion Intervention
Cephalopelvic Disproportion Intervention
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Vasa Previa Intervention
Vasa Previa Intervention
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Placenta Accreta Intervention
Placenta Accreta Intervention
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Two-Vessel Cord Intervention
Two-Vessel Cord Intervention
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Nuchal Cord
Nuchal Cord
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Two-Vessel Cord Complications
Two-Vessel Cord Complications
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VATER Association
VATER Association
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Study Notes
- Study notes on Nursing Care of a Family Experiencing a Complication of Labor or Birth
- Common deviations during labor or birth are categorized within the 3 P's: Power, Passenger, and Passage.
- National Health Goals (2020) include reducing cesarean births:
- The goal is to be no more than 23.9 per 100 births among low-risk women, from a baseline of 26.5 per 100 births.
- The goal is to be no more than 61.7 per 100 births among women with a prior cesarean, from a baseline of 90.8 per 100 births.
- Assessment for labor and birth complications relies on thorough uterine and fetal monitoring.
Complications with Power (The Force of Labor)
- Dysfunctional Labor is an old term describing sluggish contractions or insufficient labor force.
- Primary Dysfunctional Labor happens at the onset of labor.
- Secondary Dysfunctional Labor happens later in labor.
- Causes of dysfunctional labor:
- Primigravida status
- Pelvic bone contraction narrowing the pelvic diameter which prevents the fetus from passing (cephalopelvic disproportion, CPD), potentially due to rickets.
- A posterior fetal position, or extension of the fetal head rather than flexion.
- Failure of uterine muscle contraction due to overdistention from multiple pregnancy, polyhydramnios, or an oversized fetus.
- A nonripe cervix
- A full rectum or bladder impeding fetal descent
- Maternal exhaustion
- Inappropriate analgesia use (excessive or early administration)
- Hypotonic contractions: infrequent contractions where the uterus rests at less than 10 mm Hg and contraction strength doesn't exceed 25 mm Hg.
- Hypertonic contractions: frequent, intense contractions that elevate resting tone above 15 mm Hg.
- Dysfunctional labor can occur during the 1st stage of labor.
- Prolonged latent phase when contractions are ineffective.
- Protracted active phase typically associated with fetal malposition or CPD.
- Cervical dilation occurring slower than 1.2 cm/hr in nulliparas or 1.5 cm/hr in multiparas.
- Prolonged deceleration phase extending beyond 3 hours in nulliparas or 1 hour in multiparas.
- Secondary arrest of dilatation if there is no progress in cervical dilatation for longer than 2 hours
- Dysfunctional labor can occur during the second stage of labor.
- Prolonged descent if descent rate is less than 1.0 cm/hr in nulliparas or 2.0 cm/hr in multiparas.
- Arrest of descent with no descent for 2 hours in nulliparas or 1 hour in multiparas.
- Induction of labor artificially starts labor.
- Augmentation of labor assists spontaneous labor that is ineffective.
- Cervical ripening softens the cervix.
- A cervical score above 8 indicates readiness for birth and likelihood of responding to induction.
- Dysfunctional labor requires hydration, pain relief, reduced stimulation, and possibly oxytocin, cesarean birth, or amniotomy.
- Hypotonic contractions are most common in the active phase, result in limited pain, have a favorable reaction to Oxytocin, and helpful sedation
- Hypertonic contractions are most common in the latent phase, result in painful contractions, an unfavorable reaction to Oxytocin, and sedation has little value
Nursing Diagnoses
- Fatigue linked to glucose depletion during long labor.
- Risk of ineffective tissue perfusion for the woman and/or fetus.
- Risk of fluid volume deficit due to long labor.
- Risk of maternal and/or fetal injury from labor complications or medical interventions.
- Anxiety related to uncertainty concerning pregnancy outcome.
Expected outcomes
- No monitoring equipment will be used or IV's. The revised outcome is that monitoring equipment and IV fluids may need to be used. IV fluids would maintain blood volume and fetal well-being.
- Walking will assist labor. The revised outcome is that bed rest may be needed to assure fetal oxygenation and well-being
QSEN competencies:
- Patient-Centered Care
- Teamwork & Collaboration
- Evidence-Based Practice
- Quality Improvement
- Safety
- Informatics
Complications with the Passenger
- Interventions for umbilical cord prolapse:
- Relieve the pressure on the umbilical cord by proper positioning and manual pressure
- Prevent the cord from drying
- Fetal blood sampling
- Possible surgical intervention.
- Multiple gestation interventions include:
- Measures to reduce anxiety related to multiple personnel in the birthing room.
- Education about early labor signs and the importance of prompt hospitalization
- Prepare women for possible cesarean birth.
- Problems with fetal positioning interventions include:
- Interventions for a Right occipitoposterior (ROP) position
- Interventions for a Left occipitoposterior (LOP) position
- Interventions for a Posterior position
- Interventions for the oversized fetus:
- Evaluating for potential incompatibility between fetal size and woman's pelvic capacity
- Interdisciplinary interventions for shoulder dystocia.
Complications with the Passage
- Cephalopelvic disproportion interventions include:
- Trial of labor
- Forceps delivery
- Vacuum extraction
- Anomalies of the placenta intervention include:
- Vasa previa may require preparation for cesarean delivery
- Placenta accreta may require preparation for methotrexate treatment or possible hysterectomy
- Anomalies of the cord interventions include:
- A two-vessel cord requires examination of the infant for anomalies
- Nuchal cord interventions
Placenta Anomalies
- Placenta succenturiata has one or more accessory lobes connected to the main placenta.
- Placenta circumvallata has the fetal side of the placenta covered to some extent with the chorion.
- Battledore placenta indicates the cord is inserted marginally rather than centrally.
- Velamentous insertion of the cord- Instead of inserting directly into the placenta, the cord separates into small vessels that reach the placenta by spreading across a fold of amnion.
Complications of the Two-Vessel Cord
- Two-vessel cord can result in heart or kidney problems, and/or spinal defects.
- A two-vessel cord may correlate to a greater risk of genetic abnormality (VATER):
- VATER stands for vertebral defects, anal atresia, transesophageal fistula with esophageal atresia, and radial dysplasia.
- Two-vessel cord may increase the risk for inability to grow properly, potentially resulting in preterm delivery, slower-than-normal fetal growth, or stillbirth.
Uterine Inversion
- The uterus turns inside out either with the delivery of the fetus or of the placenta; this is a rare phenomenon only happening in 1:20,000 births.
- Uterine Inversion is due to over-traction of the cord and when the uterus is not contracted
- Leads to bleeding, hypotension, diaphoresis, paleness, and dizziness.
- Never try to replace an inversion
- Never remove the attached placenta
- Call for help
- Establish an IV line
- Give 02 by mask
- Be ready to do CPR
- Give the patient anesthesia, tocolytics or nitroglycerine to relax the uterus
- Administer oxytocin after manual replacement
- Initiate antibiotic therapy because the endometrium was exposed
- Be prepared for a CS
- Need for Hysterectomy if manual replacement fails
Uterine Rupture
- Uterine Rupture is rare, and can be caused by:
- CS scar, prolonged labor
- Abnormal presentation
- Multiple gestation
- Unwise use of oxytocin
- Obstructed labor
- Traumatic maneuvers with forceps or traction
- Signs include the following:
- Sudden, severe pain during contractions/ “tearing” sensation
- Contractions stop
- Two distinct swellings appear from the retracted uterus and the extrauterine fetus
- Complete rupture-until peritoneum
- Incomplete rupture-peritoneum is still intact
- Complications include Hemorrhage and Signs of shock, FHT will fade/is absent
- Action Steps:
- Administer IV
- Anticipate the use of IV oxytocin
- Prepare the patient for a possible laparotomy
- Advise patients not to conceive after uterine rupture
- CS hysterectomy
- Be prepared to tell the client the extent of surgery
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Description
Test your knowledge of labor complications, including hypertonic contractions and protracted labor. Review arrest of descent criteria, induction vs. augmentation, and Bishop scores for induction readiness. Learn about placental and cord abnormalities impacting labor.
