Post-term Pregnancy and Labor Dystocia
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Questions and Answers

What is one of the primary concerns when caring for a woman with post-term pregnancy?

  • Reduced likelihood of cesarean delivery
  • Decreased fetal monitoring needs
  • Increased risk of fetal distress (correct)
  • Higher chances of preterm labor

    • Which complication is commonly associated with dysfunctional labor?

  • Reduction in birth injuries
  • Increased maternal anxiety
  • Prolonged use of labor-enhancing medications (correct)
  • Spontaneous delivery rates

    • What is a significant challenge in caring for obese women during labor?

  • Higher likelihood of needing epidural anesthesia
  • Maintaining optimal fetal heart rate monitoring (correct)
  • Reducing the risk of infection during labor
  • Increased mobility during contractions

    • What is a critical management consideration in obstetric emergencies?

    <p>Immediate assessment and stabilization of both mother and baby</p> Signup and view all the answers

    What characteristic is typical of a post-term newborn?

    <p>Dry, cracked skin</p> Signup and view all the answers

    Which factor is associated with birth trauma in large for gestational-age (LGA) infants?

    <p>Maternal diabetes</p> Signup and view all the answers

    What type of injury may occur in a newborn experiencing soft-tissue injuries during birth?

    <p>Fractured collarbone</p> Signup and view all the answers

    What is a common peripheral nervous system injury in newborns during delivery?

    <p>Brachial plexus injury</p> Signup and view all the answers

    Which of the following is a recognized risk factor for cervical ripening when using Pitocin?

    <p>Previous cesarean section</p> Signup and view all the answers

    What are common signs that indicate severe complications during cervical ripening?

    <p>Bright red vaginal bleeding and sudden abdominal pain</p> Signup and view all the answers

    What is the primary management approach for amniotic fluid embolus following its onset?

    <p>Supportive care including oxygenation and fluid replacement</p> Signup and view all the answers

    Which of the following factors doubles the risk of amniotic fluid embolus in pregnant patients?

    <p>Maternal age over 35</p> Signup and view all the answers

    What psychological effects can birth trauma have on healthcare providers?

    <p>Requests for assignment changes</p> Signup and view all the answers

    What is the primary cause of Meconium Aspiration Syndrome (MAS) in newborns?

    <p>Long-standing intrauterine process</p> Signup and view all the answers

    Which of the following is NOT recommended by the AAP for newborns at birth?

    <p>Routine suctioning</p> Signup and view all the answers

    Which factors predispose an infant to birth injuries?

    <p>Maternal age and primigravida status</p> Signup and view all the answers

    Which of the following classifications does NOT fit under birth trauma/injury?

    <p>Congenital malformations</p> Signup and view all the answers

    What type of injury may present with bruising, lacerations, or edema during a cesarean section?

    <p>Soft-tissue injury</p> Signup and view all the answers

    Which injury is characterized by the absence, limitation, or asymmetry of movement in a newborn?

    <p>Central nervous system injury</p> Signup and view all the answers

    What indicates shoulder dystocia during birth?

    <p>Anterior shoulder cannot pass under the pubic arch</p> Signup and view all the answers

    Which is a nursing role in managing birth trauma?

    <p>Education and documentation</p> Signup and view all the answers

    What is a common risk factor for shoulder dystocia?

    <p>Macrosomia greater than 4000g</p> Signup and view all the answers

    Which intervention is NOT typically included in the management of a newborn with a clavicle fracture?

    <p>Encouraging excessive movement</p> Signup and view all the answers

    What does ACOG recommend monitoring for during labor?

    <p>Sources of fetal hypoxemia</p> Signup and view all the answers

    Which of the following best describes dystocia?

    <p>Lack of progress in labor for any reason</p> Signup and view all the answers

    What is a common indicator of placental insufficiency during labor?

    <p>Late decelerations</p> Signup and view all the answers

    Which factor may contribute to dysfunctional labor?

    <p>Ineffective uterine contractions</p> Signup and view all the answers

    What does the 'passenger' factor in dysfunctional labor refer to?

    <p>Abnormal fetal presentation</p> Signup and view all the answers

    Which symptom suggests that dysfunctional labor may be occurring?

    <p>Alteration in uterine contraction characteristics</p> Signup and view all the answers

    What is the likely cause of umbilical cord compression during labor?

    <p>Amniotic fluid decrease</p> Signup and view all the answers

    Which situation is most likely associated with dystocia?

    <p>Post-term labor</p> Signup and view all the answers

    What role does maternal position play in dysfunctional labor?

    <p>It can affect labor progression and efficiency.</p> Signup and view all the answers

    Which of the following might indicate the need for amnioinfusion during labor?

    <p>Variable decelerations</p> Signup and view all the answers

    What is one of the most common injuries associated with asphyxia during birth?

    <p>Unilateral brachial plexus injury</p> Signup and view all the answers

    Which maneuver is NOT recommended during the management of shoulder dystocia?

    <p>Fundal pressure</p> Signup and view all the answers

    Which situation is most likely to contribute to prolonged cord compression during labor?

    <p>Malpresentation of the fetus</p> Signup and view all the answers

    What is an appropriate initial action when managing a case of suspected shoulder dystocia?

    <p>Remain calm and call for help</p> Signup and view all the answers

    When should a vaginal exam be performed in relation to cord compression?

    <p>To relieve pressure on the cord</p> Signup and view all the answers

    What is the recommended course of action if a patient is fully dilated and at risk of prolonged cord compression?

    <p>Consider cesarean birth or operative vaginal delivery</p> Signup and view all the answers

    Which of the following factors does NOT contribute to the risk of uterine rupture?

    <p>Advanced maternal age</p> Signup and view all the answers

    What should be avoided in women with previous cesarean sections to prevent uterine rupture?

    <p>Labor induction with prostaglandins</p> Signup and view all the answers

    Which of the following is a contributing factor to asphyxia during delivery?

    <p>Polyhydramnios</p> Signup and view all the answers

    What is the leading cause of infant deaths under 1 year of age?

    <p>Congenital anomalies</p> Signup and view all the answers

    Which of the following congenital anomalies primarily affects the central nervous system?

    <p>Anencephaly</p> Signup and view all the answers

    What percentage of live births is estimated to be affected by congenital anomalies?

    <p>2%-3%</p> Signup and view all the answers

    Which congenital anomaly is characterized by a defect in the diaphragm?

    <p>Congenital diaphragmatic hernia</p> Signup and view all the answers

    What is a common risk associated with congenital anomalies?

    <p>No identifiable cause in many cases</p> Signup and view all the answers

    Which congenital anomaly is most frequently reported as the most common type?

    <p>Cardiac anomalies</p> Signup and view all the answers

    Which of the following is NOT a type of gastro intestinal system anomaly?

    <p>Congenital diaphragmatic hernia</p> Signup and view all the answers

    Encephalocele is typically associated with what type of abnormalities?

    <p>Multiple other congenital anomalies</p> Signup and view all the answers

    What is a common nursing care management consideration for exstrophy of the bladder?

    <p>Maintain bladder protection</p> Signup and view all the answers

    Which congenital anomaly can lead to severe complications in the respiratory system?

    <p>Choanal atresia</p> Signup and view all the answers

    What is the most common congenital anomaly related to the bladder?

    <p>Exstrophy of the bladder</p> Signup and view all the answers

    Which statement about the timing of surgical closure of the bladder in exstrophy cases is correct?

    <p>Surgical closure is often done within 48 hours after birth.</p> Signup and view all the answers

    In exstrophy of the bladder, which gender is affected more frequently?

    <p>Males</p> Signup and view all the answers

    What is the primary intervention for families dealing with congenital anomalies in newborns?

    <p>Parental and family support</p> Signup and view all the answers

    Which psychological response is commonly observed in parents of newborns with congenital anomalies?

    <p>Blame and emotional trauma</p> Signup and view all the answers

    What aspect of Caring Theory can help families cope with loss from congenital anomalies?

    <p>Maintaining presence and acceptance</p> Signup and view all the answers

    Which characteristic of emotional response may parents exhibit upon learning about their newborn's congenital anomaly?

    <p>Anger and quietness</p> Signup and view all the answers

    What is the role of providing information and guidance to parents of newborns with congenital anomalies?

    <p>To enable parents to make informed choices</p> Signup and view all the answers

    What should be done to an exposed bladder immediately after birth?

    <p>Cover it with sterile gauze soaked in saline</p> Signup and view all the answers

    Staged surgical repairs for congenital anomalies are typically completed by what age?

    <p>Before school age</p> Signup and view all the answers

    What is a characteristic sign of choanal atresia?

    <p>Cyanosis that improves with crying</p> Signup and view all the answers

    What initial nursing intervention is critical for a newborn with gastroschisis?

    <p>Covering with saline-soaked gauze</p> Signup and view all the answers

    What is the primary treatment approach for anencephaly?

    <p>Palliative care and family support</p> Signup and view all the answers

    Which of the following conditions is characterized by the herniation of abdominal contents through a wall defect?

    <p>Gastroschisis</p> Signup and view all the answers

    What nursing intervention should be prioritized for a newborn with diaphragmatic hernia?

    <p>Maintaining an adequate respiratory status</p> Signup and view all the answers

    What condition involves the absence of both cerebral hemispheres and the overlying skull?

    <p>Anencephaly</p> Signup and view all the answers

    Which of the following describes a key complication associated with a diaphragmatic hernia?

    <p>Respiratory distress</p> Signup and view all the answers

    Which symptom is a red flag for gastrointestinal obstruction in newborns?

    <p>Bilious vomiting</p> Signup and view all the answers

    What is a common nursing intervention for managing choanal atresia?

    <p>Pass a feeding tube to confirm diagnosis</p> Signup and view all the answers

    Which factor is NOT a known risk for developing omphalocele?

    <p>Obesity in pregnancy</p> Signup and view all the answers

    Study Notes

    Post-term Pregnancy

    • ACOG 2019 recommends continuous external fetal monitoring during labor to observe sources of fetal hypoxemia, such as late decelerations from placental insufficiency or variable decelerations that can be caused by umbilical cord compression.
    • Amnioinfusion can be considered when variable or prolonged decelerations suggest umbilical cord compression, as it can help increase amniotic fluid volume.

    Labor Dystocia (The 5 P’s)

    • Dystocia refers to a lack of progress in labor for any reason, most commonly encountered in post-term labor or cases with macrosomia.
    • Dysfunctional labor describes a long, difficult, or abnormal labor caused by various conditions related to:
      • The Powers: ineffective uterine contractions or maternal pushing efforts
      • The Passage: alterations in the bony pelvic structure or soft-tissue dystocia
      • The Passenger: abnormal fetal presentation, position, congenital anomalies, or multiple fetuses
      • The Psyche: maternal position and psychologic response
      • The Position: maternal positioning during labor
    • Uterine cupping can occur due to the baby being too large or positioned abnormally.

    Meconium Aspiration Syndrome

    • Meconium aspiration syndrome (MAS) is a condition in newborns where meconium is aspirated into the lungs, usually resulting from a prolonged intrauterine process rather than the first breath.
    • The American Academy of Pediatrics (AAP) no longer recommends routine suctioning of newborns.
    • Care Management for MAS often involves an interprofessional team skilled in neonatal resuscitation, supplemental oxygen, surfactant, antibiotics, and even ECMO (extracorporeal membrane oxygenation).

    Birth Trauma

    • Physical injuries sustained by a newborn during labor and birth are classified by etiology or location:
      • Soft-Tissue Injuries: bruising, lacerations, edema
      • Skeletal Injuries: fractures
      • Peripheral Nervous System Injuries: brachial plexus injury, Erb-Duchenne palsy, facial paralysis
      • Central Nervous System Injuries: subdural hematoma, subarachnoid hemorrhage
    • Birth trauma care management is dependent upon the type of injury and involves initial and ongoing assessment, education, support, and pain management.

    Shoulder Dystocia

    • Occurs when the baby's head is born but the anterior shoulder cannot pass under the pubic arch, commonly associated with macrosomia, maternal pelvic abnormalities, maternal diabetes, and prolonged second stage of labor.
    • Care management focuses on immediate intervention with maneuvers like the McRoberts maneuver, suprapubic pressure, and the Gaskin maneuver (hands and knees). Fundal pressure is strictly prohibited.

    Prolapsed Umbilical Cord

    • This occurs when the umbilical cord lies below the presenting part of the fetus, often contributing to prolonged cord compression.
    • Care management involves prompt recognition of the condition and immediate action to relieve pressure on the cord via a vaginal exam. Cesarean birth or operative vaginal delivery may be necessary if the patient is fully dilated.

    Uterine Rupture or Uterine Dehiscence

    • Uterine rupture or dehiscence is a rare but serious complication with an incidence of approximately 1%, and significant maternal/neonatal morbidity & mortality.
    • Risk factors include previous cesarean birth or uterine surgery, trauma, abortion, instrumentation injury, grand multiparity, and uterine overdistension.
    • Care management involves preventing this complication through careful assessment for risk factors and avoiding the use of prostaglandins for cervical ripening.

    Amniotic Fluid Embolus (Anaphylactoid Syndrome of Pregnancy)

    • A sudden, acute onset of hypotension, hypoxia, and hemorrhage caused by coagulopathy.
    • It is not preventable and true incidence is unknown.
    • Major risk factors include maternal age >35, rapid labor, meconium-stained fluid, post-term pregnancy, instrumental labor, and operative birth.
    • Onset occurs during labor, birth, or within 30 minutes of delivery.
    • Care Management prioritizes resuscitation efforts with oxygenation, maintaining cardiac output, fluid replacement, and correcting coagulopathies.
    • The nurse's role includes monitoring maternal/fetal status, preparing for emergency birth, and providing emotional support.

    Birth Trauma Effects on Nurses

    • Nurses often experience psychological trauma, decreased job performance, increased absenteeism, requests for assignment changes, and even leaving the field altogether following birth trauma cases.

    Newborn Congenital Anomalies

    • Congenital anomalies affect 2-3% of live births.
    • The leading cause of infant deaths under 1 year of age.
    • 50% of congenital defects have no identifiable cause.
    • Cardiac defects are the most common congenital anomaly.

    Central Nervous System Anomalies

    • Encephalocele: Herniation of the brain and meninges usually found in the occipital area of the skull.
      • Often found with other congenital anomalies like cardiac, cleft lip/palate, and microencephaly.
      • Treatment involves surgery and placement of a shunt to remove excess CSF.
    • Anencephaly: The most severe neural tube defect where both cerebral hemispheres and the overlying skull are absent.
      • Incompatible with life, many infants are stillborn or die after 20 weeks of pregnancy.
      • Palliative care and support for the family is crucial.

    Respiratory System Anomalies

    • Congenital Diaphragmatic Hernia: Intestines are located in the chest cavity, compressing the lungs.
      • Characterized by barrel chest, scaphoid abdomen, asymmetric chest expansion, respiratory distress, and bowel sounds heard in the thoracic cavity.
    • Choanal Atresia: Most common nasal congenital anomaly where the posterior nares are blocked by a membrane or bone.
      • Infants experience cyanosis and retractions at rest, but color improves with crying.
      • May also present with noisy respirations, difficulty breathing during feeding, and copious/thick mucous.

    Gastrointestinal System Anomalies

    • Omphalocele: Herniation of abdominal contents contained in a peritoneal sac.
      • May contain intestines, liver, and spleen.
      • Associated with other congenital anomalies, chromosomal abnormalities, and risk factors including young or advanced maternal age, obesity, use of SSRIs, alcohol, and tobacco use.
    • Gastroschisis: Herniation of the bowel through an abdominal wall defect.
      • Not usually associated with other congenital anomalies.
      • Risk factors include low maternal weight, IUGR, tobacco, recreational drug and antidepressant use, and exposure to agricultural chemicals.

    Gastrointestinal Obstruction

    • Obstructions can occur anywhere in the gastrointestinal tract.
    • Symptoms include bilious emesis, abdominal distention, failure to pass meconium, and respiratory distress if the obstruction is high.

    Anorectal Malformations

    • Imperforate Anus: Absence of an anal opening or an abnormally located opening.
      • May be associated with a fistula to the genitourinary tract.
      • Assessment for patency is crucial.

    Genitourinary System Anomalies

    • Exstrophy of the Bladder: The bladder is exposed outside the body.
      • More common in males than females.
      • Often associated with epispadias and requires immediate surgical closure.

    Nursing Interventions

    • Central Nervous System Anomalies - Focus on family support and care post-surgery.
    • Diaphragmatic Hernia - Maintain adequate respiratory status, provide gastric decompression, place the infant in high semi-Fowler's position, turn to the affected side to allow for lung expansion, and involve parents in care.
    • Choanal Atresia - Pass a feeding tube to confirm the diagnosis, insert an oral airway, and keep the infant prone to prevent aspiration.
    • Gastroschisis & Omphalocele - Protect from infection, provide thermoregulation, decompress the gut with an orogastric tube to low wall suction, monitor perfusion, and position on the side with support to prevent intestinal torsion.
    • Gastrointestinal Obstruction - Hold feeds, place an orogastric tube to low wall suction, and prepare for immediate surgical intervention.
    • Anorectal Malformation - Frequent assessment to ensure patency.
    • Exstrophy of the Bladder - Immediately cover the exposed bladder with sterile gauze soaked in normal saline.

    Most Important Intervention

    • Parental and Family Support - Understand that families are in crisis and may blame themselves. Provide emotional support, understand grief and loss, and encourage family involvement in care.

    Nursing Theory to Support Families

    • Caring Theory - Provides a guiding framework for supporting families in crisis. Helps facilitate:
      • Knowing - Understanding the loss for the family.
      • Being With - Providing a caring presence and acceptance.
      • Doing for - Providing care for the mother and family.
      • Enabling - Providing information, guidance, and promoting autonomy.
      • Maintaining Belief - Encouraging the family's ability to cope with the loss.

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    Description

    This quiz covers key concepts related to post-term pregnancy and labor dystocia, including recommendations for fetal monitoring and interventions for umbilical cord compression. It also examines the 5 P's of labor which can contribute to dystocia. Enhance your understanding of labor complications and management strategies.

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