1230 Chapter 17 Highlights.docx

Chapter 17: Labor and Birth Complications Define precipitous labor: recipitous labor is defined as labor that lasts less than 3 hours from the onset of contractions to the time of birth. This abnormal labor pattern occurs in approximately 3% of all births in the United States. Precipitous birth alon...

Chapter 17: Labor and Birth Complications Define precipitous labor: recipitous labor is defined as labor that lasts less than 3 hours from the onset of contractions to the time of birth. This abnormal labor pattern occurs in approximately 3% of all births in the United States. Precipitous birth alone is usually not associated with significant maternal or infant morbidity or mortality (Cunningham et al., 2018). Precipitous Risks related to precipitous labor: Precipitous labor may result from hypertonic uterine contractions that are tetanic in intensity. Conditions often associated with this type of uterine contraction include placental abruption, uterine tachysystole, and recent cocaine use. Maternal complications can include uterine rupture, lacerations of the birth canal, amniotic fluid embolus (anaphylactoid syndrome of pregnancy), and postpartum hemorrhage caused by uterine atony. Fetal complications include hypoxia caused by decreased periods of uterine relaxation between contractions, and, in rare instances, intracranial trauma rela Define pelvic dystocia: Pelvic dystocia can occur whenever there are contractures of the pelvic diameters that reduce the capacity of the bony pelvis, including the inlet, the mid pelvis, the outlet, or any combination of these planes. Pelvic contractures may be caused by congenital abnormalities, maternal malnutrition, neoplasms, or disorders of the lower spine. An immature pelvic size predisposes some adolescent mothers to pelvic dystocia. Pelvic deformities also can be the result of vehicular or other accidents or trauma. Cephalopelvic disproportion (CPD) Cephalopelvic disproportion (CPD), also called fetopelvic disproportion (FPD), is disproportion between the size of the fetus and the size of the mother’s pelvis. With CPD, the fetus cannot fit through the maternal pelvis to be born vaginally. Although CPD is often related to excessive fetal size, or macrosomia (i.e., 4000 g or more), the problem in many cases is malposition of the fetal presenting part rather than true CPD (Sheibani & Wing, 2017). Fetal macrosomia is associated with maternal diabetes mellitus, obesity, multiparity, or the large size of one or both parents. If the maternal pelvis is too small, abnormally shaped, or deformed, CPD may be of maternal origin. In this case, the fetus may be of average size or even smaller. CPD cannot be accurately predicted (Sheibani & Wing, 2017). Fetal causes: Fetal anomalies: Gross ascites, large tumors, open neural tube defects (e.g., myelomeningocele), and hydrocephalus are examples of fetal anomalies that can cause dystocia. The anomalies affect the relationship of the fetal anatomy to the maternal pelvic capacity, with the result that the fetu Fetal malposition The most common fetal malposition is persistent occipitoposterior position (i.e., right occipitoposterior [ROP] or left occipitoposterior [LOP]; see Chapter 13), which is present in 20% of early labors, though only 5% of these are persistent through the end of labor (Verhaeghe, Parot-Schinkel, Bouet, et al., 2018). Labor, especially the second stage, is prolonged. Fetal malpresentation Malpresentation (the fetal presentation is something other than cephalic [head first]) is another commonly reported complication of labor and birth. Breech presentation is the most common form of malpresentation, occurring in 3% to 4% of all labors (Thorp & Grantz, 2019). The three types of breech presentation are as follows (Fig. 17.3): Frank breech (hips flexed, knees extended) Complete breech (hips and knees flexed) Footling breech (one or both hips are partially or fully extended). One foot [single footling] or both feet [double footling] present before the buttocks. Multifetal gestation: Impact of the maternal psychologic response: Risks related to obesity and labor: Multifetal pregnancy is the gestation of twins, triplets, quadruplets, or more infants. Infants born as multiples accounted for 3.4% of all live births in the United States in 2017 (Bowers, 2021). The birth rates for both twins and triplets/higher-order multiples decreased in 2019 from their 2017 and 2018 levels (Martin et al., 2019, 2021). The number of multiple gestation pregnancies rose dramatically in the 1980s and 1990s, most likely due to assisted reproductive technology and more women older than age 35 continuing childbearing. Compared with younger women, those 35 years and older are naturally more likely to have a multife Define Version, the risks and provide the nursing care : ersion is the turning of the fetus from one presentation to another. It may be performed externally or internally by the obstetric health care provider. External cephalic version External cephalic version External cephalic version (ECV) is used to turn the fetus from a breech or shoulder presentation to a vertex presentation for birth. It may be attempted in a labor and birth setting at 36 to 37 weeks of gestation. ECV is accomplished using gentle, constant pressure on the abdomen (Fig. 17.6) (Barth, 2021). At this gestational age, the success rate for ECV is approximately 65%, and the risk for cesarean birth is reduced by 50% (Thorp & Grantz, 2019). Therefore, ECV should be offered and performed whe Internal version With internal version, the fetus is turned by the obstetric health care provider, who inserts a hand into the uterus and changes the presentation to cephalic (head) or podalic (foot). Internal version is rarely used, most often in twin gestations to assist with the birth of the second fetus. The safety of this procedure has not been documented; maternal and fetal injury are possible. Cesarean birth is the usual method for managing malpresentation in multifetal pregnancies. The nurse’s role is to monitor the status of the fetus and to provide support to the woman. Induction of labor: Cervical ripening agents used: Mechanical ripening agents: List complications related to induction of labor: Define amniotomy: Provide the related risks and nursing care: Operative vaginal birth: When is this used and nursing care and priorities: Forceps: Vacuum: Cesarean section (CS): Indications for a C/S: Risks r/t C/S: Trial of labor: Define: Provide the risks: Vaginal birth after cesarean (VBAC): Meconium aspiration (Mec): Shoulder dystocia: Prolapsed cord: