High-Risk Labor & Delivery PDF

difficult labor w/ only increase in molding I caput...

difficult labor w/ only increase in molding I caput formation " dystocia " - " - " caput succedaneum ① Passenger fetus ↳ edema of presenting part. ② Passageway - Outlet ↳ cause of pressure ③ Power labor 2 -3 days will relieved - - in event ④ Psyche perception - feelings 1 occipital posterior) - , thoughts Nursing care : counter * application of pressure - back Mb complications Of * application of heat / cold compress to sacral area passenger * double hip squeeze 2 knee press Occipito posterior Position Facilitate Rotation Of Fetal Head : - most common fetal malposition * Lateral abdominal stroking * squatting ④ / ① determine * Hands and knees Position - where back of fetus located * Pelvic Rocking * Lunges Anterior position - Fetus faced on the spine > provide great deal of support during labor Occipital posterior Position reassurance > frequent - fetal head must rotate 135° it in flexion - too large good , 135° may not possible fetal - may complains of severe back pain * Android Pelvis - male pelvis mat presentation * Gynecoid Pelvis rate of 38.1 1000 tire births per _ * Anthropoid Pelvis in 2002 * Platypeloid Pelvis highest (58-7) - rate among fetus presenting in > majority of 40-54 yrs. old posterior position are born satisfactory  > Fontanelles - soft spot on skull ③ Footling - attitude is poor months thighs lower legs are flexed - closes 2 or - - allow to pass thru vagina - single Footling - if one foot presents it both gives of brain to grow Double footling present - - - room causes of Breech Presentation : breech presentation ✓ Gestational age of fetus < Yonks - most common form of mat presentation ✓ Abnormality in fetus either buttocks or feet ✓ Hydramnios - first part that contact ✓ Anomaly of Fetus feet are congenital - cervix ✓ Pendulous Abdomen 38 Wks Gestation not normally turns cephalic by ✓ Multiple -. Risk : * Fetal Anoxia - cord prolapse Diagnosis : * Injury to fetal Head abdominal * palpation * Fracture of spine or Arm - Leupold 's Mann ever * Early Rupture of membrane * vaginal Exam poor fit in presenting part * Ultrasound ( sonography ) - * Meconium Aspiration * Dysfunctional labor Nursing care : * monitor FHR & uterine contractions types : ① Frank Breech - attitude is moderate military position Birth technique accomplished by touching chest - not - , - legs are extended mechanisms of labor manipulate - Buttocks alone present to cervix the buttocks & lower extremities - never push it not fully dilated ② Complete Breech - attitude is good external cephalic version complete flexion from to a- birth breech cephalic - - - thighs tightly flexed of - 34 - 35 Wks although usual abdomen trine is 37 -38 wks - Buttocks & Feet in Presenting - rotates internally & Painful part  OF ECV Nursing cons Contraindications : : anomalies * CS will to deliver * uterine necessary * previous CS * leave infant w/ extreme ecchymotic * CPD bruising on tace * Placenta Previa * multiple Gestation Face Presentation * * Otigohydramnios - head diameter presents to pelvis often large to too birth proceed Nursing consideration : _ no engagement on Leopold 's * informed consent - back is difficult to outline * FAR & UTZ are recorded = concave & FHT may forward * NST - non stress test thrust chest to confirm fetal well performed - to relax UHMS * tow lytic agent Risk Factors : gentle to rotate fetus in ✓ contracted Pelvis * pressure forward ✓ Placenta Ptevia ✓ Relaxed uterus multi para wt tocolytic Agents : ✓ Prematurity ftp.RB) ① Torbntaine ✓ Hydramnios ② Albnterol ③ Ritodrine Diagnosis : ④ Beta Mimetic Drugs * vaginal Exam * sonography vertex mat presentation Nursing cons : - Baby may deal of facial edema ① Asynclitism fetal head at & be purple from ecchymotic may. different than expected Observed infant airway angle - - may failure to progress in NSD - Lip edema is severe unable to suck for Day or 2. Types : _ Garage feedings may necessary to * Brow Presentation enough fluid - rarest - transferred to ICU for 24 hrs. - multi para or w/ relaxed - Edema will disappear in few abdominal muscles days  Shoulder Factors / causes : presentation ✓ tetopewic Dysuria ✓ Maternal Pelvic Anomalies - shoulder ( acromion process ) , iliac crest , hand or elbow is the s / sx : 2nd labor presenting part - prolonged stage OF arrest of descent - fetus lies horizontally _ - CS delivery - Head appears on perineum - Formation of caput ↑ in size causes : _ external rotation does not occur * relaxed abdominal wall from grand multiparty Nursing Cons : * contractions pelvic - Rubin Technique " * Placenta Previn = " reverse woods screw Manu ever - McRoberts Mann ever Nursing cons : = to correct shoulder dystocia SGA attempt to turn fetus to uterus preterm & pressure - - to horizontal lie - Gaskin Mann ever - transverse tie may be born CS deliv = Flip Flop - provide encouragement * Shoulder Dystocia - exam of fracture on clavicle - ↑ wt. of newborns - maternal assx. on early detection - occurs @ 2nd stage of labor of hemorrhage & trauma - shoulders are too broad to enter - Diabetic Mother fetal distress complications : _ develops problem during labor * can result to vaginal / cervical tears causes : Risk from excessive blood loss Contractions * * due to lacerations * Infections Fractured clavicle brachial * Placental Abruption * on * Use of oxytocin plexus * Hypotension  Diagnosis : S / SX : Monitoring ( FFM ) - Electric Fetal - fetal bradycardia P S reports feeling women cord - / sx :rupture membranes 100 bpm for fetus Cord is felt bradycardia < or seen - - - tachycardia 180 bpm - - over fever to mother caused Diagnosis = : thick meconium first bowel movement delivery a- - CS membrane - * rupture = fetal anoxia Management : * Initial vaginal exam during labor * CS delivery * Vacuum Delivery * sonography * labor induction * Episiotomy * Forceps delivery Nursing cons : - relieving pressure on cord & compression - Assx Of fetal Sounds prolapsed. cord in CNS - prolonged result damage or death of fetus umbilical cord - get pressure off the cord in of = place trendelenbnrg - cord lies below presenting part give 02 per mask @ 10L - fetus - may be occult at any time during labor - hidden or not visible conditions : ✓ PROM ✓ Fetal presentation other than cephalic ✓ pp ✓ small fetus CPD ✓ preventing him management ✓ Hydramnios ✓ multiple gestation problems with - poor fetal descent passageway with problems Abnormal size of pelvis * power causes : Dystocia - long , difficult or - disproportion of pelvis abnormal labor - pelvic contractures - 8% to 11% of women during - immature pelvic size 1st stage of labor cause of CS pelvic deformities - - = 12cm is normal diagonal causes : ① Inlet contracture * Excessive fetal size is Maternal pelvis too small diagonal conjugate < 11.5cm * , - - ↑ face & shoulder presentation abnormal shaped / deformed ② Mid plane contracture Treatment : most cause of pelvic dystocia CS delivery it cause is pelvis - - diameter of mid pelvis is 13.5cm Forceps , Vacuum extraction - - , or less episiotomy ③ Outlet Contracture * Dysfunctional Labor 1 inertia ) - interischial diameter is _ ineffective uterine contractions 8cm or less maternal - bearing down efforts - most common cause of dystonia * Cephalo pelvic Disproportion abnormal uterine contractions - " dilation preventing cervical " Feto pelvic Disproportion FPD normal -. - excessive fetal size 14000g or more ) effacement or descent. - cannot fit through maternal pelvis Placenta Succenturiata Risk Factors : / s SX : - 1 or more accessory lobes * Body Fluid - lacks engagement of beginning * Uterine abnormalities of labor * CPD - prolonged first stage of * Malpresentations labor * overstimulation of oxytocin - He providers must careful when diagnosing labor pattern as prolonged Effects : levels of Consciousness : anxiety - * conscious - fear lethargic discouragement * ] - sleepy * obtunded * Dysfunction w/ 1st stage of labor * stuporous * comatose.m!¥%¥%¥%IY + stage of labor causes : is than 20 hrs CPD latent phase longer - * in Nnllipara , 14 hrs in multi para * Fetal malposition resulting of hypertonic of uterus - - dysfunctional labor during dilatation causes : division of labor tends to hypotonic - occurs it cervix is not ripe at beginning of labor nnllipara = 1- 2cm 1hr - ineffective uterine contraction multi para = 1- 5cm 1hr Treatment : / S Sx : if CPD not present thru UR oxytocin - , - relaxation between contractions is May prescribed to augment labor inadequate - contractions are mild only * Prolonged Deceleration Phase - one segment of uterus may contract - beyond 3 hrs lnnllipara ) , w/ more force than another 1 hr ( multi para ) segment. - abnormal fetal head positions Nursing cons : Management : - administration of adequate fluid - CS birth is required to prevent dehydration - administer morphine * Secondary Arrest Of Dilatation abnormal identified by in cervical dilatation - progress - no progress cervical dilation for hrs plotting more than a.  Dysfunction labor contraindications * at 2nd stage of : pnlongedtesuent * painful contractions * ineffective , erratic , uncoordinated - less than 1.0cm / hr in nnlli , 2.0cm / hr poor portion of uterus in multi * ↑ frequency of contractions , ↓ intensity Management : it fluid intake - normal , rest and s sx / : contractions rlt muscle may apply painful - be used to induce anoxia cramping - N oxytocin may = the uterus to contract effectively - dilation & effacement not occurs semi fowler Kneeling position squatting prolonged latent phase - - -. , speed descent = 2- 3cm dont dilate as should may - fetal distress occurs early * Arrest Of Descent - no descent occurred for 1hr in complication : multi. p or d hrs in multi - fetal anoxia in latent phase cause : Nursing / Cons : * 2nd stage is CPD * relieve pain & promote normal labor pattern Management : * pain medications birth is * Cs birth Cs necessary may necessary - - no contraindication to vaginal birth used for uterine contractions , oxytocin may * Hypotonic labor - second & more common type of uterine dysfunction " " Uterine SECONDARY UTERINE INERTIA * Hypertonic Dysfunction - - ↑ resting tone or more than 15 MmHg / s sx : Most common in PHASE ↑ beyond 3 in 10min - LATENT not 2 or - OF LABOR - weak contractions becomes mild prolonged active - phase exhaustion of mother -  Etiology / causes : treatment : * overstretching of uterus / large baby) - administration of IV morphine * Excessive use of analgesia sulfate tocolytic administration - Management : nil / ray to rule * Preterm labor perform ✗ out - - cervical & uterine contractions CPD - changes FAT & rate & pattern between do -37 wks of pregnancy - assx. - ambulation - Risk Factors - nipple stimulation : old ↑ - Enema * ↓ A. yrs. , 35 yrs Old. Amniotomy * low socioeconomic - - Augmentation of labor w/ oxytocin * unmarried school education * less than high * contraction Ring - hard band forms across ntms Biophysical Risks : - junction of upper & lower - previous preterm labor segment - and times abortion grand multi parity - types : " ① Simple type - " constriction King Behavioral Risk : at any occurs in Myometrinm poor nutrition - - time of labor - smoking ② Pathologic Retraction Rings self - care measures : ' " " Bandt 's Ring ✓ drink plenty of fluids - most common form of contraction - 2- 39T. / day rings ✓ Rest bladder 2-3 hrs ✓ Empty every Diagnosis ✓ avoid overexertion - ultrasound ✓ modify sexual activity * Precipitate Labor - strong that women girls birth w/ - uterus undergoes more strain only few / rapidly contractions than capable of sustaining - 3 hours or less than when vertical - contractions be forceful Rupture commonly - = can rapid labor risk for fetus from scar previous CS - = complications : contributing Factors : * Maternal * Prolonged labor uterine rupture * abnormal presentation - lacerations of birth canal - - amniotic fluid embolism Types : ① Complete Rupture * Fetal endo peri layers myo , - , hypoxia abdominal pain - - severe intracranial hge e) FAR - - - falling BP Management : ② Incomplete Rupture * initial asx & Ongoing assx. information provide peritoneum intact - * scalp pH can be used to - localized tenderness degree of fetal distress persistent aching pain - * ultrasound complications : * Shock * absent f- It sounds = complete rupture Management : * immediate emergency * possible laparotomy * perform tubal ligation uterine prolapsed anomalies of of cent 9 falling / sliding uterus pl a - / " DESCENSUS PROCIDENTIA - " DEGREES : ① Placenta sucoentiriata half of vagina accessory lobes stage I upper one or more - : - descended connecting to placenta stage I : nearly of opening vagina no fetal abnormality - stage II of vagina : protrudes out stage I : completely out of vagina ② Placenta circumvallate - fetal side covered to some causes : extent w/ chorion 1 vaginal births fetal abnormality - * or more no * lack of estrogen F menopause * chronic tough ③ Placenta Accreta * Pelvic tumor - unusual deep attachment - myometrinm deep that placenta deliver symptoms : will not loosen & * sitting on small ball - no fetal abnormality painful sexual intercourse * = hysterectomy * low backache * profusion from vaginal opening with problems pelvic Diaphragm - composed of levator ani psyche * iliococcygens - psychological state or feelings that woman brings into Diagnosis : labor * pelvic Exam - feeling of apprehension Complications : Psychological : ✓ ulceration & infection of vagina * Fatigue walls * Fear ✓ UTI because of cystocele ✓ hemorrhoids Rectocele = constipation & postpartum blues Diagnosis : - rapid mood swings from elation to ① Edinburgh Postnatal Depression sorrow scale ( EPDS ) - occur wln a to 3 days I delivery _ to item self - rated questionnaire peaking @ 5th day & resolving WIN for detection of postpartum dep. ✗ to rule medical wks - important out causes of depression postpartum depression - can be anytime wln 1 yr postpartum Treatment : - highest vulnerability in first 3 months * counselling / psychotherapy * medication F delivery * support groups postpartum psychosis - rare occurs in 1- 2% of cases SSRIs risk Bipolar Disorder Fluoxetine l Prozac) high w/ & - - schizoaffective Disorder Patients - sertraline ( 2010ft) - paroxetine I Paxil ) Untreated can lead to : * child abuse SNRIs * suicide - Venlafaxine lttfexor) * Infanticide - Duloxetine ( cymbalta) / s SX : ECT * low energy level - severe depression / psychosis * anhedonia unable - to feel pleasurable * anorexia treatment : * apathy * Exercise * extreme sadness , fatigue * Eat healthy * inability to stop * crying promote not to isolate one 's self * try Risk Factors : * hx Of depression * troubled childhood * low - self esteem l