High-Risk Pregnancy Intrapartum Powerpoint PDF

HIGH-RISK PREGNANCY INTRAPARTUM power EDWIN DEL ROSARIO CCRN, ACNP, AGNP, MD  DYSFUNCTIONAL LABOR Dysfunctional labor Also called “inertia” Denotes sluggishness of contraction Classification Primary – occurring at the onset of labor Secondary – occurring later in labor...

HIGH-RISK PREGNANCY INTRAPARTUM power EDWIN DEL ROSARIO CCRN, ACNP, AGNP, MD  DYSFUNCTIONAL LABOR Dysfunctional labor Also called “inertia” Denotes sluggishness of contraction Classification Primary – occurring at the onset of labor Secondary – occurring later in labor DYSFUNCTIONAL LABOR HYPOTONIC UTERINE CONTRACTION ETIOLOGY  HYPOTONIC UTERINE CONTRACTION MANAGEMENT Oxytocin given as piggyback Monitor uterine contraction and FHR q 15 mins Keep Magnesium sulfate @ bedside if uterine tetany occurs Side effects -hypotension -dizziness -nausea/vomiting -tachycardia -fetal tachycardia or bradycardia -hypertonic contractions -decreased urine output HYPERTONIC CONTRACTIONS  Criteria Hypertonic Hypotonic Phase of occurrence latent Active Symptoms painful Limited pain Medications Oxytocin unfavorable Favorable Sedation helpful Little value  Uterine dyssynchrony acting can interfere independent with blood Uncoordinated ly of the supply to the contractions pacemaker placenta > 1 uterine Can occur so pacemaker closely may be together initiating contractions  Dysfunctional labor 1st Stage of labor Prolonged Secondary Prolonged Protracted deceleration arrest of latent phase active phase phase dilatation  Prolonged latent phase latent phase longer than 20 hours in a nullipara or 14 hours in a multipara Prolonged latent uterus in hypertonic state phase Inadequate relaxation Contractions : mild, ineffective unripe cervix Causes excessive analgesia early in labor Tocolytics Pain relief Supportive care: decrease stimulation Management Amniotomy Oxytocin C-section  Protracted Active Phase Cervical dilatation: < 1.2 cm/hr. Protracted nullipara, 1.5 cm/hr. multipara Duration (active phase) : > 12 hrs. active Phase primi, 6 hrs. multigravida fetal malposition Causes CPD ineffective myometrial activity C-section Management Oxytocin  Prolonged Deceleration Phase Prolonged Deceleration Secondary Arrest of Dilatation Phase no progress in descent exceed 3 cause: fetal cervical hrs. (nullipara), 1 head C-section C-section dilatation > 2 hrs. (mulipara) malposition hrs.  Dysfunctional labor 2nd stage Prolonged descent Arrest of descent descent < 1 cm/hr. no descent for 2 nullipara, 2 cm/hr. hrs. nullipara, 1 hr. multipara mulitpara 2nd stage > 2 hrs. no progress in multipara beyond station 0 Management: Oxytocin, Management: C- Amniotomy section, trial labor Positioning  PRECIPITATE LABOR strong, few, rapidly occurring uterine Precipitate contractions delivery completed < 3 hrs. labor Cervical dilatation : 5 cm/hr. primi, 10 cm/hr. multi Premature placental separation Risk cervical/perineal lacerations fetal head injury Tocolyitcs Management Sedatives Pain relief INDUCTION AND AUGMENTATION  CERVICAL RIPENING 0 1 2 3 Dilatation 0 1-2 3-4 5-6 Effacement 0-30 40-50 60-70 80 (%) Station -3 -2 -1 to 0 +1 to +2 Consistency firm medium soft Position posterior midposition anterior OXYTOCIN  Uterine rupture Uterine rupture rare, 5 % of maternal deaths Classic C-section Contributing Oxytocin administration Prolonged labor factors Multiple pregnancy traumatic labor Pathologic retraction ring Clinical finding S/sx shock FHT absent Emergency laparotomy/Hysterectomy Fluid Management Blood transfusion  INVERSION OF THE UTERUS - Refers to the uterus turning inside out Inversion of with either the birth of the uterus fetus or the placenta fundus may protrude from vagina Clinical fundus not palpable findings ssx of shock Do not replace uterus/placenta Management Hysterectomy Oxytocin  Amniotic fluid embolism Amniotic Fluid Amniotic fluid is forced to the open maternal embolism circulation Causes Meconium, fetal sheds oxytocin administration PROM Risk hydramnios abruptio placentae DIC Chest pain Dyspnea Clinical findings Cyanosis Pulmonary artery HTN Intubation/MV CPR Management ICU admission THANK YOU AIM HIGH!!!