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Abnormal Labor and Birth Complications
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Abnormal Labor and Birth Complications
test 3
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1
Question
What are common signs and care priorities for abnormal labor with prolonged duration?
Answer
Prolonged labor can lead to maternal exhaustion, characterized by inability to eat or drink, and increased anxiety or fear. Care includes providing comfort such as warm showers/baths, sedation, pain medication, and client education.
2
Question
Define precipitate labor and mention its risks.
Answer
Precipitate labor is a very rapid labor occurring within 3 hours. Risks include potential tearing of maternal tissues and fetal hypoxia because of the speedy delivery process.
3
Question
During a precipitate birth, what is the recommended maternal position and key nursing care actions?
Answer
The recommended position is side lying. Nursing care includes maintaining adequate maternal blood volume, stopping oxytocin infusion if given, promoting comfort, and the nurse must stay with the patient throughout.
4
Question
When the baby's head is delivered during birth, should the legs be held closed or the head held inside?
Answer
No, do not hold the legs closed or hold the head inside. Instead, support the head once it is out to help the baby safely emerge.
5
Question
What is macrosomia and what commonly causes it?
Answer
Macrosomia is when a baby has a large head or body, typically weighing more than 8.8 lbs (4000 g). It is usually caused by an imbalance between glucose and insulin or maternal obesity.
6
Question
List potential complications associated with fetal macrosomia.
Answer
Complications include meconium aspiration, asphyxia, shoulder dystocia, upper brachial plexus injury, fractured clavicle, hypoglycemia (glucose should remain above 40), polycythemia, and hyperbilirubinemia (due to bruising).
7
Question
What interventions are typical for a baby estimated to have macrosomia?
Answer
If the baby is estimated to weigh over 4500 g, C-section is preferred. For vaginal delivery, McRoberts maneuver may be used, fundal pressure should be avoided, and suprapubic pressure can be applied if needed.
8
Question
What postpartum care is recommended after delivery of a macrosomic baby?
Answer
Care includes monitoring for uterine hemorrhage due to excessive uterine stretching, assessing for a soft uterus, fundal massage, administering IV or IM oxytocin, and monitoring maternal vital signs.
9
Question
What do TOLAC and VBAC stand for, and how is labor managed with TOLAC?
Answer
TOLAC means Trial of Labor After Cesarean; VBAC means Vaginal Birth After Cesarean. TOLAC management includes electronic fetal monitoring, internal monitoring, IV fluids, and avoiding oxytocin to reduce uterine rupture risk.
10
Question
What key points should be considered when performing an amniotomy?
Answer
Amniotomy is the artificial rupture of membranes, performed only if the cervix is at least 2 cm dilated. After rupture, fetal heart rate should be monitored immediately, keep pads clean, and perform vaginal checks only if necessary.
11
Question
Describe the purpose and method of amnioinfusion.
Answer
Amnioinfusion involves infusing sterile isotonic fluid into the uterine cavity during labor to reduce umbilical cord compression. Only healthcare providers can perform this in many states, using warmed fluid with a bolus of 500 mL over 1 hour.
12
Question
What are some risks associated with induction of labor?
Answer
Risks include hypertonic uterine activity, uterine rupture, maternal water intoxication (related to prolonged oxytocin affecting lungs and kidneys, leading to fluid overload), and an increased risk of cesarean section.
13
Question
What is cervical ripening and which agents are commonly used?
Answer
Cervical ripening is the process of softening and thinning the cervix by artificial means to prepare for labor. Common agents include Cytotec (given rectally) and Cervidil.
14
Question
How does oxytocin infusion aid labor, and what monitoring is essential?
Answer
Oxytocin stimulates uterine contractions in small controlled doses. Continuous fetal monitoring is essential, with frequent assessment of fetal heart rate and cervical dilation every 15 minutes. If fetal distress occurs, oxytocin infusion should be stopped.
15
Question
What are signs of maternal exhaustion during labor, and how can nurses help?
Answer
Signs include fatigue and decreased pushing effectiveness. Nursing interventions include conserving maternal energy by dimming lights, reducing noise, providing comfortable positioning, offering shoulder/back rubs, sacral pressure, encouragement, and using visualization or birthing balls to promote relaxation.
16
Question
What can cause ineffective maternal pushing and how should it be managed?
Answer
Causes include fear, incorrect technique or position, exhaustion, decreased urge to push, and improper timing. Management includes position changes, keeping bladder empty (void every 2 hours), and using operative tools like vacuum or forceps if necessary.
17
Question
What are some neonatal risks associated with operative vaginal births?
Answer
Risks include bruising, edema, facial lacerations, cephalohematoma, facial paralysis, cerebral hemorrhage, and Bell's palsy.
18
Question
What is the indication and time limit for vacuum extraction during delivery?
Answer
Vacuum extraction assists birth by applying suction to the fetal head. Progress is expected within the first two pulls; maximum time is 8 to 10 minutes. After 3 pulls without progress, cesarean section is indicated.
19
Question
Define preterm labor and its fetal complications.
Answer
Preterm labor occurs between 20 and 37 weeks of gestation. Fetal complications include intrauterine growth restriction (IUGR), oligohydramnios, and chromosome or birth defects.
20
Question
What are common symptoms of preterm labor during the active phase?
Answer
Symptoms include baby balling up, menstrual-type cramping, low backache, pelvic pressure or pain, change in vaginal discharge, stomach cramping with or without diarrhea, and a general feeling of being unwell ('don't feel right').
21
Question
Which factors help predict risk of preterm labor?
Answer
Predictors include a short cervical length (<25 mm), a history of previous preterm labor, and a positive fetal fibronectin (FFN) test after 22 weeks, which may indicate labor within 72 hours (though false positives can occur after cervical exams).
22
Question
How is preterm labor stopped and what therapies are used?
Answer
Stopping preterm labor is most effective before 3 cm dilation. Treatments include steroid therapy to promote fetal lung maturity and tocolytics to relax the uterus. Maternal or fetal conditions are also assessed before treatment.
23
Question
Describe the purpose and key monitoring points of magnesium sulfate in tocolytic therapy.
Answer
Magnesium sulfate inhibits preterm labor by relaxing the uterus. It is given IV with loading and maintenance doses. Monitoring includes urine output (>30 mL/hr), deep tendon reflexes, respiratory rate, lung and heart sounds, bowel sounds, and magnesium levels to prevent toxicity.
24
Question
What is the antidote for magnesium sulfate toxicity?
Answer
Calcium gluconate is the antidote to magnesium sulfate toxicity.
25
Question
What beta adrenergic medication is used as a tocolytic and what are its dosing considerations?
Answer
Terbutaline is used off-label as a tocolytic. It may be given IV, PO, or subcutaneously with initial subq doses every 30 minutes up to 3 doses and oral doses of 2.5 to 5 mg every 2-4 hours.
26
Question
What are side effects of nifedipine when used as a calcium antagonist in tocolytic therapy?
Answer
Side effects include flushing of the skin, headache, increased heart rate in mother and baby, and hypotension.
27
Question
What are side effects of indomethacin when used as a prostaglandin synthesis inhibitor for tocolysis?
Answer
Side effects include constriction, hypertension, oligohydramnios (too little amniotic fluid), nausea, vomiting, heartburn, rash, and prolonged bleeding time.
28
Question
What are common abnormal fetal positions and how are they typically corrected?
Answer
Abnormal positions include occiput posterior (OP) and occiput transverse (OT) positions (normal is OA). Interventions for correction include hands-and-knees positioning, sidelying, lunges or kneeling, squatting, birthing ball rocking, and using vacuum or forceps if needed.
29
Question
What is the difference between fetal presentation and fetal lie, and which presentation is normal?
Answer
Fetal presentation refers to the part of the fetus entering the birth canal first; occiput (head) presentation is normal. Fetal lie relates to the orientation of the fetus' long axis to the mother (e.g., longitudinal or transverse).
30
Question
What are examples of abnormal fetal presentations?
Answer
Examples include face presentation, breech presentation, and compound presentation (two presenting parts).