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Chapter 14
Dystocia
Long, difficult, or abnormal labor
May arise from
Powers
Passenger
Passageway
Maternal-Child Nursing Care Susan Ward
Optimizing Outcomes for Mothers, Children, & Families Shelton Hisley
Dysfunctional Labor
Pattern: Hypotonic
Contractions decrease in frequency and
intensity
Maternal and fetal factors that produce
excessive uterine stretching
Management
Walking, position changes
Augmentation of labor
Maternal-Child Nursing Care Susan Ward
Optimizing Outcomes for Mothers, Children, & Families Shelton Hisley
Obstetric Interventions—
Amnioinfusion
Risks: infection, overdistention of uterus,
increased uterine tone
Nursing
Careful monitoring of infusion, intensity and frequency
of contractions, and maternal vital signs
Educate
Pharmacological induction of labor
Nonpharmacological stimulants of labor
Maternal-Child Nursing Care Susan Ward
Optimizing Outcomes for Mothers, Children, & Families Shelton Hisley
Obstetric Interventions—
Amniotomy
Artificial rupture of membranes
Augment or induce labor
Nursing
Careful monitoring of vital signs, cervical
effacement/dilation, station, FHR, contractions
Document regarding amniotic fluid
Maternal-Child Nursing Care Susan Ward
Optimizing Outcomes for Mothers, Children, & Families Shelton Hisley
Induction of Labor
Indications for induction
Bishop score
Cervical ripening agents
Mechanical methods
Oxytocin
Augmentation of labor
Maternal-Child Nursing Care Susan Ward
Optimizing Outcomes for Mothers, Children, & Families Shelton Hisley
Induction—Nursing
Considerations
Informed consent
Careful monitoring of labor
Discuss pain relief measures
Position changes
Keep patient and support person informed
of progress
Maternal-Child Nursing Care Susan Ward
Optimizing Outcomes for Mothers, Children, & Families Shelton Hisley
Instrumentation
Assistance of Birth
Forceps
Vacuum extraction
Maternal-Child Nursing Care Susan Ward
Optimizing Outcomes for Mothers, Children, & Families Shelton Hisley
Maternal Complications—
Hypertensive Disorders
Preeclampsia-eclampsia, HELLP syndrome
Nursing
Careful assessments
Monitor lab values
Administer platelets as appropriate
Ongoing education
Maternal-Child Nursing Care Susan Ward
Optimizing Outcomes for Mothers, Children, & Families Shelton Hisley
Maternal
Complications—Diabetes
Fetal lung maturity
Intrapartum management—maternal hydration and blood
glucose levels
Labor: normal progression of labor
Upright or side-lying position
Encourage breastfeeding
Maternal-Child Nursing Care Susan Ward
Optimizing Outcomes for Mothers, Children, & Families Shelton Hisley
Complications—Placental
Problems
Placenta previa
Placental abruption
Other Complications
Uterine rupture
Obstetric emergency
Uterine inversion
Umbilical cord prolapse
Maternal-Child Nursing Care Susan Ward
Optimizing Outcomes for Mothers, Children, & Families Shelton Hisley
Variations—Umbilical
Cord and Placenta
Velamentous cord insertion
Fetal vessels separate at distal end and insert into
placenta away from the margin
Vasa previa
fetal blood vessels, unsupported by either the
umbilical cord or placental tissue, traverse the fetal
membranes (bag of waters) across the lower segment
of the uterus between the baby and the cervical
opening
Maternal-Child Nursing Care Susan Ward
Optimizing Outcomes for Mothers, Children, & Families Shelton Hisley
Placental Variations
Circumvallate placenta
Succenturiate placenta
Battledore placenta
Placenta accreta
Placenta increta
Placenta percreta
Maternal-Child Nursing Care Susan Ward
Optimizing Outcomes for Mothers, Children, & Families Shelton Hisley
What to say
Cesarean Birth
Indications
Health of mother or fetus is jeopardized
Ethical considerations
Surgical procedures
Surgical and postoperative care
Vaginal birth after cesarean
Maternal-Child Nursing Care Susan Ward
Optimizing Outcomes for Mothers, Children, & Families Shelton Hisley
Postterm/Prolonged Pregnancy
Postterm—extends beyond 42 weeks
Risk for fetal/neonatal problems
Increased maternal risk
Management—labor induction
Nursing implications