11/19/23, 9:35 AM CH 21 - Summary Maternity and Pediatric Nursing
OB#Exam#2#Intrapartum# #########################################Susset#H.#Alcover#
#
Chapter(21:#Nursing(Management(of(Labor(and(Birth(at(Risk(
(
Dystocia:(Abnormal#or#difficult#labor#
#
Risk(Factors(for(Dystocia(
• Epidural#analgesia/excessive#analgesia#
• Multiple#gestation#–#to#prevent#complications#twins#and#triplets#are#usually#C-section#
• Hydramnios#
• Maternal#exhaustion#
• Ineffective#maternal#pushing#technique#
• Occiput#posterior#position#–#head#coming#under#pelvic#bone#–#big#issue#–#fetus’#face#is#facing#the#front#part#
of#the#mother#
• Longer#first#stage#of#labor#
• Nulliparity,#short#maternal#stature#
• Fetal#birth#weight#over#8.8#lb.#
• Shoulder#dystocia#
• Abnormal#fetal#presentation#or#position#
• Fetal#anomalies#
• Maternal#age#over#35#years#
• High#caffeine#intake#
• Overweight#
• Gestational#age#over#41#weeks#
• Chorioamnionitis#–#infection#of#the#cord#and#amniotic#fluid#
• Ineffective#uterine#contractions#–#cervix#dilated#but#head#is#not#engaged#
• High#fetal#station#at#complete#cervical#dilation#
#
Causes(of(Dystocia( (
• Problems#with#powers#-#contractions#
§ Hypertonic# uterine# dysfunction# –# contracting# too# much# –# fetus# jeopardy# –# compromised# fetal#
placental#perfusion#–#prolonged#latent#phase,#stays#at#2-3#cm#and#do#not#dilate#
§ Hypotonic#uterine#dysfunction#–#insufficient#contractions#and#dilation,#uterus#relax#too#much##
• Major#complication#–#hemorrhage#after#birth#because#uterus#cannot#contract#effectively#to#
compress#blood#vessels#
• Occurs#in#active#phase#>#5-6#cm#
§ Protracted#disorders#
§ Arrest#disorders#
§ Precipitate#labor#–#does#not#allow#cervix#to#dilate#and#efface#fully#and#could#lead#to#cervical#laceration#
and#uterine#rupture#–#since#it’s#too#fast,#it#could#lead#to#maternal#injury#and#places#the#fetus#to#trauma#
and#asphyxia#
• Problems#with#the#passageway#
§ Pelvic#contraction#
§ Obstructions#in#maternal#birth#canal#
• Problems#with#passenger#
§ Occiput#posterior#position##
§ Breech#presentation#
§ Multifetal#pregnancy#
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, 11/19/23, 9:35 AM CH 21 - Summary Maternity and Pediatric Nursing
OB#Exam#2#Intrapartum# #########################################Susset#H.#Alcover#
#
§ Macrosomia#(large#fetus,#larger#than#average#>#8#lb)# and#CPD#(when#the#fetus’#head#or#body#is#too#
large#to#fit#through#the#mother’s#pelvis)#
§ Structural#abnormalities#
• Problems#with#psyche#
§ Psychological#distress#
#
Dystocia(Assessment(and(Management(
• Nursing#assessment#
§ History#of#risk#factors#
§ Maternal#frame#of#mind#
§ Vital#signs##
§ Uterine#contractions#
§ Fetal#heart#rate,#fetal#position#
• Nursing#management##
§ Promoting#labor#progress#
§ Providing#physical#and#emotional#comfort#
§ Promoting#empowerment#
#
Preterm(Labor(
• Regular#uterine#contractions#with#cervical#effacement#and#dilation#between#20#and#37#weeks’#gestation#–#
corticosteroids#to#mature#the#fetus’#lungs#
• One#of#most#common#obstetric#complications#
• Therapeutic#management#
§ Risk#prediction#
§ Tocolytic#drugs:#there#are#no#clear#first-line#drugs#to#manage#preterm#labor;#may#prolong#pregnancy#
for#2#to#7#days#while#steroids#can#be#given#for#fetal#lung#maturity#–#given#to#stop#the#contraction#for#
a#while##
§ Antibiotic#prophylaxis#for#women#with#group#B#streptococcus#(GBS)#
§ Corticosteroids#decrease#respiratory#distress#between#24#and#34#weeks#in#newborns#
• For#women#who#are#at#risk#of#preterm#labor#within#7#days#
• Results#within#48#hrs.,#requires#to#be#administered#at#least#24#hrs.#to#be#effective#
#
Preterm(Labor:(Nursing(Assessment(
• Risk#factors#
• Subtle#signs#
• Contraction#pattern#(4#contractions#every#20#minutes#or#8#contractions#in#1#hour)#
• Laboratory#and#diagnostic#testing:#CBC,#urinalysis,#amniotic#fluid#analysis,#fetal#fibronectin,#cervical#length#
via#transvaginal#ultrasound,#salivary#estriol,#home#uterine#activity#monitoring#
• VS,#I/O,#FHR#monitoring,#limit#vaginal#examination,#BR#left#side#ot#enhance#placental#perfusion#
#
Preterm(Labor:(Nursing(Management(
• Tocolytic#administration#
§ Contraindications:# Abruptio# Placentae,# acute# fetal# distress# or# death,# eclampsia,# or# severe#
preeclampsia,#active#bleeding,#dilation#>#6#cm,#chorioamnionitis,#maternal#hemodynamic#instability#
• Client#education#
• Psychological#support#
#
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OB#Exam#2#Intrapartum# #########################################Susset#H.#Alcover#
#
Chapter(21:#Nursing(Management(of(Labor(and(Birth(at(Risk(
(
Dystocia:(Abnormal#or#difficult#labor#
#
Risk(Factors(for(Dystocia(
• Epidural#analgesia/excessive#analgesia#
• Multiple#gestation#–#to#prevent#complications#twins#and#triplets#are#usually#C-section#
• Hydramnios#
• Maternal#exhaustion#
• Ineffective#maternal#pushing#technique#
• Occiput#posterior#position#–#head#coming#under#pelvic#bone#–#big#issue#–#fetus’#face#is#facing#the#front#part#
of#the#mother#
• Longer#first#stage#of#labor#
• Nulliparity,#short#maternal#stature#
• Fetal#birth#weight#over#8.8#lb.#
• Shoulder#dystocia#
• Abnormal#fetal#presentation#or#position#
• Fetal#anomalies#
• Maternal#age#over#35#years#
• High#caffeine#intake#
• Overweight#
• Gestational#age#over#41#weeks#
• Chorioamnionitis#–#infection#of#the#cord#and#amniotic#fluid#
• Ineffective#uterine#contractions#–#cervix#dilated#but#head#is#not#engaged#
• High#fetal#station#at#complete#cervical#dilation#
#
Causes(of(Dystocia( (
• Problems#with#powers#-#contractions#
§ Hypertonic# uterine# dysfunction# –# contracting# too# much# –# fetus# jeopardy# –# compromised# fetal#
placental#perfusion#–#prolonged#latent#phase,#stays#at#2-3#cm#and#do#not#dilate#
§ Hypotonic#uterine#dysfunction#–#insufficient#contractions#and#dilation,#uterus#relax#too#much##
• Major#complication#–#hemorrhage#after#birth#because#uterus#cannot#contract#effectively#to#
compress#blood#vessels#
• Occurs#in#active#phase#>#5-6#cm#
§ Protracted#disorders#
§ Arrest#disorders#
§ Precipitate#labor#–#does#not#allow#cervix#to#dilate#and#efface#fully#and#could#lead#to#cervical#laceration#
and#uterine#rupture#–#since#it’s#too#fast,#it#could#lead#to#maternal#injury#and#places#the#fetus#to#trauma#
and#asphyxia#
• Problems#with#the#passageway#
§ Pelvic#contraction#
§ Obstructions#in#maternal#birth#canal#
• Problems#with#passenger#
§ Occiput#posterior#position##
§ Breech#presentation#
§ Multifetal#pregnancy#
about:blank 1/6
, 11/19/23, 9:35 AM CH 21 - Summary Maternity and Pediatric Nursing
OB#Exam#2#Intrapartum# #########################################Susset#H.#Alcover#
#
§ Macrosomia#(large#fetus,#larger#than#average#>#8#lb)# and#CPD#(when#the#fetus’#head#or#body#is#too#
large#to#fit#through#the#mother’s#pelvis)#
§ Structural#abnormalities#
• Problems#with#psyche#
§ Psychological#distress#
#
Dystocia(Assessment(and(Management(
• Nursing#assessment#
§ History#of#risk#factors#
§ Maternal#frame#of#mind#
§ Vital#signs##
§ Uterine#contractions#
§ Fetal#heart#rate,#fetal#position#
• Nursing#management##
§ Promoting#labor#progress#
§ Providing#physical#and#emotional#comfort#
§ Promoting#empowerment#
#
Preterm(Labor(
• Regular#uterine#contractions#with#cervical#effacement#and#dilation#between#20#and#37#weeks’#gestation#–#
corticosteroids#to#mature#the#fetus’#lungs#
• One#of#most#common#obstetric#complications#
• Therapeutic#management#
§ Risk#prediction#
§ Tocolytic#drugs:#there#are#no#clear#first-line#drugs#to#manage#preterm#labor;#may#prolong#pregnancy#
for#2#to#7#days#while#steroids#can#be#given#for#fetal#lung#maturity#–#given#to#stop#the#contraction#for#
a#while##
§ Antibiotic#prophylaxis#for#women#with#group#B#streptococcus#(GBS)#
§ Corticosteroids#decrease#respiratory#distress#between#24#and#34#weeks#in#newborns#
• For#women#who#are#at#risk#of#preterm#labor#within#7#days#
• Results#within#48#hrs.,#requires#to#be#administered#at#least#24#hrs.#to#be#effective#
#
Preterm(Labor:(Nursing(Assessment(
• Risk#factors#
• Subtle#signs#
• Contraction#pattern#(4#contractions#every#20#minutes#or#8#contractions#in#1#hour)#
• Laboratory#and#diagnostic#testing:#CBC,#urinalysis,#amniotic#fluid#analysis,#fetal#fibronectin,#cervical#length#
via#transvaginal#ultrasound,#salivary#estriol,#home#uterine#activity#monitoring#
• VS,#I/O,#FHR#monitoring,#limit#vaginal#examination,#BR#left#side#ot#enhance#placental#perfusion#
#
Preterm(Labor:(Nursing(Management(
• Tocolytic#administration#
§ Contraindications:# Abruptio# Placentae,# acute# fetal# distress# or# death,# eclampsia,# or# severe#
preeclampsia,#active#bleeding,#dilation#>#6#cm,#chorioamnionitis,#maternal#hemodynamic#instability#
• Client#education#
• Psychological#support#
#
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