• dysfunctional labor

• difficult or abnormal labor related to the 5 powers of labor
• atypical uterine contractions that prevent the normal process of labor
• contractions may be hypotonic or hypertonic
• may fail to efface and dilate the cervix

• overweight mom
• short mom
• over 40
• uterine abnormalities
• cephalopelvic disproportion
• fetal macrosomia
• fetal malpresentation
• multifetal pregnancy
• maternal fatigue/fear/dehydration
• inappropriate timing for analgesics/anesthesia

• slow process with sedation (contractions slow down, mom rests)
• educate patient that dystocia most often ends with assisted delivery of fetus by forceps, vacuum or even c-section
• notify patient of complications to fetus (resp. depression, possible fetal death) and mom with these procedures

percipitate delivery

• do not leave patient unattended
• provide reasssurance/emotional support
• prepare for emergency delivery of neonate
• side-lying position
• ruptire membranes with crowning if not already
• apply light pressure to perineum and head by gently pressing upward toward the vagina
• ensure cord is not around neck, if so, gently slide over baby's head
• clamp umbilical cord with x2 clamps and cut in between
• suction baby's mouth upon presentation of head
• assess for any complications
• ensure Dr is on the way

• occipitoposterior postion- fetal rotation is 135 degrees instead of the typical 90
• fetus may be rotated manually if he has reached midportion of pelvis or c-section may be performed

• intense back pain
• prolonged labor
• arrst of dilation or decent

• position change
• ice back sacral counter pressure
• educate patient
• help maintain control and relaxation

• complete
• frank
• footling
• most often delivered c-section

• fetal demise
• hydramnios
• meconium stained amniotic fluid
• fetal macrosomia
• abruption
• administration of pitocin
• multiple pregnancy

• mom c/o sudden chest pain
• respiratory distress of mom
• restlessness
• cyanosis
• dyspnea
• pulmonary edema
• tachycardia
• hypotension
• shock
• coagulaton failure
• petechiae
• uterine atony
• bleeding from injection sites

• O2 @8-10L
• CPR
• IV fluids
• blood products
• c-section
• foley catheter
• intubation as indicated
• monitor hrly output
• side-lying

• LOA- fetal heart monitor will be on the mothers LLQ of abdomen
• ROA- beast heard in RLQ
• LOP and ROP- best heard on the woman's sides
• Breech baby (LSA)- woman's ULQ

• turning the baby from breech to vertex from the outside of the uterus
• very painful, mother is usually heavily medicated in order for muscles to relax
• contraindications- multiple's, severe oilgohydramnios
• contraindications to vaginal birth- cord around baby's neck, unexplained 3rd trimester bleeding (could be sign of previa)

• given to prevent seizure activity in PIH, pre-eclampsia and eclampsia
• always have at patient beside calium gluconate
• always hung as piggback or secondary line
• freqeunt checks for signs of toxicity
• stop immeidately if respirations are less than 12 a minute, reflexes are hypotonic or urine output is less than 30ml/hr

• may be caussed by an incomplete cervix (cerclage needed)
• trauma
• multiples
• substance abuse
• PIH
• PPROM

• may be halted if cervix is less than 4cm dilated and membranes are intact
• corticosteriods given to aid fetal lung maturity
• brethine to help stop contractions (relaxes smooth muscles)     side effects are tremors, rapid heart rate, nausea, dizziness and sweating

• rare
• most commonly occurs when a vertical scar from previous c-section or hysterotomy repair tears
•  complete ruptutre: goes through endometrium, myometrium and peritoneum layers
• incomplete rupture: leaves peritoneum intact

• prolonged labor
• abnormal presentation
• multiple gestation
• unwise use of oxytocin
• obstructed labor
• traumatic maneuvers of forceps or traction

• patological retraction ring
• severe abdominal pain with tearing sensation
• stop in contractions and relief of pain
• fetal heart tones will fade then be absent
• assess FHR for signs of distress, bradycardia, late decels, tachycardia and absent variability
• possible vaginal bleeding
• decreased maternal BP, rapid weak pulse
• with complete rupture: contractions will stop and 2 distinct swellings will be noticable on mom's abdomen (retracted uterus and extrauterine fetus)
• an ultrasound may be performed to confirm rupture, although time is of the essence

• administer IV fluid
• anticipate use of oxytocin to attmept to contract and minmize bleeding
• administer blood products as ordered
• prepare pt and assist in laparotomy & transfusion of blood for incomplete rupture
• prepare pt and asist with hysterectomy and blood transfusion for complete rupture
• prepare pt for c-section
• inform patient and support system about surgery/and or treatment
• be supportive and ready for emotions that may arise
• viability of fetus depends on extent of rupture and length of time elapsed between rupture and c-section
• mom's prognosis depends on extent or rupture and blood loss

• most are advised to not conceive again
• instruct pt of activity level after surgery & weigth restrcitions
• instruct pt on incision care and signs of infection
• they need to report any hemorrhage, chest, or leg pain (possible DVT)
• encourage pt to share feelings about experience and arrange for further psychological support as necessary
• instruct pt on possible med's that will be taken at home

• present
• decreased (indicates development of fetal distress)
• absent (considered a severe sign indicating that serious fetal compromise must be present)
• accelerations: FHR >15bpm for 15 seconds = cord compression
• variable accelerations: occur at the beginning/end of contractions; more often seen with variable decels, indicates good functioning chemoreceptors
• rebound accelerations: uniform in shape; immediately follows variable decels; absent baseline variability and sometimes tachycardia

• early decels: FHR slows with onset of uterine contractions and returns to the baseline before contraction is over (HEAD CONTRACTION DURING LABOR= NORMAL)
• late decels: FHR begins to fall at beginning of contraction and returns to baseline after contraction has ceased (UTEROPLACENTAL INSUFFICIENCY=TURN OFF PITOCIN/LATERAL POSITIONING/O2 AT 5-6L PER MASK)
• variable decels: FHR declines with or between contractions. makes u or v shape on strip (CORD COMPRESSION=POSITION CHANGE/O2 AT 5-6L PER MASK)

what is:

p

o

t

i

p

• P=pitocin off
• O=oxygen
• T=turn patinet to left side
• I=IV fluids increased
• P=provider notified

what is:

VEAL

CHOP

V=variable decels....   C=cord compression

 E=early decels....       H=head compresson

A=accelerations....      O=okay                 

      L=late decels....         P=placental insufficiency

• corticosteriod
• given to pregnant women 12-24hrs prior to birth of fetus <34 weeks gestation
• increases lung development and helps with respiratory distress syndrome in newborn

• burning, itching and irritation at injections site
• swelling
• tachycardia
• headache
• dizziness
• weight gain
• sodium and fluid retention
• increased risk of infection with long term use

• explain purpose of drug to client
• administer initial dose IM
• reapeat dose in 1-2 weeks
• assist with measuresss to halt preterm labor
• continue to monitor VS/FHR changes
• if pt is taking a tocolytic, monitor for cardiac decompensation (increased pulse, decreased bp, presence of edema)
• assess for s/s or infection with long term use
• instruct pt for possibility that repeat dose may be necessary

artificil rupturing of membranes

must be dilated at least to 3cm to be done

• always measure the FHR immediately after rupture of membranes to determine that prolapsed cord did not happen
• take maternal temperature
• assess for infection

• ensure clean under pad on bed
• observe color and consistency of amniotic fluid
• VS every 1-2hr including temp

• amniotomy-
•  "stripping the membranes"- separating the membranes from lower uterine segment manually
• medication- pitocin IV drip
• hygroscopic suppositories- inserted vaginally to gradually and gently cause dilation
• prostaglandin gel- absorbs water in cervical mucus, expands, dilates cervix
• cytotec- orally or vaginally

• with classical (vertical incision) disadvantages are: leaves wide scar, runs through active contractile portion of uterus, woman won't be able to have vaginal birth with future pregnancies
• low segment (transverse or bikini increases ability to VBAC) disadvantages: longer to perform, impractical for emergent

• NPO
• explain procedure
• informed consent
• abdominal prep
• foley
• epidural
• antacid
• antibiotics
• position
• type and cross, CBC
• spouse in OR if epidural or spinal

• recovery monitoring (VS, pulseox, cardiac monitor)
• assess fundus for firmness and location(boggy=massage til firm)
• check foley
• assess vaginal bleeding (soaked pad >1 an hr)
• assess urine output
• TCDB hrly
• pain meds
• bonding and breastfeeding