A. 8 or more, induction usually successful. a. A) Im feeling contractions mostly in my back. Classic incision: not advised to labor or attempt vaginal birth. Abnormal labor pattern. IV access difficult, mobility problem, difficulty establishing an epidural or spinal block, accomplished endotracheal intubation. Born before 32 weeks gestation, most serious morbidity. Risk for prolapse of cord if membranes rupture in early labor. Breastfeeding and alone time needed asap. Assisted birth often necessary, Gross ascites, open neural tube defects, hydrocephalus. OR contractions of normal duration occurring within 1 minute of each other. Induced: monitored for tachysystole, can precipitate uterine rupture. IV fluids to maintain hydration, open line for administration of blood or meds as needed. In planning for home care of a woman with preterm labor, the nurse needs to address which concern? Bleeding at Implantation in uterus in first or second trimester and preterm labor. Transfer mother to hospital equipped for preterm infant, antibiotics to prevent group B strep infection, administer glucocorticoids to prevent or reduce infant morbidity/mortality, administer magnesium sulfate to women giving birth before 32 weeks of gestation to reduce incidence of CP in infants. Postop: increased risk for blood clot formation (TED hose, SCD), heparin for clot prevention. Vaginal Birth; Scheduled Cesarean; Unplanned Cesarean; My Birth Options. Multiple births associated with more complications than single births. Medical or obstetric conditions that affect mother, fetus, or both. 34-36 weeks. Fatigue. Many maternal and fetal side effects: cardiopulmonary effects, metabolic effects. If expected: discuss before birth, management plan. Inadequate fluid volume can lead to compression of umbilical cord, results in fetal hypoxia that is reflected in variable or prolonged deceleration patterns. Cost of surgery higher. Occurs as a means to resolve maternal or fetal risk related to continuing pregnancy. Perinatal morbidity increases greatly after 42 weeks gestation, Postterm Pregnancy Clinical Manifestations, Maternal weight loss (more than 3 lbs/wk) and decreased uterine size (related to decreased amniotic fluid), meconium in amniotic fluid, advanced bone maturation of fetal skeleton with an exceptionally hard fetal skull. Other causes: leiomyomas (uterine fibroids), ovarian tumors, full bladder or rectum, cervical edema when cervix caught between presenting part and symphysis pubis or women begins bearing down efforts prematurely. Cannot be predicted or prevented. a. Pre-existing or gestational diabetes, chronic hypertension, preeclampsia, obstetrical disorders or risk factors in the current or a previous pregnancy, previous c-section via a classic uterine incision, placental disorders, medical disorders (seizures, thromboembolism, maternal HIV or herpes infection, obesity), advanced maternal age, fetal disorders (chronic IUGR or acute NST or BPP fetal compromise, excessive or inadequate amount of amniotic fluid, birth defects), Risk factors for spontaneous preterm labor, Hx of previous spontaneous preterm birth, african-american race, genital tract infection, multifetal gestation, second-trimester bleeding, low prepregnancy weight, poverty, lack of education, living in disadvantaged neighborhood, state, or region, lack of access to prenatal care. Fetal presentation is something other than head first. Allay fears and anxieties, ensure experienced personnel available to handle anticipated maternal or neonatal complications. Like many biological processes, the process of labor and delivery is divided into stages. Occurring at or after 23 weeks gestation, managed conservatively if risks to fetus and newborn associated with preterm considered to be greater than risks of infection. Determined by urgency of surgery, presence of prior skin incisions. Low Birth Weight. Premature birth complications can occur when a baby is born early, usually before 37 weeks of pregnancy. Risk for hyperbilirubinemia, jaundice as bruising resolves. However, some problems during labor are serious, even life-threatening, for a … Prolonged second stage of labor, need to shorten second stage of labor for maternal reasons (exhaustion, cardiopulmonary, cerebrovascular disease). If more than 30-40 mins, resume at initial starting dose. Major maternal complication: postpartum hemorrhage, rectal injuries, Retraction of fetal head against perineum immediately after emergency is an early warning sign that birth of shoulders may be difficult, Usually caused by asphyxia related to delay in completing birth or trauma from maneuvers used to accomplish birth. 17. After: continue to monitor maternal VS and UA, assess for vaginal bleeding until stable, FHR and pattern monitoring should continue for at least 1 hour. Most serious complication. For example, preeclampsia (high blood pressure with protein in the urine) may lead to premature detachment of the placenta from the uterus (placental abruption) and problems in the newborn. Initial dose of oxytocin is larger and increased more rapidly, found to result in shorter labors, less forceps-assisted births, fewer c-sections because of dystocia, less chorioamnionitis, less neonatal sepsis. Explain what will be done, assess FHR and pattern before to get baseline, underpads under buttocks, position on padded bedpan, fracture pan, rolled up towels (to elevate hips), assist HCP with procedure by providing sterile gloves and lubricant to examination, unwrap sterile package containing Amnihook or Allis clam and pass to HCP, reassess FHR and pattern, assess color, consistency, odor of fluid, assess temp every 2 hrs (38 or higher bad), evaluate for s/s of infection. Most induce labor at 41 weeks gestation. Having labor contractions before 37 weeks of pregnancy is called preterm labor. Antenetal glucocorticoids: administered less than 32 weeks gestation. Balloon catheters (Foley) can be inserted through the intracervical canal to ripen and dilate cervix. The second stage of labor begins when you're fully dilated and ends with the birth of your baby.This is sometimes referred to as the "pushing" stage. Document all assessment findings, interventions, woman's responses in record, assess whether woman and family fully informed about procedures consenting for, provide full explanation on what … Ritodrine (Yutopar) approved but withdrawn from market. The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of your baby. Not performed before 39 weeks, Labor and vaginal birth contraindicated (complete placenta previa, active genital herpes, positive HIV with high viral load), birth necessary but labor not inducible (hypertensive states), course of action chosen by HCP and woman. Cervical ripeness most important predictor of successful induction. Positioning of woman on table, uterus should be displaced laterally to prevent compression of inferior vena cava (deceased placental perfusion).
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