Maternal-Child Nursing Care Optimizing Outcomes for Mothers
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Transcript Maternal-Child Nursing Care Optimizing Outcomes for Mothers
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Chapter 14
Caring for the Woman
Experiencing Complications
During Labor and Birth
Catherine Marin, MSN/Ed(c), WHCNP, RN
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Dystocia
Long, difficult, or abnormal labor
May arise from
Powers
Passenger
Passageway
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Dysfunctional Labor Pattern:
Hypertonic
Strong, painful, ineffective contractions
Contributing factor—maternal anxiety
Occiput-posterior malposition of fetus
Management
Rest, hydration, sedation
Facilitate rotation of the fetal head
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
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
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Precipitate Labor and Birth
Rapid intense contractions
Nursing considerations
Careful examination for dilation and effacement
Reassure woman and support person
Breathing to avoid pushing and prevent tearing
Careful examination of maternal soft tissue and
placenta
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Pelvic Structure Alterations
Pelvic dystocia
Soft tissue dystocia
Trial of labor
To assess safety of vaginal birth
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
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
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
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
Optimizing Outcomes for Mothers, Children, & Families
Induction of Labor
Indications for induction
Bishop score
Cervical ripening agents
Mechanical methods
Oxytocin
Augmentation of labor
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
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
Optimizing Outcomes for Mothers, Children, & Families
Instrumentation
Assistance of Birth
Forceps
Vacuum extraction
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
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
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
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
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Preterm Labor and Birth
Careful maternal monitoring
FHR monitoring ***
Identify and report symptoms suggestive of
fetal hypoxia
Assess psychological status
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Labor and Birth
Complications—Fetal
Fetal malpresentation
Version: external or internal
Shoulder dystocia- McRoberts Maneuver
Cephalopelvic disproportion
Multiple gestation
Non-reassuring FHR patterns
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Amniotic Fluid Complications
Oligohydramnios
Hydramnios
Meconium
Nuchal cord
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Complications—Placental
Problems
Placenta previa
Placental abruption
Disseminated intravascular coagulation
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Other Complications
Uterine rupture
Obstetric emergency
Uterine inversion
Umbilical cord prolapse
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
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
Optimizing Outcomes for Mothers, Children, & Families
Placental Variations
Circumvallate placenta
Succenturiate placenta
Battledore placenta
Placenta accreta
Placenta increta
Placenta percreta
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Amniotic Fluid Embolism
Rapidly deteriorating maternal condition
Acute dyspnea, severe hypotension
Rapid delivery after stabilizing mother
Ethical conflict
Save mother versus fetus
Collaboration in Perinatal
Emergencies
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Perinatal Fetal Loss
Nursing considerations
What to say
What not to say
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
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
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Postterm/Prolonged Pregnancy
Postterm—extends beyond 42 weeks
Risk for fetal/neonatal problems
Increased maternal risk
Management—labor induction
Nursing implications