ATI Maternal Newborn Chapter 16 – Flashcards

When the umbilical cord is displaced, preceding the presenting part of the fetus, or protruding through the cervix.

Results in cord compression and compromised fetal circulation.

1. Rupture of amniotic membranes 2. Abnormal fetal presentation (any presentation other than vertex [occiput presenting]) 3. Transverse lie - Presenting part is not engaged, leaves room for the cord to descend. 4. Small-for-gestational-age fetus 5. Unusually long umbilical cord 6. Multifetal pregnancy 7. Cephalopelvic disproportion - due to unusual space between maternal pelvis and presenting part, leaving room for the cord to descend. 8. Placent previa 9. Intrauterine tumor - prevents engagement of presenting part. 10. Hydramnios

Client reports that she feels something coming through her vagina.

•Visualization/palpation of the umbilical cord protruding. •FHR monitoring show variable or prolonged deceleration •Excessive fetal activity followed by cessation of movement; suggestive of severe fetal hypoxia

•Call for assistance immediately •Notify the provider •Use sterile-gloved hand, insert two fingers, apply finger pressure on either side of the cord to the fetal presenting part to elevate it off of the cord. •Reposition client: knee-chest, Trendelenburg, or a (either) side-lying position with rolled towel under hip to relieve pressure on the cord. •Apply a warm, sterile, saline-soaked towel to the visible cord to prevent drying and to maintain blood flow. •Provide continuous electronic monitoring of FHR for variable decelerations, which indicate fetal asphyxia and hypoxia. •Administer oxygen at 8-10 L/min via a face mask to improve fetal oxygenation. •Initiate IV access, administer IV fluid bolus. •Prepare for a cesarean birth if other measures fail. •Inform and educate the client and her partner about the interventions.

No. The fetus has had an episode of loss of sphincter control, allowing meconium to pass into amniotic fluid.

38 weeks. Due to fetal maturity of normal physiological functions.

Cord compression > fetal hypoxia > vagal nerve stimulation > induces peristalsis of the fetal GI tract and relaxation of the anal sphincter.

black to greenish, yellow, or brown. Consistency may be thin or heavy.

•Often present in breech presentation, and may not indicate fetal hypoxia. •Present with no changes in FHR •Stained fluid accompanied by variable or late decelerations in FHR (ominous sign)

•Document color and consistency •Notify neonatal resuscitation team to be present at birth •Gather equipment needed for neonatal resuscitation

•Follow designated suction protocol -Assess neonate's respiratory efforts, muscle tone, HR. -Suction mouth and nose using bulb syringe if respiratory efforts strong, muscle tone good, and HR > 100/min.

•Suction below the vocal cords using an endotracheal tube before spontaneous breaths occur if respirations are depressed, muscle tone decreased, and heart rate < 100/min.

•FHR is below 110/min or above 160/min •FHR shows decreased or no variability •There is fetal hyperactivity or no fetal activity.

•Fetal anomalies •Uterine anomalies •Complications of labor and birth

•Non-reassuring FHR pattern with decreased or no variability.

•Monitor uterine contractions •Monitor FHR •Monitor findings of ultrasound and any other prescribed diagnostics.

•Monitor vital signs and FHR. •Position the client in the left side-lying reclining position with legs elevated. •Administer 8-10 L/min of oxygen via a face mask. •D/C Pitocin if being administered •Increase IV fluid rate and treat hypotension if indicated •Prepare the client for an emergency cesarean birth.

Dysfunctional labor that is difficult or abnormal.

•Atypical uterine contraction patterns prevent the normal process of labor and its progression.

•Hypotonic: weak, inefficient, or completely absent •Hypertonic: excessively frequent, uncoordinated, and of strong intensity with inadequate uterine relaxation. **All with failure to efface and dilate the cervix.

•Short stature, overweight status •Age > 40 years •Uterine abnormalities •Pelvic soft tissue obstructions or pelvic contracture •Cephalopelvic disproportion (fetal head larger than maternal pelvis) •Fetal macrosomia (LGA) •Fetal malpresentation, malposition •Multifetal pregnancy •Hypertonic or hypotonic uterus •Maternal fatigue, fear, or dehydration •Inappropriate timing or anesthesia or analgesics

•Lack of progress in dilation, effacement, or fetal decent during labor. Hypotonic uterus stay soft even at peace contractions. Hypertonic uterus stays hard even between contracts. •Client is ineffective in pushing with no voluntary urge to bear down. Occiput position...prolongs labor...greater back pain reported by client as fetus presses against sacrum.

•Ultrasound •Amniotomy or stripping of membranes ir not ruptured.

•Oxytocin infusion •Vacuum-assited birth •Cesarean birth

•Assist with application of fetal scalp electrode and/or IUPC. •Assist with amniotomy (article rupture of membranes) •Encourage client to engage in regular voiding to empty bladder •Assist the client into a beneficial position for pushing and coach her about how to bear down with contractions. •Apply counter pressure using fist or heel of hand to sacral area to alleviate discomfort. •Prepare for a possible foreceps-assisted, vacuum-assisted, or cesarean birth.

•Encourage position changes to aid in fetal descent or to open up the pelvic outlet. Hands-knees position to help fetus rotate from posterior to anterior position.

•Maintain hydration •Promote rest and relaxation, comfort measures between contractions. •Place the client in a lateral position, provide oxygen by mouth.

•Oxytocin: used to augment labor and strengthen uterine contractions. Not used for hypertonic contractions. •Administer analgesics if prescribed for rest from hypertonic contractions.