o Hypertonic uterine dysfunction Uncoordinated uterine activity contractions

O hypertonic uterine dysfunction uncoordinated

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o Hypertonic uterine dysfunction # Uncoordinated uterine activity; contractions are frequent and painful but ineffective in promoting dilation and effacement # Risk factors: first time mothers # Concerned with maternal exhaustion " evaluate labor progress, hydrate (IV or PO fluids) to improve uterine perfusion and coordination of UCs, pain management (Demerol/morphine decreases labor contractions and allows the uterus to rest), assess FHR and UCs, PROMOTE REST o Hypotonic uterine dysfunction # Pressure of the UC is insufficient to promote cervical dilation and effacement # UCs become weaker and less effective during active phase # IUPC < 25 mm Hg # Common in multiparous women # augment (helping woman out when she’s already in labor) using oxytocin # amniotomy: break the water # cesarean birth # Stimulate uterine activity to achieve a normal labor pattern ! precipitous labor: labor that lasts less than 3 hours from onset of labor to birth o risk factors: grand multiparity " more than 5 deliveries o provide comfort measures o more than 5 contractions in 10 minutes, uterine contractions lasting greater than 60 seconds o medical management ! inadequate expulsive forces: occurs in the second stage of labor when the woman is not able to push or bear-down o risk factor: epidural anesthesia because woman may not feel the urge to push o medical management: augment with oxytocin, assists birth with vacuum or forceps, cesarean birth o can wait up to 4 hours to push after dilated to 10 cm ! fetal dystocia may be caused by excessive fetal size, malpresentation, multifetal pregnancy or fetal anomalies o fetus can move through birth canal most effectively when head is flexed and is presenting anterior to woman’s pelvis (occiput anterior position) o risk factors: fetal macrosomia (greater than 4500 grams), abnormal fetal presentation (breech) o main concern with mom having excessive lacerations o FHR may be heard above umbilicus ! breech ! Cephalopelvic disproportion: size, shape or position of the fetal head prevents it from passing through the lateral aspect of the maternal pelvis or when the pelvis is of a size or shape that prevents the descent of fetus through the pelvis o most common type of pelvis: gynecoid ! Pelvic dystocia o Inlet contraction occurs the widest part of the pelvis is small o midpelvis contraction related to ischial spines, convergent pelvic side walls, and a narrow sacrosciatic notch may result in arrest of descent of the vertex o outlet contraction : past 0 station # risk factors: petite moms, abnormal pelvic shape ! maternal obesity o BMI greater than 30 o Risks at delivery: abnormal progress of labor, fetal macrosomia, shoulder dystocia, higher rates of operative vaginal birth and cesarean birth, epidural and spinal anesthesia may be problematic, increased postoperative complications ! Labor interventions ! Induce = initiate ! Augment = strengthen ! Induction of labor is the deliberate stimulation of UC’s before the onset of spontaneous labor to facilitate a vaginal delivery ! Oxytocin induction: most common o ALWAYS INFUSED VIA A PUMP o Administer low-dose oxytocin starting at 0.5 mU/min and increase the dose by 1-2 mU/min every 30-60 min
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