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Effects of Hypertonic ContractionsNon-reassuring fetal heart rate pattern Prolonged pressure on the fetal head-cephalohematoma, caput, excessive molding Hypotonic Labor PatternsIn order for dx pt must have been in active laborLess than 2-3 contractions in a 10-minute period Ineffective contraction pattern, no changes in dilation or effacementOccurs with overstretched uterus, bowel/bladder distention and CPDPotential Risk Factors:Maternal Fatigue
Stress and Ineffective CopingNon-reassuring Fetal StatusFetal Infection/Sepsis(Why is it happening? Too much oxytocin can be the cause of hypo/hyper, or it may be neededfor hypo)Collaborative ManagementIncrease uterine contractions for hypoOxytocin administration for hypoAROM (Amniotomy)Monitor the FHR Maintain IV fluidsDystocia /Failure to ProgressLabor that progresses at a slower than normal rateuterine dysfunction/insufficient contractionspelvic size/shapeMal-presentations/mal-positionsfetal abnormalities or sizematernal anxietyamniotomy, oxytocin, or cesarean section are treatment optionsPrecipitous LaborLabor lasts less than 3 hours and results in a rapid birthoMultiparous women, women with a large pelvisoSmall fetus in favorable position (preterm)oHx cocaine useRisk Factors for MotherRapid labor, not gradual inability to copeTrauma and lacerations of perineum, cervix or vagina - Head didn’t have time to mold to pelvisIncreased risk for Post-Partum Hemorrhage Risks Factors for the BabyNon-reassuring FHRPoor fetal perfusion-hypoxiaLacerations to scalp, soft tissue trauma, clavicle fracture, cerebral traumaPneumothorax (rapid descent)TXAlways be prepared for rapid delivery – gloves in pocketPromote fetal oxygenation, stop Pitocin induction, give O2, IV fluids, tocolytic drugs as ordered.Prepare for delivery. Note building of membranes, crowning, urge to bear down, monitor VS. If rapid and no MD > catch, check cord around neck, APGAR, clavicle (can develop TTN)Post-term PregnancyPregnancy that lasts longer than 42 weeksApproximately 4% to 14% of pregnancyRisksProbable labor Induction – don’t want to wait until there in inadequate blood flowIncreased risks for LGAIncreased risk of forceps assisted, or vacuum assisted cesarean birthPlacenta ages Decreased perfusion from the placenta
oOligohydramniosoMeconium Aspiration (anal sphincter relaxes with flight or fight response) Treatment (Post Term)NST (nonstress test), BPP (biophysical profile)Induction (amniotomy, Pitocin augmentation etc.)InfectionS/SFetal tachycardia (more than 160 BPM)Maternal fever (38C or 100.4F)Foul- or strong-smelling amniotic fluidCloudy or yellow amniotic fluidInterventionsReduce the risk of infection-handwashing, limit vaginal examinations, change under pads and linen frequentlyIdentify infectionsMom and baby cultures-prophylactic antibioticsChorioamnionitis“Chorio”Chorioamnionitis is an infection of the membranes (placental tissues) and amniotic fluid.