Maternal-Child

Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
Hisley

Chapter 14

Caring for the Woman

Experiencing Complications
During Labor and Birth
Catherine Marin, MSN/Ed(c), WHCNP, RN
Maternal-Child
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
Hisley

Dystocia
 Long, difficult, or abnormal labor
 May arise from
 Powers
 Passenger
 Passageway
Maternal-Child
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
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
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
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
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
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
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
Hisley

Pelvic Structure Alterations

 Pelvic dystocia
 Soft tissue dystocia
 Trial of labor
 To assess safety of vaginal birth
Maternal-Child
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
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
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
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
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
Hisley

Induction of Labor
 Indications for induction
 Bishop score
 Cervical ripening agents
 Mechanical methods
 Oxytocin
 Augmentation of labor
Maternal-Child
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
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
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
Hisley

Instrumentation
Assistance of Birth

 Forceps

 Vacuum extraction
Maternal-Child
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
Hisley

Maternal Complications—
Hypertensive Disorders
 Preeclampsia-eclampsia, HELLP syndrome
 Nursing
 Careful assessments
 Monitor lab values
 Administer platelets as appropriate
 Ongoing education
Maternal-Child
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
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
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
Hisley

Preterm Labor and Birth

 Careful maternal monitoring
 FHR monitoring ***
 Identify and report symptoms suggestive of
fetal hypoxia
 Assess psychological status
Maternal-Child
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
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
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
Hisley

Amniotic Fluid Complications

 Oligohydramnios
 Hydramnios
 Meconium
 Nuchal cord
Maternal-Child
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
Hisley

Complications—Placental
Problems
 Placenta previa

 Placental abruption

 Disseminated intravascular coagulation

Maternal-Child
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
Hisley

Other Complications
 Uterine rupture
 Obstetric emergency
 Uterine inversion
 Umbilical cord prolapse
Maternal-Child
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
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
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
Hisley

Placental Variations
 Circumvallate placenta
 Succenturiate placenta
 Battledore placenta
 Placenta accreta
 Placenta increta
 Placenta percreta
Maternal-Child
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
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
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
Hisley

Perinatal Fetal Loss

 Nursing considerations

 What to say

 What not to say

Maternal-Child
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
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
Maternal-Child Nursing
Nursing Care
Care Susan
Susan Ward
Ward
Optimizing
Optimizing Outcomes
Outcomes for
for Mothers,
Mothers, Children,
Children, &
& Families
Families Shelton
Shelton Hisley
Hisley

Postterm/Prolonged Pregnancy
 Postterm—extends beyond 42 weeks
 Risk for fetal/neonatal problems
 Increased maternal risk
 Management—labor induction
 Nursing implications