Maternal Newborn (OB) Nursing – Complications During Labor and Delivery

a nurse is speaking with a client who is trying to make a decision about uterine tube occlusion
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in this video Im going to talk about some complications that can occur during labor and delivery so the first thing Im going to touch on is a prolapsed umbilical cord so this is basically where the umbilical cord protrudes through the mom cervix ahead of the baby and causes cord compression and this compromises fetal circulation so they are the cords compress and theres not enough blood getting through there to provide oxygen and nutrients to the baby so in terms of nursing care of a prolapsed umbilical cord you want to call for assistance first then you want to insert two fingers into the vagina one on either side of the cord and lift the presenting part of the fetus off the cord so that the cord is no longer compressed then you want to place the mom in a knee chest position or in a Trendelenburg position which is where the moms head is lower and her feet are higher to try to like lift you know lift the baby off that cord and then youre gonna apply a warm saline moistened gauze or towel over the cord okay so those are some important interventions to know for this emergency and then the next thing were going to touch on is meconium stained amniotic fluid so this occurs more often when a pig when a baby is in a breech position and then the thing we worry about is that it often indicates fetal hypoxia so if we have meconium stained amniotic fluid in addition to either late or variable fetal heart rate decelerations this is an ominous sign so if we have these things present were going to want to arrange for equipment and resources for possible neonatal resuscitation after birth all right the next thing I want to talk about is dystocia so dystocia is basically difficult or abnormal labor due to uterine abnormalities these or if the birth canal is like too small for the size of the baby or if theres fetal Malazan tation so signs and symptoms

of dystocia include insufficient progress in dilation of basement and descent of the baby if dystocia is occurring then as a nurse you can help with progression of labor by encouraging the mom to change positions frequently and also to ambulate you may need to assist with an amniotic if that is indicated you will administer oxytocin as prescribed by the provider for shoulder dystocia you can apply suprapubic pressure to help assist with delivery of that baby and then advise the mom to be on her hands and knees to help rotate the baby from a posterior position to an anterior position if thats whats going on in her particular situation and then prepare for a forceps assisted or vacuum assisted birth if needed and then possible cesarean section if that baby is just not going to be able to be delivered vaginally the next complication we talk about is precipitous labor so this is where labor lasts less than three hours from the onset of contractions to the time when the baby is delivered so risk factors associated with precipitous labor include hypertonic uterine contractions oxytocin and a multiparous mom meaning a mom who has had previous births may be several different births so this labor is happening a little more quickly complications can occur for both the mom and the baby for the mom we can end up with lacerations tissue trauma possible uterine rupture which well be talking about here shortly amniotic fluid embolism which will also be touching on and then possible postpartum hemorrhage so when you think about precipitous labor you we need to know that mom is at risk for postpartum hemorrhage in terms of the baby complications can include fetal hypoxia due to hypertonic contractions also there is the possibility for intracranial hemorrhage due to head trauma when the baby is born with a precipitous labor all right next were gonna talk about uterine rupture so there are a variety of risk factors that are associated with uterine rupture one is trauma so like if a mom

is in a motor vehicle accident when shes pregnant this can result in uterine rupture also over distension of the uterus is a risk factor so if a mom is carrying twins triplets or more this can over distend the uterus and place her at higher risk for rupture and then finally hyper stimulation of the uterus with oxytocin is a risk factor in terms of signs and symptoms if mom is complaining of severe abdominal pain that she describes as ripping or tearing then that should really raise a red flag in your mind and you should immediately think about the possibility of uterine rupture in addition if fetal heart rate patterns are non reassuring meaning that you see either bradycardia variable or late decelerations or decreased variability those are potential signs and symptoms that you would see with uterine rupture and then lastly if mom is exhibiting signs and symptoms of hypovolemic shock such as tachycardia hypotension and pallor then you may suspect uterine rupture so in terms of nursing care youre going to administer IV fluids and blood products as prescribed and youre going to prepare the patient for immediate emergency c-section and possible hysterectomy and then the last complication were going to talk about is an amniotic fluid embolism so this is where you have infiltration of the amniotic fluid into maternal circulation and it will travel to and obstruct the pulmonary vasculature so this leads to respiratory distress and circulatory claps in the mom in terms of signs and symptoms if mom is complaining of sudden chest pain if shes exhibiting dyspnea cyanosis tachycardia hypotension and bleeding these are all signs and symptoms that she may have an amniotic fluid embolism in terms of nursing care were going to administer oxygen IV fluids and blood products as prescribed and were also going to assist with intubation and mechanical ventilation if indicated so that does it for labor and delivery and when we come back we will start getting into postpartum topics so thanks so much for watching and stay tuned

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