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NUR4445 Intrapartum Complications Study Set Exam
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NUR4445 IntrapartumComplications Study Set Exam
What is macrosomia? What are the risk factors for macrosomia (6)? - Answer - Baby
weighing ≥ 4,000 g (8 lb 8 oz) at birth.
- Risk factors associated with macrosomia:
· Obesity, diabetes, pelvic abnormalities, post-date pregnancy, short stature, previous
shoulder dystocia
What are the maternal complications associated with macrosomia (5)? - Answer -
Cephalopelvic disproportion (CPD)
- Dysfunctional labor
- Prolonged labor
- Soft tissue laceration during vaginal birth
- Postpartum hemorrhage
What are the fetal complications associated with macrosomia (9)? - Answer - Shoulder
dystocia (head is born but anterior shoulder cannot pass through cervix, if unresolved
can lead to death)
- Brachial plexus injury
- Fractured clavicle
- Asphyxia
- Hypoglycemia
- Meconium aspiration
- Hyperbilirubinemia
- Obesity
- Diabetes
What does nursing assessment in preparation for delivery look like in macrosomia (4)? -
Answer - Want to identify before labor onset to reduce the occurrence of associated
maternal fetal problems.
- Evaluation of maternal pelvis if a large fetus is suspected
, - Estimation of fetal size
- Ultrasonography may be indicated
What does nursing management look like during delivery with macrosomia (7)? - Answer
- Unexpected shoulder dystocia is critical problem
- assist woman in McRoberts maneuver or apply suprapubic pressure to aid in the birth
of the fetal shoulders
- Application of fundal pressure is contraindicated
- Evaluation of rates of cervical dilation and fetal descent
- Continuous fetal monitoring: report any sign of labor dysfunction or non-reassuring
fetal status to HCP
- Lack of fetal descent should raise suspicion that infant may be too large for vaginal
birth
- Support and inform laboring woman and her partner
What does neonatal assessment look like with macrosomia (4)? - Answer - Inspect
newborn for cephalohematoma, Erb palsy, and fractured clavicles
- Inform nursery staff of any problems
- Close monitoring for cerebral, neurologic, and motor problems
- Monitor BG
What does maternal care/assessment look like with macrosmia (2)? - Answer - Expect
uterine atony and boggy (soft) uterus
- Monitor for and treat uterine hemorrhage
How do we treat a uterine hemorrhage (3)? - Answer - Fundal massage
- IV or IM oxytocin (Pitocin) may be needed
- Monitor maternal VS for development of shock
What is cephalopelvic disproportion (CPD)? What can cause it (2)? - Answer - occurs
when the fetus is larger than the passageway (head is too big to fit through the pelvis)
- Causes:
· Narrowed pelvis or soft-tissue dystocia (fibroids, Bandl ring, stool, full bladder)
· Reproductive tract anomalies impact birthing ability
What are the maternal complications associated with CPD (5)? - Answer - Prolonged
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