Labor Dystocia, Prolapsed Umbilical Cord, Cesarean Section - Maternity Nursing | @LevelUpRN

Summary

In this educational video, Meris from Level Up RN discusses labor dystocia, prolapsed umbilical cords, and C-section births, using maternity flashcards for reference. She explains causes of dystocia, such as fetal macrosomia and maternal fatigue, and outlines interventions like ambulation and position changes. Meris addresses shoulder dystocia as a medical emergency, detailing the application of pressure on the suprapubic region. She also covers the management of prolapsed umbilical cords, emphasizing the importance of reducing cord compression and proper positioning. Lastly, she touches on C-sections, including anesthesia types and nursing care, highlighting the significance of prompt and appropriate interventions for maternal and fetal well-being.

Takeaways

• 😌 Dystocia refers to a prolonged or difficult birth, which can be caused by factors such as fetal macrosomia, maternal fatigue, uterine abnormalities, cephalopelvic disproportion, fetal malpresentation, and anesthetic use.
• 🚶‍♀️ To manage labor dystocia, encourage the patient to ambulate or change positions, if possible, to facilitate fetal movement and rotation.
• 🆘 Shoulder dystocia is a medical emergency where the fetal shoulder is stuck on the maternal pelvis, potentially causing nerve, muscle, or bone damage.
• 🤲 For shoulder dystocia, the nurse may apply pressure on the suprapubic region to help dislodge the stuck shoulder.
• 🤰 Prolapsed umbilical cord is a serious condition where the cord protrudes through the cervix before the baby, risking fetal hypoxia and distress.
• 🙏 In the case of a prolapsed umbilical cord, the nurse should call for assistance, apply sterile gloves, and attempt to lift the fetal presenting part off the cord to reduce compression.
• 🧘‍♀️ Positioning the mother in knee-chest or Trendelenburg position can help alleviate cord compression in a prolapsed umbilical cord scenario.
• 🛑 If a prolapsed umbilical cord is exposed, it should be covered with a warm, sterile saline-soaked towel to prevent drying and infection.
• ✂️ C-sections involve surgical delivery of the baby through an abdominal and uterine incision, with anesthesia options including spinal, epidural, or general anesthesia.
• 🩺 Risk factors for C-sections include labor dystocia, fetal malpresentation, failure to progress, fetal distress, and a history of previous C-sections.
• 💊 Post-C-section nursing care involves ensuring a patent IV, administering foley catheter, providing IV fluids, administering antibiotics and analgesics, and monitoring the incision site for signs of infection or complications.

Q & A

What is dystocia?

Dystocia refers to a prolonged or difficult birth, which can occur for multiple reasons such as fetal macrosomia, maternal fatigue, uterine abnormalities, cephalopelvic disproportion, fetal malpresentation, or anesthetic or analgesic use.

What are some signs and symptoms of labor dystocia?

Signs and symptoms of labor dystocia include lack of progress in dilation, no change in fetal station, and the fetus not descending.

How can a nurse help a patient experiencing dystocia?

A nurse can encourage the patient to ambulate or change positions if allowed, and if the goal is to move the baby from a posterior to an anterior position, the patient can be positioned on their hands and knees.

What is shoulder dystocia and why is it considered an emergency?

Shoulder dystocia occurs when the fetal shoulder gets stuck on the maternal pelvis, which can cause damage to nerves, muscles, and bones. It is a true emergency due to the potential for severe complications.

Where should a nurse apply pressure in the case of shoulder dystocia?

In the case of shoulder dystocia, a nurse should apply pressure on the suprapubic region, just above the pubic bone.

What is a prolapsed umbilical cord and why is it dangerous?

A prolapsed umbilical cord occurs when the cord protrudes through the cervix before the baby, which can lead to cord compression, fetal hypoxia, distress, and compromised fetal circulation.

How can a nurse identify a prolapsed umbilical cord?

A nurse can identify a prolapsed umbilical cord by seeing it or feeling it during a cervical check, and by observing variable decelerations in fetal heart rate monitoring.

What positions are indicated for a patient experiencing a prolapsed umbilical cord?

For a patient with a prolapsed umbilical cord, the nurse should position the mother in either the Trendelenburg or knee-chest position to use gravity to shift the baby off the cord.

How should a nurse care for an exposed prolapsed umbilical cord?

An exposed prolapsed umbilical cord should be covered with a warm, sterile, saline-soaked towel to protect it from drying out or exposure to germs.

What are the different types of anesthesia that can be used during a C-section?

The types of anesthesia that can be used during a C-section include spinal anesthesia, epidural anesthesia, and general anesthesia, depending on the situation.

What are some risk factors for a C-section?

Risk factors for a C-section include labor dystocia, fetal malpresentation, failure to progress, fetal distress, and a history of previous C-sections.

What are the common complications associated with C-sections?

Common complications associated with C-sections are hemorrhage and infection.

What is the nursing care for a patient after a C-section?

Nursing care after a C-section includes ensuring a patent IV, starting a foley catheter, running IV fluids, administering preoperative medications like antibiotics, providing analgesia for post-op pain, and assessing the incision site for signs of infection or other issues.

Outlines

00:00

🤰 Labor Dystocia and C-Section Births

This paragraph discusses labor dystocia, which refers to a prolonged or difficult birth that can occur due to various reasons such as fetal macrosomia, maternal fatigue, uterine abnormalities, cephalopelvic disproportion, fetal malpresentation, and anesthetic use. The signs and symptoms include lack of progress in dilation, effacement, and fetal descent. The suggested nursing interventions include encouraging the patient to ambulate or change positions, and specific positioning for posterior fetal head. The paragraph also covers shoulder dystocia, a serious emergency where the fetal shoulder gets stuck on the maternal pelvis, and the appropriate nursing actions, such as applying suprapubic pressure and performing the McRoberts maneuver. Additionally, it mentions the management of dystocia through amniotomy, oxytocin administration, and preparing for assisted delivery or C-section.

05:04

🚨 Prolapsed Umbilical Cord and Its Management

The second paragraph delves into the topic of a prolapsed umbilical cord, where the umbilical cord protrudes through the cervix before the baby, potentially leading to cord compression and fetal hypoxia. The nurse is advised to call for assistance without leaving the patient, apply sterile gloves, and attempt to alleviate cord compression by lifting the fetal presenting part off the cord. Positioning the mother in knee-chest or Trendelenburg position is recommended to use gravity to reduce compression. If the cord is exposed, it should be covered with a warm, sterile saline-soaked towel to prevent drying and infection. The patient may require oxygen administration, and preparations should be made for a C-section delivery. The nurse's role during this emergency is crucial, potentially accompanying the patient to the operating room to continue relieving cord compression until the baby is delivered.

10:08

✂️ Cesarean Section: Types, Anesthesia, and Care

The final paragraph focuses on cesarean sections (C-sections), explaining that they involve surgical delivery of the infant through an abdominal and uterine incision. It outlines the types of C-sections and the anesthesia options, including spinal, epidural, and general anesthesia, each suitable for different scenarios. The paragraph highlights risk factors for C-sections, such as labor dystocia, fetal malpresentation, failure to progress, and previous C-sections. It also discusses complications like hemorrhage and infection, and the nursing care required, which includes ensuring a patent IV, administering preoperative medications, providing postoperative analgesia, and assessing the incision site for signs of infection or dehiscence. The video concludes with a quiz to test the viewer's understanding of key points related to shoulder dystocia, prolapsed umbilical cord, and C-section care.

Keywords

💡Dystocia

Dystocia refers to a prolonged or difficult labor, which is a critical concept in the video as it sets the stage for discussing various complications during childbirth. The video mentions several causes of dystocia, such as fetal macrosomia (large baby), maternal fatigue, uterine abnormalities, cephalopelvic disproportion, and fetal malpresentation. Understanding dystocia is essential for nurses as it influences the management and care provided to the mother during labor.

💡Prolonged Labor

Prolonged labor is a significant aspect of dystocia, indicating that the process of labor is taking longer than expected, which can lead to complications for both the mother and the baby. In the video, prolonged labor is discussed as a sign of dystocia, where the dilation of the cervix is not progressing as it should, potentially requiring medical intervention.

💡Fetal Macrosomia

Fetal macrosomia is defined as a condition where the baby is significantly larger than average, often weighing more than 4000 grams (8.8 pounds) at birth. The video explains that a large baby can cause dystocia because of the difficulty in passing through the maternal pelvis. This concept is crucial as it directly relates to the potential need for a C-section if vaginal delivery is not feasible.

💡Cephalopelvic Disproportion

Cephalopelvic disproportion (CPD) is a condition where the baby's head is too large to pass through the mother's pelvis. The video uses this term to illustrate a specific cause of dystocia, emphasizing the importance of assessing the baby's size and the mother's pelvis to determine the safest delivery method.

💡Fetal Malpresentation

Fetal malpresentation occurs when the baby is not in the optimal position for delivery, such as a breech position where the baby's buttocks or feet are the first to enter the birth canal. The video highlights this as a factor that can complicate labor and potentially necessitate a C-section.

💡Epidural

An epidural is a type of regional anesthesia used during labor to manage pain. The video discusses how an epidural that is too strong can lead to dystocia by impairing the mother's ability to push effectively during labor. This term is important as it illustrates the balance between pain management and the physical requirements of labor.

💡Shoulder Dystocia

Shoulder dystocia is a serious obstetric emergency where the baby's shoulder becomes stuck behind the mother's pelvic bone after the head has been delivered. The video explains that this can cause significant harm to the baby, such as nerve damage or broken bones, and requires immediate and skilled intervention by medical staff.

💡Prolapsed Umbilical Cord

A prolapsed umbilical cord is a life-threatening condition where the umbilical cord precedes the baby through the birth canal. The video describes this as a situation that can lead to cord compression and fetal hypoxia, requiring swift action by healthcare providers to ensure the baby's safety.

💡Cesarean Section (C-Section)

A C-section, or cesarean section, is a surgical procedure used to deliver a baby through an incision in the mother's abdomen and uterus. The video discusses various types of C-sections and the circumstances under which they might be performed, such as in cases of dystocia, fetal distress, or a previous C-section. It is a key concept as it represents a critical intervention in cases where vaginal delivery is not possible or safe.

💡Anesthesia

Anesthesia is medication used to prevent pain during surgery, and the video discusses different types of anesthesia that can be used during a C-section, including spinal, epidural, and general anesthesia. Understanding the types of anesthesia is crucial as they determine the mother's level of consciousness and comfort during the procedure.

💡VBAC

VBAC stands for Vaginal Birth After Cesarean, which is a term used when a woman who has had a previous C-section attempts a vaginal delivery. The video touches on the risks associated with VBAC and the criteria that must be met for a woman to be considered a candidate for this type of delivery, emphasizing the importance of careful assessment and planning.

Highlights

Dystocia refers to a prolonged or difficult birth, which can occur due to various reasons such as fetal macrosomia, maternal fatigue, uterine abnormalities, cephalopelvic disproportion, fetal malpresentation, and anesthetic or analgesic use.

Signs of dystocia include lack of progress in dilation, no change in fetal station, and the fetus not descending.

Encouraging the patient to ambulate or change positions can help in cases of dystocia, unless contraindicated by a heavy epidural.

For shoulder dystocia, where the fetal shoulder is stuck on the maternal pelvis, applying pressure on the suprapubic region can help.

The McRoberts maneuver is a technique used to assist in cases of shoulder dystocia.

Assisting with an amniotomy, administering oxytocin, and preparing for an assisted delivery or C-section are interventions for dystocia.

A prolapsed umbilical cord occurs when the cord protrudes through the cervix before the baby, potentially leading to fetal hypoxia.

Nursing care for a prolapsed umbilical cord involves calling for assistance, applying sterile gloves, and attempting to relieve cord compression.

Positioning the mother in knee-chest or Trendelenburg position can help alleviate cord compression in a prolapsed umbilical cord scenario.

Covering an exposed prolapsed umbilical cord with a warm, sterile, saline-soaked towel is crucial to prevent drying and infection.

C-sections involve the surgical delivery of an infant through an incision in the abdomen and uterine wall.

Types of anesthesia for C-sections include spinal, epidural, and general anesthesia, depending on the situation.

Risk factors for C-sections encompass labor dystocia, fetal malpresentation, failure to progress, fetal distress, and previous C-section.

Complications of C-sections can include hemorrhage and infection, which require vigilant postoperative care.

Nursing care after a C-section involves ensuring a patent IV, starting a foley catheter, administering IV fluids and antibiotics, and providing postoperative analgesia.

Assessing the incision site for signs of infection or dehiscence is part of post-C-section nursing care.

Transcripts

Hi, I'm Meris with Level Up RN. And in this  video, I'm going to be talking to you about  

labor dystocia, prolapsed umbilical cords, and  C-section births. I'm going to be following  

along using our maternity flashcards which  are available on our website, leveluprn.com,  

if you want to grab a set of your own. And if you  already have a set, I would invite you to follow  

along with me. So let's go ahead and get started. I'm going to start here with labor dystocia. So  

what is dystocia? It just means a prolonged or  difficult birth. So this can be for multiple  

reasons. Fetal macrosomia, so a big baby is going  to be one of the reasons for dystocia, right? This  

is going to be because that's a big baby to get  through the pelvis, so that's one possible reason.  

Maternal fatigue. Think about being in labor  for hours and hours, possibly even days,  

Mom is going to tire out. It's just going to  happen. Uterine abnormalities, so maybe the  

structure of the uterus is different or there's  a weakness to it. Cephalopelvic disproportion,  

which is a fancy way of saying that head  is way too big to get through that pelvis.  

And then fetal malpresentation, if the baby  isn't in a good position for labor, that can  

prolong things or make it more difficult. And then  also anesthetic or analgesic use can contribute  

to dystocia because, for instance, if we have an  epidural that is too strong, we're not going to be  

able to push effectively as an example. So signs and symptoms here,  

we're not progressing, right? The dilation is not  moving forward, right? We're not fully dilated,  

maybe we're not fully effaced, and maybe the  fetus just isn't descending. That fetal station  

isn't changing. All of those would be signs and  symptoms. Now we would want to encourage our  

patient to ambulate or change positions if it is  allowed. So if they have a very heavy epidural,  

they're not going to be walking, but we can help  them to change positions that may help to move  

the baby to help rotate things or get things  moving. But if we want to get the baby from  

the posterior to the anterior position, referring  to where the back of the head is, then we would  

want to position the patient on their hands and  knees to help get into that sort of position. 

Now there's something called shoulder dystocia,  and shoulder dystocia refers to when the fetal  

shoulder gets stuck on the maternal pelvis and  this is a true emergency. This can cause all  

kinds of damage to the nerves and the muscles,  even the bones. We can cause bone breaks here  

when the baby is stuck like that. This is  a very big deal. So you need to know that  

when we have a patient with shoulder dystocia,  the place that the nurse may be asked to put  

pressure is on the suprapubic region. So right  above that pubic bone, we're going to push down,  

and that's hopefully going to help to pop that  shoulder down off of that pelvic bone. We can also  

help to perform McRoberts maneuver.  So McRoberts maneuver is going to be  

something that can be done for shoulder dystocia.  Now, other things that we can do for dystocia in  

general would be assisting with an amniotomy.  We can administer oxytocin as ordered, and we  

may have to prepare for an assisted delivery  or for surgical birth through a C-section. 

Moving on to prolapsed umbilical cord. So if you  have seen previous videos where we talk about  

fetal heart rate monitoring or we talk about  amniotomies and all of these different things,  

and we've mentioned prolapsed umbilical cords,  but let's really talk about what it is and what we  

should be doing for this. So a prolapsed umbilical  cord means that the cord itself is protruding  

through the cervix before the baby. So baby  is still fully inside the uterus, but that  

cord is poking out through the cervix. This can  lead to cord compression, and cord compression can  

lead to fetal hypoxia, fetal distress, compromised  fetal circulation. So remember that that cord  

is not just like pretty decoration for the uterus,  right? That's how the baby is getting that rich  

oxygenated blood to the baby and getting rid  of waste and carbon dioxide so that Mom can get  

that stuff out, right? So if we have prolapse and  compression, it's having a big effect on the baby. 

Now, how do we know this? Well, first, we could  either see it, right? It might be fully out of  

the vagina or we feel it, perhaps we're doing a  cervical check and we feel something poking out  

that doesn't feel like a part of the baby. That's  when we're going, "Oh no," right? And, again,  

we talked about variable decelerations being  caused by cord compression. So if I saw those,  

I might say, "Oh no, we could have a prolapsed  cord." So nursing care, number one is calling for  

assistance. You need help, but don't leave your  patient. So that could be literally calling out,  

"I need help in here," pushing some kind  of emergency button or panic button either  

in the room or, for instance, at work, I have a  panic button on my badge so that I can get help  

immediately and it tracks where I am also. And  then I need to apply sterile gloves - not clean  

gloves, sterile gloves - and I'm going to insert  my fingers into the patient's vagina. And what  

I'm going to do is I'm basically going to try and  get my fingers one on either side of the cord, and  

I want to try and lift the fetal presenting part  off of that cord. So literally fingers going in,  

hopefully cord is running in between them, and  I'm trying to lift the fetal presenting part off  

of the cord to reduce some of that compression  so that we can still be getting good blood flow. 

Next, it would be positioning Mom knee-chest  position or Trendelenburg position. We're going to  

try and use gravity to shift the baby off of that  prolapsed cord. And then if the cord is exposed  

like outside of the vagina, then I need  to make sure that it is covered so it's  

not going to dry up or be exposed to germs. So  we need to put a warm, sterile saline-soaked  

towel over the cord to protect it. We're going  to administer oxygen to the patient and we're  

going to prepare for the birth of the infant. So  this is typically going to be with a C-section.  

So in that instance, the nurse who is lifting  that presenting part off of the cord is going to  

ride on the stretcher to the OR and is going  to continue to lift that presenting part off  

of the cord until the doctor or whoever  the provider is delivers that baby through  

C-section and now there's no longer the need to  lift anything off of the cord, right? So it's a  

true medical emergency and it can lead to fetal  death if there is not appropriate intervention. 

So now let's talk about C-sections. So cesarean  sections which we abbreviate as C-sections,  

so this is going to be delivery of the infant  through an incision that's made in the abdomen and  

the uterine wall. So literally, we are surgically  delivering this baby. And there's a lot of  

different types of C-sections depending on if it's  a classic, transverse, and emergency section, all  

of these things. But no matter what, we're still  doing a surgical procedure to deliver the infant.  

We can either have spinal anaesthesia, and that  would typically be someone who is having a planned  

C-section. They're going to go and get the spinal  anaesthesia which is what I got. It's just the  

shot into the CSF and that's going to provide  anesthesia up until about the nipple level.  

There can be epidural anesthesia, that would  typically be someone who maybe was attempting  

vaginal delivery, had an epidural catheter placed,  and now is going to have a C-section. And also  

general anesthesia. It's uncommon, this is not  the thing that you think of when you think of a  

C-section, but general anaesthesia can be given  to the patient in an emergency situation. So we  

sometimes call these splash-and-dash C-sections,  meaning that we have a time limit. We have to get  

baby out. We don't have time to do a spinal and  all of these things, so we're going to put Mom to  

sleep, splash Betadine on the belly and get going,  right? We got to get that baby out of there. 

So risk factors for C-section, there are so many  of them. There's a few here: labor dystocia, fetal  

malpresentation, failure to progress, right? We're  not getting that good dilation and effacement.  

Fetal distress. Of course, if the baby's in  distress, we're going to get them out. And  

then previous C-section, I had a C-section with my  daughter and then I had a C-section with my son.  

Some patients do choose to VBAC which is vaginal  birth after a C-section. However, that comes with  

a lot of risks and a lot of like kind of things  that have to be met for you to be a candidate for  

that. So in general, if you have had a C-section  before, you are likely to just have a planned  

C-section again in the future. Complications. Of  course, as with any sort of surgical procedure,  

hemorrhage and infection, right? Those are our big  concerns in complications for a surgical delivery. 

And as far as nursing care, we got to make sure  we have a patent IV, right? We're going to start  

foley in our patients so that we can empty their  bladder for them. We're going to run IV fluids,  

any sort of preoperative medications like  antibiotics would be given, and then we need  

to provide analgesia for post-op pain. In most  cases, Duramorph, a form of morphine, is given  

with the spinal and this actually provides really  good analgesia for about 24 hours after delivery.  

But once that starts to wear off, it's going  to be pretty painful. So we need to give those  

analgesics to our patients. And then  we need to, of course, be assessing  

the incision site itself for signs of  infection, purulent drainage, wound dehiscence,  

anything like that. Of course, that's what we're  going to do for any sort of surgical procedure. 

So I hope this review was helpful to you.  I'm going to give you a quick quiz now so  

that you can test your understanding of some  key points that I gave you in this video. So  

get your thinking caps on and let's go through it. For a patient who's experiencing shoulder  

dystocia, where should the nurse apply  pressure? Where should you apply pressure  

for shoulder dystocia? [Suprapubic region] 

What positions are indicated for  a patient experiencing a prolapsed  

umbilical cord? I told you two of  them. See if you can remember both.  

But even if you get one, that is awesome. [Trendelenburg or knee-chest position] 

And lastly, how should the nurse care  for an exposed prolapsed umbilical  

cord? So I have an umbilical cord that  has prolapsed and it is exposed to the  

outside. What am I going to do to take care of it? 

[Cover the umbilical cord with a  warm, sterile, saline-soaked towel] 

Let me know how you did. I hope you did  great. Thanks so much and happy studying. 

I invite you to subscribe to our channel  and share a link with your classmates and  

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