NUR 4445 Intrapartum Complications

NUR 4445 Intrapartum Complications

• What is macrosomia? What are the risk factors for macrosomia (6)?

Answer

• Baby weighing e 4,000 g (8 lb 8 oz) at birth.

• Risk factors associated with macrosomia

· Obesity, diabetes, pelvic abnormalities, post-date pregnancy, short stature, previ- ous 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

• Shoul- der 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 1 / 2

• 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

• Ex- pect uterine atony and boggy (soft) uterus

• Monitor for and treat uterine hemorrhage
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