Transcript Complications of Labor & Delivery

Normal labor is characterized by
progress.
 Dystocia is a general term that applies to
any difficult labor or birth.
 Causes
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› The Powers
› The Passenger
› The Passageway
› The Psyche
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Ineffective uterine contractions
› Uterine Dystocia
 Hypertonic Contractions
 Hypotonic Contractions
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Ineffective Maternal Pushing
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Hypotonic contractions
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Weak
Infrequent
Short
Pt comfortable
Nursing interventions
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Walking
Position changes
Amniotomy
Oxytocin
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Hypertonic Contractions
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Uncoordinated and eratic
Painful but ineffective
Usually occurs in latent phase
High resting tone
Maternal fatigue
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Pain management
Promote relaxation
Analgesics
Oxytocin or amniotomy
Tocolytics may be ordered
Nursing interventions
Incorrect technique
 Fear
 Decreased urge
 Exhaustion
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Fetal Size
 Malpositions
 Malpresentations
 Multifetal pregnancy
 Fetal Anomalies
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Vacuum extraction
 Forcep delivery
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› Risks of both to the baby
› Risks of both to the mother
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Pelvis
› Pelvic Dystocia (Cephalopelvic
Disproportion)
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Bladder
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Interventions
Monica, a G1, P0 @ 39.4wks is admitted to L&D with
occasional uterine contractions that started soon
after her BOW broke an hour ago. She pauses during
conversation to breath during contractions and gives
a pain rating of 5. Monica states she will probably
want an epidural.
While performing the admission history/assessment you
notice that Monica’s contractions are occurring
every 2 minutes and palpate strong. Monica is
beginning to demonstrate difficulty with coping
during contractions. Monica grunts during her last
contraction.
What nursing interventions will you provide?
Pain
 Stress
 Fear
 Support
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Prolonged Labor
› Once in active
phase should
proceed at 1-2
cm/hr
› Risk Factors
› Nursing interventions
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Precipitous Labor
› Birth that occurs
within 3 hours of the
onset of labor
› Causes
› Nursing interventions
Spontaneous rupture of membranes prior to
the onset of labor
 Associated conditions:
› Infection
 STDs, UTI, GBS
› Previous history of PROM
› Amniotic sac with a weak structure
› Fetal abnormalities
› Overdistention of the urterus
› Maternal stress
› Trauma
Determine time of PROM
Verification of PROM:
• Visualization
• Sterile speculum
exam for ferning
• pH
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Nursing Assessment
› Vital signs (temp q 2hr)
› Fetal monitoring
› Nature of fluid
› WBC count
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Administration of Celestone betamethasone
› PROM: preterm
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If leak seals, discharge instructions
Defined as: labor that occurs between 20
and 37 weeks gestation.
 Associated conditions
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Multiple gestation
Hydraminos
UTI
Abdominal trauma
Infection
No prenatal care
Low socio-economic status
Cervical Length
 Fetal Fibronectin test
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› 99% accurate predictor of NO preterm birth
within 7 day
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Infections
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Treat the underlying cause
› Preeclampsia
› Hypovolemia
› Serious Infection
Promote rest
 Hydration
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Tocolytics
 Medications prescribed to stop preterm
labor
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› Terbutaline – B adrenergic receptor agonist
› Indomethacin- Prostaglandin inhibitor
› Magnesium sulfate – CNS depressant
› Nifedipine - Calcium channel blocker
Necessary if infant < 34 weeks (24-34
weeks)
 Betamethasone
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› Every 7 days
› Birth should be delayed by 24 hours
Occurs when the umbilical cord precedes the
presenting part.
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Primary Risk Factor
› Fetal head is not engaged or at a high station
Vessels carrying blood to & from the fetus are
compressed, usually results in fetal distress
or possible demise
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Nursing Interventions
› Knee chest position
› Administer O2
› Manual lift of fetal head off the cord
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Causes:
› Long difficult labor
› Injudicious use of Pitocin
› Dehisence
› High parity
› Blunt abdominal trauma
Pain
 Chest pain
 Hypovolemic shock
 Impaired fetal oxygenation
 Absent fetal heart sounds
 Cessation of uterine contractions
 Palpation of fetus
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Identify the risks
 Use oxytocin cautiously
 Monitor bleeding
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In the presence of a small tear in the amnion
and chorion, a small amount of amniotic
fluid may leak into the chorionic plate and
enter the maternal blood system.
Can also occurs at areas of placental
separation, cervical tears or during
trumultuous labor
The more debris (meconium, vernix, lanugo) in
the amnionic fluid, the greater the maternal
problems caused by possible anaphylactic
reaction to fetal antigens
Assessment Findings: Sudden onset
 Respiratory distress (dyspnea)
 Circulatory collapse (cyanosis)
› First the right ventricle, then left
Tachycardia
 Hypotension
 Acute hemorrhage
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› DIC
Obstetrical Emergency
 Interventions:
› CPR
› Mechanical ventilation
› Correction of hypotension
› Blood transfusion - DIC
› Emergency C/S if pregnant
Prognosis – 50% of women die with the first hour of
symptoms