Post on 30-Sep-2015
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Maternal and Child Health Nursing
Labor and Delivery Complication
MCHN Abejo
MATERNAL and CHILD HEALTH NURSING
LABOR AND DELIVERY COMPLICATION
Lecturer: Mark Fredderick R. Abejo RN, MAN
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LABOR AND DELIVERY COMPLICATIONS
A. Preterm Labor
Preterm labor is labor that begins after 20 weeks gestation and before 37 weeks gestation.
Etiology PROM Incompetent cervix Multiple gestation Previous history of Preterm labor DES exposure Emotional stress Hydramnios Placenta previa Abruptio placenta Maternal age 35
Clinical Manifestation Low back pain Suprapubic pressure Vaginal pressure Rhythmic uterine contractions (2 uterine contractions lasting 30 seconds within
15 minutes)
Cervical dilatation
Maternal and Child Health Nursing
Labor and Delivery Complication
MCHN Abejo
Nursing Management Perform measures to manage or stop Preterm labor
Place on CBR in side-lying position
Prepare fro possible ultrasound, amniocentesis, tocolytic and steroid therapy
Administer meds as prescribed
Assess S/E such as hypotension, dyspnea, chest pain and FHR exceeding 180 b.p.m.
Dyspnea on exertion and increased vaginal mucus are common
discomforts caused by the physiologic changes of pregnancy.
Provide adequate hydration
Provide emotional support
B. PROM (Premature Rupture of Membrane)
Spontaneous rupture of amniotic membranes prior to onset of labor, maybe preterm (before 38 weeks
gestation) or term
Contributing Factors Incompetent cervix Trauma Infection
Clinical Manifestation Leakage of amniotic fluid pH higher than 6.5 Nitrazine paper reaction = blue
Risk For Prolapsed cord Infection RDS
Management 1. With infection: antibiotics and delivery of infant 2. Without infection:
34-36 weeks of gestation= delay birth, amniocentesis and monitor LS ratio of the baby
28-32 weeks of gestation= delay birth, administer steroids to hasten maturity of the lungs and decreased RDS
The good indicator of fetal lung maturity in a pregnant diabetic is presence of
phosphatidglycerol in the amniotic fluid.
C. Umbilical Cord Prolapse
If the fetus is at 2 station and the membranes rupture, the patient is at risk for prolapsed cord. You can determine if a prolapsed cord exists if you perform a vaginal exam.
Maternal and Child Health Nursing
Labor and Delivery Complication
MCHN Abejo
Definition The umbilical cord is displaced, either between the presenting post and the amnion or protruding through the cervix.
Synonyms Cord Prolapse Predisposing Factors Fetal Position other than cephalic presentations
Prematurity: NOTE: Small fetus allows more space around presenting part.
Polyhydramnios Multiple fetal gestation FetoPelvic disproportion Abnormally long umbilical cord. Placenta Previa Intrauterine tumors that prevent the presenting part from engaging > Breech presentation, Transverse lie, Unengaged presenting part, Twin
gestation, Hydramnios
Small fetus Initial Sign Cord Prolapse:
NOTE: first discovered when there is variable decelerated pattern
FHR pattern variable: Decelerations with contractions or between
contraction or fetal bradycardia present
Persistent non reassuring fetal heart rate fetal distress Atrophy of the umbilical cord & cord protruding from vagina Cord may be palpated in cervix/vagina Reflex constriction when cord is exposed to air
Late Sign Cool, moist skin Dystocia
Cardinal Sign Rupture of Membrane spontaneously The cord may then present/visible @ the vulva. Note: Do not attempt to push the cord into the uterus.
Confirmatory Test Amniotomy: Rupture of Membranes Best Major Surgery Cesarian Section if the cervix incompletely dilated.
Fast vaginal delivery with forceps Disease Complication #1 Maternal & Fetal Infection - Causing compression of the cord
and compromising fetal circulation
OTHERS: Prematurity, Hypoxia, Meconium aspiration,Fetal death if
delayed or undiagnosed
Best Position
Trendelenbergs position or Knee Chest position -which causes the presenting part to fall back from the cord.
Turn side to side -Helps may be elevated to shift to fetal presenting toward diaphragm.
Bedside equipment Eternal Electronic Fetal Heart Rate monitoring
Oxygen with face-mask.
Sterile hand glove
Best Drug
Nature of the drug
Heparin IV
To control intravascular coagulation in the pulmonary circulation
History of the Disease Fetal nutrients supply
Compression of the umbilical cord
Nursing Diagnosis Fluid volume deficit related to active hemorrhage Altered tissue perfusion related to maternal vital organ and fetal
related to hypovolemia
Risk for infection related traumatize tissue Nursing Intervention NOTE: The nurses #1 priority action to a prolapse cord is to assess the
fetal heart rate. A prolapsed cord interrupts the oxygen and nutrient flow
to the fetus. If the fetus doesnt receive adequate oxygen, hypoxia develops, which can lead to central nervous system damage in the fetus.
The primary goal with a prolapsed of the umbilical cord is to remove the
pressure from the cord. Changing the maternal position is the first
intervention. Acceptable positions include knee-chest, side-lying and
elevation of the hips. The nurse may also perform a vaginal examination
and attempt to push the presenting part off the cord. Administering the
oxygen benefits the fetus only if circulation through the cord has been
reestablished.
Maternal and Child Health Nursing
Labor and Delivery Complication
MCHN Abejo
Start or maintain an IV as prescribed. Use of large-gauge catheter when starting the IV for blood and large quantities of fluid intake.
Administer oxygen by face mask to provide high oxygen concentration at 8 10L/min.
Instruct patient to cleanse from the front to the back. Explain the importance of hand washing before and after perineal
care.
OTHER MANAGEMENT:
Reposition client to trendelenburg or knee- chest position Oxygen Push presenting part upward Apply moistened sterile towels Delivery as soon as possible
D. Dystocia
Difficult, painful, abnormal progress of labor of more than 24 hours
HYPERTONIC LABOR
PATTERNS (Primary
inertia)
HYPOTONIC LABOR PATTERNS
(Secondary inertia)
OCCURRENCE Latent phase of labor Active phase of labor
TREATMENT Rest and sedation
Fetal monitoring
Oxytocin and amnionity
Cesarean section if labor does not resume
CAUSES Early analgesia
Bowel or bladder distention
Multiple gestation
Large fetus
Hydramnios
Grandmultiparity
1. Passageway a. Contracted pelvis b. Unfavorable pelvic shapes
Management:
i. Evaluate pelvic diameters ii. Continue labor with careful monitoring iii. Perform assisted vaginal or caesarean delivery
2. Psyche a. Fear, anxiety ad tension increase stress and decrease uterine contractility b. Stress interferes with the clients ability with her contractions c. Stress increase fatigue
Management:
i. Monitor clients psychologic response to labor ii. Determines clients level of stress iii. Provide support iv. Encouraged relaxation
Maternal and Child Health Nursing
Labor and Delivery Complication
MCHN Abejo
E. Precipitate delivery
- Labor that is completed within 3 hours
A pregnant patient with a known history of crack cocaine use is in labor must be prepared for a precipitous labor
and notify the neonatologist of the infants high-risk status.
If a patient has a precipitous labor at risk, the result of the labor process would be laceration of the soft tissues,
uterine rupture, and excessive uterine bleeding.
ASSESSMENT NURSING INTERVENTION
Predisposing Factors:
1. Multiparity 2. History of rapid labor 3. Premature or small fetus 4. Large bony pelvis
Risks:
1. Perineal lacerations & Hemorrhage When delivering the neonate, you should deliver the
head between contractions. This will prevent the head
from being delivered too suddenly, thuds preventing a
possible tearing of the perineum.
3. Fetal Cerebral trauma
Management:
1. Monitor client and fetus closely 2. Possibly administer tocolytic agents 3. Prepare for emergency birth
F. Uterine Rupture
The two findings on physical exam indicate uterine rupture is loss of uterine contour and palpable fetal part.
The number one risk factor for uterine rupture is previous cesarean section.
COMPLETE INCOMPLETE
Sudden sharp abdominal pain during contractions
Abdominal tenderness Cessation of contractions Bleeding into abdominal cavity & sometimes
into vagina
Fetus easily palpated, FHT ceased Signs of shock
Abdominal pain during contractions Contractions continue, but cervix fail to dilate Vaginal bleeding may be present Rising pulse rate and skin pallor Loss of fetal heart tones
G. Amniotic fluid embolism
An amniotic fluid embolism is when the amniotic fluid leaks into the maternal bloodstream bThe causes of an
amniotic fluid embolism are difficulty in labor, or hyperstimulation of the uterus. Polyhydramnios is an excessive
amniotic fluid.
MANIFESTATION MANAGEMENT
Dyspnea Sharp, chest pain Pallor or cyanosis Frothy, blood-tinged mucus
Oxygen CPR Intubation Delivery