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