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Complications of Labor and Delivery

Dystocia - An abnormal, long, or difficult labor or delivery


COMPLICATIONS OF THE PSYCHE

Etiology and Pathophysiology:


Hormones released in response to anxiety can cause DYSTOCIA

Intense anxiety stimulates Sympathetic nervous system which releases


catecholamines that lead to myometrial dysfunction.

Norepinephrine and epinephrine lead to uncoordinated or increased uterine activity

Nursing Care

Assess support available and be there for the patient


Patient Teaching- breathing/relaxation
Provide with non-pharmacological measures
Keep informed
Provide quiet calm environment
HYPERTONIC UTERINE CONTRACTIONS

Most often occur in first-time mothers, Primigravidas


Contractions are ineffectual, erratic, uncoordinated, and involve only a portion of the
uterus

Increase in frequency of contractions, but intensity is decreased, do not bring about


dilation and effacement of the cervix.
Signs and Symptoms:
1. PAINFUL contractions RT uterine muscle anoxia, causing constant cramping pain
2. Dilation and effacement of the cervix does not occur.
3. Prolonged latent phase. Stay at 2 - 3 cm. dont dilate as should
4. Fetal distress occurs early uterine resting tone is high, decreasing placental
perfusion.
5. Anxious and discouraged
Treatment of Hypertonic Uterine Contractions

Provide with COMFORT MEASURES


Warm shower; Mouth Care; Imagery; Music; Back rub

Mild sedation
Bedrest
Hydration
Tocolytics to reduce high uterine tone

HYPOTONIC UTERINE CONTRACTIONS


UTERINE INERTIA

Etiology and Pathophysiology:

Overstretching of the uterus

--large baby, multiple babies, polyhydramnios, multiple

parity

Bowel or bladder distention preventing descent


Excessive use of analgesia

Signs and Symptoms of HYPOTONIC UTERINE INERTIA:

Weak contractions become mild


Infrequent (every 10 15 minutes +) and brief,
Can be easily indented with fingertip pressure at peak of contraction.
Prolonged ACTIVE Phase
Exhaustion of the mother
Psychological trauma - frustrated
Therapeutic Interventions:
1. Ambulation getting up and walking will increase contractions
2. Nipple Stimulation causes release of endogenous Pitocin which can stimulate
contractions
3. Enema--warmth of enema may stimulate contractions
4. AMNIOTOMY artificial rupture of the membranes
Advantages of doing this before Pitocin
Contractions are more similar to those of spontaneous labor
Usually no risk of rupture of the uterus
Does not require as close surveillance
Disadvantages of an Amniotomy
Delivery must occur
Increase danger of prolapse of umbilical cord
Compression and molding of the fetal head (caput)
Nursing Care:
# 1-Check the fetal heart tones
Assess color, odor, amount
Provide with perineal care
Monitor contractions
Check temperature every 2 hours
5. Pitocin for augmentation of labor
Use only if CPD is not present
Give 20 units / 1000 cc. fluid and hang as a secondary infusion, never as primary
GOAL:
Achieve contractions every 2 - 3 minutes of good intensity with relaxation
between
Nursing Care:
Assess contractions--are they increasing but not tetanic
Assess dilation and effacement
Monitor vital signs and FHTs
Prolonged Labor
Definition: A labor lasting more than 18-24 hours
Normally:
Cervical dilation -- Primigravida 1.2 cm / hr. Multigravida 1.5 cm / hr
Descent 1 cm. / hr in primigravida and 2 cm./ hr. in multigravida
PRECIPITIOUS LABOR OR DELIVERY
Labor that last less than 3 hours

Unexpected fast delivery


Etiology
Lack of resistance of maternal tissue to passage of fetus
Intense uterine contractions
Small baby in a favorable position
Complication:
If the baby delivers too fast, does not allow the cervix to dilate and efface which
leads to cervical lacerations
Uterine rupture
Fetal hypoxia and fetal intracranial hemorrhage
Rapid Delivery
Delivery Outside Normal Setting
Everything is OUT OF CONTROL!
mom is frightened, angry, feels cheated
Nursing Care:
Do NOT leave the mother alone
Try to make the place clean, (dont break down table)
Try to get the mother in control -- Have mom pant to decrease the urge to push
Apply gentle pressure to the fetal head as it crowns to prevent rapid change in
pressure in the fetal head which can cause subdural hemorrhage or dural tears.
Deliver the baby BETWEEN contractions to control delivery
Suction or hold babys head low and place on mom/s abdomen, tie off cord
Allow to breast feed, Document!

Pelvic Dystocia

Definition:
Pelvic Inlet or Outlet is not of sufficient size or proper shape to allow the baby to get
through

Etiology
Congenital defect
Malnutrition -- Rickets
Neoplasms
Fracture / Trauma

Signs and Symptoms:

Labor is arrested.

Station does not decrease. Baby does not move down in the birth
canal after long time in labor or with prolonged pushing.

Therapeutic Interventions:

cesarean delivery
Complications of the Passenger

Malpositions:
Posterior position--usually mom complains of back pain

Treatment:

Forceps -- low forceps or outlet forceps usually applied after crowning


Vacuum extraction -- disk shaped cup placed over vertex of head and vacuum
applied.

Episiotomy - surgical incision to allow more room

Malpresentation -- brow, face, transverse, breech


may allow to deliver vaginally with caution or Cesarean birth

Treatment:
May allow to deliver with caution or C-birth

Version -- alteration of fetal position by abdominal or intrauterine manipulation


Cephalopelvic Disproportion
Large baby or small pelvis
Usually diagnosed when there is an arrest in descent
Station remains the same
Treatment:
Cesarean Delivery
Multiple Fetus
may be delivered by cesarean birth

CESAREAN DELIVERY
OPERATIVE PROCEDURE IN WHICH THE FETUS IS DELIVERED THROUGH AN INCISION
IN THE ABDOMEN
REMEMBER -- IT IS A BIRTH !
Mom may feel less than normal, so may need support
May have option of a VBAC the next time

Preterm Labor
Definition:
Labor that occurs after 20 weeks but before 37 weeks
Etiology:
urinary tract infections
Premature rupture of membranes
Goal -- STOP THE LABOR ! suppress uterine activity
Therapeutic Interventions:

Drug Therapy / Tocolytics


Uses: Stop or arrest labor
Criteria for use, dont give if:
Patient is in Active labor, cervix has dilated to 4 cm. or more
Presence of Severe Pre-eclampsia
Fetal complications / Fetal demise
Hemorrhage is present
Ruptured membranes
Examples:
Yutopar (ritodrine) or Brethine (terbutaline sulfate)
SIDE EFFECTS or WARNING SIGNS:
Palpitations
Tachycardia - pulse ~120

Tremors, nervousness, restlessness


Headache, severe dizziness
Hyperglycemia

TOXIC EFFECTS - PULMONARY EDEMA


- rales, crackles, dyspnea
- Must perform chest assessment with nursing assessment every shift
and chart lung sounds.
Nursing Care:

Stop the medication


Start oxygen
Give ANTIDOTE: INDERAL
Patient Teaching:
Teach how to take medication -- on time
Teach patient to check pulse, call Dr. if > 120 140 (dehydration increases
contractions)
Teach to assess fetal movement daily, kick counts
Drink 8-10 glasses of water per day
Monitor uterine activity -- Home monitoring -- call dr. if has contractions
Decrease activity
Lie on side
Keep bladder empty