Complications of Labor & Delivery
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Transcript of Complications of Labor & Delivery
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Complications of Labor & Delivery
Fall 2012
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Dysfunctional Labor
Normal labor is characterized by progress.
Dystocia is a general term that applies to any difficult labor or birth.
Causes› The Powers› The Passenger› The Passageway› The Psyche
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Complications of The Powers
Ineffective uterine contractions› Uterine Dystocia
Hypertonic Contractions Hypotonic Contractions
Ineffective Maternal Pushing
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Uterine Dystocia
Hypotonic contractions› Weak › Infrequent› Short› Pt comfortable
Nursing interventions› Walking › Position changes› Amniotomy› Oxytocin
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Hypertonic Contractions› Uncoordinated and eratic› Painful but ineffective› Usually occurs in latent phase› High resting tone› Maternal fatigue
Nursing interventions› Pain management› Promote relaxation› Analgesics› Oxytocin or amniotomy› Tocolytics may be ordered
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Ineffective Pushing
Incorrect technique Fear Decreased urge Exhaustion
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Complications of the Passenger
Fetal Size Malpositions Malpresentations Multifetal pregnancy Fetal Anomalies
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Interventions
Vacuum extraction Forcep delivery
› Risks of both to the baby› Risks of both to the mother
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Complications of the Passageway
Pelvis› Pelvic Dystocia (Cephalopelvic
Disproportion) Bladder
Interventions
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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?
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Problems of the Psyche
Pain Stress Fear Support
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Abnormal Labor Duration
Prolonged Labor› Once in active
phase should proceed at 1-2 cm/hr
› Risk Factors› Nursing
interventions
Precipitous Labor› Birth that occurs
within 3 hours of the onset of labor
› Causes› Nursing
interventions
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Premature Rupture of Membranes
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
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Premature Rupture of Membranes (PROM)Determine time of PROMVerification 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
Administration of Celestone - betamethasone› PROM: preterm
If leak seals, discharge instructions
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Preterm Labor
Defined as: labor that occurs between 20 and 37 weeks gestation.
Associated conditions› Multiple gestation› Hydraminos› UTI› Abdominal trauma› Infection› No prenatal care› Low socio-economic status
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Cervical Length Fetal Fibronectin test
› 99% accurate predictor of NO preterm birth within 7 day
Infections
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Preventing Preterm Birth
Treat the underlying cause› Preeclampsia› Hypovolemia› Serious Infection
Promote rest Hydration
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Medications
Tocolytics Medications prescribed to stop preterm
labor› Terbutaline – B adrenergic receptor agonist› Indomethacin- Prostaglandin inhibitor› Magnesium sulfate – CNS depressant› Nifedipine - Calcium channel blocker
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Accelerating Fetal Lung Maturity
Necessary if infant < 34 weeks (24-34 weeks)
Betamethasone› Every 7 days› Birth should be delayed by 24 hours
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Intrapartum Emergencies
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Prolapsed Umbilical Cord
Occurs when the umbilical cord precedes the presenting part.
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
Nursing Interventions› Knee chest position› Administer O2› Manual lift of fetal head off the cord
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Prolapsed Umbilical Cord
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Ruptured Uterus
Causes:› Long difficult labor› Injudicious use of Pitocin› Dehisence› High parity› Blunt abdominal trauma
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Manifestations
Pain Chest pain Hypovolemic shock Impaired fetal oxygenation Absent fetal heart sounds Cessation of uterine contractions Palpation of fetus
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Nursing considerations
Identify the risks Use oxytocin cautiously Monitor bleeding
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Ruptured Uterus
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Anaphylactoid Syndrome(Amniotic Fluid Embolus)
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
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Assessment Findings: Sudden onset Respiratory distress (dyspnea) Circulatory collapse (cyanosis)
› First the right ventricle, then left Tachycardia Hypotension Acute hemorrhage
› DIC
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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