Maternal and Child Health Nursing

Labor and Delivery Complication

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

Clinical Manifestation

Diagnostic

Medical Management

PROM
Incompetent cervix
Multiple gestation
Previous history of Preterm labor
DES exposure
Emotional stress
Hydramnios
Placenta previa
Abruptio placenta
Maternal age <18 or >35
Low back pain
Suprapubic pressure
Vaginal pressure
Rhythmic uterine contractions (2 uterine contractions lasting 30 seconds within
15 minutes)
Cervical dilatation <4 cm & effacement 50% or less
Expulsion of cervical mucus plus
Bloody show

Obtain thorough obstetric history

Obtain specimen for CBC & U/A
Determine frequency, duration & intensity of uterine contractions
Determine cervical dilatations and effacement
Assess status of membranes and bloody show
Evaluate fetus for distress, size and maturity

Goal: PREVENTION OF PRETERM DELIVERY

Conservative Treatment:
Bed rest in lateral position
Hydration w/ IVF and continuous fetal and uterine contraction monitoring
Tocolytic Therapy:
Beta mimetic agents: Ritodrine (Yutopar)
Use of ritodrine can lead to pulmonary edema. Therefore, the nurse should assess for
crackles and dyspnea. Blood glucose levels may temporarily rise, not fall, with
ritodrine. Ritodrine may cause tachycardia, not bradycardia. Ritodrine may also cause
hypokalemia, not hyperkalemia.
Ritodrine (Yutopar) can cause tremor and jittery feelings, so it must be assessed
whether the feelings are from the medication or from the Preterm labor
Steroid
therapy

MCHN

Abejo

Maternal and Child Health Nursing

Labor and Delivery Complication

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
gestation) or term

(before 38 weeks

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.

MCHN

Abejo

Maternal and Child Health Nursing

Labor and Delivery Complication

Definition
Synonyms
Predisposing Factors

Initial Sign

The umbilical cord is displaced, either between the presenting post

and the amnion or protruding through the cervix.
Cord Prolapse
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
Cord Prolapse:
NOTE: first discovered when there is variable decelerated pattern
FHR pattern variable: Decelerations with contractions or between
contraction or fetal bradycardia present

Late Sign
Cardinal Sign

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

Cool, moist skin

Dystocia
Rupture of Membrane spontaneously
The cord may then present/visible @ the vulva.
Note: Do not attempt to push the cord into the uterus.

Disease Complication

Best Position

Confirmatory Test
Best Major Surgery

Amniotomy: Rupture of Membranes

Cesarian Section if the cervix incompletely dilated.
Fast vaginal delivery with forceps
#1 Maternal & Fetal Infection - Causing compression of the cord
and compromising fetal circulation
OTHERS: Prematurity, Hypoxia, Meconium aspiration,Fetal death if
delayed or undiagnosed

Bedside equipment

Best Drug
Nature of the drug
History of the Disease
Nursing Diagnosis

Nursing Intervention

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.

Eternal Electronic Fetal Heart Rate monitoring

Oxygen with face-mask.
Sterile hand glove
Heparin IV
To control intravascular coagulation in the pulmonary circulation
Fetal nutrients supply
Compression of the umbilical cord
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
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.

MCHN

Abejo

Maternal and Child Health Nursing

Labor and Delivery Complication

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

OCCURRENCE
TREATMENT

HYPERTONIC LABOR
PATTERNS (Primary
inertia)
Latent phase of labor
Rest and sedation
Fetal monitoring

CAUSES

1.

HYPOTONIC LABOR PATTERNS

(Secondary inertia)
Active phase of labor
Oxytocin and amnionity
Cesarean section if labor does not resume
Early analgesia
Bowel or bladder distention
Multiple gestation
Large fetus
Hydramnios
Grandmultiparity

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

MCHN

Abejo

Maternal and Child Health Nursing

Labor and Delivery Complication

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
Predisposing Factors:
1. Multiparity
2. History of rapid labor
3. Premature or small fetus
4. Large bony pelvis

NURSING INTERVENTION
Management:
1. Monitor client and fetus closely
2. Possibly administer tocolytic agents
3. Prepare for emergency birth

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

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
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

INCOMPLETE
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
Dyspnea
Sharp, chest pain
Pallor or cyanosis
Frothy, blood-tinged mucus

MCHN

MANAGEMENT
Oxygen
CPR
Intubation
Delivery

Abejo