PRECIPITATE LABOR
contractions and FHR patterns
 Refers to labor that lasts 3 hours or
less
 More common in multiparous
patients and in women who have
received oxytocin induction or
amniotomy.
 The mother is at risk for hemorrhage
secondary to premature separation
of the placenta and for lacerations
due to the force and rapidity of the
birth.
Causes:
 Lack of maternal tissue resistance to
the passage of the fetus.
** The fetus is at risk for subdural
hematoma, possibly from the rapid
release of pressure on the fetal head.
Assessment Findings :
 Strong uterine contractions with
signs of premature placental
separation.
Treatment :
 A tocolytic may be administered to
reduce the strength and frequency
of the contractions.
 Plans for immediate delivery are
necessary.(CS)
Nursing Interventions:
 Provide emotional and physical
support to the woman and family.
 Continuously monitor uterine
 Encourage the woman to relax as
possible
 Explain all procedures and
treatments being initiated.
 Instruct the woman with a history of
precipitate labor that it may occur
with future pregnancies; advise to
plan for such an occurrence in
advance.
UTERINE INVERSION
 The inverted fundus may lie within
the uterine cavity of the vagina or, in
total inversion, protrude from the
vagina.
Causes :
 May occur after the birth of the
neonate, especially if traction is
applied to the uterine fundus when
the uterus is not contracted.
 May also occur when the placenta is
inserted at the fundus, during birth
the passage of the fetus pulls the
fundus down.
Assessment Findings :
 A large sudden gush of blood from
the vagina.
 Non-palpable fundus in the
abdomen
 Signs and symptoms of shock if the
loss of blood continues unchecked
for more than few minutes
 Hypotension
 Pallor
 dizziness and diaphoresis
 Possible exsanguination if bleeding
continues unchecked
Treatment :
 IV fluids and blood component
therapy to replace fluid volume and
blood loss
 General anesthesia, or tocolytic may
be administered to relax the uterus
 Due to uterine exposure, antibiotic is
indicated postpartally
 As a last resort, the patient may
require an emergency hysterectomy.
Nursing Interventions :
 Initiate IV therapy as ordered – if the
woman has an IV line in place,
increased the flow rate to achieve
optimal flow of fluid to restore fluid
volume.
 Administer oxygen by mask as
ordered
 Keep in mind that administering an
oxytoxic only compounds the
inversion
 Never attempt to remove the
placenta if it's still attached because
this will create more bleeding.
 Monitor VS at least every 15
minutes.
 Assist with the measures to relax
the uterus
 Provide emotional support and
explaination what's happening and
procedures being done
 Be prepared to perform CPR if the
woman's heart fails from the sudden
blood loss.
 Anticipate administering antibiotic as
ordered
UTERINE RUPTURE
 Occurs when the uterus undergoes
more strain than it's capable of
sustaining and then ruptures.
 Rupture can be complete, going
through endometrium, myometrium,
and peritoneum, or incomplete,
leaving the peritoneum intact.
Causes :
 Usually occurs from a previous
cesarean birth, such as when a
vertical scar from a previous incision
is present.
 Can also occur from hysterectomy
repair.
 Other causes include :
 prolonged labor, faulty
presentation, multiple gestation,
use of oxytocin, traumatic
maneuvers using forceps or
traction.
Assessment Findings :
 Indentation appearing across the  Anticipate the use of IV oxytocin to
abdomen over the uterus contract the uterus and minimize
(pathologic retraction ring) bleeding.

 Strong uterine contractions without  Prepare the woman for a possible

any cervical dilation.
 Indications of complete uterine
rupture
 sudden, severe pain during a
strong labor contraction
laparotomy as an emergency
measure – explanation is necessary.
 If applicable, offer emotional support
for the loss of this child or loss of
future children (if hysterectomy or
tubal ligation is performed).

 report of a tearing sensation  Allow them to express their

emotions without feeling threatened.
 cessation of uterine contractions

 hemorrhage

Treatment :

 Focuses on the following measures :

 Fluid replacement

 IV oxytocin to contract the uterus

and minimize bleeding

 A cesarean birth will be done to

ensure safety of neonate

 Manual removal of the placenta

under general anesthesia may be
necessary.

 A laparotomy may be necessary as

an emergency measure to control
bleeding and repair the rupture;
hysterectomy or tubal ligation may
be performed.

Nursing Interventions :

 Administer emergency fluid

replacement therapy as ordered.