Maternal and Child Health Nursing

Labor and Delivery Complication

MATERNAL and CHILD HEALTH NURSING

LABOR AND DELIVERY COMPLICATION

BYL: DR. CHRIS SORONGON

_____________________________________________________________________________
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 <18 or >35
Clinical Manifestation  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

Diagnostic  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

Medical Management 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
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 (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.

MCHN
Maternal and Child Health Nursing
Labor and Delivery Complication

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  Trendelenberg’s 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 Heparin IV
Nature of the drug 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 nurse’s #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 doesn’t 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
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

HYPERTONIC LABOR HYPOTONIC LABOR PATTERNS

PATTERNS (Primary (Secondary inertia)
inertia)
OCCURRENCE Latent phase of labor Active phase of labor
TREATMENT Rest and sedation Oxytocin and amnionity
Fetal monitoring 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

MCHN
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 infant’s 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: Management:
1. Multiparity 1. Monitor client and fetus closely
2. History of rapid labor 2. Possibly administer tocolytic agents
3. Premature or small fetus 3. Prepare for emergency birth
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

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 Abdominal pain during contractions
contractions Contractions continue, but cervix fail to dilate
Abdominal tenderness Vaginal bleeding may be present
Cessation of contractions Rising pulse rate and skin pallor
Bleeding into abdominal cavity & sometimes Loss of fetal heart tones
into vagina
Fetus easily palpated, FHT ceased
Signs of shock

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 Oxygen
Sharp, chest pain CPR
Pallor or cyanosis Intubation
Frothy, blood-tinged mucus Delivery

MCHN