Complications of LABOR

PRETERM LABOR
o LABOR that occurs after the 2oth week and before 37th week of gestation
RISK FACTORS
o MATERNAL FACTORS
 MATERNAL INFECTION
 PROM
 BLEEDING
 UTERINE ABNORMALITIES/OVERDISTENTION
 INCOMPETENT CERVIX
 PREVIOUS PRETERM LABOR
 SPONTANEOUS/ INDUCED ABORTION
 PREECLAMPSIA( SHORT INTERVAL) LESS THAN 1 YEAR between pregnancies
 TRAUMA
 POOR NUTRITION probably due to socioeconomic status, no prenatal care, lack of
childbirth experience
 EXTREMES OF AGE, DECREASED WEIGHT(LESS THAN 100 LB)
 LESS HEIGHT(LESS THAN 5 FT)
 LACK OD REST/ EXCESSIVE FATIGUE
 SMOKING
 EXTREME EMOTIONAL STRESS
o FETAL FACTORS
o MULTIPLE PREGNANCY
o INFECTIONS
o POLYHYDRAMNIOS
o CONGENITAL ADRENAL HYPERPLASIA
o FETAL MALFORMATIONS
o PLACENTAL FACTORS
o PLACENTAL SEPARATION
o PLACENTAL DISORDERS
o UNKNOWN CAUSES
COMPLICATIONS
o PREMATURITY
o FETAL DEATH
o SGA/IUGR
o INCREASE PERINATAL MORBIDITY AND MORTALITY
TREATMENT: Hospitalization to prevent premature delivery
1. Bed rest on lateral recumbent
2. Adequate hydration: oral & parenteral
3. Monitoring
a. Uterine contractions and irritability q1-2 hrs( to determine increasing or decreasing
contractions)
 b. Vital signs as major drugs employed can alter them
c. I & O
d. Signs of Infection
e. Cardiac & Respiratory Status and distress signs
f. Cervical consistency, dilatation and effacement
g. Fetal well being
h. Early signs of edema: pulmonary edema is a possible complication of ritrodrine use
4. Promotion of Physical and emotional comfort: keep client informed of progress
5. Administration of tocolytics to arrest labor by causing relaxation of the uterus, examples:
MGS04, Terbutaline and Ritodrine
a. Contraindications to arresting premature labor
Advanced pregnancy
Ruptured bag of waters
Maternal dses like bleeding complications, PIH, cardiovascular dse.
Fetal distress
Presence of fetal problems like RH isoimmunization
6. Administration of corticosteroids like (Betamethasone) to enhance maturation of fetal lungs
by stimulating the production of surfactant when there are contraindications to attempts to
arrest preterm labor.
a. Administer ordered drugs according to protocol
b. Assess effects of drugs on labor and fetus
c. Monitor side effects of the drugs
Discharge
Once contractions have stopped, maternal and fetal conditions stabilized the client is
discharged.
Health Teachings should include measures to prevent recurrence to premature labor:
1. Maintain bed rest, left lateral preferred
2. Well balanced diet: high in iron, vitamins and important minerals
3. Continuation of oral medications ( Yutopar) at home
4. Frequent prenatal visit every week for the duration of the remaining wks.
5. Activity/Lifestyle evaluated and restricted as necessary
6. Illness: chronic- monitored; acute- treated STAT
7. Provide client teaching: symptoms of preterm labor and prompt reporting to the
physician when present
OTHER INTERVENTIONS: Provision of psychological support and encouragement.
PRECIPITATE LABOR
- SHORT labor that lasts for 2-3 hours or less

 RISK FACTORS
1. Multiparity- the most common/ important factor
2. Trauma
3. Large pelvisand lax soft tissues
4. Small fetus
5. Labor induction by oxytocin and rupture of membranes
6. Severe emotional stress
 Complications

Maternal
a. Laceration
b. Hemmorrhage
c. Infection
d. Uterine rupture if birth canal is not readily distensible
e. Hypotonic contractionshemorrhage

FETAL
A. HYPOXIA, ANOXIA
B. SEPSIS
C. INTRACRANIAL HEMORRHAGE
 Treatment
1. Episiotomy
2. Delivery
 Assessment Findings
1. Tetanic-like contractions
2. Rapid labor and delivery
3. S/S of impending delivery
a. Desire to push
b. Strong contractions
c. Ruptured membranes
d. Heavy bloody show
e. Bulging rectum
f. Severe anxiety

NURSING IMPLEMENTATION

1. Never leave pt
2. Monitor FHT Q 15 min to detect distress from fetal hypoxia secondary to
tetanic contractions
3. Provide emotional support
4. Assist with delivery.
Dystocia
 Prolonged difficult labor and/ or delivery because of problems with the factors in labor(4
P’s)

 Risk Factors

1. Fault of the Passengers

a. Abnormal position
b. Malpresentation
c. Hydrocephaly
d. Large fetus
e. Abnormal lie(TRANSVERSE)
f. MULTIPLE pregnancy
2. Fault of the Passages
a. Cervical inertia
b. Contracted pelvis
c. CPD
d. Non gynecoid pelvis
e. Cervical scar tissue from previous surgery
3. Faults of the Primary Power
a. Hypertonic uterine inertia
b. Hypotonic uterine inetia
4. Faults of the Client: poor psychosocial response which are influenced by the
following factors:
a. Education and preparation
b. Previous experience
c. Readiness
d. Support system
e. Maternal position
f. Race and culture
g. Environment
h. Socioeconomic status
Complications
 Maternal exhaustion and dehydration
 Infection
 Traumatic operative births
 Fetal distress
 Birth injuries
 Perinatal mortality
Treatment
 Bed rest
 Sedation for hypertonicity
 Stimulation with oxytocin for hypotonicity
  CS
 Forceps as indicated
Diagnosis
o Vaginal examination
o Leopolds maneuver
o Pelvimetry
o Ultrasonography
o Diagnosis of type of dystocia
NURSING IMPLEMENTATION
o PREPARE CLIENT FOR/ ASSIST in various diagnostic examinations
o Promote rest and comfort; quiet darken room
o Proper position for comfort: lateral position is comforting
o Monitor :
 Labor- uterine contractions, cervix
 Fetal well being- FHT, Movement, passage of meconium
o ADMINISTER oxytocin as ordered for hypotonic uterine inertia to augment labor.
o Safety ALERT! Oxytocic drugs in labor induction and augmentation may
cause uterine hypertonicity and lead to serious complications as UTERINE
RUPTURE, ABRUPTIO PLACENTA and fetal distress. The WOMAN with
OXYTOCIN drip should not be LEFT ALONE
o Monitor VS drip rate of IV oxytocin carefully and frequently. Maternal
hypotension and hypertension can result from oxytocin drip.
o BP is therefore the single most important vital sign to be monitored.

Assignment: Write on your Notebook

Differentiate HYPOTONIC UTERINE INERTIA vs. Hypertonic Uterine Inertia in terms of the

ONSET, CONTRACTIONS, CAUSES and Treatment

PROM(PREMATURE RUPTURE OF MEMBRANES)

Rupture of membranes before term/labor; unconnected with labor

 ASSESSMENT FINDINGS
o MATERNAL REPORT of passage of fluid per vagina
o Determination of alkaline amniotic fluid and not acidic urine or vaginal discharge
Diagnosis
o Nitrazine test
o Ferning Test
o Sterile speculum examination: direct visualization of fluid from cervical os is the most
reliable diagnosis of PROM
COMPLICATIONS
o MATERNAL infection/ chorioamnionitis- most common
o Cord prolapse
 o Premature labor

Nursing implementation
o Maintain bed rest. Do not allow ambulation(to prevent prolapseof the
umbilical cord)
o Calculate gestational age
o Monitor vs and fetal well being
o Observe and record the character, amount, color and odor of amniotic fluid
o Be alert for early signs of infection: fever, chills, malaise, and signs of labor
onset.
o Provide appropriate treatment as ordered:
 If there are signs of infection: antibiotics and immediate delivery
 If without signs of infection induction of labor delayed, provided
fetus is healthy
o Provide psychological support

Assignment:

What is Nitrazine test and Ferning’s Test

UTERINE RUPTURE
 RUPTURE OF THE UTERUS Because of the stress of labor with extrusion of uterine contents into the
abdominal cavity
 Risk factors
 Previous CS scar -MOST COMMON CAUSE/contributory factor
 Improper use of oxytocin
 Overdistention of the uterus
 Strong contractions with non progressive labor
 Abnormal presentation
 Trauma
 Injudicious obstetrics: application of forceps when the cervix is not fully dilated; second
stage of labor -fundal pressure; forced delivery of the fetus with
abnormality(hydrocephaly)
 Ill- advised podalic version
 Assessment Findings
 Sudden acute abdominal pain and tenderness
 cessation of uteraine contractions and FHT
 Presenting part no longer felt through the cervix
 A feeling in the mother that something happened inside her
 Signs of external bleeding; signs of shock
 Presence of predisposing factors
 Complications
 Hemorrhage/shock
 Maternal AND FETAL mortality
 Infection from traumatized tissues
  Treatment
 Laparotomy to deliver the fetus
 Hysterectomy for complete rupture
 Blood, plasma and IV fluid replacement
 Antibiotics
 Nursing IMPLEMENTATION
o STAY WITH CLIENT; CALL FOR ASSISTANCE
o PROMPTLY implement supportive measures
o Positioning:shock position
o Provision of warmth
o Prompt IV infusion: D5LRS
o NOTIFY PHYSICIAN; INFORM SUPPORT person
o Prepare immediate surgery
o Provide psychological support

FETAL DISTRESS
-FETAL condition resulting from fetal hypoxia

o RISK FACTORS
o DYSTOCIA
o CORD COIL, CORD COMPRESSION
o IMPROPER USE OF OXYTOCIN, ANESTHESIA/ANALGESIA
o DM,CARDIAC DSE AND OTHER CO EXISTING CONDITIONS IN THE MOTHER
o BLEEDING complications in the 3rd trimester like placenta previa and abruptio placenta
o PIH
o Supine hypotensive syndrome

ASSESSMENT FINDINGS TRIAD SYMPTOMS

1. FHT above 160 OR BELOW 120 PER MINUTE

2. Meconium-stained amniotic fluid in a non breech presentation
3. Fetal hypermobility/hyperactivity

Nursing implementation

1. Reposition mother to left lateral recumbent(LLR) this relieves pressure on inferior vena cava,
thereby increasing venous return resulting in increased perfusion of placenta and fetus
2. Stop oxytocin drip if being infused
3. Administer oxygen per mask at 6-7 lpm
4. Correct hypotension
5. Monitor fht continuously
6. Notify the physician
7. Prepare for emergency CS if indicated.
 Assignment:

 What is VENA CAVAL SYNDROME

 Risk Factor of VCS
 NURSING implementation

(please write this on your notebook)

AMNIOTIC FLUID EMBOLISM

- ESCAPE of amniotic fluid into maternal circulations through placental site and into the
pulmonary arterioles
Risk factors:
1. Premature/ normal rupture of membranes(the risk of having amniotic fluid embolism starts from
the moment the bag of water ruptures)
2. Abruptio placenta
3. Difficult labor

Incidence:

Rare but usually fatal; mortality in the 1st hour n 25 %of pregnant womenwith amniotic fluid embolism

Prognosis- usually fatal for both mother and baby

ASSESSMENT FINDINGS
Maternal RESPIRATORY DISTRESS
A. Acute dyspnea
B. Cyanosis
C. Sudden chest pain
D. Pulmonary shock and edema
CIRCULATORY COLLAPSE: SIGN OF SHOCK
SECONDARY : uncontrolled bleeding from disseminated intravascular coagulation

TREATMENT: Cardiorespiratory support

o Oxygenation stat
o Improve hydration
 IV fluid and plasma
 Whole blood, fibrinogen transfusion
 Monitor fluids, I & O
o Digitalis for failing cardiac function
o Heparin as ordered; be ready with antidote Protamine sulfate
o Antibiotics
 o Delivery: forceps (if cervix is fully dilated) or vaginal (if cervix is open and dilating well)
o Continued monitoring of mother and fetus

NURSING IMPLEMENTATION

1. Institute MEASURES to support life( place on shock position as indicated, oxygenate

promptly,maintain and monitor fluids and blood transfusion, provide warmth, administered
ordered drugs)
2. Inform family of the womans condition; provide support
3. Transfer to ICU when stabilized for close monitoring and intensive care