TOPIC: NURSING CARE OF A FAMILY EXPERIENCING A COMPLICATION OF LABOR

LECTURER: PROF. ROSARIO CHARISSE R. VENZON

SUBJECT: MATERNAL AND CHILD HEALTH NURSING II

• The number of contractions is low or

infrequent (not increasing beyond 2
or 3 in a 10-minute period
DYSTOCIA • Resting tone of the uterus remains
<10 mm Hg, & strength of
A difficult labor which can arise from the contractions does not rise above
Power, the Passageway, the Passenger, 25 mm Hg
Psyche and medical interventions. • Common in the ACTIVE PHASE
• Increases length of labor & uterus
A labor that lasts >24 hours does not contract effectively
postpartally due to exhaustion,
Common Causes of Dysfunctional Labor increasing chance for postpartal
hemorrhage
• Inappropriate use of analgesia • Cervix is dilated for prolonged
(excessive or too early periods increasing risk for infection
administration) of mother & fetus
• Pelvic bone contraction that has
narrowed the pelvic diameter so that Causes of Hypotonic Uterus
a fetus cannot pass (rickets)
• Poor fetal position (posterior rather • Administration of analgesia when
than anterior positions) cervix is not dilated to 3 or 4 cm,
• Extension rather than flexion of the • Bowel or bladder distention- prevents
fetal head descent or firm engagement,
• Overdistention of the uterus, as with • multiple gestation,
multiple pregnancy, hydramnios, or • LGA fetus
an excessively oversized fetus • hydramnios,
• Cervical rigidity (unripe) • lax uterus due to grand multiparity
• Presence of a full rectum or urinary
bladder that impedes fetal descent Complications
• Mother becomes exhausted from
labor • Maternal / fetal infections - cervix is
• Primigravida status dilated for a prolonged time
• Postpartum hemorrhage
Complications with the Power (Force of • Fetal distress and death
Labor) • Maternal exhaustion

INERTIA- sluggishness of contractions, now Management of Hypotonic Uterus

known as DYSFUNCTIONAL LABOR
• UTZ to rule out CPD
PRIMARY (occurring at the onset of labor) • Walking, if not contraindicated
SECONDARY (occurring later in labor) • OXYTOCIN to augment labor by
strengthening contractions & making
UTERINE TONES: them effective
Normal Values: • Amniotomy to speed up labor
• 1st hour postpartum, palpate the
Resting Tone – 5-15 mmHg uterus and assess lochia q 15
Mild Contraction – 15-30 mmHg minutes to ensure that postpartal
Moderate Contraction – 30-50 mmHg contractions are not also hypotonic &
Strong Contraction – 50-70 mmHg inadequate to halt bleeding

INEFFECTIVE UTERINE FORCE Oxytocin for Hypotonic UI

HYPOTONIC CONTRACTIONS • Do not leave pt alone

(Secondary Inertia) / HYPOTONIC • Client must be in true labor- at least 3
UTERINE INERTIA cm

BATCH 2023 | PPTX/ BOOKS | STUDENT NURSE | LAGUAN 2021 1

 TOPIC: NURSING CARE OF A FAMILY EXPERIENCING A COMPLICATION OF LABOR
LECTURER: PROF. ROSARIO CHARISSE R. VENZON
SUBJECT: MATERNAL AND CHILD HEALTH NURSING II

HYPOTONIC vs HYPERTONIC
CONTRACTIONS

CRITERIA HYPERTONIC HYPOTONIC

• No obstruction, uterine Phase of Latent Active
overdistention, multiple gestation Labor
• Monitor VS esp. BP (most important Symptoms Painful Painless
because oxytocin may cause Medication
hypo/hypertension Oxytocin Unfavorable Favorable
• Assist w/ delivery: after failed trial reaction reaction
labor of 6 hours Sedation Helpful Little value
• After delivery: observe for signs of
injury & signs of poor bonding dt CONTRACTION RING
difficult delivery
It is a hard band that forms across the uterus
HYPERTONIC UTERUS (Primary Inertia) at the junction of the upper and lower uterine
segments and interferes with fetal descent.
• Increase in resting tone to > 15 mm
Hg, mostly seen in the LATENT BANDL’S RING OR PATHOLOGIC
PHASE RETRACTION RING
• Muscle fibers do not repolarize or
relax after a contraction, thereby A type of contraction ring that usually
wiping it clean to receive a new appears at the 2nd stage of labor & can be
pacemaker stimulus palpated as a horizontal indentation across
• More painful because the the abdomen.
myometrium becomes tender from
constant lack of relaxation & the It is a warning sign that severe dysfunctional
anoxia of uterine cells that results labor is occurring as it is formed by excessive
• Lack of relaxation between retraction of the upper uterine segment; the
contractions may not allow uterine myometrium is much thicker above than
artery filling leading to fetal anoxia below the ring.
• **Any woman whose pain is out of
proportion to the quality of her It is caused by uncoordinated contractions
contractions should have both a due to CPD, manipulation or the use of
uterine & fetal external monitor oxytocin.
applied for at least 15 mins to make
sure that the resting phase of The fetus and the undelivered placenta are
contractions is adequate & that the gripped by the retraction ring and cannot
fetal pattern is not showing late advance beyond this point.
deceleration

Management of Hypertonic Uterus

• Rest & pain relief with a drug like

morphine sulfate & sedatives
• Change linen and client’s gown,
darken the room lights, decrease
noise & stimulation
• If (+) for deceleration in FHR,
abnormally long 1st stage of labor,
or lack of progress with pushing (“2nd
STAGE ARREST”), CS may be
necessary

BATCH 2023 | PPTX/ BOOKS | STUDENT NURSE | LAGUAN 2021 2

 TOPIC: NURSING CARE OF A FAMILY EXPERIENCING A COMPLICATION OF LABOR
LECTURER: PROF. ROSARIO CHARISSE R. VENZON
SUBJECT: MATERNAL AND CHILD HEALTH NURSING II

• Patient is admitted & placed in

complete bed rest (preferably left
side-lying) to relieve pressure of the
MANAGEMENT fetus on the cervix
• IV fluid to maintain hydration which
• Administration of IV morphine may help stop contractions
sulfate or inhalation of amyl nitrate (dehydration stimulates PG to
• Tocolytics to halt the contractions secrete oxytocin)
• Cesarian birth to ensure safety of • Vaginal, cervical & urine cultures to
the fetus and manual removal of the rule out infection
placenta under general anesthesia • Increase fluid intake since a full
bladder inhibits contractions
COMPLICATIONS • TOCOLYTICS- to halt labor
• Discharge- once contractions have
• Uterine rupture stopped and maternal and fetal
• Neurologic damage to the fetus conditions have stabilized
• No MEPERIDINE (DEMEROL)
PRETERM / PREMATURE LABOR
TOCOLYTIC AGENTS TO HALT LABOR
Labor that occurs before the end of 37
weeks of gestation DRUG TYPE / MAJOR NURSI
PURPO SIDE NG
Associated with: SE EFFECT CONC
• Dehydration S ERNS
• Urinary tract infection Ritrodrin Beta- Maternal Assess
e adrener or fetal VS,
• Periodontal disease
(Yutopar) gic tachycar breath
• Chorioamnionitis
receptor dia, sounds,
• Large fetal size
agonist / shortnes FHR,
• Strenuous jobs during pregnancy
tocolysis s of contract
• Shift work
breath, ions
• Intimate partner violence and trauma pulmona and
ry matern
ASSESSMENT edema, al
tremors, respons
• Persistent uterine contractions (4
N/V, e
contractions every 4 minutes or less) hypergly
• Low abdominal cramping with or cemia,
without diarrhea hypokale
• Intermittent sensation of pelvic mia
pressure, urinary frequency
Terbutali Beta- Same as Same
• Persistent, dull low backache
ne adrener Above as
• Increased vaginal discharge, may be
(Brethine) gic / Above
pink-tinged
tocolysis
• Leaking amniotic fluid
;
• Cervical effacement > 80% &
antidote:
dilatation > 1 cm
Propan
olol
MANAGEMENT
MgSO4 CNS Lethargy Assess
Depress , heat RR,
• Lab test to detect presence of fetal
ant/ sensatio DTR,
fibronectin to predict impending
Tocolysi n, hourly
delivery; if absent, labor will not
s respirato urinary
occur for at least 14 days
ry output,
• UTZ of cervix to determine
depressi serum
shortening

BATCH 2023 | PPTX/ BOOKS | STUDENT NURSE | LAGUAN 2021 3

 TOPIC: NURSING CARE OF A FAMILY EXPERIENCING A COMPLICATION OF LABOR
LECTURER: PROF. ROSARIO CHARISSE R. VENZON
SUBJECT: MATERNAL AND CHILD HEALTH NURSING II

SYMPTOMS

• rate of dilatation in the active phase:

on, Mg • > 5 cm/hr (1 cm/12 mins) in a
depresse levels nullipara
d • 10 cm/hr (1 cm/6 mins) in a multipara;
reflexes, • tocolytics may be administered
cardiac
arrest if MATERNAL COMPLICATIONS
high
serum • Premature separation of the placenta
levels (> leading to hemorrhage,
10-12 • Infection
mg/dL) • Lacerations on the birth canal
Betameth Corticost Increase Must be • Uterine rupture
asone eroid/ d risk of given Amniotic fluid embolism
(Celeston stimulat infection 24 to 48
e) or es fetal & poor hours FETAL COMPLICATIONS
Dexamet lung wound before
hasone maturati healing, delivery • Fetal hypoxia, anoxia
on by hypoglyc to be • Erb - Duchenne palsy
stimulati emia, effectiv • Injuries like falling to the floor in
ng increase e; unattended childbirth
surfacta d risk of commo • Subdural hemorrhage on the fetus
nt pulmona nly due to sudden release of pressure on
producti ry edema used the head,
on when betwee • hemorrhage
given a n 24 to
beta- 34 MANAGEMENT
adrenerg weeks
ic agent AOG • TOCOLYTICS
unless • In multiparous women with history of
fetal a brief past labor, advise to prepare
lung for appropriately timed transport
maturity starting on her 28th week of gestation
can be (BIRTH PLAN)
docume • Never leave client
nted. • Monitor FHT q15 min
• Provide emotional support: inform
PRECIPITATE LABOR
client of what is happening
• Assist with the delivery, advising the
It is a labor that is completed in < 3 hours
client to pant or blow and NOT to
push
It occurs when uterine contractions are so
• Never hold the baby back
strong that the woman gives birth with only a
few, rapidly occurring contractions. • Support the perineum with a towel to
prevent lacerations and also subdural
Causes: hemorrhage (MODIFIED RITGEN’S
MANEUVER)
• Grand multiparity, • Deliver baby in-between contractions
• Inspect the perineum for possible
• Induction of labor by OXYTOCIN or
lacerations
AMNIOTOMY
• Large pelvis
• Small fetus

BATCH 2023 | PPTX/ BOOKS | STUDENT NURSE | LAGUAN 2021 4

 TOPIC: NURSING CARE OF A FAMILY EXPERIENCING A COMPLICATION OF LABOR
LECTURER: PROF. ROSARIO CHARISSE R. VENZON
SUBJECT: MATERNAL AND CHILD HEALTH NURSING II

TYPES OF INVERSION

1. Complete or Total Inversion

– The uterus is visible outside
the vaginal introitus. It is life
threatening because of
severe hemorrhage & shock.
2. Partial Inversion – The
inverted fundus may lie within
the uterine cavity. It is not
visible but may be palpated. It
hampers or impedes
contractions & control of
hemmorhage

ASSESSMENT

• Sudden gushing of blood from the

vagina
• Signs of blood loss: hypotension,
dizziness, paleness or diaphoresis
• because bleeding is continuous,
exsanguination could occur within 10
minutes

MANAGEMENT

• Never attempt to replace an inversion

since handling of the uterus will
INVERSION OF THE UTERUS
worsen the hemorrhage
• Never attempt to remove the
Turning inside out of the uterus with either
placenta if it is still attached
birth of the fetus or the delivery of the
• Oxytocic drugs makes the uterus
placenta
more tense thus, more difficult to
replace
• Start an IV line (use a large-gauge
needle to be used in BT) & open it to
achieve optimal flow to restore fluid
volume
• Administer O2 by mask
• Assess VS
• Prepare to administer CPR
• General anesthesia, nitroglycerin
or a tocolytic is administered to
relax the uterus
PREDISPOSING FACTORS • Physician or midwife will then
replace the fundus manually
• Pulling or traction on the umbilical • After replacement, administer
cord to remove the placenta Oxytocin
• Vigorous pressure is applied to the • Antibiotic therapy to prevent infection
fundus while the uterus is not • CS is recommended for succeeding
contracted pregnancies
• The placenta is attached at the
fundus and the passage of the fetus
during birth pulls it down

BATCH 2023 | PPTX/ BOOKS | STUDENT NURSE | LAGUAN 2021 5

 TOPIC: NURSING CARE OF A FAMILY EXPERIENCING A COMPLICATION OF LABOR
LECTURER: PROF. ROSARIO CHARISSE R. VENZON
SUBJECT: MATERNAL AND CHILD HEALTH NURSING II

PREDISPOSING FACTORS

• Premature rupture of membranes

• Fetal presentation other than
cephalic
• Placenta previa
• Intrauterine tumors preventing the
presenting part from engaging
• A small fetus
• CPD preventing firm engagement
• Hydramnios
• Multiple gestation
PROBLEMS WITH THE PASSENGER
Cord Compression

PROLAPSED OF THE UMBILICAL CORD ASSESSMENT

• The cord may be felt as the

presenting part on an initial vaginal
examination during labor
• UTZ evidence (a CS is necessary
before rupture of membranes)
• Variable deceleration pattern
becomes apparent
• The cord may be visible at the vulva
• To r/o prolapse, assess FHR
A loop of the umbilical cord slips down in immediately after rupture of
front of the presenting fetal part membranes

It may occur any time after the membranes MANAGEMENT

have ruptured if the presenting part is not
fitted firmly into the cervix • Cord prolapse will lead to cord
compression because the presenting
part will press against the cord at the
pelvic brim
• Place the mother’s hips higher than
her head: knee-chest position
• Trendelenburg position

BATCH 2023 | PPTX/ BOOKS | STUDENT NURSE | LAGUAN 2021 6

 TOPIC: NURSING CARE OF A FAMILY EXPERIENCING A COMPLICATION OF LABOR
LECTURER: PROF. ROSARIO CHARISSE R. VENZON
SUBJECT: MATERNAL AND CHILD HEALTH NURSING II

o Put on sterile gloves and insert 2

fingers into the vagina, then push
presenting part upward

3. If cord is exposed to air, cover with

saline- moistened sterile compress to
prevent drying.

o Drying of cord leads to atrophy &

constriction of BV

4. Never replace the cord back into the

vagina as it may result in kinking and
knotting obstructing blood flow

5. Administer O2 at 10 LPM to improve O2

supply to fetus

6. Deliver baby ASAP:

MANAGEMENT
o Vaginal delivery if cervix is fully
• Amnioinfusion - to reduce dilated & no fetal distress
compression on the cord with o CS if cervix is not fully dilated & fetal
infusion of 500 ml warmed NSS. distress is present
• Used for only a short time until the
cervix is fully dilated, or a cesarean Cesarian Section
birth can be arranged.
• Can also be performed for women
with oligohydramnios
• Nursing Consideration
• Monitor FHR and uterine contractions
continuously.
• Monitor maternal temp every hour
• Placed the bag of fluid in a radian
warmer to prevent chilling

MANAGEMENT

• Place a gloved hand in the vagina

and manually lift the fetal head off
the cord
• Administer O2 at 10 LPM by face
mask to the mother to increase
oxygenation to the fetus
• Tocolytic agent may be
1. Prevention: administered to reduce uterine
activity & pressure on the fetus
o Always assess FHT after • Maintain continuous electronic fetal
membranes rupture monitoring
o Place woman on bed rest after • Prepare for rapid delivery vaginally or
membranes rupture by CS

2. Reduce pressure on the cord by:

o Place in Knee-chest or
Trendelenburg position, or place
folded towel under the hips

BATCH 2023 | PPTX/ BOOKS | STUDENT NURSE | LAGUAN 2021 7

 TOPIC: NURSING CARE OF A FAMILY EXPERIENCING A COMPLICATION OF LABOR
LECTURER: PROF. ROSARIO CHARISSE R. VENZON
SUBJECT: MATERNAL AND CHILD HEALTH NURSING II

SYMPTOMS

• prolonged active phase,

• arrested descent,
Emergency Management • FHT heard best at the lateral sides of
the abdomen,
Call for help • intense back pain during labor

Organize delivery ROP / LOP

Relive pressure on the cord • Maternal risks: prolonged labor,

potential for CS birth, 3rd or 4th degree
Deliver lacerations
• Fetal risks: umbilical cord prolapse,
FETAL MALPOSITION
increased molding, caput formation
The ideal position is flexed with the occiput in
OCCIPUT TRANSVERSE POSITION – due
the R or L Anterior quadrant (ROA/LOA)
to ineffective contractions or a flattened bony
Types of Malposition: pelvis

OCCIPITOPOSTERIOR POSITION - It Vaginal delivery is possible with oxytocin

occurs in 1/10 of all labors and during internal administration and application of forceps for
rotation the head must rotate through 135 delivery
degrees instead of 90 degrees

MANAGEMENT

Failure to rotate is termed PERSISTENT • Encourage mother to lie on her

OCCIPUT POSTERIOR opposite side from the fetal back
which may help with rotation
Common in women with android, anthropoid • Other positions: Hands and knees
or contracted pelvis position, squatting, pelvic rocking
• Apply sacral counter-pressure with
the heel of the hand or do back rubs
to relieve back pain
• Apply heat or cold, as desired by the
patient

OCCIPITOTRANSVERSE

• Encourage voiding every 2 hours

In prolonged labor, provide sports
drink or IV glucose to replenish
glucose stores
• Provide constant encouragement
and inform the client & family of
progress
• Prepare for a forceps delivery

BATCH 2023 | PPTX/ BOOKS | STUDENT NURSE | LAGUAN 2021 8

 TOPIC: NURSING CARE OF A FAMILY EXPERIENCING A COMPLICATION OF LABOR
LECTURER: PROF. ROSARIO CHARISSE R. VENZON
SUBJECT: MATERNAL AND CHILD HEALTH NURSING II

Breech Presentation

Most fetuses are in breech presentation early

in pregnancy but by week 38, turn into a
FETAL MALPRESENTATION cephalic presentation

Fetal head is the widest single diameter but

1. Breech Presentation
the buttocks plus the legs take up more
space

Three types:

• Complete Breech
• Frank Breech
• Footling Breech – single or double

2. Vertex Malpresentations

o Face Presentation
o Brow Presentation
o Sincipital
Presentation (Military
Attitude)

Meconium staining due to pressure on the

buttocks is not a sign of fetal distress but can
lead to meconium aspiration

Risks:

• Anoxia from a prolapsed cord

• Traumatic injury to the aftercoming
head (intracranial hemorrhage or
anoxia); entrapment
• Fracture of the spine or the arm
• Dysfunctional labor
3. Shoulder Presentation
• Early rupture of the membranes
(Transverse Lie)
due to poor fit of the presenting part
• CS or forceps delivery
• Trauma to the birth canal due to
manipulation and forceps
• Intrapartum or postpartum
hemorrhage

ASSESSMENT
4. Compound Presentation
• FHT are heard high in the abdomen
• Diagnosed by Leopold’s maneuver
and UTZ

MANAGEMENT

• Monitor FHT & contractions

continuously

BATCH 2023 | PPTX/ BOOKS | STUDENT NURSE | LAGUAN 2021 9

 TOPIC: NURSING CARE OF A FAMILY EXPERIENCING A COMPLICATION OF LABOR
LECTURER: PROF. ROSARIO CHARISSE R. VENZON
SUBJECT: MATERNAL AND CHILD HEALTH NURSING II

• Piper forceps may be applied of the

head to prevent damaging the
infant’s neck
• Cesarean Section to lessen the risks

Pinard’s Maneuver

It is done to assist in the delivery of extended

legs
Mariceau-Smellie-Veit Maneuver
Move your fingers along the thigh up to the
popliteal fossa & push the knee laterally. This
The index and middle finger of one hand are
will flex the knee & bring the ankle down. applied over the maxilla to flex the head,
Hold the ankles between the fingers & pull
while two fingers of the other hand are
the leg out hooked over the fetal neck and grasping the
shoulders; downward traction is applied until
Frank Breech Extraction (Pinard’s
suboccipital region appears under the
Maneuver)
symphysis

Loveset Maneuver

To release extended arms

EXTERNAL CEPHALIC VERSION
Hold baby pelvis firmly, provide traction.
Rotate 180 degrees back upwards (baby
• The manipulation of the fetus through
facing maternal pelvis). Causes arm to
the abdominal wall to a vertex
sweep in front of face
presentation
• External fetal monitoring
Release arm by reaching over shoulder,
• IV fluids, Brethine is given via
supporting humerus press into cubital fossa
piggyback
to flex arm. Sweep down over face and chest
• Version is discontinued if undue fetal
Repeat in opposite direction or maternal stress is noted

BATCH 2023 | PPTX/ BOOKS | STUDENT NURSE | LAGUAN 2021 10

 TOPIC: NURSING CARE OF A FAMILY EXPERIENCING A COMPLICATION OF LABOR
LECTURER: PROF. ROSARIO CHARISSE R. VENZON
SUBJECT: MATERNAL AND CHILD HEALTH NURSING II

MANAGEMENT

• External fetal heart rate monitoring

ONLY
INTERNAL PODALIC VERSION • Vaginal delivery if the chin is
ANTERIOR & the pelvis is adequate
Indication: • CS is the chin is POSTERIOR or
Retained Second twin in a transverse lie signs of fetal distress are present
Shoulder Presentation
BROW PRESENTATION

Rarest type, occurs in multipara or woman

with relaxed abdominal muscles

Often leads to obstructed labor because the

head becomes jammed in the brim of the
pelvis

CS is recommended
Causes extreme ecchymotic bruising of the
face

SINCIPITAL PRESENTATION (Military

Attitude)

Labor progress is slowed with slower

VERTEX MALPRESENTATIONS
descent of the fetal head
FACE PRESENTATION
SHOULDER PRESENTATION (Transverse
A fetal head presenting at a different angle Lie)
than expected is termed ASYNCLITISM
(FACE and BROW) Occurs in women with pendulous abdomens,
uterine fibroid tumors, contraction of the
ASSESSMENT pelvic brim, congenital anomalies of the
uterus, hydramnios, fetus with
• A head that feels more prominent hydrocephalus or anything that prevents
than normal, with no engagement engagement, prematurity, multiple gestation
apparent on Leopold’s maneuver or short umbilical cord.
suggests face presentation
• Head and back are felt on the same • Obvious on inspection because the
side of the uterus with LM uterus is more horizontal
• Back is difficult to palpate because it
is concave
• Diagnosed by LM, confirmed by UTZ
• Mouth, nose or chin is felt by vaginal • Mature fetus cannot be delivered
examination as the presenting part vaginally; CS is recommended
• Cord or arm may prolapse
DIAGNOSIS
COMPOUND PRESENTATION
• UTZ
• Leopold’s Maneuver
• More than 1 part of the fetus
RISKS presents: most commonly hand or
arm prolapsing with the head
• Prolonged labor • Risk of cord compression and
• Cesarean section prolapse is increased
• Facial edema and bruising of the • Method of delivery depends on size,
infant presence of distress and progress of
labor

BATCH 2023 | PPTX/ BOOKS | STUDENT NURSE | LAGUAN 2021 11

 TOPIC: NURSING CARE OF A FAMILY EXPERIENCING A COMPLICATION OF LABOR
LECTURER: PROF. ROSARIO CHARISSE R. VENZON
SUBJECT: MATERNAL AND CHILD HEALTH NURSING II

NURSING CARE

• Assess FHR baseline, variability &

pattern of changes
FETAL DISTRESS • Asses UC & maternal responses to
labor
Insufficient O2 supply to meet the demands • Correct fetal hypoxia
of the fetus
• For LD: reposition on her left side
• Administer O2 at 8-10 LPM
Causes:
• Increase IVF
• Discontinue oxytocin if labor is
• UC compression
induced
• Uteroplacental insufficiency due to
• Notify physician
anomalies or maternal condition
• For VD or prolonged bradycardia:
Signs and Symptoms reposition on either side
• If not corrected, reposition to
• Meconium-stained AF (excluding opposite side
breech presentations) • Administer O2 by face mask at 8-10
• Changes in FHR baseline: LPM
tachycardia (>160) - early sign of • Trendelenberg or knee-chest position
distress • Perform vaginal examination & apply
• Bradycardia (<110) - late sign of upward pressure on the presenting
distress part to relieve pressure on the UC
• Decreased or absence of • Provide appropriate information and
variability of the heart rate support

o HR varies <2 to 5 bpm causing PROBLEMS WITH THE PASSAGEWAY –

a flattened appearance of the ABNORMAL SIZE AND SHAPE OF THE
heart rate PELVIS
o indicates depression of the
autonomic nervous system INLET CONTRACTION
that controls HR
o fetal sleep, sedation or hypoxia
It is the narrowing of the anteroposterior
may affect variability
diameter of the pelvis to < 11 cm, or the
• Late deceleration pattern transverse diameter to 12 cm or less
o FHR slows following the peak of
a contraction & slowly returns to Usually caused by rickets in early life or
baseline rate during the resting inherited pelvic size
phase due to uteroplacental
insufficiency “what goes in comes out”- a head that
o ominous sign engages proves it fits into the pelvic brim &
will probably be able to fit through the
midpelvis and outlet
• Severe variable deceleration
pattern
It makes engagement difficult (in primis, at
36-38 wks.; in multis, during labor)
o FHR repeatedly decelerates
<90bpm for over 60 sec
It influences fetal position and presentation
before returning to baseline
-due to interference of blood
Primigravidas must have pelvic
flow from cord compression measurements done before 24 weeks
o leads to fetal hypoxia and low
APGAR scores

BATCH 2023 | PPTX/ BOOKS | STUDENT NURSE | LAGUAN 2021 12

 TOPIC: NURSING CARE OF A FAMILY EXPERIENCING A COMPLICATION OF LABOR
LECTURER: PROF. ROSARIO CHARISSE R. VENZON
SUBJECT: MATERNAL AND CHILD HEALTH NURSING II

• When the head appears on the

perineum it retracts instead of
protruding with each contraction
(TURTLE SIGN)
OUTLET CONTRACTION
Maternal risks:

Narrowing of the transverse diameter of the • Lacerations

outlet to < 11 cm (distance between the
• Postpartum hemorrhage
ischial tuberosities)
Fetal risks:
TRIAL LABOR
• Hypoxia
• Done when the inlet has a borderline • Fractures to the clavicle
measurement (just adequate) and • Injury to neck and head
the fetal lie & position is good
• It is allowed to continue as long as MANAGEMENT
descent and dilatations continue to
occur. • McROBERT’S MANEUVER- ask pt
• Urge her to void every 2 hours to flex her thighs sharply on her
• After rupture of membranes, assess abdomen to widen the pelvic outlet
FHR; if head is still high, increased and allow the anterior shoulder to be
risk for UC prolapse born
• If after a definite period (6-12 hours) • Suprapubic pressure may be
adequate progress is not apparent, applied to help the shoulder escape
CS is done from beneath the symphysis pubis
and be born
CEPHALOPELVIC DISPROPORTION
ANOMALIES OF THE PLACENTA
Fetal head is too large to pass through the
bony pelvis Normal placenta:

• Symptom: fetal head does not • weighs 500 g

descend even if there are strong • 15 to 20 cm in diameter,
contractions • 1.5 to 3 cm thick,
• Risks: prolonged labor, exhaustion, • weight is about 1/6 of the weight of
hemorrhage, infection, fetal hypoxia the fetus
and distress
• CS is necessary PLACENTA SUCCENTURIATA

SHOULDER DYSTOCIA It has 1 or more accessory lobes

connected to the main placenta
Problem occurs at the 2nd stage of labor,
when the fetal head is born but the The small lobes may be retained in the
shoulders are to broad to enter and be born uterus leading to hemorrhage and therefore
through the pelvic outlet must be removed

Usually due to: The placenta appears torn at the edge

• Fetal macrosomia
• Maternal diabetes
• Multipara
• Postdate pregnancies

Symptoms

• Prolonged 2nd stage of labor

• Arrest of descent

BATCH 2023 | PPTX/ BOOKS | STUDENT NURSE | LAGUAN 2021 13

 TOPIC: NURSING CARE OF A FAMILY EXPERIENCING A COMPLICATION OF LABOR
LECTURER: PROF. ROSARIO CHARISSE R. VENZON
SUBJECT: MATERNAL AND CHILD HEALTH NURSING II

PLACENTA CIRCUMVILATA

The fetal side of the placenta is covered

to some extent by the chorion

The placenta is cup-shaped with raised

margins with the whitish opaque chorion VASA PREVIA
covering the periphery
The umbilical vessels of a velamentous cord
insertion cross the cervical os & deliver
before the fetus

BATTLEDORE PLACENTA

The cord is inserted marginally rather than PLACENTA ACCRETA

centrally giving the appearance of a tennis
racket It is the unusually deep attachment of the
placenta to the uterine myometrium

Attempts to remove it will lead to massive

hemorrhage because of the deep attachment

Hysterectomy or treatment with

methotrexate to destroy the still-attached
tissue may be necessary

VELAMENTOUS INSERTION OF THE

CORD

The cord, instead of entering the placenta

directly, separates into small vessels that
reach the placenta by spreading cross a
fold of amnion

Usually found with multiple gestation & is

associated with anomalies

BATCH 2023 | PPTX/ BOOKS | STUDENT NURSE | LAGUAN 2021 14

 TOPIC: NURSING CARE OF A FAMILY EXPERIENCING A COMPLICATION OF LABOR
LECTURER: PROF. ROSARIO CHARISSE R. VENZON
SUBJECT: MATERNAL AND CHILD HEALTH NURSING II

PROBLEMS WITH THW PSYCHE

Factors influencing the psyche of the
client in labor

• Fear & anxiety

• Perception of the problem
• Self-image
• Preparation for childbirth
• Support systems
• Coping ability

The Effects of fear and anxiety on labor

progress:

• Epinephrine secretion in response

to stess
• Vascular changes divert blood from
the uterus to skeletal muscles
• Decrease in O2 & glucose supply to
support effective contractions
• Labor progress is slowed

NURSING ASSESSMENT

• Determine past experiences with

preparations for, and expectations of
labor and birth
• Determine the client’s coping
behaviors and their effectiveness

MANAGEMENT

• Establish a trusting relationship with

the client & family
• Remain at bedside during labor
• Encourage relaxation
• Keep client & family informed about
progress and procedures
• Encourage positive coping behaviors
and discourage negative behaviors
• Promote self-image by praising
efforts

BATCH 2023 | PPTX/ BOOKS | STUDENT NURSE | LAGUAN 2021 15