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Dystocia
Premature labor
Precipitate labor & birth
Uterine inversion
Uterine rupture
Amniotic fluid embolism
Dystocia
Factors:
Maternal fatigue
Maternal inactivity
Inappropiate use of analgesia (excessive or too early administration)
disproportion between the maternal pelvis and fetal presenting part
Poor fetal position (posterior rather than anterior position)
Overdistention of the uterine as with multiple gestation, hydramnios,or
oversized fetus
Presence of a full rectum or urinary bladder that impedes fetal descent
Management:
fetal and uterine external monitor applied every 15 mins
Oxytocin to stimulate labor
Complication:
Mother: exhaustion and dehydration
Fetus: injury and death
dynsfunction in labor can occur at any point in labor, and classified
according to time when it occurs:
Primary dysfunction occuring at the onset of labor or prolong
latent phase of labor
Secondary dysfunction occuring later in labor or prolonged
active phase of labor fetus does not descend; cervix not dilated
b. Constriction Ring
can occur at any point in the myometrium and anytime during labor, when
pathologic
occur during early labor, it is usually from uncoordinated
contractions.
Pathophysiology:
Fetus is grasped by the ring and cant advance or descent if fetus is
delivered, placenta can be held after delivery
Management:
PREMATURE LABOR/DELIVERY
Or Preterm labor
Occurs before the end of 37weeks AOG or before fetus weigh 2500gms.
Results in a premature infant, 2/3 neonatal death is due to LBW
Occurs in Approximately 10% of all pregnancies
Unknown cause
Conditions resulting to premature labor:
1. Cervical surgery as cone biopsy
2. Chorioamnionitis
3. Hydramnios
4. Multiple gestation
5. Maternal age
6. Previous preterm labor
7. Polynephritis, UTI
8. Short inter-pregnancy period
9. Smoking
10. Streneous or shift work
11. Uterine anomaly as tumor
Assessment:
1. More painless uterine contractions (30 sec. duration,or frequently as every 10
minutes for more
than 1 hour)
2. More backaches
3. More vaginal discharges
4. Associated with UTI or Chorioamnionitis
Management:
Halt Labor when [criteria]
* fetal membranes are intact [BOW]
* Fetal heart beat good
* No evidence of bleeding
* Cervical dilation not more than 3-4 cms.
* Effacement not more than 50%
[ Note: All these above criteria must be present ]
Measures to Halt labor:
4 Drugs used for Tocolysis
a. Beta-adrenergics
b. Calcium antagonists
c. Magnesium S04
d. Prostaglandin inhibitors
1. Ethanol (ethyl alcohol)
administered thru IV
blocks the release of oxytocin by the pituitary glands thereby blocking
or delaying labor pains
2. Beta-Adrenergic (sympathomimetic drugs)
- most frquently used beta receptors sites
- adipose tissue, heart, liver, pancreatic cells, GIT & other smooth
muscles as uterine muscles, bronchi, blood vessels
Beta-Adrenergic
stops production of prostaglandin stopping labor pain
3. Ritodrine Hydrochloride [Yutopar]
Terbutaline (Brethine) most used
Acts on Beta 2 receptor sites - it relaxes the bronchial and blood vessels
along with the uterine muscles labor is halted but heart rate
increases to move blood effectively hypocalcemia may occur from a
shift of K into the cells blood glucose and plasma insulin Increase
pulmonary edema occurs headache, nausea and vomiting due to
dilation of the blood vessels also manifests
Check pulse should not be given if pulse exceeds 120 BPM
Also acts entirely on beta 2 receptor sites
Mild tachycardia and hypotensive effects
[Note: use with caution in patients with DM increase BS overly DM, thyroid
dysfunction]
4. Magnesium SO4
- Effective to halt labor
- Check for signs of toxicity
5. Other Measures
Bedrest to take the pressure of the gravid uterus off the cervix
Hydration oral, hydration affects the secretion of ADH and oxytocin
by the pituitary gland oxytocin causes uterine contraction
Avoid psychologic stress
Administration of corticosteroid (betamethasone) to hurry formation of
fetal lung surfactant
Post-Mature Infant
Whose gestation age is 42 weeks or longer
May show signs of weight loss with placental insufficiency
Develop post-mature syndrome
Etiology:
Unknown in many instances
Maternal Factors
- Primi and high parity at given age
- Prolonged gestation in preceding pregnancies
Characteristics: (Seen in 44 weeks or more)
I. Physical Appearance
Reduced subcutaneous tissues
Loose skin turgor at buttocks & thighs
Long curved fingernails & toenails
Amounts of vernix caseosa
Hypoglycemia-no adequate stores of glycogen
Abundant scalp hair
Poor temperature regulation-Low levels of subcutaneous fat
Wrinkled macerated skin, pale, cracked parchment- like skin
Alert appearance 2-3 weeks old infant after delivery
Greenish-yellow stain on skin fetal distress (meconium aspiration)
Intrauterine malnutrition and hypoxia = placental perfusion = oxygen &
nutrients
Low levels of estrogen
One post-term to another post-term
Maternal weight loss and uterine size
Complications:
Meconium aspiration
hypo or hypercalcemia
polycythemia ( Oxygenation)
pulmonary hemorrhage
pneumonia
asphyxia neonatorum
pneumothorax
Note: severity of problems depends on length of gestation. Nursing Care
is the same with premature
UTERINE RUPTURE
Strained uterus
Beyond its capacity
Previous C/S, repair or hysterotomy
Contributory:
Prolonged labor
Faulty presentation
Multiple gestation
Unwise use of oxytocin
Obstruction labor
Traumatic maneuvers using forceps
Assessment:
Impending rupture suggested by pathologic retraction ring, strong uterine
contractions with cervical dilatation
When uterus rupture
S/S: sudden severe pain during strong labor
Management:
Monitor for and treat signs of shock (administer oxygen, IV fluids, and blood
products)
Prepare client for immediate
Cesarean Section or
hysterotomy with hysterectomy
Provide emotional support for the client and partner
Causes:
Attachment of placenta at fundus sudden delivery of fetus without support
fundus is pulled down
strong fundal push in an non-contracted state
attempts to deliver placenta before separation
Assessment:
the interior of the uterus protrude from vagina,
sudden gush of blood,
fundus no longer palpable,
uterus is not contracted
severe pain
hemorrhage with signs of shock
Management:
Monitor for hemorrhage and signs of shock and treat shock
Prepare the client for a return of the uterus to the correct position via the
vagina;