Professional Documents
Culture Documents
COLLEGE OF NURSING
DYSTOCIA
and
POSTPARTUM HEMORRHAGE
(case report)
Submitted by:
Del Rosario, Jovella
BSN III-12
Submitted to:
Reenah Zarah N. Macarayo, RN, MN
Clinical Instructor
DYSTOCIA
Dystocia is an abnormal or difficult childbirth or labor. It came from the Greek "dys"
meaning "difficult, painful, disordered, abnormal" and "tokos" meaning "birth."
It occurs in 1% of vaginal deliveries.
Birth Dystocia
ETIOLOGY
1. Uterine factors: Good contractions start at the fundus and move down towards
the pelvis. If uterine activity is uncoordinated or contractions short or infrequent
then labor will be difficult and prolonged. Primigravida mothers may be more at
risk of dystocia as they have a degree of uterine uncoordination which is why
their labours tend to be longer. Oxytocin can enhance and coordinate uterine
contractions.
2. Fetal factors: Position or lie. E.G. transverse or breech, macrosomia, shoulder
dystocia (this results as a combination of fetal factors and pelvic passage factors).
3. Pelvic passage factors: A pelvis with a round brim is very favourable in labour,
however some women have a long and oval brim. A small pelvic brim should be
suspected if the fetal head has not engaged into the pelvis by 37 weeks gestation.
Other factors that can lead to cephalopelvic disproportion are scoliosis, kyphosis
and historically rickets. Shoulder dystocia in part results from a small or abnormal
pelvic inlet.
RISK FACTORS
• Diabetes mellitus
• Fetal macrosomia
• Maternal obesity
• Induction of labour
• Prolonged labour
• Oxytocin - too much can lead to hyperstimulation of the uterus
HYPERTONIC UTERINE DYSFUNCTION – frequent contractions of the uterus that
generally occurs at the latent phase of labor.
Causes:
contraction of the mid-segment of the uterus is greater than the contraction of the
fundus
muscle fibers of the myometrium do not repolarize or relax after a contraction
Medical Management:
1. Bed rest
2. Pain relief with drugs such as morphine sulfate
3. ceasarean birth if no progress in labor, deceleration in FHR, and long first stage of
labor
Nursing Management:
Complications:
Causes:
Medical Management:
1. administration of oxytocin
2. amniotomy to improve labor
Complications:
Nursing Diagnosis:
1. Fear related to uncertainty of pregnancy outcome
2. Anxiety related to medical procedures necessary to ensure health of mother and
fetus
3. Fatigue related to loss of glucose stores through work and during labor
4. Risk for ineffective tissue perfusion related to excessive blood loss with
complication of labor
5. Risk for injury related to effect on mother and fetus of a labor complication and
treatment required.
POSTPARTUM HEMORRHAGE
Postpartum hemorrhage is defined as a loss of blood in the postpartum period of more
than 500 mL. The average, spontaneous vaginal birth will typically have a 500 mL blood
loss. In cesarean births the average blood loss rises to 800-1000 mL. There is a greater
risk of hemorrhage in the first 24 hours after the birth, called primary postpartum
hemorrhage. A secondary hemorrhage occurs after the first 24 hours of birth. It is one of
the most important causes of maternal mortality associated with childbearing.
Risk Factors
Multiple Gestation
Large baby
Polyhydramnios
Multipartity (particularly grand multiparity, more than 5 term pregnancies)
Prolonged labor (uterine inertia)
Labor induced with oxytocin
General Anesthesia
Placenta Previa / Abruptio Placentae
Magnesium Sulfate infusion
4 MAJOR CAUSES:
1. Uterine Atony- relaxation of the uterus. The uterus is not contracting enough to control
the bleeding at the placental site.
Therapeutic Management:
Nursing Management:
1. Uterine massage
2. Supine position
3. Monitor Vital signs frequently
2. Lacerations- occur most often in different circumstances such as delivery with
difficult or precipitate births, primigravidas, macrosomic babies, use of lithotomy
positions and instrument.
Nursing Management:
3. Retained Placental Fragments- the placenta does not deliver in its entirety; the
fragments of it separate and are left behind.
Medical Management:
1. DNC
2. Methotrexate may be prescribed
Nursing Management:
1. Report any tendency for the discharge to change from lochia serosa or alba back
to rubra.
2. Be certain the client knows to continue the observation of the color of lochia
discharge.
Medical Management:
Nursing Mangement:
Be certain a woman and her support person have a full explanation of what is
happening.
Nursing Diagnosis:
1. Deficient fluid volume related to excess fluid blood loss after birth.
2. Acute pain related to tissue trauma
3. Risk for ineffective tissue perfusion related to loss of blood
4. Risk for deficient diversional activity related to activity restrictions and bedrest.