Complications of Labor and Delivery
Preexisting Risk Factors
Age- Adolescent Mother under 17 versus Mature Mother over age 35
Adolescent Mothers
Less prenatal care- unprepared for labor experience
Increased chance of infection
CPD (cephalopelvic disproportion)
Abruptio placentae
Mature mother
Better psychological preparation but are at risk of more physiologic changes
Gestational Diabetes
Cardiac problems
Hypertension
Chromosomal Abnormalities
Diabetes Mellitus
Hypoglycemia
Hyperglycemia
Diabetic Ketoacidosis
Fetal Distress
Congenital malformation especially if not well controlled
PIH
Controlled by insulin and possible IV insulin during the delivery- Regular insulin IV
Cardiac Complications
Highest level of risk during labor
VS frequently
A pulse rate faster than 100 or irregular
Respirations greater than 24 or abnormal congested lung sounds
Abnormal lungs
May indicate early cardiac decompensation
ECG’s or EKG’s
Avoid supine position- use left lateral
Elevate shoulders and head
Supplemental oxygen
Epidural anesthesia slows the heart rate and produces peripheral vasodilation and decreases BP- good
for this patient
Cardiac
Monitor FHR
Do not elevate legs during delivery- excessive venous return back to weak heart
Use short, open glottis bearing down efforts- no Valsalva
Vacuum assistance
Hypertensive Disorders
Seizures are more likely to occur during labor and 48-72 hours afterward
Padded side rails
Magnesium Sulfate decreases cerebral edema and slows neuromuscular impulse transmission
Watch for toxicity- deep tendon reflexes and respirations
Watch urinary output
Blood levels of magnesium sulfate assessed- 2.5-7.5 is therapeutic range for MgSO4
Calcium Gluconate is the antidote
Drug Abuse
Analgesics and Regional anesthetics are not withheld from suspected substance abusers but must be used
with caution!
Track marks
Dilated or constricted pupils
Disorientation/agitation
Inflamed nasal mucosa
Premature Onset of Labor
Associated with UTI’s and RTI’s
Any delivery that occurs before 37 weeks
Stay at home-no chores-bed rest
Early recognition is important and call doctor
Vaginal bleeding and cramps
Treatment
Bed rest in the left lateral recumbent position
External fetal monitoring only
Encouragement to Mom and family
Nothing in the vagina
Tocolytic Drugs
Suppress Contractions and stop labor
Ritrodine (Yutopar)- causes maternal tachycardia
Terbutaline sulfate (Brethine)- causes maternal tachycardia
Magnesium Sulfate- depresses CNS and relaxes muscles of uterus
PROM
ROM- “bag of waters” rupture before labor
Infection- amniochorionitis
Endometritis
Parametritis
Peritonitis
Monitor temperature every 2 hours
Nitrazine test- turns blue
May give antibiotics and use bed rest if only a small amount trickles out
Cord prolapse/gray/bulging/pulsates
FHR- Trendelenburg/Knee chest/ Oxygen-C section
Problems with Umbilical Cord
Lifeline that provides oxygen to the fetus
Nuchal Cord
FHR
Loosen if not too tight and unwrap
Clamp and sever the cord before delivery- done by Dr. or Midwife
C-section
Patient Teaching for Women with an infection or Preterm labor
Report a temperature that is above 100.4
Avoid sexual intercourse of insertion of anything into vagina
Avoid orgasms
Avoid breast stimulation
Maintain any activity restrictions prescribed
Note any uterine contractions, reduced fetal activity, and other signs of infection
Record fetal kick counts daily and report fewer than 10 kicks in a 12 hours period
Obstetric Procedures
Amnioinfusion with NS or Ringers Lactate
Olighydramnios
Umbilical cord compression
Reduction of recurrent variable decelerations
Dilution of meconium stained amniotic fluid
Replaces the “cushion” for the umbilical cord and relieves the variable decelerations
Labor
Hypertonic
Usually occurs during the latent phase of labor
Characterized by contractions that are frequent, cramp like, and poorly coordinated
Painful, but not productive
Uterus is tense, even between contractions, which leads to reduced blood flow
to the placenta
Excessively strong or longer than expected for a certain stage
Results: precipitous delivery or complete exhaustion of uterus- C section and risk of hemorrhage
Hypotonic
Weak contractions around 5-9 cm- amniotomy or Pit drip- contractions every 2-3 minutes
Labor begins normally, but diminishes during active phase
More likely to occur if uterus is over-distended
Stretches the muscle fibers and reduces their ability to contract effectively
Dysfunctional Labor
Dystocia- failure to progress toward delivery
CPD- Cephalopelvic Disproportion
Abnormal uterine contractions
Analgesics or Anesthetics
Maternal Exhaustion
CPD and Malpresentations
Give chance to deliver vaginally
Remarkable to see how head can mold
Vacuums or forceps- watch for damage to facial nerve in baby- asymmetry
Occiput anterior preferred
Occiput posterior- more backache
Watch FHR
Version may be attempted with malpresentations
Use of birthing chairs, bars, overbed tables can sometimes help
Placenta Disorders
Placenta Previa
Abruptio Placentae
C-section- low transverse
Retained placenta- 15 minutes after delivery- detaches and expelled
D&C
Placenta accrete, increta, or percreta
Accreta- most common- 75% of cases- Placenta become part of the Endometrium (D&C)
Increta- 17% of cases- placenta extends into the uterine muscle (hysterectomy)
Percreta- 5-7% of cases- involves the entire uterine wall (hysterectomy)
Placenta succenturiate- satellite placenta tissue (extra placenta)- D&C, possible hysterectomy
Care
Vital Signs
Examination of Placenta
Pitocin
Surgery
Late PP hemorrhage due to retained placental fragments
Infection
Uterine Rupture
Concern with VBAC- vaginal birth after C-section
Prolonged labor
Pitocin administration- stop Pit if occurring every 90 seconds and call doctor
Frequently fatal to fetus
High risk of death to mom
Intrauterine Fetal Death (IUFD)
Rh sensitization
Sickle cell anemia
Trauma
Disease
Labor continues for extended time
No labor- 2 weeks and induce
Grieving process
Viewing infant, taking pictures if normal appearance
Should be prepared if infant has anomalies
Move Mom away from maternity unit