Developed by D. Ann Currie RN, MSN
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Preterm Labor
Premature Rupture of Membranes
Dystocia
Labor Dysfunctions
Precipitous Labor and Birth
Fetal MalPositions
Fetal Malpresentations
Shoulder Dystocia
Prolapsed Umbilical Cord
Cephalopelvic Disproportion
Placenta Problems
Lacerations
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Define as a labor that occurs between
20-37 weeks of pregnancy
Prematurity is the number one cause
of neonatal mortality in USA.
Preterm births occurs in 11-12% of
births
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Many factors may place a woman at
risk for preterm labor: such as
antepartum hemorrhage
trauma
infections
lower socioeconomic status
Multiple gestation
See text for other causes
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Clinical Manifestations of PTL:
Abdominal Pain
Back Pain
Pelvic Pain
Menstrual –like Cramps
Increased Vaginal Discharge
Pelvic Pressure
Urinary Frequency
Diarrhea
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Bedrest
Pelvic Rest
Hydration
Medications:
Tocolytics:
Beta agonists- terbutaline
Magnesium Sulfate
Calcium Channel BlockersNifedipine (Procardia EL)
Indomethacin (Indocin)
Others: Antibiotics
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Fetal Demise
Lethal Fetal Anomaly
Severe Preeclampsia/ eclampsia
Hemorrhage/Abruptio placenta
Chorioamnionitis
Severe Fetal Growth Restriction
Fetal Maturity
Acute Nonreassuring Fetal Heart
Pattern
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Teach all pregnancy clients the
clinical manifestations of PTL and to
report to their health care provider if
they occur.
Teach self care measures to prevent PTL
Teach and assist in treatment of PTL
Prevent complications of TreatmentProlong bedrest
Tocolytic medications
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PROM is defined as rupture of membranes
one hour prior to labor starting.
Premature Premature Rupture of
Membrane is rupture of membranes prior
to 37 weeks. (PPROM)
Complications associated with PPROM:
Preterm labor
Infections
Oliohydramnios
Abruptio Placenta
Fetal Problems-IUGR, Pulmonary
Hypoplasia, and other
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Defined as an abnormal labor pattern
that may occur because of
abnormalities in the power, the
passenger, or the passage.
It may encompass many things in
labor.
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Primary Labor dysfunction:
Hypertonic Labor Pattern is ineffectual
uterine contractions of poor quality
occurring in the latent phase of labor. UC
are painful but do not dilate or efface the
cervix.
It may cause:
Increased discomfort
Fatigue
Stress
Dehydration
Infection
Nonreassuring Fetal Heart Pattern
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Management:
Rest
Hydration
Sedation - Sedatives such as :
Seconal
Dalmane
Morphine Sulfate
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This is poor uterine contractionsirregular or low amplitude.
If not caused by CPD
Management:
Oxytocin (Pitocin)
Augmentation
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It is when the entire process of labor
and birth occurs within 3 hours.
Precipitous Labor is when cervical
dilation is 5cm or more per hour for a
primigravida and 10 cm per hour for a
multipara.
Precipitous birth is a sudden birth
It may be unattended or nurse
attended birth.
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Complications: Abruptio placenta
Lacerations
Fetal Risks:
MAS,
Brachial Palsy,
Intracranial
Trauma
Management: Closely monitor
Scheduled induction in
control environment with
physician available
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Occiput posterior position (OP) is the
most common mal position.
The client experiences intense BACK
PAIN while in labor.
Complications:
Pain
3rd or 4th degree lacerations
or extension of episiotomy
Arrest of decent
C/S
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Position- Side –lying
Hand-and-knee position
Pelvic Rocking
Counter Pressure in small of back
Physician may have to assist in turn
baby with forceps or vacuum extraction
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Breech
Brow
Face
Shoulder
Complex
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Breech Presentation is the most
common malpresentation
About 4% of all Births
Frank Breech is the most common type
of Breech. It is characterized by flexed
hips and extended knees.
Footling Breech is characterized by
one or both feet presenting.
Complete Breech
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Head Entrapment
Prolapsed Cord
MAS
Fetal Asphyxia and Hypoxia
Increased Risk for perinatal morbidity
and morality.
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Brow Presentations are the least common of
all presentations.
In a Brow presentation the forehead is the
presenting part.
Results in a prolonged labor or secondary
arrest of labor.
C/S is best for delivery
Complications:
Extension of episiotomy or lacerations
Birth injuries to fetus: cerebral or neck
compression
Damage to the trachea and larynx.
Infant Mortality
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A Mentoanterior position can be
delivered vaginally.
A Mentoposerior position can not be
delivered vaginally.
Complications of a face presentation:
Prolonged labor
Infection
C/S
Facial Trauma
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Transverse Lie
Vaginal Birth is impossible
Cesarean Birth
Possibility of Prolapsed Cord if
Membranes Rupture
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An Obstetric Emergency
Occurs with :
Macrosomic fetuses.
Obese woman or excessive weight
gain during pregnancy.
Woman of short statue.
Management:
McRoberts maneuver
Client should bring back legs/
thighs against abdomen
The nurse will apply suprapubic
anterior pressure to release anterior
shoulder.
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When the umbilical cord precedes the
fetal presenting part.
The cord may fall or be washed down
through the cervix into the vagina or
Trapped between the presenting part
and the maternal pelvis
Occult cord prolapse may lay beside or
just ahead of the fetal head
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Ant time the presenting part is not well
engaged or firmly against the cervix, a
prolapsed cord can occur.
This is an emergency because the cord
can be compressed causing hypoxia
and possible fetal death.
Prevent cord compression by manually
preventing presenting part
compressing the cord
Position- Knee-Chest position
( gynopectorus position) or Tendelburg
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Immediate Cesarean Section is needed
Remember to cover client when going
through hall.
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Abruptio Placenta
Placenta Previa
Placenta and Umbilical Cord
Variations
Placenta Adherence :
Placenta Accreta
Placenta Increta
Placenta Percreta
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Placenta Accreta: is when the chorionic
villi attaches directly to the myometrium.
This is the most common form of placenta
adherence.
Placenta Increta is when the placenta
invades the myometrium.
Placenta Percreta is when the placenta
penetrates the myometrium.
Complication is maternal hemorrhage.
Depending on the amount and depth of
involvement will determine treatment
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First Degree Laceration is limited to
the fourchette, perineal skin, and
vaginal mucous membrane.
Second Degree Laceration involves the
perineal skin, vaginal mucous
membrane, underlying fascia, and the
muscles of the perineal body.
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Third Degree Laceration extends
through the perineal skin, vagina
mucous membranes , and perineal
body and involves the anal sphincter
and may extend up the anterior wall
of the rectum.
Fourth Degree Laceration extends
through the rectal mucosa to the
lumen of the rectum.
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Care:
Get order for ice pack
Pain medications
Stool Softener
Pericare
Sitzbath
Remember nothing in rectumNo Suppostories
No Enemas
No Rectal Exams