Labor Complications


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Labor Complications

  1. 1. LABOR COMPLICATIONS Anna Mae Smith, MPAS, PA-C Lock Haven University Physician Assistant Program
  2. 2. Dystocia/CPD <ul><li>Dystocia – Laboring patient is not making any progress at cervical dilatation &/or fetal descent during the active phase of labor </li></ul><ul><li>CephaloPelvic Disproportion –head fails to come down into the pelvis with full dilation of cervix </li></ul>
  3. 3. Causes of Dystocia <ul><li>Not in labor! </li></ul><ul><li>Dysfunctional labor </li></ul><ul><li>CPD causes: </li></ul><ul><ul><li>Persistent occiput posterior (OP) presentaion </li></ul></ul><ul><ul><li>Fetal macrosomia </li></ul></ul><ul><ul><li>Pelvis </li></ul></ul><ul><ul><li>Fetal malpresentations </li></ul></ul><ul><ul><li>Congenital anomalies (hydrocephalus) </li></ul></ul>
  4. 4. Pelvic Types and Characteristics Poor Short Flat, Oval Platypelloid Poor Short Heart shape Android Good Long Long,oval Anthropoid Good Average Round Gynecoid PROGNOSIS Diameter SHAPE TYPE Sagital Posterior
  5. 5. Management <ul><li>Amniotomy </li></ul><ul><li>Pitocin </li></ul><ul><li>Possible C-section </li></ul>
  6. 6. Shoulder Dystocia <ul><li>The anterior shoulder gets caught above the pubic symphysis </li></ul><ul><li>Common in macrosomia </li></ul><ul><li>Diabetics </li></ul><ul><li>Maternal obesity </li></ul><ul><li>Post dates pregnancy </li></ul>
  7. 7. Shoulder Dystocia Complications <ul><li>Maternal: lacerations & hemorrhage </li></ul><ul><li>Fetal: Brachial plexus injury (Erb’s Palsy) adduction & internal rotation of the shoulder& flaccid paralysis of the affected arm(Waiter’s tip hand) </li></ul><ul><li>Fx clavicle </li></ul><ul><li>C-spine </li></ul><ul><li>Asphyxia of the infant </li></ul>
  8. 8. Chorioamnionitis <ul><li>Preterm labor with intact mambranes </li></ul><ul><li>Maternal infection/sepsis/endometritis </li></ul><ul><li>Neonatal Sepsis </li></ul><ul><li>Diagnosis: </li></ul><ul><ul><li>Fever </li></ul></ul><ul><ul><li>Uterine tenderness </li></ul></ul><ul><ul><li>Fetal tachycardia </li></ul></ul><ul><ul><li>Foul-smelling amniotic fluid </li></ul></ul>
  9. 9. PROM <ul><li>Must deliver within 24hrs or greatly increased of infection!! </li></ul><ul><li>If premature may gain time with antibiotics </li></ul>
  10. 10. ACTIVE PHASE COMPLICATIONS <ul><ul><li>Hypertonic dysfunction: contractions that are generated in the lower pole of the uterus or in multiple sites </li></ul></ul><ul><ul><li>Hypotonic dysfunction: </li></ul></ul><ul><ul><li>An insufficient generation of action potentials from the myometrial pacemaker </li></ul></ul><ul><ul><li>Inadequate propagation of the signal throughout the myometrium </li></ul></ul><ul><ul><li>Lack of mechanical response to the signal </li></ul></ul><ul><ul><li>In either circumstance, the contraction pattern fails to result in cervical effacement and dilatation. </li></ul></ul>
  11. 11. Primary Dysfunctional Labor <ul><li>Active-phase dilatation that occurs at a rate less than the 5th percentile </li></ul><ul><li>This value is 1.2 cm/hr in nulliparas and 1.5 cm/hr in multiparas </li></ul><ul><li>Tx of above & hypo/hypertonic dysfunction is oxytocin </li></ul>
  12. 12. Labor Induction <ul><li>Maternal indications </li></ul><ul><ul><li>Fetal demise </li></ul></ul><ul><ul><li>Severe hypertensive disease </li></ul></ul><ul><ul><li>Other medical problems (DM, renal, pulm) </li></ul></ul><ul><ul><li>Risk of precipitous labor or distance from hospital </li></ul></ul>
  13. 13. Labor Induction <ul><li>Fetal Indications: </li></ul><ul><ul><li>Post-term pregnancy </li></ul></ul><ul><ul><li>Maternal HTN </li></ul></ul><ul><ul><li>DM </li></ul></ul><ul><ul><li>PROM </li></ul></ul><ul><ul><li>Chorioamnionitis </li></ul></ul><ul><ul><li>Oligohydramnios </li></ul></ul><ul><ul><li>IUGR </li></ul></ul><ul><ul><li>Rh sensitization </li></ul></ul>
  14. 14. Relative Contraindications to Labor Induction <ul><li>Placenta previa </li></ul><ul><li>Abnormal lie or presentation </li></ul><ul><li>Prior classic incision </li></ul><ul><li>Active genital herpes </li></ul><ul><li>Pelvic abnormalities </li></ul><ul><li>Invasive cervical cancer </li></ul><ul><li>Presenting part above pelvic inlet </li></ul>
  15. 15. Induction Methods <ul><li>Membrane Stripping </li></ul><ul><li>Amniotomy </li></ul><ul><li>Pitocin </li></ul><ul><li>Vaginal prostaglandins </li></ul>
  16. 16. Complications with second stage of Labor <ul><li>Full dilation to delivery of the infant </li></ul><ul><li>Problems are caused by protraction or arrest of descent </li></ul><ul><li>Check for… hypotonic dysfunction, overdistended bladder, strong perineal resistance, conduction anesthesia, or ineffectual bearing down </li></ul><ul><ul><li>May require forceps, vacuum extractor or C-section </li></ul></ul>
  17. 19. Prerequisites for Forceps Delivery <ul><li>The membranes must be ruptured. </li></ul><ul><li>The cervix must be fully dilated. </li></ul><ul><li>The operator must be fully acquainted with the use of the instrument. </li></ul><ul><li>The position and station of the fetal head must be known with certainty. </li></ul><ul><li>Adequate maternal anesthesia for proper application of the forceps must be present. </li></ul>
  18. 20. Prerequisites for Forceps Delivery <ul><li>6. The maternal pelvis must be adequate in size for atraumatic delivery. </li></ul><ul><li>7. The characteristics of the maternal pelvis must be appropriate for the type of delivery being considered. </li></ul><ul><li>8. The fetal head must be engaged. </li></ul>
  19. 21. Vacuum Extractor <ul><li>Mom requires less anesthesia </li></ul><ul><li>Similar outcomes to forceps </li></ul>
  20. 22. Complications of the Third Stage <ul><li>Interval between delivery of the infant & delivery of the placenta </li></ul><ul><li>Placenta will come out on own in 10-15 mins after baby! </li></ul><ul><ul><li>Don’t interfere…risk uterine inversion & hemorrhage! </li></ul></ul>
  21. 23. Placenta is ready..have mom push one more time! <ul><li>(1) a gush of blood from the vagina </li></ul><ul><li>(2) descent of the umbilical cord </li></ul><ul><li>(3) a change in shape of the uterine fundus from discoid to globular </li></ul><ul><li>(4) an increase in the height of the fundus as the lower uterine segment is distended by the placenta </li></ul><ul><li>INSPECT the PLACENTA!! </li></ul>