Complication on Labor and Delivery


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Complication on Labor and Delivery

  1. 1. Maternal and Child Health NursingLabor and Delivery Complication MATERNAL and CHILD HEALTH NURSING LABOR AND DELIVERY COMPLICATION Lecturer: Mark Fredderick R. Abejo RN, MAN_____________________________________________________________________________ LABOR AND DELIVERY COMPLICATIONSA. Preterm Labor Preterm labor is labor that begins after 20 weeks gestation and before 37 weeks gestation.Etiology  PROM  Incompetent cervix  Multiple gestation  Previous history of Preterm labor  DES exposure  Emotional stress  Hydramnios  Placenta previa  Abruptio placenta  Maternal age <18 or >35Clinical Manifestation  Low back pain  Suprapubic pressure  Vaginal pressure  Rhythmic uterine contractions (2 uterine contractions lasting 30 seconds within 15 minutes)  Cervical dilatation <4 cm & effacement 50% or less  Expulsion of cervical mucus plus  Bloody showDiagnostic  Obtain thorough obstetric history  Obtain specimen for CBC & U/A  Determine frequency, duration & intensity of uterine contractions  Determine cervical dilatations and effacement  Assess status of membranes and bloody show  Evaluate fetus for distress, size and maturityMedical Management Goal: PREVENTION OF PRETERM DELIVERY Conservative Treatment: Bed rest in lateral position Hydration w/ IVF and continuous fetal and uterine contraction monitoring Tocolytic Therapy: Beta mimetic agents: Ritodrine (Yutopar) Use of ritodrine can lead to pulmonary edema. Therefore, the nurse should assess for crackles and dyspnea. Blood glucose levels may temporarily rise, not fall, with ritodrine. Ritodrine may cause tachycardia, not bradycardia. Ritodrine may also cause hypokalemia, not hyperkalemia. Ritodrine (Yutopar) can cause tremor and jittery feelings, so it must be assessed whether the feelings are from the medication or from the Preterm labor Steroid therapyMCHN Abejo
  2. 2. Maternal and Child Health NursingLabor and Delivery ComplicationNursing Management Perform measures to manage or stop Preterm labor Place on CBR in side-lying position Prepare fro possible ultrasound, amniocentesis, tocolytic and steroid therapy Administer meds as prescribed Assess S/E such as hypotension, dyspnea, chest pain and FHR exceeding 180 b.p.m. Dyspnea on exertion and increased vaginal mucus are common discomforts caused by the physiologic changes of pregnancy. Provide adequate hydration Provide emotional supportB. PROM (Premature Rupture of Membrane) Spontaneous rupture of amniotic membranes prior to onset of labor, maybe preterm (before 38 weeksgestation) or termContributing Factors  Incompetent cervix  Trauma  InfectionClinical Manifestation  Leakage of amniotic fluid  pH higher than 6.5  Nitrazine paper reaction = blueRisk For  Prolapsed cord  Infection  RDSManagement 1. With infection: antibiotics and delivery of infant 2. Without infection:  34-36 weeks of gestation= delay birth, amniocentesis and monitor LS ratio of the baby  28-32 weeks of gestation= delay birth, administer steroids to hasten maturity of the lungs and decreased RDS The good indicator of fetal lung maturity in a pregnant diabetic is presence of phosphatidglycerol in the amniotic fluid.C. Umbilical Cord Prolapse If the fetus is at –2 station and the membranes rupture, the patient is at risk for prolapsed cord.You can determine if a prolapsed cord exists if you perform a vaginal exam.MCHN Abejo
  3. 3. Maternal and Child Health NursingLabor and Delivery Complication Definition  The umbilical cord is displaced, either between the presenting post and the amnion or protruding through the cervix. Synonyms  Cord Prolapse Predisposing Factors Fetal Position other than cephalic presentations  Prematurity: NOTE: Small fetus allows more space around presenting part.  Polyhydramnios  Multiple fetal gestation  FetoPelvic disproportion  Abnormally long umbilical cord.  Placenta Previa  Intrauterine tumors that prevent the presenting part from engaging > Breech presentation, Transverse lie, Unengaged presenting part, Twin gestation, Hydramnios  Small fetus Initial Sign  Cord Prolapse: NOTE: first discovered when there is variable decelerated pattern FHR pattern variable: Decelerations with contractions or between contraction or fetal bradycardia present  Persistent non reassuring fetal heart rate – fetal distress  Atrophy of the umbilical cord & cord protruding from vagina  Cord may be palpated in cervix/vagina  Reflex constriction when cord is exposed to air Late Sign  Cool, moist skin  Dystocia Cardinal Sign  Rupture of Membrane spontaneously  The cord may then present/visible @ the vulva. Note: Do not attempt to push the cord into the uterus. Confirmatory Test  Amniotomy: Rupture of Membranes Best Major Surgery  Cesarian Section if the cervix incompletely dilated.  Fast vaginal delivery with forceps Disease Complication  #1 Maternal & Fetal Infection - Causing compression of the cord and compromising fetal circulation OTHERS: Prematurity, Hypoxia, Meconium aspiration,Fetal death if delayed or undiagnosed Best Position  Trendelenberg’s position or Knee Chest position -which causes the presenting part to fall back from the cord.  Turn side to side -Helps may be elevated to shift to fetal presenting toward diaphragm. Bedside equipment Eternal Electronic Fetal Heart Rate monitoring Oxygen with face-mask. Sterile hand glove Best Drug Heparin IV Nature of the drug To control intravascular coagulation in the pulmonary circulation History of the Disease Fetal nutrients supply Compression of the umbilical cord Nursing Diagnosis  Fluid volume deficit related to active hemorrhage  Altered tissue perfusion related to maternal vital organ and fetal related to hypovolemia  Risk for infection related traumatize tissue Nursing Intervention NOTE: The nurse’s #1 priority action to a prolapse cord is to assess the fetal heart rate. A prolapsed cord interrupts the oxygen and nutrient flow to the fetus. If the fetus doesn’t receive adequate oxygen, hypoxia develops, which can lead to central nervous system damage in the fetus. The primary goal with a prolapsed of the umbilical cord is to remove the pressure from the cord. Changing the maternal position is the first intervention. Acceptable positions include knee-chest, side-lying and elevation of the hips. The nurse may also perform a vaginal examination and attempt to push the presenting part off the cord. Administering the oxygen benefits the fetus only if circulation through the cord has been reestablished.MCHN Abejo
  4. 4. Maternal and Child Health NursingLabor and Delivery Complication  Start or maintain an IV as prescribed. Use of large-gauge catheter when starting the IV for blood and large quantities of fluid intake.  Administer oxygen by face –mask to provide high oxygen concentration at 8 –10L/min.  Instruct patient to cleanse from the front to the back.  Explain the importance of hand washing before and after perineal care. OTHER MANAGEMENT:  Reposition client to trendelenburg or knee- chest position  Oxygen  Push presenting part upward  Apply moistened sterile towels  Delivery as soon as possibleD. Dystocia Difficult, painful, abnormal progress of labor of more than 24 hours HYPERTONIC LABOR HYPOTONIC LABOR PATTERNS PATTERNS (Primary (Secondary inertia) inertia)OCCURRENCE Latent phase of labor Active phase of laborTREATMENT Rest and sedation Oxytocin and amnionity Fetal monitoring Cesarean section if labor does not resumeCAUSES Early analgesia Bowel or bladder distention Multiple gestation Large fetus Hydramnios Grandmultiparity 1. Passageway a. Contracted pelvis b. Unfavorable pelvic shapes Management: i. Evaluate pelvic diameters ii. Continue labor with careful monitoring iii. Perform assisted vaginal or caesarean delivery 2. Psyche a. Fear, anxiety ad tension increase stress and decrease uterine contractility b. Stress interferes with the clients ability with her contractions c. Stress increase fatigue Management: i. Monitor clients psychologic response to labor ii. Determines clients level of stress iii. Provide support iv. Encouraged relaxationMCHN Abejo
  5. 5. Maternal and Child Health NursingLabor and Delivery ComplicationE. Precipitate delivery - Labor that is completed within 3 hours A pregnant patient with a known history of crack cocaine use is in labor must be prepared for a precipitous labor and notify the neonatologist of the infant’s high-risk status. If a patient has a precipitous labor at risk, the result of the labor process would be laceration of the soft tissues, uterine rupture, and excessive uterine bleeding. ASSESSMENT NURSING INTERVENTIONPredisposing Factors: Management: 1. Multiparity 1. Monitor client and fetus closely 2. History of rapid labor 2. Possibly administer tocolytic agents 3. Premature or small fetus 3. Prepare for emergency birth 4. Large bony pelvisRisks: 1. Perineal lacerations & HemorrhageWhen delivering the neonate, you should deliver thehead between contractions. This will prevent the headfrom being delivered too suddenly, thuds preventing apossible tearing of the perineum. 3. Fetal Cerebral traumaF. Uterine Rupture The two findings on physical exam indicate uterine rupture is loss of uterine contour and palpable fetal part. The number one risk factor for uterine rupture is previous cesarean section. COMPLETE INCOMPLETE Sudden sharp abdominal pain during Abdominal pain during contractions contractions Contractions continue, but cervix fail to dilate Abdominal tenderness Vaginal bleeding may be present Cessation of contractions Rising pulse rate and skin pallor Bleeding into abdominal cavity & sometimes Loss of fetal heart tones into vagina Fetus easily palpated, FHT ceased Signs of shockG. Amniotic fluid embolismAn amniotic fluid embolism is when the amniotic fluid leaks into the maternal bloodstream bThe causes of anamniotic fluid embolism are difficulty in labor, or hyperstimulation of the uterus. Polyhydramnios is an excessiveamniotic fluid. MANIFESTATION MANAGEMENT Dyspnea Oxygen Sharp, chest pain CPR Pallor or cyanosis Intubation Frothy, blood-tinged mucus DeliveryMCHN Abejo