for mera

2. The woman who develops a
complication during labor and birth

3. Hypotonic Uterine Contraction
The number of contractions is usually low or
infrequent
May occur after the administration of
analgesia especially if the cervix is not
dilated to 3 or 4 cm or if bowel and bladder
distension prevents descent or from
engagement.

4. Management
Start oxytocin
infusion
Amniotomy, to further speed
labor
In the first hour after birth palpate
the uterus and assess lochia every
5 minutes.

5. Hypertonic
Contractions
Are marked by an increased in resting
tone.
Management:
Rest and pain relief with a drug such
as morphine sulfate.
Darkening room lights.
Decrease noise and stimulation
Cesarean birth maybe necessary.

6. POSTMATURE
PREGNANCY
General information
 Defined as those pregnancies lasting beyond
the end of the 42nd week.
 Fetus at risk due to placental degeneration and
loss of amniotic fluid
 Decreased amounts of vernix also allow the
drying of the fetal skin, resulting in a dry,
parchment like skin condition

7. Medical management
 Directed toward ascertaining precise fetal
gestational age and condition, and
determining fetal ability to tolerate labor
 Induction of labor and possibility cesarean
birth
Nursing Interventions
 Perform continual monitoring of maternal/fetal
vital signs
 Support mother through all testing and labor

8. PROLAPSED UMBILICAL
CORD
General information
 Displacement of cord in a downward direction,
near or ahead of the presenting part, or into the
vagina
 May occur when membranes rupture.
 Associated with breech presentation, unengaged
presentations and premature labor
 Obstetric emergency if compression of the cord
occurs, fetal hypoxia may result in CNS damage
or death.
Assessment findings
 Vaginal examination identifies cord prolapsed
into vagina

9. PROLAPSED UMBILICAL
CORD

10. Nursing Interventions
 Check FHT immediately when membranes
rupture, and again after next contraction, or
within 5 minutes; report decelerations
 If fetal bradycardia, perform vaginal
examination and check for prolapsed cord
 If cord prolapsed into vagina, exert upward
pressure against presenting part to lift part off
cord, reducing pressure on cord

11.  Get help to move the mother into a position where
gravity assist in getting presenting part off cord
(knee chest position or severe trendelenburg’s)
 Administer oxygen for immediate cesarean birth
 If cord protrudes outside vagina, cover it with
sterile gauze moistened with sterile saline while
carrying out above tasks. Do not attempt to
replace cord.

12. FETAL
DISTRESS
General information
 Cord compression
 Placental abnormalities
 Preexisting maternal disease
Assessment findings
 Decelerations in FHR
 Meconium-stained amniotic fluid with
a vertex presentation

13. Nursing interventions:
 Check FHR on appropriate basis
 Conduct vaginal exam for presentation and
position
 Place mother on left side, administer oxygen,
check for prolapsed cord, notify physician
 Support mother and family
 Prepare for emergency birth if indicated

14. DYSTOCIA
General information
 Any labor/delivery that is prolonged or difficult
 Usually results from a change in the
interrelationships among the 4 P’s that is the factors
in labor and delivery
 Frequently seen causes include:
 disproportion between fetal presentation
(usually the head) and the maternal pelvis
(CPD)
 if disproportion is minimal, vaginal birth may
be attempted if fetal injuries can be
minimized or eliminated.
 cesarean birth needed if disproportion is
great.

15. – problems with presentation
» any presentation unfavorable for
delivery (e.g. breech, shoulder,
face, transverse lie)
» posterior presentation that does
not rotate, or cannot be rotated
with ease.
» cesarean birth is the usual
intervention
– problems with maternal soft tissue

16. Nursing Interventions
 Individualized as to cause
 Provide comfort measures for client
 Provide clear, supportive descriptions
of all actions taken
 Administer analgesia if ordered
 Prepare oxytocin infusion for induction
of labor as ordered.
 Monitor mother/fetus continuously
 Prepare for cesarean birth if needed

17. Shoulder dystocia
Shoulder dystocia happens
when after delivery of the
head the anterior shoulder
is trapped and arrested
behind symphisis pubis.
Fetal complications:
1. Erbs palsy
2. Fracture humerus and
clavicle
3. Abnormal neurologic
examinations

18. shoulder dystocia.flv

19. Management of shoulder dystocia

20. Mc Robert’s maneuver- flexing legs of the
parturient sharply over the abdomen

21. Woodcorkscrew maneuver- rotating
anterior shoulder 180 degrees to dislodge
it

22.  Cleidotomy- cutting the
clavicles
 Rubins maneuver- rocking the
shoulders from side by side
by applying force over the
abdomen
 Suprapubic pressure
 Strong fundal pressure
• Rotate posterior arm to
anterior position
• Extraction of posterior arm
• All procedures should not take
more than five minutes

23. PRECIPITOUS LABOR
AND DELIVERY
General Information
• Labor less than 3 hours
• Emergency delivery without clients
physician or midwife
Assessment findings
• As a labor is progressing quickly,
assessment may need to be done rapidly.
• Client have history of previous precipitous
labor and delivery

24. Nursing Intervention:
If you have to deliver the baby
yourself:
Asses the client’s affect and ability to
understand directions, as well as
other resources available
Stay with the client at all times
Do not prevent birth of the baby
Maintain sterile environment if
possible

25. Rupture membranes if necessary
Support baby’s head as it emerges,
preventing too-rapid delivery with
gentle pressure
Use gentle aspiration with bulb
syringe to remove blood and mucus
from nose and mouth
Deliver shoulders after external
rotation, asking mother to push
gently
Provide support for baby’s body as
it delivered

26. Hold baby in a head down position
to facilitate drainage of secretions
Promote cry by gently rubbing over
back and soles of feet
Dry to prevent heat loss
Place baby on mother’s abdomen
Check for signs of placental
separation
Check mother for excess bleeding,
massage uterus prn

27. Hold placenta as it delivers
Cut cord when pulsation cease, if
cord clamped available, if no
clamps keep it intact.
Wrap baby in dry blanket, give to
mother, put to breast if possible
Check mother for fundal firmness
and bleeding
Record all pertinent data
Comfort mother and family as
needed

28. SPONTANEOUS DELIVERY
• The encirclement of the largest head diameter
by the vulvar ring is known as crowning.
• RITGEN MANEUVER
* gloved hand is used to exert pressure on the
chin of the fetus through the perineum just in
front of the coccyx
* allows controlled delivery of the fetal head
* favors extension of the fetal head

29. RITGEN MANEUVER

30. Vaginal delivery of breech
presentation

31. PINARD MANEUVER

32. MAURICEU MANEUVER

33. PRAGUE MANEUVER

35. External
Cephalic
Version

36. AMNIOTIC FLUID
EMBOLISM
General information
 Escape of amniotic fluid into the maternal
circulation, usually in conjunction with a pattern
of hypertonic, intense uterine contractions,
either naturally or oxytocin induced.
 Obstetric emergency; may be fAtal to the
mother or to the fetus.
Assessment findings
 Sudden onset of respiratory distress,
hypotension, chest pain, signs of shock
Bleeding
Cyanosis
Pulmonary edema

37. Nursing Intervention
 Initiate emergency life support
activities for mother.
 administer oxygen
 utilize CPR in case of cardiac arrest
 establish IV line for blood transfusion
 administer medication to control
bleeding as ordered
 prepare for emergency birth of baby
 keep client/family informed as
possible

38. INDUCTION OF
LABOR
General Information
 -Deliberate stimulation of uterine
contractions before the normal
occurrence of labor.
Medical management
 Amniotomy (the deliberate rupture of
the membrane)
 Oxytocins, usually Pitocin
 Prostaglandin in gel/suppository form to
improve cervical readiness

39. Assessment findings
Indication for use
 Postmature pregnancy
 Preeclampsia/eclampsia
 Diabetes
 Premature rupture of membranes
Condition of fetus; mature,
engaged vertex fetus , no
distress
Condition of mother; cervix
“ripe” for induction, no CPD

40. Nursing Interventions
 Explain the procedure to client
 Prepare appropriate equipment and
medications.
 Amniotomy; a small tear made in
amniotic membrane as part of
sterile vaginal exam
 Oxytocin (Pitocin); IV administration
“piggybacked” to main IV

41.  Know the continuous monitoring
and accurate assessment are
essential.
 Discontinue oxytocin infusion when
fetal distress, hypertonic
contractions occur, signs of
obstetric complications appear.
(hemorrhage/shock, abruption
placenta, amniotic fluid embolism)
 Notify physician of any untoward
reactions.

42. RUPTURED UTERUS
A ruptured uterus is
characterized by a
tearing or splitting of the
uterine wall during labor;
it is usually a result of a
thinned or a weakened
area that cannot
withstand the strain and
force of uterine
contraction.

43. ASSESSMENT
Risk factor:
1. Multiparity
2. Obstructive labor
3. Improper use of pitocin
4. Large fetus
5. Weakened, old cesarean section
scar
6. External forces such as trauma
Clinical manifestations:
 Pain above the symphysis pubis
 Sudden, acute abdominal pain
during a contraction
 Vaginal bleeding, shock; fetal
distress

44. Uterine Rupture.flv
Treatment:
Surgical: laparotomy to
remove fetus, followed
by a hysterectomy.
Medical management:
1. Blood transfusion
2. Prophylactic antibiotics

45. Nursing Intervention:
Provide nursing management
associated with hemorrhage.
Assess for early diagnosis:
Maternal mortality rate is high
Prognosis for fetus is poor; fetus
usually dies as a result of anoxia
caused by placental separation.

46. INTRAUTERINE FETAL
DEATH
Intrauterine fetal death is also called
fetal demise.
ASSESSMENT:
 Absence of FHR and fetal
movement.
 Negative pregnancy test result
 Ultrasound examination
determines absence of FHR and
occurrence of fetal skull collapse.

47. Nursing Intervention:
Goal: To support the couple through the
grieving process.
• Encourage expression of feelings; do
not minimize the situation or event.
• Provide opportunity for the couple to
spend time with still born, if they so
desire.
• Monitor for complication.