The document discusses various issues that may arise in labor and birth and their management, including: 1) Trial labor is used to determine if normal labor can progress with conditions like borderline pelvis, induction and augmentation are used to artificially start or assist stalled labor, and instrumental deliveries like forceps and vacuum can be used when pushing is ineffective. 2) Cesarean delivery is performed by making an abdominal and uterine incision when vaginal birth poses risks, and complications include infections, hemorrhage, and injury to mother or baby. 3) Postpartum complications are also reviewed like hematoma, infection, mastitis, thrombosis, and postpartum depression or psychosis.

1. THERAPEUTIC
MANAGEMENT OF
PROBLEMS OR
POTENTIAL PROBLEMS
IN LABOR AND BIRTH
DIANNA S. GERONA, RN 1

2. TRIAL LABOR
• Done to determine whether labor can
progress normally
• Indication:
– Borderline inlet measurement but good
fetal lie and position
• Nursing management:
– Monitor FHR and uterine
contractions
– Emptying of the bladder
– Prepare for CS
DIANNA S. GERONA, RN 2

3. EXTERNAL CEPHALIC VERSION
• Done as early as 34-35 weeks but usually
done 37-38 weeks.
• Containdications:
– Multiple gestation
– Severe oligohydramnios
– Contraindications to vaginal birth
– Unexplained 3rd trimester bleeding
• Nursing Management:
– Tocolytic agent administration
as ordered
– Record UTZ and FHR continuously
DIANNA S. GERONA, RN 3

4. INDUCTION AND
AUGMENTATION OF LABOR
• Labor induction
– Artificially starting labor
• Labor Augmentation
– Assisting labor that has started
spontaneously to be more effective.
DIANNA S. GERONA, RN 4

5. INDUCTION AND
AUGMENTATION OF LABOR
• Primary reasons:
– Preeclampsia / Eclampsia
– Rh sensitization
– Postmaturity
• Should be used in caution if with:
– Multiple gestation
– Hydramnios
– Grand multiparity
– Previous uterine scars
DIANNA S. GERONA, RN 5

6. INDUCTION AND
AUGMENTATION OF LABOR
• Conditions that should be present:
– Must be in a longitudinal lie
– Cervix is ripe
– Presenting part is engaged
– There is no CPD
– Fetus is matured by date
DIANNA S. GERONA, RN 6

7. INDUCTION AND
AUGMENTATION OF LABOR
• Cervical Ripening
– Laminaria method
– Prostaglandin gel
• Oxytocin Administration
– Nursing Management:
• Monitor uterine contractions, FHR,
and VS q 15 mins.
• Watch out for signs of water intoxication
and tonic uterine contractions
DIANNA S. GERONA, RN 7

8. INSTRUMENTAL
DELIVERIES
DIANNA S. GERONA, RN 8

9. FORCEPS DELIVERY
• Indications:
– The woman is unable to push with
contractions
– Spinal anesthesia or spinal cord injury
– Cessation of progress in the
2nd stage of labor
– Abnormal fetal position
DIANNA S. GERONA, RN 9

10. FORCEPS DELIVERY
2 TYPES:
• Low forceps birth
– Fetal head at +2 station
• Mid forceps birth
– Fetal head is engaged but less than
+2 station
DIANNA S. GERONA, RN 10

11. FORCEPS DELIVERY
• Before forceps are applied:
– Ruptured membranes
– No CPD
– Fully dilated Cervix
– Empty bladder
DIANNA S. GERONA, RN 11

12. FORCEPS DELIVERY
Complications:
• Urinary stress incontinence
• Birth trauma
– Facial paralysis
– Subdural hematoma
– Erythemetous mark on the baby’s cheek
• Cord compression
DIANNA S. GERONA, RN 12

14. VACUUM EXTRACTION
• For a fetus that is positioned far down
the vaginal canal
• A disk shaped cup is pressed
against the posterior fontanlle.
DIANNA S. GERONA, RN 14

17. VACUUM EXTRACTION
• Advantage: Fewer lacerations at the birth
canal
• Disadvantage: Caput – noticeable until 7
days
• Contraindications:
– Pre term infants
– Previous scalp blood sampling
DIANNA S. GERONA, RN 17

18. CESARIAN BIRTH
DIANNA S. GERONA, RN 18

19. CESARIAN BIRTH
DELIVERY OF THE
BABY THROUGH AN
ABDOMINAL &
UTERINE INCISION.
DIANNA S. GERONA, RN 19

20. INDICATIONS:
2.FETAL DISTRESS
2. BREECH PRESENTATION
3. DYSTOCIA
4. CPD
5. PRIOR CESARIAN SURGERY
6. CORD PROLAPSE
7. ABRUPTIO PLACENTA
8. PLACENTA PREVIA

21. COMPLICATIONS:
2.INFECTIONS
2. HEMORRHAGE
3. BLOOD CLOTS
4. SURGICAL INJURY
TO THE BLADDER OR INTESTINES
5. SURGICAL INJURY TO THE
FETUS.

22. TYPES:
1. LOW SEGMENT / LOW TRANSVERSE /
LOW CERVICAL ( LTCS) /
PFANNENSTIEL INCISION

23. ADVANTAGES:
2. INVOLVES LESS BLOOD LOSS
2. LESS POSSIBILITY OF RUPTURE OF
CS SCAR DURING SUBSEQUENT
PREGNACY
3. LESS INCIDENCE OF
POSTOPERATIVE COMPLICATIONS:
INFECTION, ADHESION OF BOWEL
TO THE INCISIONAL LINE,
INTESTINAL OBSTRUCTION.
4. ALLOWS A VAGINAL DELIVERY
AFTER A PREVIOUS CESARIAN
SECTION.(VBAC)

24. DISADVANTAGES:
2.DIFFICULT & LONGER TO PERFORM
THAN THE CLASSICAL TYPE.
2. NOT RECOMMENDED WITH ANTERIOR
PLACENTA PREVIA

28. 2. CLASSICAL TYPE
- A VERTICAL INCISION IS MADE
DIRECTLY INTO THE WALLS OF THE
CORPUS, WHICH IS THE MOST
CONTRACTILE PORTION.
ADVANTAGES:
1.EASIEST & QUICKEST INCISION TO
PERFORM
2. RAPID EXTRACTION OF FETUS CAN BE
DONE.

29. DISADVANTAGES:
1. INVOLVES MORE BLOOD LOSS BECAUSE
INCISION IS MADE ON THE THICK VASCULAR
PORTION OF THE UTERUS
2. HIGHER INCIDENCE OF POST-OP
COMPLICATIONS
3. RUPTURE OF CS SCAR ON SUBSEQUENT
PREGNANCY IS MORE LIKELY.
4.INVOLVES MORE HEALING DISCOMFORT & A
WIDER CS SCAR.

30. Post Partum Complications

31. Hematoma
• Bluish or purple discoloration of SQ tissue of
vagina or perineum.
• Mgt:
• cold compress every 30 minutes with rest
period of 30 minutes for 24 hrs
• incision on site, scraping & suturing
lgeblancomd maternal disorders 31

32. Late Post Partum Hemorrhage
• Bleeding after 24 hrs
• Mgt:
– D&C or manual extraction of fragments
lgeblancomd maternal disorders 32

33. Sub Involution
• Management:
– D&C
– Proper position - prone
– Cold compress – to prevent bleeding
– Mefenamic acid
lgeblancomd maternal disorders 33

34. DIC
• Disseminated Intravascular Coagulopathy.
• Management:
– hysterectomy if with abruption placenta
– Heparin
– Platelet concentrate
– cryoprecipitate or fresh frozen plasma
lgeblancomd maternal disorders 34

35. Puerperal Infection
General signs of inflammation:
• – calor (heat), rubor (red), dolor (pain)
tumor(swelling)
– Purulent discharges
– Fever
• Supportive care
– CBR -Paracetamol
– Hydration - Culture & sensitivity
– TSB - Antibiotics as ordered
– Cold compress
lgeblancomd maternal disorders 35

36. Mastitis
• Inflammation of the mammary gland
• Signs & Symptoms
– Fever
– Chils
– Malaise
– Flu like symptoms
lgeblancomd maternal disorders 36

37. Management
• Antibiotic therapy for 7 to 10 days
• May continue with BF unless there is an open
abcess formation
• If with abcess, use pump to evacuate milk until
it heals
• May continue to breastfeed on the unaffected
side
lgeblancomd maternal disorders 37

38. Deep Vein Thrombosis
• Inflammation of the lining of a blood vessel in
conjunction with clot formation
• Idiopathic
• Most common is Femoral usually manifested
by (+) Homan’s Sign
lgeblancomd maternal disorders 38

39. MAnagement
• Bed rest
• Anticoagulants
• Antibiotics
• Anlagesics
• Moist heat applications
• Never massage affected area
• Elevation of affected extremity
lgeblancomd maternal disorders 39

40. • Postpartum Depression
– A feeling of overwhelming feeling of sadness
which cannot be accounted for
– Symptoms:
• Excessive anxiety
• Irritability
• Fatigue
• Loss of apetite
• Feelings of worthlessness
– Management:
• Psychological counseling
• Encourage talking about her feelings
DIANNA S. GERONA, RN 40

41. • Postpartum Psychosis
– Mental state which involves a loss of contact with
reality
– May result from unrecognized and untreated
depression.
– Symptoms:
• Agitation
• Euphoria
• Delusions
• Disorganized behavior
– Management:
• Psychiatric counseling
• Anti-psychotic drugs
DIANNA S. GERONA, RN 41