Getting through labor is one of the most anticipated events during a womans pregnancy.

To
avoid complications during labor, thorough assessment should be conducted by the health
care providers early during the womans pregnancy.

Contents [hide]
1 Uterine Rupture
2 Inversion of the Uterus
3 Amniotic Fluid Embolism
4 Prolapse of the Umbilical Cord
5 Multiple Gestation
6 Practice Quiz: Labor Complication Nursing Care

Uterine Rupture
Uterine rupture is a rare but serious complication.
Uterine rupture is a condition wherein the uterus cannot sustain the strain that it
underwent.
Factors that contribute to uterine rupture are abnormal presentation,
prolonged labor, multiple gestation, improper use of oxytocin, and traumatic
effects of forceps use or traction.
Fetal death can be avoided in uterine rupture if immediate cesarean birth can be
performed.
Symptoms that a woman may feel preceding rupture are a sudden, severe pain
during a laborcontraction or a tearing sensation.
Rupture can be complete or incomplete.
With complete uterine rupture, the rupture goes through the endometrium,
myometrium, and peritoneum, and then the contractions would immediately stop.
With incomplete uterine rupture, the rupture only goes through the endometrium
and the myometrium only, with the peritoneum still intact.
Symptoms of complete uterine rupture include hemorrhage, shock, fading fetal
heart sounds, distinct swellings of the retracted uterus and extrauterine fetus.
For incomplete rupture, there is localized tenderness, persistent aching pain in the
lower uterine segment, and lack of contractions and fetal heart sounds.
Confirmatory diagnosis of uterine rupture can be revealed through ultrasound.
 Administration of emergency fluid replacement as ordered should be anticipated
as well as IV oxytocin.
Laparotomy would be performed to control the bleeding and repair the rupture.
Cesarean hysterectomy or tubal ligation can also be performed with consent from
the patient to remove the damaged uterus and remove the childbearing activity of
the woman.
Fetal outcome, the womans safety, and the extent of the surgery must be
revealed to the patient and allow time for them to express their emotions.
The woman would be advised not to conceive again after a rupture of the uterus
unless the rupture is in the inactive lower segment.
The viability of the fetus and the womans prognosis depends on the extent of the
rupture.

Inversion of the Uterus

Uterine inversion occurs when the uterus turns inside out due to the delivery of
the fetus or the placenta.
Factors that contribute to inversion are application of traction to the umbilical cord
to remove the placenta, if pressure is applied to the uterine fundus when the
uterus is not contracting, or if the placenta is attached to the fundus so during
birth the fundus pulls it down.
Signs of inversion include sudden gush of a large amount of blood from the
vagina, a non-palpable fundus, signs of blood loss such as hypotension,
dizziness, and paleness, and if bleeding continues, exsanguinations.
The inversion should never be replaced and the placenta, if still attached, should
never be removed.
Administration of oxytoxic drugs could only worsen the inversion and make the
uterus tense so that it is difficult to replace.
To manage uterine inversion, an IV line with a large-gauge needle should be
established to restore fluid volume, oxygen administration should be started,
assessment of vital signs, and cardiopulmonary resuscitation if the woman
undergoes arrest.
Nitroglycerin or a tocolytic drug would be given intravenously to relax the uterus,
and the physician would replace the fundus manually.
 Oxytocin would be given after manual replacement to help the uterus contract and
remain in its natural place.
Antibiotics would be prescribed because the endometrium was exposed to
prevent infection.
Inform the woman that a future pregnancy would need to be delivered via
cesarean section because there is a possibility that the inversion would re-occur.

Amniotic Fluid Embolism

Amniotic fluid embolism occurs when the amniotic fluid is forced into an open
maternal uterine blood sinus or after membrane rupture or partial premature
separation of the placenta.
The most likely cause of the embolism is anaphylactoid or humoral response.
Amniotic fluid embolism cannot be prevented because it cannot be predicted.
Risk factors include abruption placenta, hydramnios, and oxytocin administration.
The woman experiences sharp chest pain, inability to breathe, pallor, and lack of
blood flow.
Emergency measures include oxygen administration and CPR.
The womans prognosis would depend on the speed of the detection of the
condition, the skill and speed of the emergency interventions, and the size of the
embolism.
Endotracheal intubation and fibrinogen therapy would be needed because the risk
for DIC is high.
The prognosis for the fetus is uncertain because reduced placental perfusion
happens from a severe drop in maternal blood pressure.

Prolapse of the Umbilical Cord

In prolapsed of the umbilical cord, a loop of umbilical cord slips down in front of
the presenting fetal part.
Factors that occur with prolapse are a small fetus, placenta previa, CPD,
premature rupture of membranes, hydramnios, and multiple gestation.
During assessment of the presenting fetal part through vaginal examination, the
cord might be felt.
Diagnosis of prolapsed of the membrane can be made through ultrasound.
 Cesarean section should be performed before rupture of the membrane or the
cord would slide down the vagina.
However, cord prolapsed is mostly discovered after rupture of the membranes,
when the fetal heart rate has a variable deceleration.
Assessment of fetal heart sounds is necessary after rupture of membranes to rule
out cord prolapse.
The goal in therapeutic management is to relieve cord compression to avoid fetal
anoxia that can be achieved through manually lifting the head of the fetal head off
the cord through the vagina or placing the woman in a Trendelenburg position.
Oxygen administration is also necessary to improve the fetal oxygenation.
Uterine activity and pressure of the fetus should also be reduced through a
tocolytic agent.
Once the cord has prolapsed and is exposed to air, drying of the umbilical cord
and atrophy of the umbilical vessels would begin.
Cover any exposed portion of the cord with a sterile saline compress to avoid
drying.
If there is already complete dilatation, the physician can deliver the baby to
prevent fetal anoxia.
If the cervical dilatation is not yet complete, cesarean birth would be performed as
an emergency procedure because of the reduced blood flow that can harm the
fetus.
Amnioinfusion, which is the addition of a sterile fluid into the uterus to supplement
the amniotic fluid, can be performed just to prevent additional cord compression.
During the infusion, monitor the fetal heart rate and uterine contractions internally
and record maternal temperature hourly to detect infection.

Multiple Gestation
When a woman has multiple gestation, additional personnel are needed for the
birth and there is excitement inside the birthing room.
Be aware of the needs of the woman during a multiple birth because she may be
more frightened than excited of the delivery.
Multiple gestations often result in fetal anoxia on the part of the second fetus, so
cesarean birth is more preferable than normal delivery.
 Anemia and pregnancy-induced hypertension mostly occur in women with
multiple gestations, so assessment of the blood pressure and hematocrit is
necessary.
If the woman plans to give birth vaginally, she should be advised to come to the
hospital early inlabor.
Instruct the woman breathing techniques to minimize the use of analgesia or
anesthesia, thereby decreasing the possibility of respiratory difficulties that the
infants might experience because of lung immaturity.
There may not be firm head engagement for multiple gestations because the
babies are small.
Common conditions that occur with multiple gestations are abnormal fetal
presentation, an overstretched uterus, premature separation of placenta, and
uterine dysfunction due to a longlabor.
Twin pregnancies usually have vertex presentations, but in gestations with three
or more fetuses, the presentations are varied.
Oxytocin is administered after the birth of the last fetus unlike in singleton
pregnancies to avoid compromising the remaining fetuses.
If the next fetus does not have a vertex presentation, external version might be
attempted to make it vertex or cesarean birth can be performed.
To shorten the time span between births, an oxytocin infusion can be started.
To relax the uterus, nitroglycerin may be administered.
The first infants placenta separates before the birth of the second fetus which
causes a sudden, profuse bleeding at the vagina, creating a great risk for the
woman.
If the separation of the first placenta causes loosening of the other placentas or
there is a common placenta, the fetal heart rate of the other fetuses would signal
distress.
Most multiple gestations today which are not in vertex presentation are born
through cesarean section because they need to be born all at once so they can
survive.
Parents should be given an opportunity to view and inspect their fetuses to dispel
the fears that they have that their infants are less than perfect.
Assess the woman thoroughly and immediately after birth because an overly
distended uterus might have difficulty in contracting, placing her at risk for
hemorrhage due to uterine atony.
 Infants also need careful assessment to determine their gestational age and if any
unusual conditions have occurred.