(DURING LABOR AND DELIVERY)

Prepared By: MARY ELEANOR N. USIS, RN, MSN

 Can arise from any of the 3 main
components of the labor process:
1. The power
2. The passenger
3. The passageway

Prepared By: MARY ELEANOR N. USIS, RN, MSN

 (THE FORCE OF LABOR)

Prepared By: MARY ELEANOR N. USIS, RN, MSN

This denotes that
sluggishness of
contractions, or the force
of labor, has occurred

Prepared By: MARY ELEANOR N. USIS, RN, MSN

1. PRIMARY – occurring at the onset of
labor
2. SECONDARY – occurring later in labor

Prepared By: MARY ELEANOR N. USIS, RN, MSN

Factors resulting to Prolonged
Labor (Abnormal Contractions)
 Hypotonic Contractions
 Hypertonic Contractions
 Uncoordinated
Contractions

Prepared By: MARY ELEANOR N. USIS, RN, MSN

Prepared By: MARY ELEANOR N. USIS, RN, MSN
Prepared By: MARY ELEANOR N. USIS, RN, MSN
Hypotonic Contractions
▪ The number of contractions is usually low
or infrequent (not increasing beyond two
or three in a 10-minute period

▪ Most apt to occur during the active phase

of labor.

Prepared By: MARY ELEANOR N. USIS, RN, MSN

Hypertonic Contractions
 Marked by an increase in resting tone to
more than 15 mmHg

 Tend to occur frequently

 They are most commonly seen in the

latent phase of labor

Prepared By: MARY ELEANOR N. USIS, RN, MSN

 Comparison of Hypotonic and
Hypertonic Contractions

CRITERIA HYPERTONIC HYPOTONIC

Phase of Labor Latent Active

Symptoms Painful Painless

Medication

Oxytocin Unfavorable Favorable reaction

reaction
Sedation Helpful Little value
Prepared By: MARY ELEANOR N. USIS, RN, MSN
Uncoordinated Contractions
 More than one pacemaker may be
initiating contractions, or receptor points
in the myometrium are acting
independently of the pacemaker

Prepared By: MARY ELEANOR N. USIS, RN, MSN

Precipitate Labor
 This occur when uterine contractions are
so strong that the woman gives birth with
only a few rapidly occurring contractions.

 It is often defined as a labor that is

completed in a fewer than 3 hours

Prepared By: MARY ELEANOR N. USIS, RN, MSN

Uterine Rupture
 A rare case
during labor
when the uterus
undergoes more
strain than it is
capable of
sustaining

Prepared By: MARY ELEANOR N. USIS, RN, MSN

 Contributing Factors in the
Occurrence of Uterine Rupture
1. Prolonged labor
2. Faulty presentation
3. Multiple gestation
4. Unwise use of oxytocin
5. Obstructed labor
6. Traumatic maneuvers using forceps or
tractions

Prepared By: MARY ELEANOR N. USIS, RN, MSN

 Inversion of The Uterus
 A rare
phenomenon
in which the
uterus turns
inside out

Prepared By: MARY ELEANOR N. USIS, RN, MSN

Manual replacement of an
Inverted Uterus

Prepared By: MARY ELEANOR N. USIS, RN, MSN

Amniotic Fluid Embolism
 Occurs when amniotic fluid is
forced into an open maternal
uterine blood sinus through some
defect in the membranes or after
membrane rupture or partial
premature separation of the
placenta.

Prepared By: MARY ELEANOR N. USIS, RN, MSN

Signs and Symptoms
 The woman in labor suddenly sits up and
grasps her chest
 Sharp pain and inability to breathe
during labor
 Pale to bluish gray skin color

Prepared By: MARY ELEANOR N. USIS, RN, MSN

Management:
 O2 administration
 CPR
 Endotracheal intubation
 Fibrinogen therapy
 Monitor vital signs

Prepared By: MARY ELEANOR N. USIS, RN, MSN

Prepared By: MARY ELEANOR N. USIS, RN, MSN
Prolapse of the Umbilical Cord

 A loop of the
umbilical cord
slips down in
front of the
presenting
fetal part

Prepared By: MARY ELEANOR N. USIS, RN, MSN

 Conditions Associated with
Prolapsed Umbilical Cord
 Premature rupture of membranes
 Fetal presentation other than cephalic
 Placenta previa
 Intrauterine tumors
 A small fetus
 CPD
 Hydramnios
 Multiple gestation

Prepared By: MARY ELEANOR N. USIS, RN, MSN

 Signs and Therapeutic
Symptoms Management
 Place a gloved hand in the
 Cord may be felt on vagina and manually
vaginal examination elevating the fetal head off
the cord
 Place the woman in a knee-
 Cord is visible at chest or Tredelenburg
position
the vulva  Oxygen at 10L/min by
facemask
 Tocolytic agent
 Cover exposed portion with
a sterile saline compress
 Delivery of the infant

Prepared By: MARY ELEANOR N. USIS, RN, MSN

PROBLEMS WITH
POSITION,
PRESENTATION
OR SIZE

Prepared By: MARY ELEANOR N. USIS, RN, MSN

Breech Presentation
Causes:
➢ Gestational age under 40 weeks
➢ Abnormality in the fetus
➢ Hydramnios
➢ Congenital anomaly of the uterus
➢ Space-occupying mass in the pelvis
➢ Pendulous abdomen
➢ Multiple gestation

Prepared By: MARY ELEANOR N. USIS, RN, MSN

Assessment
 FHR usually heard high in the
abdomen
 Leopold’s Maneuvers, a vaginal
examination and ultrasound will reveal
the presentation
 Sonogram confirms breech
presentation

Prepared By: MARY ELEANOR N. USIS, RN, MSN

Prepared By: MARY ELEANOR N. USIS, RN, MSN
Prepared By: MARY ELEANOR N. USIS, RN, MSN
Prepared By: MARY ELEANOR N. USIS, RN, MSN
Prepared By: MARY ELEANOR N. USIS, RN, MSN
Asynclitism
 A fetal head presenting at a different
angle than expected
 Also known as face presentation
 Examples:
1. Face presentation
2. Brow presentation

Prepared By: MARY ELEANOR N. USIS, RN, MSN

Macrosomia
 Oversized fetus
 Fetus weighs more than 4000 to 4500 g (9
to 10 lb)
 Usually born to diabetic mothers

Prepared By: MARY ELEANOR N. USIS, RN, MSN

Prepared By: MARY ELEANOR N. USIS, RN, MSN
Inlet Contraction Outlet Contraction

 Narrowing of the  Narrowing of the

anteroposterior transverse diameter
diameter to less at the outlet to less
than 11 cm, or a than 11 cm.
maximum
transverse diameter
of 12 cm or less

Prepared By: MARY ELEANOR N. USIS, RN, MSN