Labor and Complications

LABOR AND COMPLICATIONS
NCM102
LABOR AND BIRTH COMPLICATIONS
LEARNINGOBJECTIVES
On completion of this chapter, the reader will be able to:

• Differentiate between preterm birth and low birth weight.
• Discuss major risk factors associated with preterm labor.
• Analyze current interventions to prevent spontaneous preterm birth.
• Discuss the use of tocolytics and antenatal glucocorticoids in preterm labor.
• Evaluate the effects of prescribed bed rest on pregnant women and their families.
• Design a nursing care plan for women with preterm premature rupture of the
membranes (preterm PROM).
• Describe the care of a woman with postterm pregnancy.
• Explain the challenge of caring for obese women during labor and birth.
• Summarize the nursing care for a woman experiencing a trial of labor, induction or
augmentation of labor, a forceps- or vacuum-assisted birth, a cesarean birth, or a
vaginal birth after a cesarean birth (VBAC).
• Discuss obstetric emergencies and their appropriate management.
• PRETERM LABOR AND BIRTH
• Preterm labor is defined as cervical changes and uterine contractions occurring between 20
and 37 weeks of pregnancy.
• Pretermbirth is any birth that occurs before the completion of 37 weeks of pregnancy,
regardless of birth weight.
• describes length of gestation (i.e., less than 37 weeks regardless of the weight
of the infant
• more dangerous health condition for an infant because less time in the uterus
correlates with immaturity of body systems
• infants born at a preterm gestation can weigh more than 2500g at birth
• such as infants born to women with diabetes who have poorly controlled
blood glucose levels
• Complications related to preterm birth account for more newborn and infant deaths than any
other cause (Simhan, Iams, and Romero, 2012).
• Late preterm occurs between 34 and 36 weeks of gestation.
• Low birth weight describes only weight at the time of birth (i.e., 2500g or less).
• babies can be, but are not necessarily, preterm
• can be caused by conditions other than preterm birth,
e.g. intrauterine growth restriction
Preterm birth is divided into two categories:
1. Spontaneous
2. indicated.
Spontaneous preterm birth
• occurs after an early initiation of the labor
• Conditions such as preterm labor with intact membranes, preterm premature
rupture of membranes (preterm PROM), cervical insufficiency, or amnionitis often
result in preterm birth
RISK FACTORS FOR SPONTANEOUS PRETERM LABOR
• History of previous spontaneous preterm birth
• Genital tract infection
• Multifetal gestation
• Second-trimester bleeding
• Low prepregnancy weight
Predictor Spontaneous preterm birth
I. Fetal Fibronectin Test
• a biochemical marker, a diagnostic test for preterm labor.
• It is a glycoprotein “glue” found in plasma and produced during fetal life.
• normally appears in cervical and vaginal secretions early in pregnancy and then
again in late pregnancy.
• The presence during the late second and early third trimesters of pregnancy may
be related to placental inflammation, which is thought to be one cause of
spontaneous preterm labor.
II. Cervical Length
• Changes in cervical length occur before uterine activity, so cervical measurement can
identify women in whom the labor process has begun. However, because preterm cervical
shortening occurs over a period of weeks, neither digital nor ultrasound cervical examination
• is very sensitive at predicting imminent preterm birth. Women whose cervical length is
greater than 30mm are unlikely to give birth prematurely even if they have symptoms of
preterm labor
Causes of Spontaneous Preterm Labor and Birth
• Infection
• is definitely associated with preterm labor. Women in
• spontaneous preterm labor with intact membranes commonly have organisms that are
normally found in the lower genital tract present in their amniotic fluid, placenta, and
membranes.
• Clinical and laboratory evidence of infection are more common when birth occurs
• earlier than 30 to 32 weeks of gestation rather than closer to term.
• Urinary tract and intraabdominal (e.g., appendicitis) infections
• have also been related to preterm birth (Simhan, Iams, and Romero,
• 2012). Women with periodontal disease have been shown to have an
• increased risk for preterm birth. However, the risk is not reduced by
• periodontal care, suggesting that the link between periodontal
• disease and preterm birth is not a cause-and-effect relationship
• (Simhan, Iams, and Romero, 2012).
• Indicated preterm birth
• occurs as a means to resolve maternal or fetal risk related to continuing the
pregnancy
• indicated because of medical or obstetric conditions that affect the mother, the
fetus, or both.
PRETERM LABOR AND BIRTH
COMMON CAUSES OF INDICATED PRETERM BIRTH

• Pre-existing or gestational diabetes
• Chronic hypertension
• Preeclampsia
• Obstetrical disorders or risk factors in the current or a previous pregnancy
• Previous cesarean birth via a classic uterine incision
• Placental disorders
• Medical disorders
• Seizures
• Thromboembolism
• Maternal HIV or herpes infection
• Obesity
• Advanced maternal age
• Fetal disorders
• Chronic (IUGR) or acute (abnormal NST or BPP) fetal compromise
• Excessive or inadequate amount of amniotic fluid
• Birth defects
SIGNS AND SYMPTOMS OF PRETERM LABOR

Uterine Activity
• Uterine contractions occurring more frequently than every 10 minutes persisting for 1 hour or
more
• Uterine contractions may be painful or painless
Discomfort
• Lower abdominal cramping similar to gas pains; may be accompanied by diarrhea
• Dull, intermittent low back pain (below the waist)
• Painful, menstrual-like cramps
• Suprapubic pain or pressure
• Pelvic pressure or heaviness; feeling that “baby is pushing down”
• Urinary frequency
Vaginal Discharge
• Change in character or amount of usual discharge: thicker (mucoid) or thinner (watery),
bloody, brown or colorless, increased amount, odor
• Rupture of amniotic membranes
PATIENT TEACHING If Symptoms of Preterm Labor Occur

• Empty your bladder.
• Drink two to three glasses of water or juice.
• Lie down on your side for 1 hour.
• Palpate for contractions.
• If symptoms continue, call your health care provider or go to the hospital.
• If symptoms go away, resume light activity but not what you were doing when the symptoms
began.
• If symptoms return, call your health care provider or go to the hospital.
• If any of the following symptoms occur, call your health care provider or go to the hospital
immediately:
• Uterine contractions every 10 minutes or less for 1 hour or more
• Vaginal bleeding
• Fluid leaking from the vagina
• Suppression of Uterine Activity

• Tocolytics
• are medications given to arrest labor after uterine contractions and cervical change have
occurred.
• No specific medications used
• No tocolytic has been shown to reduce the rate of preterm birth.
Drugs use:
1. Magnesium Sulfate
• CNS depressant; relaxes smooth muscles including uterus
2. Beta-Adrenergic Agonist (Beta-Mimetic)
• Terbutaline (Brethine)
• Relaxes smooth muscles, inhibiting uterine activity, and causing bronchodilation
3. Prostaglandin Synthetase Inhibitors (NSAIDS)
• Indomethacin (Indocin)
• Relaxes uterine smooth muscle by inhibiting prostaglandins
4. Calcium Channel Blockers
• Nifedipine (Adalat,Procardia)
• Relaxes smooth muscles including the uterus by blocking calcium entry
• Rather, the rationale for giving these medications is to delay birth long enough to allow time for maternal
transport and for corticosteroids to reach maximum benefit to reduce neonatal morbidity and mortality.
Promotion of Fetal Lung Maturity

• Antenatal glucocorticoids
• given as intramuscular injections to the mother
• to accelerate fetal lung maturity by stimulating fetal surfactant production
• one of the most effective and cost-efficient interventions for preventing morbidity and
mortality associated with preterm labor.
• Antenatal glucocorticoids have been shown to significantly reduce the incidence of
• respiratory distress syndrome,
• intraventricular hemorrhage,
• necrotizing enterocolitis
• death in neonates without increasing the risk for infection in either mothers or
newborns.
• recommended that all women between 24 and 34 weeks of gestation be given a single
course of antenatal glucocorticoids when preterm birth is threatened unless evidence
indicates that glucocorticoids will have an adverse effect on the mother or birth is imminent.

Antenatal Glucocorticoid Therapy with Betamethasone or Dexamethasone
Action
• Stimulates fetal lung maturation by promoting release of enzymes that induce
production or release of lung surfactant.
• NOTE: The U.S. Food and Drug Administration has not approved these
medications for this use (i.e., this is an unlabeled use for obstetrics).
Indication
• To prevent or reduce the severity of neonatal respiratory distress syndrome
by accelerating lung maturity in fetuses between 24 and 34 weeks of
gestation.
• Infants born to women who received antenatal glucocorticoids are also less
likely to experience intraventricular hemorrhage, necrotizing enterocolitis, or
neonatal death.

Dosage and Route
• Betamethasone: 12mg intramuscular (IM) for two doses 24 hours apart
• Dexamethasone: 6mg IM for four doses 12 hours apart
Maternal Effects
• Transient (lasting 72 hours) increase in white blood cell (WBC) count
• Hyperglycemia
Fetal Effects
• Transient (lasting 72 hours) decrease in fetal breathing and body
movements

Nursing Considerations
• Give deep IM in ventral gluteal or vastus lateralis muscle.
• Medication must be given by intramuscular injection; oral administration is not an
acceptable alternative.
• Injection is painful.
• Medication should not affect maternal blood pressure.
• Assess blood glucose levels. Women with diabetes whose blood sugars
• have previously been well controlled may require increased insulin doses for several
days.
Management of Inevitable Preterm Birth

• Magnesium Sulfate may be administered
• to reduce or prevent neonatal neurologic morbidity
(e.g., cerebral palsy)
• for neuroprotection
• To be given at least 24 but less than 32 weeks of gestation
• If birth appears imminent
• preparations to care for a small, immature neonate should be made. Women in
preterm labor may rapidly progress to birth and a very small fetus may be born
through a partially dilated cervix.
• Also, malpresentation (e.g., breech presentation) occurs much more frequently in
preterm than in term fetuses. Therefore nurses must be prepared to handle the
emergency birth of a preterm infant, from either cephalic or breech presentation,
without the woman’s primary health care provider being present.
• Personnel skilled at neonatal resuscitation should be present at the time of birth.
PREMATURE RUPTURE OF MEMBRANES (PROM)
• the spontaneous rupture of the amniotic sac and leakage of amniotic fluid
beginning before the onset of labor at any gestational age.
Preterm premature rupture of membranes (preterm PROM)
(i.e., membranes rupture before the completion of 37 weeks of gestation)
• Preterm PROM
• most likely results from pathologic weakening of the amniotic membranes
Causes:
• inflammation,
• stress from uterine contractions,
• other factors that cause increased intrauterine pressure.
• Infection of the urogenital tract
• a major risk factor associated with preterm
• PROM or preterm PROM is diagnosed
• after the woman reports either a sudden gush of fluid or a slow leak of fluid
from the vagina.
Maternal complication of preterm PROM
• Chorioamnionitis - the most common
• making it a major complication of pregnancy
• Other less common but serious maternal complications include
• placental abruption,
• retained placenta and hemorrhage
• requiring dilation and curettage (D&C),
• sepsis, and death.
Fetal complications
• from preterm PROM are related primarily to
• intrauterine infection
• cord prolapse
• umbilical cord compression associated with oligohydramnios
• placental abruption.
• pulmonary hypoplasia
• (possible fetal complication thatoccurs before 20 weeks of gestation)
CHORIOAMNIONITIS
• bacterial infection of the amniotic cavity
• major cause of complications for both mothers and newborns at any gestational
age.
• Other terms for this condition include
• clinical chorioamnionitis
• amnionitis,
• intrapartum infection
• amniotic fluid infection
• intra-amniotic infection
• Clinical findings:
• maternal fever
• maternal and fetal tachycardia
• uterine tenderness
• foul odor of amniotic fluid
CHORIOAMNIONITIS
• most often occurs after membranes rupture or labor begins, as organisms that are
part of the normal vaginal flora ascend into the amniotic cavity.
• Many of the risk factors associated with a long labor,
• such as prolonged membrane rupture,
• multiple vaginal examinations
• use of internal FHR and contraction monitoring modes
• Other risk factors include
• young maternal age
• low socioeconomic status
• Nulliparity
• preexisting infections of the lower genital tract
• POSTTERM PREGNANCY, LABOR, AND BIRTH
Postterm Pregnancy
• is one that extends beyond the end of week 42 of gestation, or 294 days from the
first day of the last menstrual period (LMP).
• also sometimes referred to as a postdate or prolonged pregnancy
• more common in primiparous women,
• a woman who experiences one postterm pregnancy is more likely to experience it
again in subsequent pregnancies
Clinical manifestations:
• Maternal weight loss (more than 3 lbs/wk)
• and decreased uterine size (related to decreased amniotic fluid)
• meconium in the amniotic fluid
• advanced bone maturation of the fetal skeleton with an exceptionally
hard fetal skull
Postterm Pregnancy complications
Maternal Risks
• Maternal risks are often related to dysfunctional labor, such as
• increased risk for perineal injury related to fetal macrosomia.
• Risk for hemorrhage
• infection is higher
Fetal Risks
• abnormal fetal growth
• small-forgestational-age infant
• only 10% to 20% of postterm fetuses are undernourished.
• Macrosomia (birth weight more than 4000g
• increased risk for birth injuries caused by difficult forceps-
assisted births and shoulder dystocia
• Having less than the normal amount of amniotic fluid available to
dilute it makes the meconium thicker and stickier than it would
otherwise be
• POST TERM PREGNANCY, LABOR, AND BIRTH
Post Term Pregnancy complications
• Hypoxia
• Decreased
• Oligohydramnios (amniotic fluid less than 400mL)
• the complication most frequently associated with postterm pregnancy
• Because of the decreased amount of amniotic fluid, there is a potential for
• cord compression
• and resulting hypoxemia
• meconium-stained amniotic fluid
• increased chance of meconium aspiration
• Low Apgar scores
Post Term Pregnancy complications
• Postmaturity syndrome
• occurs in about 20% of neonates born after postterm pregnancies.
• Characterized by
• dry, cracked, peeling skin
• long nails
• meconium staining of skin, nails, and umbilical cord
• Possibly loss of subcutaneous fat and muscle mass
Post term Pregnancy
• perinatal morbidity and mortality increase greatly after 42 weeks of gestation,
pregnancies are usually not allowed to continue after this time
• most physicians induce labor at 41 weeks of gestation.
CARE MANAGEMENT
• An alternative approach is to initiate twice-weekly fetal testing at 41 weeks of
gestation.
• The testing generally consists of either a BPP or a NST along with an assessment of
amniotic fluid volume (modified BPP)
• Evidence is insufficient to determine which of the two management approaches is
better
• During the postterm period, the woman is encouraged to assess fetal activity daily,
assess for signs of labor, and keep appointments
• with her primary health care provider (see Patient Teaching box).
• The woman and her family should be encouraged to express their
• feelings (e.g., frustration, anger, impatience, fear) about the prolonged
• pregnancy and helped to realize that these feelings are
• normal. At times, the emotional and physical strain of a postterm
Post term Pregnancy
CARE MANAGEMENT
• During the postterm period
• the woman is encouraged to
• assess fetal activity daily
• assess for signs of labor
• keep appointments with her primary health care provider
• The woman and her family should be encouraged to express their feelings about the
prolonged pregnancy
• (e.g., frustration, anger, impatience, fear)
• This will helped to realize that these feelings are normal. .
• Referral to a support group or another supportive resource may be needed.
• the emotional and physical strain of a postterm pregnancy may seem
overwhelming
Post term Pregnancy
CARE MANAGEMENT
• During labor,
• continuously monitoring the fetus electronically
• for a more accurate assessment of the FHR and pattern.
• Findings with variable or prolonged deceleration patterns
Will result to fetal hypoxia
• Inadequate fluid volume can lead to compression of the umbilical cord,
• If oligohydramnios is present,
• an amnioinfusion may be performed to restore amniotic fluid volume to
maintain a cushioning of the cord.
DYSFUNCTIONAL LABOR (DYSTOCIA)
• defined as a long, difficult, or abnormal labor caused by various conditions
associated with the five factors affecting labor.
Can be caused by any of the following factors:
• Ineffective uterine contractions or maternal bearing-down efforts (the powers)
• Alterations in the pelvic structure (the passage)
• Fetal causes, including abnormal presentation or position, anomalies, excessive
size, and number of fetuses (the passenger)
• Maternal position during labor and birth
• Psychologic responses of the mother to labor related to past experiences,
preparation, culture and heritage, and support system (the Psyche)
Risk factors:
• Overweight
• Short stature
• Advanced maternal age
• Infertility difficulties
• Prior version
• Masculine characteristics
• Uterine abnormalities
• (e.g., congenital malformations; overdistention, as with multiple
gestation; or polyhydramnios)
• Malpresentations and positions of the fetus
• Cephalopelvic disproportion (CPD) (or fetopelvic disproportion [FPD])
• Uterine overstimulation with oxytocin
• Maternal fatigue, dehydration and electrolyte imbalance, and fear
• Administration of an analgesic medication too early in labor or use of
continuous epidural analgesia
Abnormal Uterine Activity

1. hypertonic
2. Hypotonic
Hypertonic Uterine Dysfunction (Primary Dysfunctional Labor)
• The woman experiencing hypertonic uterine dysfunction, or primary dysfunctional
labor, often is an anxious first-time mother who I s having painful and frequent
contractions that are ineffective in causing cervical dilation or effacement to
progress.
• These contractions usually occur in the latent phase of first-stage labor (cervical
• dilation of less than 4cm) and are usually uncoordinated.
• The force of the contractions may be in the midsection of the uterus rather than in
the fundus; therefore the uterus cannot apply downward pressure to push the
presenting part against the cervix. The uterus may not relax completely between
contractions.
• Women with hypertonic uterine dysfunction may be exhausted and express concern
about loss of control because of the intense pain they are experiencing and the lack
of progress.
• Therapeutic rest (achieved with a warm bath or shower and the administration of an
analgesic such as morphine, to inhibit uterine contractions, reduce pain, and

• Hypotonic Uterine Dysfunction
• The second and more common type of uterine dysfunction is hypotonic uterine
dysfunction, or secondary uterine inertia. The woman initially makes normal
progress into the active phase of first-stage labor, but then the contractions become
weak and inefficient or stop altogether. The uterus is easily indented, even at the
peak of contractions.
• Intrauterine pressure (IUP) during the contraction (usually less than 25â•¯mm Hg) is
insufficient for progress of cervical effacement and dilation. CPD and malposition
are common causes of this type of uterine dysfunction.
• A woman with hypotonic uterine dysfunction may become exhausted and be at
increased risk for infection. Management usually consists of ruling out CPD and
assessing the FHR and pattern, characteristics of the amniotic fluid if the
membranes are ruptured, and maternal well-being. An intrauterine pressure catheter
• (IUPC) may be inserted to evaluate uterine activity accurately. If findings are normal,
labor augmentation measures may be implemented (e.g., ambulation, hydrotherapy,
rupture of membranes, nipple stimulation, oxytocin infusion).

• Secondary Powers
• Secondary powers, or bearing-down efforts, are compromised when
• large amounts of analgesic medications are given. Anesthesia may
• also block the bearing-down reflex and, as a result, alter the effectiveness
• of voluntary bearing-down efforts. Exhaustion resulting from
• lack of sleep or long labor and fatigue resulting from inadequate
• hydration and food intake reduce the effectiveness of the woman’s voluntary
bearing-down efforts. Maternal position can work against
• the forces of gravity and decrease the strength and efficiency of the
• contractions. Table 17-1 summarizes the characteristics of dysfunctional
• labor.
Abnormal Labor Patterns

• Six abnormal labor patterns were identified and classified by Friedman (1989)
according to the nature of the cervical dilation and fetal descent.
• These patterns are
• (1) prolonged latent phase
• (2) protracted active-phase dilation
• (3) secondary arrest: no change
• (4) protracted descent
• (5) arrest of descent
• (6) failure of descent.

• These patterns may result from a variety of causes, including
• Ineffective uterine contractions
• pelvic contractures
• CPD
• abnormal fetal presentation or position
• early use of analgesics, nerve block analgesia or anesthesia
• anxiety
• Stress
• Progress in either the first or the second stage of labor can be protracted
(prolonged) or arrested (stopped). Abnormal progress can be identified by plotting
cervical dilation and fetal descent on a labor graph (partogram) at various intervals
after the onset of labor and comparing the resulting curve with the expected labor
curve for a nulliparous or multiparous labor. If a woman exhibits an abnormal labor
pattern, the primary health care provider should be notified.
• Maternal morbidity and mortality from uterine rupture, infection,

• Table 17-2 further describes these abnormal labor patterns.
• Progress in either the first or the second stage of labor can be protracted
(prolonged) or arrested (stopped). Abnormal progress can be identified by plotting
cervical dilation and fetal descent on a labor graph (partogram) at various intervals
after the onset of labor and comparing the resulting curve with the expected labor
curve for a nulliparous or multiparous labor.
• If a woman exhibits an abnormal labor pattern, the primary health care provider
should be notified.
Maternal Complications (morbidity and mortality)
• uterine rupture
• Infection
• severe dehydration
• postpartum hemorrhage
Fettal Complication
• increase risk for hypoxia.

Maternal Complications (morbidity and mortality)
• uterine rupture
• Infection
• severe dehydration
• postpartum hemorrhage
Fettal Complication
• increase risk for hypoxia.
• Precipitous Labor
• Precipitous labor is defined as labor that lasts less than 3 hours from the
onset of contractions to the time of birth.
• Precipitous birth alone is usually not associated with significant maternal or
infant morbidity or mortality (Wing and Farinelli, 2012).
• Precipitous labor
✓ may result from hypertonic uterine contractions that are tetanic in
intensity.
✓ Conditions often associated with this type of uterine contractions
include
✓ placental abruption,
✓ uterine tachysystole,
✓ and recent cocaine use (Wing and Farinelli, 2012).
• Precipitous Labor
• Maternal complications can include
✓ uterine rupture,
✓ lacerations of the birth canal,
✓ amniotic fluid embolus (anaphylactoid syndrome of pregnancy),
✓ and postpartum hemorrhage.
• Fetal complications include
✓ shoulder dystocia (Wing and Farinelli, 2012),
✓ hypoxia caused by decreased periods of uterine relaxation between
contractions,
✓ , intracranial trauma related to rapid birth (and, in rare instances ).
Alterations in Pelvic Structure
Pelvic Dystocia
• occur whenever contractures of the pelvic diameters exist that reduce the capacity of inlet, the
midpelvis, the outlet, or any combination of these planes.
Causes:
• Pelvic contractures may be caused by congenital abnormalities
• maternal malnutrition
• Neoplasms
• lower spinal disorders
• immature pelvic size (predisposes some adolescent mothers to pelvic dystocia)
• Pelvic deformities (may be the result of automobile or other accidents or trauma)
Soft-Tissue Dystocia
• results from obstruction of the birth passage by an anatomic abnormality other than that involving the
bony pelvis.
Causes:
• placenta previa (low-lying placenta) that partially or completely obstructs the internal cervical os
• leiomyomas (uterine fibroids) in the lower uterine segment
• ovarian tumors
• full bladder or rectum, may prevent the fetus from entering the pelvis.
• Occasionally cervical edema occurs during labor when the cervix is caught between the
presenting part and the symphysis pubis or when the woman begins bearing-down efforts
prematurely, thereby inhibiting complete dilation.
• Sexually transmitted infections (e.g., human papillomavirus) can alter cervical tissue integrity and
thus interfere with adequate effacement and dilation
Fetal Causes
Causes Fetal Dystocia of origin may be
1. anomalies
2. excessive fetal size (macrosomia),
3. Malpresentation
4. Malposition
5. Multifetal pregnancy
Complications:
• neonatal asphyxia
• fetal injuries or fractures
• Maternal vaginal lacerations
Fetal Causes
I. Anomalies
• Gross ascites
• large tumors
• open neural tube defects (e.g., myelomeningocele),
• hydrocephalus
II. Cephalopelvic Disproportion (CPD)
• also called fetopelvic disproportion (FPD)
• disproportion between the size of the fetus and the size of the mother’s pelvis.
• Although CPD is often related to
• excessive fetal size, or macrosomia (i.e., 4000g or more)
• the problem in many cases is malposition of the fetal presenting part
• rather than true CPD (Wing and Farinelli, 2012).
• Fetal macrosomia is associated with maternal diabetes mellitus, obesity, multiparity, or
the large size of one or both parents.
• Maternal pelvis is too small, abnormally shaped, or deformed
• CPD may be of maternal origin.
• In this case, the fetus may be of average size or even smaller
Fetal Causes
III. Malposition
• most common fetal malposition is occipitoposterior position
• (i.e., right occipitoposterior [ROP] or left occipitoposterior [LOP]
• occurring in approximately 15% of all labors during the latent phase of the first stage of labor.
About 5% of all fetuses are in this position at birth (Gilbert, 2011).
• Labor, especially the second stage, is prolonged.
• severe back pain of the mother
• from the pressure of the fetal head (occiput) pressing against her sacrum.
Fetal Causes
Malpresentation
• the fetal presentation is something
other than cephalic or head first
• Breech presentation is the most
common form of malpresentation
• The three types of breech presentation are
• Frank breech (hips flexed, knees
extended)
• Complete breech (hips and knees
flexed)
• Footling breech (when one foot
[single footling] or both feet [double
footling] present before the buttocks)
Fetal Causes
Malpresentation
Breech presentations are associated with
• multifetal gestation,
• preterm birth
• fetal and maternal anomalies
• Hydramnios
• Oligohydamnios
• Diagnosed by
• abdominal palpation (e.g., Leopold maneuvers)
• vaginal examination
• usually confirmed by ultrasound scan

Labor and Complications

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LABOR AND COMPLICATIONS

On completion of this chapter, the reader will be able to:

COMMON CAUSES OF INDICATED PRETERM BIRTH

SIGNS AND SYMPTOMS OF PRETERM LABOR

PATIENT TEACHING If Symptoms of Preterm Labor Occur

• Suppression of Uterine Activity

Promotion of Fetal Lung Maturity

Promotion of Fetal Lung Maturity

Promotion of Fetal Lung Maturity

Promotion of Fetal Lung Maturity

Management of Inevitable Preterm Birth

Abnormal Uterine Activity

Abnormal Uterine Activity

Abnormal Uterine Activity

Abnormal Labor Patterns

Abnormal Labor Patterns

Abnormal Labor Patterns

Abnormal Labor Patterns

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