Perry: Maternal Child Nursing Care, 6th Edition

Chapter 17: Labor and Birth Complications

Key Points

 Preterm labor is diagnosed as regular contractions along with a change in cervical effacement
or dilation or both, or presentation with regular uterine contractions and cervical dilation of at
least 2 cm. Preterm birth is any birth that occurs between 20 0/07 and 36 6/7 weeks of gestation.
 Complications related to preterm birth account for more newborn and infant deaths than any
other cause.
 The incidence of preterm birth in the United States varies considerably by race.
 Preterm birth describes length of gestation, whereas low birth weight describes only weight at
the time of birth.
 Preterm birth is divided into two categories: spontaneous and indicated. Spontaneous preterm
birth occurs after an early initiation of the labor process and comprises nearly 75% of all preterm
births in the United States. Indicated preterm birth occurs as a means to resolve maternal or fetal
risk related to continuing the pregnancy.
 The cause of preterm labor is unknown and is assumed to be multifactorial.
 Preconception counseling and care for women, especially those with a history of preterm birth,
may identify correctable risk factors and provide a means to encourage women to participate in
health-promoting activities.
 Because the onset of preterm labor can often be mistaken for normal discomforts of pregnancy,
nurses should teach all pregnant women how to detect the early symptoms of preterm labor and
to call their primary health care provider when symptoms occur.
 Bed rest, still a commonly prescribed intervention for preterm labor, has many deleterious side
effects and has never been shown to decrease preterm birth rates; modified bed rest is
recommended.
 The best reason to use tocolytic therapy is to achieve sufficient time to administer
corticosteroids in an effort to accelerate fetal lung maturity and reduce the severity of respiratory
complications in infants born preterm. In addition, time is allowed for transport of the woman
before birth to a center equipped to care for preterm infants.
 Magnesium sulfate is the most commonly used tocolytic agent because maternal and fetal or
neonatal adverse reactions are less severe and less frequent than with the beta-adrenergic
agonists.
 When preterm birth appears inevitable, magnesium sulfate may be administered to reduce or
prevent neonatal neurologic morbidity.
 If fetal or early neonatal death is expected, the parents and members of the health care team
need to discuss the situation before the birth and decide on a management plan that is acceptable
to everyone.
 Premature rupture of membranes (PROM) is 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 is associated with approximately 10% of all preterm births in
the United States.
 Vigilance for signs of infection is an essential part of the care for women with preterm PROM.

Copyright © 2018 by Elsevier Inc. All rights reserved.

Key Points 17-2

 A postterm pregnancy poses a risk to both the mother and the fetus.
 Dysfunctional labor results from differences in the normal relationships among any of the
factors affecting labor and is characterized by differences in the pattern of progress in labor.
 Malpresentation (the fetal presentation is something other than cephalic or head first) is another
commonly reported complication of labor and birth. Breech presentation is the most common
form of malpresentation.
 Obese women are at risk for several complications during labor and birth, including cesarean
birth. Even routine procedures require more time and effort to accomplish when the woman is
obese.
 Labor should not be induced electively until the woman has reached at least 39 weeks of
gestation.
 Cervical ripening using chemical or mechanical measures can increase the success of labor
induction.
 Amniotic membrane stripping or sweeping is a method of inducing labor through the release of
prostaglandins and oxytocin.
 Oxytocin is a hormone normally produced by the posterior pituitary gland. It stimulates uterine
contractions and aids in milk let-down. Synthetic oxytocin (Pitocin) may be used either to induce
labor or to augment a labor that is progressing slowly because of inadequate uterine contractions.
 Expectant parents benefit from learning about operative obstetrics (e.g., forceps- or vacuum-
assisted or cesarean birth) during the prenatal period.
 Maternal indications for forceps-assisted birth include a prolonged second stage of labor and
the need to shorten the second stage of labor for maternal reasons. Fetal indications include an
abnormal FHR tracing or certain abnormal presentations, arrest of rotation, or extraction of the
head in a breech presentation.

Copyright © 2018 by Elsevier Inc. All rights reserved.