5 High Risk Labor and Delivery

3/30/2022
 Can arise from any of the 4 main

components of the labor process:
1. The power
(DURING LABOR AND DELIVERY)
2. The passenger
3. The passageway
4. The psyche
Prepared By: MARY ELEANOR N. USIS, RN, MSN Prepared By: MARY ELEANOR N. USIS, RN, MSN
1 2
This denotes that

sluggishness of
(THE FORCE OF LABOR)
contractions, or the force

of labor is less than usual.
3 4
Prepared By: MARY ELEANOR N. USIS, RN, MSN 1

3/30/2022
Factors resulting to Prolonged

Labor (Abnormal Contractions)
 Hypotonic Contractions
 Hypertonic Contractions
1. PRIMARY – occurring at the onset of
labor  Uncoordinated
2. SECONDARY – occurring later in labor Contractions
5 6
(A) Normal uterine contractions. (B)

Hypotonic contractions; notice that the rise
in pressure is no more than 10 mmHg. (C)
Hypertonic contractions; notice the high
resting pressure (35–40 mmHg).
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Hypotonic Contractions Hypertonic Contractions

 The number of contractions is usually low  Marked by an increase in resting tone to
or infrequent (not increasing beyond two more than 15 mmHg
or three in a 10-minute period
 Tend to occur frequently
 Most apt to occur during the active phase
of labor.  They are most commonly seen in the
latent phase of labor
9 10
Comparison of Hypotonic and

Hypertonic Contractions
CRITERIA HYPERTONIC HYPOTONIC
Phase of Labor Latent Active
Symptoms Painful Limited pain
Hypertonic uterine contractions caused by an Medication

oxytocin infusion. Contractions are as high as
100 mmHg in intensity. Late decelerations and
a fetal heart rate (FHR) of 170 beats/min Oxytocin Unfavorable Favorable reaction
baseline are present. reaction
Sedation Helpful Little value
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Uncoordinated Contractions Precipitate Labor

 More than one pacemaker may be  This occur when uterine contractions are
initiating contractions, or receptor points so strong that the woman gives birth with
in the myometrium are acting only a few rapidly occurring contractions.
independently of the pacemaker
 It is often defined as a labor that is
completed in a fewer than 3 hours
13 14
Contributing Factors in the

Uterine Rupture Occurrence of Uterine Rupture
 A rare case 1. Prolonged labor
during labor 2. Faulty presentation
when the uterus 3. Multiple gestation
undergoes more 4. Unwise use of oxytocin
strain than it is
5. Obstructed labor
capable of
6. Traumatic maneuvers using forceps or
sustaining
tractions
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3/30/2022
Manual replacement of an
Inversion of The Uterus Inverted Uterus
 A rare
phenomenon
in which the
uterus turns
inside out
17 18
Amniotic Fluid Embolism Signs and Symptoms

 Occurs when amniotic fluid is  The woman in labor suddenly sits up and
grasps her chest
forced into an open maternal
uterine blood sinus through some  Sharp pain and inability to breathe
defect in the membranes or after during labor

membrane rupture or partial  Pale to bluish gray skin color
premature separation of the
placenta.
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Management:
 O2 administration
 CPR
 Endotracheal intubation
 Fibrinogen therapy
 Monitor vital signs
21 22
Conditions Associated with

Prolapse of the Umbilical Cord
Prolapsed Umbilical Cord
 A loop of the  Premature rupture of membranes
umbilical cord  Fetal presentation other than cephalic
slips down in  Placenta previa
front of the  Intrauterine tumors
presenting  A small fetus
fetal part  CPD

 Hydramnios
 Multiple gestation
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Signs and Therapeutic

Symptoms Management
Cord may be felt on
 Place a gloved hand in the
vagina and manually
PROBLEMS WITH
POSITION,

vaginal examination elevating the fetal head off
the cord
 Place the woman in a knee- PRESENTATION
Cord is visible at chest or Tredelenburg

the vulva
position OR SIZE
 Oxygen at 10L/min by
facemask
 Tocolytic agent
 Cover exposed portion with
a sterile saline compress
 Delivery of the infant
25 26
Breech Presentation Assessment

Causes:  FHR usually heard high in the
 Gestational age under 40 weeks abdomen
 Abnormality in the fetus  Leopold’s Maneuvers, a vaginal
 Hydramnios
examination and ultrasound will reveal
the presentation
 Congenital anomaly of the uterus
 Sonogram confirms breech
 Space-occupying mass in the pelvis
presentation
 Pendulous abdomen
 Multiple gestation
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29 30
31 32

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Asynclitism Macrosomia
 A fetal head presenting at a different  Oversized fetus
angle than expected  Fetus weighs more than 4000 to 4500 g (9
 Also known as face presentation to 10 lb)
 Examples:  Usually born to diabetic mothers
1. Face presentation
2. Brow presentation
33 34
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
35 36

3/30/2022
Question #1
Answer #1
A. Traditional labor room suites
cannot accommodate the
A pregnant woman who is personnel needed during the birth
carrying triplets is
concerned when her
of three infants like the operating
room can.
C. A cesarean delivery helps to prevent
obstetrician suggested
complications due to cord prolapse or premature
B. It is safer to know exactly when placental separation.
that she give birth by the delivery will occur so that the
cesarean delivery. What is heathcare team will be available. Rationale: Multiple gestations are more likely to
the most accurate
A cesarean delivery helps to
have labor complications such as prolapsed cords
and premature placental separation. Cesarean
C.
statement that the nurse
prevent complications due to cord
can make to the woman
prolapse or premature placental delivery should not be suggested as a matter of
regarding this?
separation. convenience, or availability of healthcare providers.
Labor contractions are so powerful
Because the uterus is “overstretched” during a
multiple pregnancy, it is more likely that hypotonic
D.
in a multiple gestation that a
cesarean delivery is safer for the contractions might occur, which would prolong
infants and mother. labor.
37 38
Questions #2 Answer #2
Will have a shorter
B. May experience more pronounced back pain
A.
You assess that the fetus second stage of labor

of a woman is in occiput May experience more
B.
Rationale: An occiput posterior presentation
posterior position. You pronounced back pain.
means that labor will be longer because the
know that her labor May need to have an
occiput needs to rotate to an anterior position.
C.
most likely will be external cephalic version
different from a woman performed Women often complain of intense back pain
whose fetus is in an D. Probably will need to during labor. External cephalic versions are not
anterior position in that have the delivery assisted used to correct posterior cephalic positions.
the woman by forceps or vacuum Most women are able to deliver without
extraction instrument assistance.
39 40

3/30/2022
Question #3 A. Prepare oxytocin using

piggyback intravenous
Answer #3
A. Prepare oxytocin as prescribed using a piggyback
setup.
You are B. Teach the pregnant
intravenous setup.
preparing for an woman to lie on her back
as much as possible Rationale: As a safety measure, oxytocin should
induction of during labor. always be administered through a secondary line. A
labor. Which of C. Make sure that a
fetoscope is available in
side-lying position (Especially the left side) is
preferable because it is the optimum position for
these would the the room for monitoring. fetal oxygenation and avoids vena cava syndrome. It
nurse expect to D. Assure the pregnant is anticipated that continuous uterine and fetal
monitoring will be performed rather than episodic
do in
woman that the induction
process will assure a monitoring with a fetoscope because this does not
preparation? shorter than usual labor. monitor uterine contractions. Induction of labor does
not assure that the period of labor will be any shorter.
41 42

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3/30/2022

 Can arise from any of the 4 main

This denotes that

contractions, or the force

Prepared By: MARY ELEANOR N. USIS, RN, MSN 1

Factors resulting to Prolonged

2. SECONDARY – occurring later in labor Contractions

(A) Normal uterine contractions. (B)

Prepared By: MARY ELEANOR N. USIS, RN, MSN 2

Hypotonic Contractions Hypertonic Contractions

Comparison of Hypotonic and

CRITERIA HYPERTONIC HYPOTONIC

Phase of Labor Latent Active

Symptoms Painful Limited pain

Hypertonic uterine contractions caused by an Medication

Prepared By: MARY ELEANOR N. USIS, RN, MSN 3

Uncoordinated Contractions Precipitate Labor

Contributing Factors in the

Prepared By: MARY ELEANOR N. USIS, RN, MSN 4

Amniotic Fluid Embolism Signs and Symptoms

defect in the membranes or after during labor

Prepared By: MARY ELEANOR N. USIS, RN, MSN 5

Conditions Associated with

slips down in  Placenta previa

front of the  Intrauterine tumors

presenting  A small fetus

fetal part  CPD

Prepared By: MARY ELEANOR N. USIS, RN, MSN 6

Signs and Therapeutic

Breech Presentation Assessment

Prepared By: MARY ELEANOR N. USIS, RN, MSN 7

Prepared By: MARY ELEANOR N. USIS, RN, MSN 8

Inlet Contraction Outlet Contraction

 Narrowing of the  Narrowing of the

Prepared By: MARY ELEANOR N. USIS, RN, MSN 9

You assess that the fetus second stage of labor

Prepared By: MARY ELEANOR N. USIS, RN, MSN 10

Question #3 A. Prepare oxytocin using

Prepared By: MARY ELEANOR N. USIS, RN, MSN 11

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