Basic Factors Involved for Effective Contraction to Occur 1.

Evaluate fetal position, presentation, size & or

1. Contractile enzyme ATP (adenosine triphosphate)
2. Influence of major electrolyte - Calcium, sodium and
potassium
3. Specific contractile protein - actin and myosin
4. Epinephrine and norepinephrine
5. Oxytocin from posterior pituitary hormone
6. Estrogen, progesterone, prostaglandin
Complications of Labor and Delivery
1. Dystocia - abnormal, inefficient & difficult, prolonged
and more painful labor which may be mechanical or
functional.
a) Mechanical Dystocia - anything that can obstruct the
passageway
Maternal Causes
1. Contracted pelvis
2. Obstructive tumor (ovarian/ uterine fibro myoma)
3. Ineffective contractions (maternal fatigue,
exhaustion, F/E imbalances, hypoglycemia)
Fetal Causes
1. Failure of vertex to rotate (occiput posterior or
occiput transverse)
2. Fetal mal presentation (shoulder, brow, face,
breech)
3. Malformation of fetus (hydrocephalus,
anencephaly)
b) Functional Dystocia - this refers to uterine
dysfunction or inertia
1. Inertia - timed honor term to denote sluggishness of
contraction that deviate from the normal contractions
that becomes ineffectual.
Contributory Factors
a) Uterine anomalies (Infantile uterus/ septum or cornuate)
b) Over distention of uterus (hydramnios, twinning,
macrosomia)
c) Cervical scar from previous surgery
d) Anesthesia given too early
twinning.
2. Non engagement of fetal head that may indicate
contracted pelvis
3. Note any known uterine or fetal anomalies
4. X-ray pelvimetry to evaluate CPD
5. Monitor vital signs, contraction pattern and FHT every
15 minutes
6. Trial labor may be entertained (6-hour labor monitoring
to evaluate progress)
7. Last recourse is cesarean section if more than 6 hours
with maternal exhaustion and fetal distress.
Management & Nursing Interventions
1. IF OP -
a) Relive back due to sacral pressure- (Back rubs &
frequent change in position)
b) Monitor character and frequency of contractions
and FHT
c) Administer IV line to prevent DHN & provide
glucose needed for effective contraction
d) Rotate fetal head when cervix is fully dilated
(EXTERNAL CEPHALIC VERSION)
An attempt to turn the fetus from a breech or
shoulder presentation to a vertex presentation.
e) Give encouragement & reassurance to the woman
throughout labor
2. IF BREECH PRESENTATION - Labor is longer
because soft buttocks does not aid in cervical
dilatation compared to vertex
a) Amniotomy is not done until well engage due to
greater chances of cord prolapse Breech does not
fill the pelvic cavity 100%.
b) ELFA using Piper Forceps as indicated
c) CS if shoulder presentation
NOTE: Posterior presentation is common among females with
android, anthropoid, or contracted pelvis. Baby delivers with
caput succedaneum & molding if delivered vaginally.
Complication with the Power or Force of Labor

Risks Involved Due to Prolonged Labor Definition of terms

1. Postpartum infection 1. Dysfunctional Labor - denotes sluggishness of

2. Hemorrhage contractions or that the force of labor is less than usual.
3. Infant mortality
Classification
Causes
a) Primary - occurring on the onset of labor
1. Large fetus b) Secondary - occurring later in labor
2. Hypoactive, hyperactive, uncoordinated uterine 2. Ineffective Uterine Force - have less strength of
contractions uterine contraction than usual or rapid but Ineffective.
3. Uterine anomalies
4. Analgesia given too early in labor

Assessment Classification of Uterine Contraction

 1. Hypotonic Uterine Contraction - Contraction is
inadequate (lack intensity) ineffective irregular painless,
coordinated but are too week to expel the baby out. Characteristics
Contractions are infrequent (not more than 2-3 times in 1. Muscle of the uterus is in the state of greater than
10 minutes). normal tension
 This occurs in the active phase & tend to occur after 2. Contractions are painful & ineffective for
administration of anesthesia. accomplishing dilatation
 When cervix is 3-4 cm & bladder full preventing 3. UC is erratic in frequency, duration and intensity
descent. 4. Usually occurs in latent phase
 It also occurs in multiple gestation & hydramnios when 5. Contractions are uncoordinated and involved only a
uterus is lax portion of uterus
 If uterus becomes exhausted-uterus may not contract in
the postpartum period leading to Intervention
 bleeding. 1. Provide rest with the aid of sedatives (Morphine 16 mg
Intervention to reduce uterine contraction
2. Administer IV fluids to maintain hydration &
a) Pelvis is re-evaluated (pelvimetry) electrolyte balance
b) IV fluid is started for hydration & maintain F/E balance 3. Observe for normal uterine contraction when woman
c) Oxytocin may be given if pelvic size is adequate, fetal awakens
position, presentation & station are Normal. 4. Darkening room lights and decrease noise for rest and
d) Monitor FHT and uterine contraction (Duration, sleep
interval and frequency) 5. Prepare for LCCS PRN
e) If presenting part is engaged, cephalic, ripened cervix
ready for birth, no CPD and fetus is mature by date, Dangerous Effect
NSD may be allowed 1. Lack of relaxation may not allow optimal uterine artery
Complication filling so it can lead to fetal anoxia early in the latent
phase.
1. Tetanic contraction may ensue intermittent UC with Apply uterine & fetal external monitor whose pain
increased irritability & fibrillary contractions seems to be out of proportion to help identify that
2. Can cause abruptio resting phase between contractions is adequate and
3. Uterine rupture FHT is not showing late deceleration.
4. Fetal hypoxia
5. Pathologic retraction ring (Bandl's ring) Implication
Physiologic Ring - hard bands that forms around the "Second Stage Arrest" - LCCS is necessary because uterine
uterus at the junction of the upper and lower uterine contraction is strong but uterine contraction is ineffective and no
segment & interferes with fetal descent. cervical dilatation.
Implication Nursing DX
1. Prostaglandin gel may be given to ripen the cervix 1. Fatigue and anxiety R/T prolonged labor
(Evening primrose, misoprostol) 2. Fluid volume deficit as imposed by NPO
2. Oxytocin augmentation if no complication 3. Knowledge deficit about outcome of pregnancy and
3. Report maternal and fetal distress immediately effect on the baby

2. Hypertonic Uterine Contraction - Contractions that
occur frequently & commonly seen in latent phase. It
occurs because more than one uterine pacemaker
stimulate contraction or because muscle fibers of uterus
don't repolarize or relax after contraction "wiping it
clean" to accept a new pacemaker or new command.
 It is more painful than usual due to lack of relaxation
and anoxia of uterine cells result. It may not allow
optimal uterine artery filling resulting to fetal anoxia
early in latent phase.
Uncoordinated Contractions - contractions that occur so close
to one another that don't allow good Cotyledon filling.
 Erratic - no relaxation between contractions
 Presents as painful, frequent though irregular
contractions that does not cause effacement
 Or dilatation. It is important that malpresentation or
posterior presentation to be ruled out.
Management

1. Oxytocin may be indicated in the following conditions

a) Fetus is in longitudinal lie- cephalic b) Cervix is ripe and ready for birth
 c) Presenting part is engaged e) Fetus is mature by date
d) No CPD f) L/S ratio 2:1
2. Stop the contraction & rest the mother for a Maternal Complications
period of time. When contractions resume
spontaneously the condition will be resolved 1. Laceration/ hemorrhage
& labor will progress normally. 2. Infection
3. If all measures fail-induction and 3. Abruptio
augmentation of labor follows in order to 4. Uterine rupture if birth canal is not readily
assist labor that has started spontaneously but distensible
is not effective Fetal Complications
a) Oxytocin - careful observation during infusion
is an important nursing responsibility. Done 1. Intracranial hemorrhage - due to sudden
only when all the criteria above is met release of pressure from the head
4. No oxytocin drip if criteria above is not met 2. Fetal Anoxia
5. Cervical ripening - How? Cervix is expected
Assessment findings
to be firm to soft in consistency
a) Stripping or ironing the membranes or 1. Tetanic uterine contractions
separating the membranes from the lower 2. Rapid labor and delivery
uterine segment manually by gloved hands 3. Strong contractions that rupture the
b) Laminaria Technique - suppository of membranes spontaneously
seaweed that swell in contact with cervical 4. Desire to push
secretions
c) Insertion of Prostaglandin (Misoprostol, Nursing Care
Cytotec) - client must remain on bed side
1. Do not leave the patient alone
lying to absorb the drug. Other drug used are
2. Monitor FHT- to detect hypoxia from tetanic
HNBB, Evening primrose inserted vaginally-
contractions
gel like Where 6 capsules are inserted
3. Inform patient of what is happening
vaginally 1000mg/capsule. They may be
4. Assists with delivery
instructed to come back when contractions
5. Explain precipitate labor in simple terms
become more regular.
6. Never hold the baby back to uterus
d) Oxytocin drip induction may be started after
7. Inspect for laceration and assist in the
12 hours
episiorrhaphy
8. Maintain sterile environment as possible
9. Rupture membranes if necessary
Precipitate Labor - a woman who give birth with only 10. Support baby's head as it emerges, preventing
a few rapidly occurring contractions or labor that is too rapid delivery with gentle pressure
completed in 3 hours after onset of true labor.
Nursing DX
Characteristics
1. Trauma to mother and fetus from strong,
1. Cervical dilatation that occurs at a rate of 5 cm frequent uterine contractions
or more per hour in PRIMI 2. Maternal anxiety resulting from unexpected
and unusual labor pattern
Risk Factors

1. Multiparity - most common

2. Trauma
3. Large pelvis and lax soft tissues
4. Small fetus in good position
5. Severe emotional stress
6. Labor induction by Oxytocin
7. Early amniotomy
8. History of previous precipitate labor