EMERGENCIES DURING

CHILDBIRTH

Health is a state of complete

physical, mental and social well-
being and not merely the
absence of disease or infirmity
Prolapse umbilical cord
• The umbilical cord prolapses if it slips
downward after the membranes have
ruptured
• In this position it can be compressed between
the fetal head and the woman’s pelvis,
interrupting blood supply to and from the
placenta
Classification
 Risk factors:
• It is more likely if the fetus does not fill
completely the space in the pelvis or if fluid
pressure is great when the membranes
rupture like:
– Fetus is high in the pelvis when the membranes
rupture (presenting part is not engaged)
– Very small fetus, as in prematurity
– Abnormal presentations, such as footling breech
or transverse lie
– Hydramnios (excess amniotic fluid)
 Medical treatment:
• First action is to displace the fetus upward to
stop compression against the pelvis
– Maternal positions such as knee-chest,
Trendelenburg can accomplish the displacement
– Side-lying with hips elevated on pillows
– The experienced physician may push the fetus
upward from the vagina
• Oxygen and a tocolytic drug such as
terbutaline may be indicated
• The primary focus is to deliver the fetus by the
quickest possible means, usually cesarean
delivery
Medical treatment
 Nursing care:
• Monitor FHT regularly
• Position client to promote relief of
compression
• In addition to prompt corrective actions and
assisting with emergency procedures, the
nurse should remain calm to avoid the
woman's anxiety
• After birth, help the woman understand the
experience
UTERINE RUPTURE
• A tear in the uterine wall occurs if the muscle
cannot withstand the pressure inside the
organ
Complete Rupture
• There is a hole through the uterine wall, from
the uterine cavity to the abdominal cavity
Incomplete Rupture
Incomplete Rupture
• The uterus tears into a nearby structure, such
as a ligament, but not all the way into the
abdominal cavity
Dehiscence
• An old uterine scar, usually from a cesarean
birth, separates
 Risk factors:
• Women with previous surgery on the uterus
– Classical incision prone to rupture
– Low transverse uterine incision is least likely to
rupture
• Grandmultiparity
• Intense labor contractions, oxytocin
stimulation
• Blunt abdominal trauma
 Characteristics:
• The woman may have no symptoms, or she
may have sudden onset of severe signs and
symptoms, such as:
– Shocked caused by bleeding into the abdomen (
vaginal bleeding may be minimal)
– Abdominal pain, pain in the chest, between the
scapula or with inspiration
– Cessation of contractions
– Abnormal or absent fetal heart tones
– Palpitations of the fetus outside the uterus
 Medical management:
• Surgery
• Hysterectomy for extensive tear while small
tears can be surgically repaired
 Nursing care:
• Monitor closely clients receiving oxytocin or in
trial labor for VBAC
• Monitor client’s vital signs
• Place in trendelenburg if in shock ( rising pulse
rate and falling blood pressure
• Notify physician immediately
UTERINE INVERSION
• Occurs if the uterus turns inside out after the
infant is born
• May be partial or complete
• A small depression in the top of the uterus is
not in the abdomen and protrudes from the
vagina with its inner surface showing is a
common manifestation
• Rapid onset of shock is common
 Causes:
• Uterus is not firmly contracted and health care
provider pulls the cord to deliver the placenta
• Vigorous fundal massage when the uterus is
not firm and is pushed downward toward the
pelvis
Degrees of Uterine Inversion
 Medical treatment:
• Physician will try to replace the inverted
uterus while the woman is under general
anesthesia
• After the uterus is replaced, oxytocin is given
to contract the uterus and control bleeding
• If replacement is unsuccessful, hysterectomy
is indicated
 Nursing care:
• Assess client’s uterus at least every 15
minutes for firmness, height and deviations (
the lower uterus is supported every
assessment )
• Monitor vital signs and signs of bleeding
• An indwelling catheter may be used to keep
bladder empty so that the uterus will contract
well
– Assess patency
• Provide emotional support
• Occurs when amniotic fluid, with its particles
such as vernix, fetal hair and sometimes
meconium, enters the woman’s circulation
and obstructs small blood vessels in the lungs
• Likely to occur during a very strong labor
because the fluid is “pushed” into small blood
vessels that rupture as the cervix dilates.
• Characterized by abrupt onset of hypotension,
respiratory distress, and coagulation
abnormalities triggered by the thromboplastin
contained in the amniotic fluid
 Treatment includes:
• Providing respiratory support with intubation
and mechanical ventilation as necessary
• Treating shock with electrolytes and volume
expanders
• Replacing coagulation factors such as platelets
and fibrinogen
• Packed RBC are sometimes given
intravenously
 Nursing care:
• Assist in the above treatment
• Monitor intake and output
• Monitor oxygen saturation
General Trauma