COMPLICATIONS OF LABOR AND BIRTH
maternal signs, FHR, contractions for later comparison,
INDUCTION OR STIMULATION OF LABOR
- Is prompting the uterus to contract during
pregnancy before labor begins on its own for a
vaginal birth.
- Augmentation of labor: assisting client when
labor process is not progressing normally
(prolonged labor) by pharmacologic or mechanical
means.
ELECTIVE INDUCTION: initiation of labor contractions
by:
 Pharmacologic means
 Vaginal insertion of prostaglandin E2 to promote
cervical softening and effacement (ripening)
 8-12 hrs after prostaglandin E2 administration, pump
infusion of oxytocin (Pitocin) to stimulate contractions
 Mechanical means
 Amniotomy
 Insertion of Laminaria
 Stimulation of breast
MEDICATION-INDUCED LABOR
 Prostaglandin: Dinoprostone (Prepidil, Prostin E2
[suppository gel])
 Keep the suppository cold and bring it to room
temperature before insertion
 Monitor for the following side effects: headache,
nausea, vomiting, hypotension, hypertension, dyspnea,
and uterine hyperstimulation.
 Oxytoxic: Oxytocin (Pitocin, Syntocinon [intravenous
drip])
 Monitor vital signs and fetal heart rate closely.
 Assess the contractile pattern.
 Limit IV fluids to 150 ml/hour.
 Monitor for water intoxication.
Nursing Management
 Monitor for safe and labor and delivery process. AROM
 Explain the procedure, and inform the client that labor
usually follows within 6-8 hrs of AROM.
 Monitor for fetal heart tones immediately before,
during, and after the procedure.
 Observe and record color, amount, and odor of amniotic
fluid; time of procedure; cervical status; and maternal
temperature.
 Take and record the client’s temperature every 2 hrs to
assess for infection.
 Monitor for the onset of labor.
Assessment
 Obstetric history, including expected date of birth
(EDD)
 Maternal status: parity; contractions; status of
membranes; status of cervix; ultrasonographic findings;
level of anxiety
 Fetal status: gestational age; absence of cephalopelvic
disproportion; position; results of fetal monitoring.
Planning/Implementation
 Prepare mother and labor coach for induction; explain
all procedures; obtain informed consent whenever
necessary.
 Obtain and record baseline information such as
continue to monitor all vital indices
 Monitor Pitocin administration
 Monitor effect of prostaglandin: if hypertonic
contraction occur, discontinue infusion; if they persist,
prepare for a tocolytic therapy
 Assist with artificial rupture of membranes
(Amniotomy)
 Maintain hydration
 Provide for blood typing, Rh compatibly cross-
matching
 Have oxygen, suction, and resuscitation equipment
readily available
 Prepare for emergency cesarean birth if necessary
Evaluation/Outcomes
 Progresses through labor to safe delivery newborn
 Remains free from complications
PREMATURE RUPTURE OF MEMBRANES
- Is a rupture (breaking open) of the membranes
(amniotic sac) before labor begins
- If PROM occurs before 37 wks of pregnancy =
PPROM Premature rupture of membranes
- PROM occurs in about 8-10% of all pregnancies
Signs and Symptoms
 Sudden gush of fluid from the vagina
 Fever, heavy or foul-smelling vaginal discharge,
abdominal pain, and fetal tachycardia, (intra-
amniotic infection)
Pathophysiology
 PROM is associated with malpresentation, possible
weak areas in the amnion and chorion, subclinical
infection, and possibly, incompetent cervix.
 Basic and effective defense against the fetus contracting
on infection is lost and the risk of ascending intrauterine
infection, known as CHORIOAMNIONITIS, is
increased.
 The leading cause of death associated with PROM is
infection
 When the latent period (time between ROM and onset
of labor) is less than 24 hours, the risk of infection is
low.
PROM (Premature Rupture of Membranes) – can also be
used to mean prolonged rupture of membranes.
PPROM (Preterm Premature Rupture of Membranes) – is
before 37 weeks
SROM (Spontaneous Rupture of Membranes)
ROM (Rupture of Membranes)
Assessment
 Amniotic fluid gushing from the vagina
 Laboratory and diagnostic study findings
 Ferning (Fern Test)
 Nitrazine test tape
Nursing Management
 Prevent infection and other potential complications
 Provide client and family education

PRETERM LABOR
- Preterm labor occurs when regular contractions
result in the opening of your cervix after week 20
and before week 37 of pregnancy.
- Preterm labor can result in premature birth.
Etiology
 PROM
 Preeclampsia
 Hydramnios
 Placenta previa
 Abruption placentae
 Incompetent cervix
 Trauma
 Uterine structural anomalies
 Multiple gestation
 Intrauterine infection (chorioamnionitis)
 Congenital adrenal hyperplasia
 Fetal death
 Maternal factors, such as stress (physical and
emotional), UTI, and dehydration
Risk Factors
 Previous preterm labor or premature birth, particularly
in the most recent pregnancy or in more than one
previous pregnancy
 Pregnancy with twins, triplets or other multiples
 Shortened cervix
 Problems with the uterus or placenta
 Smoking cigarettes or using illicit drugs
 Certain infections, particularly of the amniotic fluid and
lower genital tract
 Some chronic conditions, such as high BP, diabetes,
autoimmune disease and depression
 Stressful life events, such as the death of a loved one
 Too much amniotic fluid (polyhydramnios)
 Vaginal bleeding during pregnancy
 Presence of a fetal birth defect
 An interval or less than 12 months – or of more than 59
months – between pregnancies
Signs and Symptoms
 Regular or frequent sensations of abdominal tightening
(contractions)
 Constant low, dull backache
 A sensation of pelvic or lower abdominal pressure
 Mild abdominal cramps
 Vaginal spotting or light bleeding
 Preterm rupture of membranes – in a gush or a
continuous trickle of fluid after the membrane around
the baby breaks or tears
 A change in type of vaginal discharge – watery, mucus-
like or bloody
Nursing Care Plan and Management
 Assess the mother’s condition and evaluate signs of
labor
 Evaluate the fetus for distress, size, and maturity
 Perform measures to manage or stop preterm labor
 Provide physical and emotional support
 Provide adequate hydration
 Provide client and family education
POST TERM LABOR
- A pregnancy that lasts more than 42 wks= POST
TERM
- A pregnancy that is bet. 41 & 42 wks = LATE TERM
- Most women deliver between 37 and 42 weeks of
pregnancy
Assessment
 Number of weeks of gestation; date of last menstrual
period; EDB
 Biophysical profile, particularly amount of amniotic
fluid
 FHR; results of stress and nonstress tests
 Presence of meconium
 Level of anxiety related to delayed date of birth
Nursing Diagnoses
 Fear related to fetal well-being because of aging
placenta and decreased amniotic fluid
 Risk for injury to mother and neonate related to large
size of neonate
Nursing Management
 Carefully assess the fetus to identity risk.
 Prevent birth complications.
 Provide physical and emotional support.
 Provide client and family education.
DYSTOCIA
 Dysfunctional labor is difficult, painful, prolonged labor
due to mechanical factors.
Etiology
 Fetal factors (passenger): unusually large fetus, fetal
anomaly, malpresentation, and malposition
 Uterine factors (powers): hypotonic labor, hypertonic
labor, precipitous labor, and prolonged labor.
 Pelvic factors (passage): inlet contracture, midpelvis
contracture, and outlet contracture.
 "Psyche" factors: maternal anxiety and fear and lack
of preparation.
Assessment
 Irregular uterine contractions and ineffective uterine
contractions in terms of contractile strength and
duration.
Nursing Management
 Optimize uterine activity. Monitor uterine contractions
for dysfunctional patterns; use palpation and an
electronic monitor.
 Prevent unnecessary fatigue. Check the client's level of
fatigue and ability to cope with pain.
 Prevent complications of labor for the client and infant.
 Provide physical and emotional support.
 Provide client and family education.
PRECIPITATE LABOR
- Precipitous labor (or rapid labor) describes labor
that's quick and short.
- Rapid labor and birth of less than 2-hour duration
 - Hazards to mother are perineal laceration and
postpartum hemorrhage
Assessment
 Rapid cervical dilation
 Accelerated fetal descent
 History of rapid labor
 Rapid uterine contractions with decreased periods of
relaxation between contractions
Nursing Diagnoses
 Risk for maternal injury related to rapid expulsion
of fetus resulting in lacerations and hemorrhage
 Risk for fetal trauma related to cranial battering
during rapid birth
Planning and Implementation
 Remain with mother and monitor closely
 Keep emergency birth pack at bedside
 Keep mother and partner informed throughout process
of labor and birth
 Support and guide fetal head through birth canal when
birth occurs
Evaluation/Outcomes
 Mother remains injury free
 Neonate remains injury free
BREECH BIRTH
- Position of fetus in which buttocks alone (frank
breech), buttocks and feet (complete breech), or
one or both feet (footling) descend through the
birth canal first
- Maternal implication: required, especially in
cesarean birth may be primigravida
- Fetal implications:
Increased mortality
Occurrence of prolapsed cord leading to
asphyxia
Birth trauma such as brachial palsy and
fracture of the upper extremities
Assessment
 Recognition of breech presentation on performing
Leopold's maneuvers and vaginal examination
 Auscultation of fetal heart tones above umbilicus
 Presence of meconium without signs of fetal distress
Nursing Diagnoses
 Pain related to prolonged posterior pressure of
fetal buttocks
 Risk for maternal or neonatal injury related to
difficult birth
 Risk for suffocation of fetus related to interruption
in umbilical blood flow because of umbilical cord
compression
Implementation
 Use measure to promote comfort
 Monitor the FHR in upper quadrants
 Watch for prolapsed cord. If it occurs:
a. With a sterile gloved hand, push the presenting
part off the cord
b. Place the client in the Trendelenburg position
to keep presenting part away from the cord
c. Keep prolapsed cord moist with sterile saline
 Observe for frank meconium; results from contraction
of the uterus on lower colon of the fetus; not significant
in breech birth
 Add Piper forceps to the delivery set-up if vaginal birth
is anticipated
 Prepare client for cesarean birth; usually done in
primigravidas
 Teach mother and partner about the process of breech
birth
CESAREAN BIRTH
- Birth of infant via transabdominal incision:
transverse incision; lower uterine vertical Incision.
- Indicated in cephalopelvic disproportion, dystocia,
placenta previa and abruptio placentae,
postmaturity. growths within the birth canal,
multiple births, diabetes, PIH, Rh incompatibility,
fetal distress, active herpes, and malpresentations
such as breech birth
- Vaginal birth after cesarean (VBAC) is being
done more frequently
Assessment
 Vital signs
 Abdominal dressing: intact; presence of bleeding
 Fundus and lochia: lochia may be less than that with
vaginal birth
 Urinary output: amount; specific gravity; presence of
blood
 Neurovascular status following regional anesthesia
 Presence of pain
 Response to neonate
Implementation
 Assist with bonding: offer emotional support;
encourage touching; include father in process
 Encourage early ambulation to prevent blood stasis and
promote peristalsis
 Check vital signs, fundus, and abdominal incision:
maintain IV infusion of oxytocin if ordered
 Encourage eating of solids to promote peristalsis
(prevents distention) when bowel sounds have returned
 Administer analgesics as ordered
 Promote lung aeration: deep breathing and coughing:
Incentive spirometer
 Maintain fluid and electrolyte balance: monitor intake
and output
 Monitor urinary output
Evaluation/Outcomes
 States relief from pain
 Maintains urinary and fecal elimination
 Remains free from complications
 Demonstrates bonding with newborn