Nursing care of client with

High Risk labor and delivery/

Complications of Labor and Delivery
JENELYN A. OJOYLAN, RN, MN
 Introduction to
Complications of Labor
and Delivery
 Usually, labor and delivery occur without any
problems. Serious problems are relatively rare, and
most can be anticipated and treated effectively.
However, problems sometimes develop suddenly and
unexpectedly. Regular visits to a doctor or certified
nurse midwife during pregnancy make anticipation of
problems possible and improve the chances of having
a healthy baby and safe delivery.
Problems may involve:

-The timing of labor—whether labor occurs earlier

or later than normal
-Problems in the fetus or newborn
-Problems in the mother
-A problem with the placenta called placenta
accreta (abnormally firm attachment to the uterus)
Most problems are obvious before labor begins.
Such problems include

-Prelabor (premature) rupture of the membranes (the

mother's water breaks too soon)
-Postterm pregnancy and post maturity (a pregnancy
continues longer than normal, sometimes causing
problems with the baby)
-Abnormal position and presentation of the fetus (the
fetus is in the wrong position for the safest delivery)
-Multiple births (such as twins or triplets)
Some problems (complications) that women
develop during pregnancy can cause problems
during labor or delivery. For example, 
preeclampsia (high blood pressure with protein in
the urine) may lead to premature detachment of
the placenta from the uterus (placental abruption)
and problems in the newborn.
Some problems develop or become obvious during labor or delivery.
Such problems include

-Amniotic fluid embolism (the fluid that surrounds the fetus in the uterus
enters the woman’s bloodstream, sometimes causing a life-threatening
reaction in the woman)
-Shoulder dystocia (the fetus's shoulder lodges against the woman's pubic
bone, and the baby is caught in the birth canal)
-Labor that starts too early (preterm labor)
-Labor that progresses too slowly
-Prolapsed umbilical cord (the umbilical cord comes out of the birth canal
before the baby)
-Nuchal cord (the umbilical cord is wrapped around the baby's neck)
-A fetus that is too large to pass through the birth canal (pelvis and vagina)—
called fetopelvic disproportion
-Rarely, spontaneous tearing (rupture) of the uterus
When complications develop, alternatives to
spontaneous labor and vaginal delivery may be
needed. They include

-Artificial starting of labor (induction of labor)

-Forceps or a vacuum extractor (called operative
vaginal delivery) to deliver the baby
-Cesarean delivery
Some problems occur immediately after delivery of
the fetus, around the time the placenta is delivered.
They include

-Excessive uterine bleeding at delivery

-A uterus that is turned inside out (inverted uterus)
Some problems occur immediately after delivery of
the fetus, around the time the placenta is delivered.
They include

-Excessive uterine bleeding at delivery

-A uterus that is turned inside out (inverted uterus)
Timing of Labor and
Delivery
No more than 10% of women deliver on their
specified due date

(usually estimated to be about 40 weeks of

pregnancy).

About 50% of women deliver within 1 week (before

or after), and almost 90% deliver within 2 weeks of
the due date.
Labor may start

-Too early (preterm): Before the 37th week of

pregnancy

-Late (post term): After the 42nd week of pregnancy

In such cases, the health or life of the fetus may be
endangered.

Labor may be early or late because the woman or

fetus has a medical problem or the fetus is in an
abnormal position.
Determining the length of pregnancy can be difficult
because the precise date of conception often
cannot be determined.

Early in pregnancy, an ultrasound examination,

which is safe and painless, can help determine the
length of pregnancy.

In mid to late pregnancy, ultrasound examinations

are less reliable in determining the length of
pregnancy.
Abnormal Position
and Presentation
of the Fetus
Position refers to whether the fetus is facing
rearward (toward the woman’s back—that is,
face down when the woman lies on her back) or
forward (face up).
Abnormal Position
Presentation refers to the part of the fetus’s
body and Presentation
that leads the way out through the birth
canal (called the presenting
of the Fetus part). Usually, the
head leads the way, but sometimes the buttocks
or a shoulder leads the way.
Toward the end of pregnancy, the fetus moves
into position for delivery. Normally, the position
of a fetus is facing rearward (toward the
woman’s back) with the face and body angled to
one side and the neck flexed, and presentation
Abnormal
is head first. Position
and Presentation
An abnormal position
of the is facing forward, and
Fetus
abnormal presentations include face, brow,
breech, and shoulder.
Abnormal Position
and Presentation
of the Fetus
Abnormal Position
and Presentation
of the Fetus
Occiput posterior presentation
In occiput posterior presentation (also called
sunny-side up), the fetus is head first but is
facing up (toward the mother's abdomen). It is
the most common abnormal position or
presentation.
Abnormal Position
and Presentation
of the Fetus
When a fetus faces up, the neck is often
straightened rather than bent, and the head
requires more space to pass through the birth
canal. Delivery by a vacuum extractor or
forceps or cesarean delivery may be necessary.
Abnormal Position
and Presentation
of the Fetus
 Breech presentation
In breech presentation, the buttocks or
sometimes the feet present first. Breech
presentation occurs in 3 to 4% of full-term
deliveries. It is the second most common type
Abnormal
of abnormal Position
presentation.
and Presentation
of the Fetus
When delivered vaginally, babies that present
buttocks first are more likely to be injured than
those that present head first. Such injuries may
occur before, during, or after birth. The baby
may even die. Complications are less likely
when breech presentation is detected before
laborAbnormal
or delivery. Position
and Presentation
of the Fetus
In face presentation, the neck arches
back so that the face presents first.

In brow presentation, the neck is

moderately arched so that the brow
presents first the Fetus

Usually, fetuses do not stay in a face or brow presentation.

They often correct themselves. If they do not, forceps,
vacuum extractor, or cesarean delivery may be used.
In transverse lie, the fetus lies horizontally across the birth
canal and presents shoulder first. A cesarean delivery is
done, unless the fetus is the second in a set of twins. In such
a case, the fetus may be turned to be delivered through the
vagina.
 Shoulder Dystocia
occurs when one shoulder of the fetus lodges against the
woman’s pubic bone, and the baby is therefore caught in the
birth canal.

In shoulder dystocia, the fetus is 

positioned normally (head first) for delivery, but
the fetus’s shoulder becomes lodged against the
woman’s pubic bone as the fetus’s head comes
out. (The two pubic bones are part of the pelvic
bone. They are joined together by cartilage at
the bottom of the pelvis, behind the vaginal
opening.) Consequently, the head is pulled back
tightly against the vaginal opening. The baby
cannot breathe because the chest and umbilical
cord are compressed by the birth canal. As a
result, oxygen levels in the baby’s blood
decrease.
Shoulder dystocia is not common, but it is more common
when any of the following is present:

 A large fetus is present.

 Labor is difficult, long, or rapid.
 A vacuum extractor or forceps is used because the fetus’s
head has not fully moved down (descended) in the
pelvis.
 Women are obese.
 Women have diabetes.
 Women have had a previous baby with shoulder
dystocia.
When this complication occurs, the doctor quickly
tries various techniques to free the shoulder so that
the baby can be delivered vaginally. Sometimes
when these techniques are tried, the nerves to the
baby’s arm are damaged or the baby’s arm bone or
collarbone may be broken.

An episiotomy (an incision that widens the opening

of the vagina) may be done to help with delivery.
If these techniques are unsuccessful, the baby may
be pushed back into the vagina and delivered
by cesarean . If all of these techniques are
unsuccessful, the baby may die.
Shoulder dystocia increases the risk of problems and of
death in the newborn. The newborn's bones may be broken
during delivery, and the brachial plexus (the network of
nerves that sends signals from the spinal cord to the
shoulders, arms, and hands) may be injured.
The woman is also more likely to have problems such as
Excessive bleeding at delivery (postpartum hemorrhage)
Tears in the area between the vaginal opening and the anus
Injury of muscles in the genital area and nerves in the groin
Separation of the pubic bones.
 Assignment

Based on what we have discussed on

the Abnormal Position and Presentation
of the Fetus, Identify problems that the
pregnant women may experience
during labor and delivery and make 3
NCPs specific to complications of
pregnancy.