NCM 109- Care of Mother

and Child at Risk or wifh

Problems
(Acute and Chronic)-
LECTURE
General Rule “
The earlier in labor thof a
complication is recognized, the
befter is the chance thot it con
be resolved (Buhimschi,
2009).
 Nursing care/priorities for a woman with labor
or birth complication
a. Complications with the
power
b. Problems with the
passenger
c. Problems with the
passage
d. Anomalies of the placenta
and cord
Complications • These are your contractions and your additional
• Your contractions need to be strong enough
with the power to
dilate the cervix and aid the baby in his decent

Higher risk for:

• Postpartal Infection
• Hemorrhage
• Infant Mortality
 Complications with the power

inertia is a ti me-honored
term to denote that
sIuggishness of force of
labor, has occurred A
more current term used
 Complications with the power

dysfunctional or prolonged
labor refers to prolongation
in the duration of labor,
typically in the first stage of
labor.
 Complications with the power
C o m m o n C a u s e s o f Dysfuncti onal

It is most likely to occur if a fetus is

large
Ineff ecti ve Uterine Force:
Hypotonic, hypertonic, and
uncoordinated contractions all
play additional roles
 Complications with the power
Ineff ecti ve Uterine Force

Uterine contractions are the basic force moving the fetus

through the birth canal.
 Complicati ons with the power
Ineff ecti ve U t e r i n e F o r c e

Uterine contractions

They occur because of the interplay of the

contracti le enzyme ATP and the
influence of major electrolytes as Ca
Na. and K+, specifi c contracti le
proteins (acti n and mvosin), epinephrine
and norepinephrine, oxytocin, estrogen
progestefone and prostaglandins.
 Complications with the power
Ineffective Uterine Force
Uterine contractions: Generally
speaking, the desired frequency of
uterine contractions in a normal labor
is one contration everv two to three
minutes or less than five contractions
in a 10 minute period
Hypotonic Contractions
- Hypertonic Contractions
• Uncoordinated Contractions
Wait mga momsh... balikan lang natin ito.
• Stage 1 : 0 - 10 cm.
- Active - dilate 4 -
7 cm.
- Transition - dilate
6 - 10 cm
•• E2 : From complete dilation
and
• effacement to delivery of the baby
E3 : From delivery of baby to
 Wait mga momsh... balikan lang natin ito.
• Stage 1: • Stage 2: Pushing
Dilatlon Phase 1: • Stage 3: Placenta
Early &6 cm Phase 2:
Actlve 6-8 cm • Stage 4: Recovery
Phase3. Transition 8-10
cm
 Complications with the power
Ineffecti ve Uterine Force
Uterine contractions:
- Hypotonic Uterine Force
The contractions is usually low or infrequent (not more two or
three occurring in a 10 minute period)
- Usually occurs during active phase of labor
- Occur in uterus that is overstretched
- Not painful (but subjective to woman)
- Increase the length of labor
- Increase hemorrhage
 Complications with the power
Ineff ectlve Uterine Force

Uterine contractions:
Hypertonic Contractions
- The contractions occur frequently
- Commonly seen during the latent phase
of labor
- More painful
- May lead to fetal anoxia
 Complications with the power
Ineffective Uterine Force
TABLE 23.1 S Conversion of Hypotonic and hypertonic
Contraction
Crlterie Hypertonic Hypotonic
Phase of labor Latent Active
Symptbms Painful Limited
pain
Meclications uced:
Oxytocin Unfavorable Favorable
reaction reaction
Sedation Helpful Liltle value
 Complications with the power
Ineffective Uterine Force
• Hypotonic Contractions
• Hypertonic Contractions
• Uncoordinated Contractions
 Complications with the power
Dysfunction at the First Stage of Labor

Prolonged Latent Phase - The cervix is not ripe

Management:
• Changing linen and gown
- Decreasing noise and stimulation
• Darkening room lights
• Amniotomy
• Oxytocin administration
• Ceasarean Section
 Complications with the power
Dysfuncti on at the First S tage of Labor

Protracted Acti ve Phase - Associated with cephalopelvic

disproportion (CPD) or fetal malposition

Management:
Oxytocin Administration
• CPD – Cesarean Section
 Complications with the power
Dysfunction at the first stage of labor

Prolonged Deceleration Phase –

occurs when it extends beyond 3 hours
in nullipara or 1 hour in mulitpara
- Occur due to abnormal fetal head
position

Management:
Cesarean Section
 Complications with the power
Dysfunction at the First Stage of Labor
Secondary Arrest of Dilation - Occur if there is no progress in
cervical dilatation for longer than 2 hours

Management:
Cesarean Section
 Complications with the power
Dysfuncti on at the First Stage of Labor

Prolonged Descent - Second stage lasts over 3 hours

Management:
If CPD, poor fetal presentation have been ruled out:
- Rupture of amniotic fluid
ocin Administration
Positioning:
semi-fowler's. squatting, kneeling, pushing
 Complications with the power
Dysfuncti on at the First S t a g e o f Labor

Arrest of Descent - Expected descent of the fetus does not begin

or engagement r movement beyond 0 station has not occurred.

Management:
If CPD occur:
Caesarean Secti on

Vaginal delivery if no contraindication through administration of

oxytocin
 Complications with the power
Common Causes of Dysfunctional Labor:

Inappropriate use of analgesia

Poor fetal position
Extension rather than flexion of the fetal head

Overdistention of the uterus

Cervical rigidity (unripe)
Presence of a full rectum or urinary bladder
Woman becoming exhausted from labor
Primigravida status
TEST YOUR KNOWLEDGEKUNG
MAY ...
Nung tinanong ka ng pasyente mo patungkol sa Stage 1 ng pag-labor
nya, ano ang mga phases na kasama? Piliin and tamang pagkakasunod
sunod.

• A. Transition, Latent,
Active
• B. Active, Latent,
Transition
• C.Active, Transition,
Latent
•
TEST YOUR KNOWLEDGE KUNG /V\AY...
You overheard the discussion of patient and
the new nurse. The patient asked the nurse
regarding the labor and the new nurse
responded that the stage 2 of labor begins
with the delivery of the baby and ends with
the delivery of thR placenta.

• Katotohanan
• Kasinungalingan.
 Complications with the power
Contraction Rings - A hard band tnat forms across tne
uterus at the iunction of the upper and
ower uterine segments and interferes with fetal descent
- Pathologic Retraction Ring (Bandl's Ring) Is the
most frequent type

Management:
Adm inistration of morphine IV
Tocolytic*
Ceasa rean Section
Manual evacuation of placenta
 Complications with the power

A contraction ring is a s
asmodic contraction of the lower
ortion of tne uterus wnicn
usually occurs during the first
phase of labour, but persists into
tne second stage.
 Complicati ons with the power
Precipitate Labor
Uterine contractions are so stronq tnat a woman
gives birth with only few, rapidIy occurring
contractions
Labor that is completed in fewer than 3 hours
May occur after induction of labor by oxytocin or
amniotomv

Management: tocolytic administrati on

 Complications with the power
Precipitate Labor
 Complications with the power
Precipitous Labor

Labor < 3 hours from onset

 Comphcations:
• Woman
• Loss of coping ability
• Lacerations of cervix, vagina, perineum
 Fetus
• Hypoxia
• Cerebral trauma
• pneumothorax
 Complications with the power
Precipitate Labor

The most com mon tocolytic ag ents

used for the treatment of preterm la
bor a rd m a g n e s i u m sulfate
(MgSO4), indomethacin, and
nifedipine
Induction and Augmentation of Labor

-Induction of Labor —
started artificially

-Augmentation of Labor —
refers to assisting labor that has
started spontaneously but is not
effective.
Inducti on and Augmentati on of Labor

Reasons:
Fetus is in danger
Te r m b a b y b u t n o s p onta n e ou s uterine contracti on

Diabetes
Rh sensitization
Prolonged rupture of membrane
Post mature
Induction and Augmentation of Labor

Consideration to perform Induction

and Augmentation of Labor
• The fetus is in longitudinal llie
• The cervix is ripe, or ready for birth
• A presenting port is engaged
• There is no CPd
• The felus is estimated to be mature
by date
 Induction and Augmentation of Labor
Procedures:
Cervical Ripeninq: A more commonly used
method of speeding cervical ripening is the
application of a prostaglandin gel, such as
misoprostol.

Administration of Oxytocin: Administration of

oxytocin (synthetic form of naturally occurring
pituitary hormone) initiates contractions in a uterus at
pregnancy term (Archie, 2007).
 Uterine Rupture
- Occurs when a uterus undergoes more strain than it
is capable of sustaining
- Strong contraction without cervical dilatation

Causes:
• Prolonged labor
• Abnormal presentation
• Multiple Gestation
• Unwise use of oxytocin
• Obstructed Labor
• Traumatic Manoeuvres
 Uterine Rupture
Sign/Symptoms:
Sudden, Severe pain during uterine
contraction (Tearing sensation) Sign of
shock

Management:
• Ceasarean Section
• Fluid Replacement Therapy
• Oxytocin Administration
• Possible laparotomy or hysterectomy
• Advised not to conceive again
 Hindi ka man sinagot ng nililigawan mo, at
least dito may sagot p a ra sayo uwu!
You are assigned in LR and your patient has transitioned to stage 2 of
labor. What are the changes in the perineum may indicate the birth
of the baby is imminent?
Increase jn meconium-stained fluid and retracting perinE'UF0
Retracting perineum and anus with an increase of bloody
show Rapid and intense contractions
•D. Bulging perineum and rectum with an increase in bloody
show.
 Hindi ka man sinagot ng nililigawan mo, at l east dito
may s a got p a r a sayo uwu!

When your patient in the LR suddenly hava a uterine

rupture, which of the following would be the priority.

a) Limiting hypovolemic shock

b) Obtaining blood specimens
c) Instituting complete bed rest
d) Inserting a urinary catheter
 Uterine Inversion
- Refers to the uterus turning inside
out with either birth of the fetus or
delivery of the placenta
- Occurs when traction is applied to
the umbilical cord to remove the
placenta
- Occurs when pressure is applied
to uterine fundus when the uterus
is not contracted
 Uterine Invers ion
- Management:
• Never attempt to replace
inversion
• Never attempt to remove the placenta
• Start an IV line
• Administer oxygen by mask
• Perform CPR if CP arrest
• Antibiotic Therapy
• Ceasarean Section for future
pregnancy
 Amniotic Fluid Embolism
- Occurs when amniotic fluid is forced into an open maternal uterine
blood sinus through some defect in the membranes or after
membrane rupture O r partial premature separation of the
placenta.
- Not preventable because it cannot be predicted

Sign/Symptoms:
- Sharp pain in the chest
- Inability to breathe
- Pale then turn to bluish gray
Amniotic Fluid Embolism

Management:
O Administration of oxygen by
cannula or mask
O Perform CPR
Amniotic FIuid Embolis m

Management!
Administration of oxygen by
cannula or mask
Perform CPR

What is lhe nursing priority in

amniotic fI id embolism?
Medical and Nursing
Interventions for Amniolic Fluid
Embolism.
(1) Give immediate and vigorous
treatment.
 Kung CP gamit mo, zoom mo na lang
Your patient is admitted to the labor room at 36 weeks'
gestation. She has a history of C-section and complains of
severe abdominal pain that started less than 1 hour earlier When
the nurse palpates tetanic contractions, the client again
complains of severe pain After the client vomits, she states
that the pain is better and then passes out. Which is the
probable cause of her signs and symptoms?

A. Hysteria compounded by the flu

B. Placental abruption
c. Uterine rupturE
D. Dysfunctional labor
 Test your knowledge dito so lost question
A nurse in a labor room is assisting with the
vaginal delivery of a newborn infant. The nurse
would monitor the client closely for the risk of
uterine rupture if which of the following
occurred?

a) Hypotonic contractions
b) Forceps delivery
c) Schultz delivery
d) Weak bearing down efforts
“ s ) End of morning
'9 session

prepare for your