Caring for the Woman Experiencing Complications During Labor and Birth

1
Chapter 14

• Caring for the Woman Experiencing Complications
  During Labor and Birth
• Catherine Marin, MSN/Ed(c), WHCNP, RN

2
Dystocia

• Long, difficult, or abnormal labor
• May arise from
• Powers
• Passenger
• Passageway

3
Dysfunctional Labor Pattern Hypertonic

• Strong, painful, ineffective contractions
• Contributing factormaternal anxiety
• Occiput-posterior malposition of fetus
• Management
• Rest, hydration, sedation
• Facilitate rotation of the fetal head

4
Dysfunctional Labor Pattern Hypotonic

• Contractions decrease in frequency and intensity
• Maternal and fetal factors that produce excessive
  uterine stretching
• Management
• Walking, position changes
• Augmentation of labor

5
Precipitate Labor and Birth

• Rapid intense contractions
• Nursing considerations
• Careful examination for dilation and effacement
• Reassure woman and support person
• Breathing to avoid pushing and prevent tearing
• Careful examination of maternal soft tissue and
  placenta

6
Pelvic Structure Alterations

• Pelvic dystocia
• Soft tissue dystocia
• Trial of labor
• To assess safety of vaginal birth

7
Obstetric InterventionsAmnioinfusion

• Risks infection, overdistention of uterus,
  increased uterine tone
• Nursing
• Careful monitoring of infusion, intensity and
  frequency of contractions, and maternal vital
  signs
• Educate
• Pharmacological induction of labor
• Nonpharmacological stimulants of labor

8
Obstetric InterventionsAmniotomy

• Artificial rupture of membranes
• Augment or induce labor
• Nursing
• Careful monitoring of vital signs, cervical
  effacement/dilation, station, FHR, contractions
• Document regarding amniotic fluid

9
Induction of Labor

• Indications for induction
• Bishop score
• Cervical ripening agents
• Mechanical methods
• Oxytocin
• Augmentation of labor

10
InductionNursing Considerations

• Informed consent
• Careful monitoring of labor
• Discuss pain relief measures
• Position changes
• Keep patient and support person informed of
  progress

11
Instrumentation Assistance of Birth

• Forceps
• Vacuum extraction

12
Maternal ComplicationsHypertensive Disorders

• Preeclampsia-eclampsia, HELLP syndrome
• Nursing
• Careful assessments
• Monitor lab values
• Administer platelets as appropriate
• Ongoing education

13
Maternal ComplicationsDiabetes

• Fetal lung maturity
• Intrapartum managementmaternal hydration and
  blood glucose levels
• Labor normal progression of labor
• Upright or side-lying position
• Encourage breastfeeding

14
Preterm Labor and Birth

• Careful maternal monitoring
• FHR monitoring
• Identify and report symptoms suggestive of fetal
  hypoxia
• Assess psychological status

15
Labor and Birth ComplicationsFetal

• Fetal malpresentation
• Version external or internal
• Shoulder dystocia- McRoberts Maneuver
• Cephalopelvic disproportion
• Multiple gestation
• Non-reassuring FHR patterns

16
Amniotic Fluid Complications

• Oligohydramnios
• Hydramnios
• Meconium
• Nuchal cord

17
ComplicationsPlacental Problems

• Placenta previa
• Placental abruption
• Disseminated intravascular coagulation

18
Other Complications

• Uterine rupture
• Obstetric emergency
• Uterine inversion
• Umbilical cord prolapse

19
VariationsUmbilical Cord and Placenta

• Velamentous cord insertion
• Fetal vessels separate at distal end and insert
  into placenta away from the margin
• Vasa previa
• fetal blood vessels, unsupported by either the
  umbilical cord or placental tissue, traverse the
  fetal membranes (bag of waters) across the lower
  segment of the uterus between the baby and the
  cervical opening

20
Placental Variations

• Circumvallate placenta
• Succenturiate placenta
• Battledore placenta
• Placenta accreta
• Placenta increta
• Placenta percreta

21
Amniotic Fluid Embolism

• Rapidly deteriorating maternal condition
• Acute dyspnea, severe hypotension
• Rapid delivery after stabilizing mother
• Ethical conflict
• Save mother versus fetus

22
Collaboration in Perinatal Emergencies
23
Perinatal Fetal Loss

• Nursing considerations
• What to say
• What not to say

24
Cesarean Birth

• Indications
• Health of mother or fetus is jeopardized
• Ethical considerations
• Surgical procedures
• Surgical and postoperative care
• Vaginal birth after cesarean

25
Postterm/Prolonged Pregnancy

• Posttermextends beyond 42 weeks
• Risk for fetal/neonatal problems
• Increased maternal risk
• Managementlabor induction
• Nursing implications