High Risk Labor and Delivery FETAL DANGER SIGNS OF LABOR

Problems with Power Fetal Distress

DYSTOCIA abnormal or difficult labor
Complications with power:
1. Dysfunctional labor (uterine inertia)
failure to progress cervical dilatation
- Sluggishness of contractions
- Decreasing of uterine contractions, strength,
frequency, duration
- Primary: onset Secondary: later in labor
Causes
1. Primigravida
2. CPD
3. Nonripe cervix
4. Inappropriate use of analgesic
Risk:
1. Maternal postpartal infection
2. Hemorrhage
3. High infant mortality
A, ineffective uterine force
1. Hypotonic -infrequent no. of contractions
2. Hypertonic -increase in frequency
3. Uncoordinated uterine contractions are too
weak or too ineffective
Nullipara- 20hrs
Multipara 14rhs
1. High or Low FHR
2. Meconium staining
3. Hyperactivity sign of hypoxia
4. Low O2 saturation 40%-70% normal
PRETERM LABOR -occur before end of 37 wks
Criteria:
- contractions, effacement, dilatation
Risk factors
MATERNAL
1. Excessive fatigue
2. Maternal infections
3. Dehydration
4. Large feta; size
5. Intimate violence and trauma
6. Chronic illness or disease
7. Extreme emotional stress
Signs and symptoms
1. Persistent, dull and low backache
2. Vaginal spotting
3. Abdominal tightening, pelvic pressure
4. Menstrual like cramping
5. Pain in vulva or thighs
Management
1. Hospitalization
2. Bed rest: left-lateral
3. Monitor FHR and uterine contractions
4. Clean catch urine sample
5. Adequate hydration
6. Drug tocolytics and corticosteroid
a. Tocolytic agent to arrest labor by
relaxation
** Terbutaline antidote: propranolol
** magnesium sulfate -stops premature
contractions -antidote: calcium gluconate
b. Corticteroids -enhace maturation of lungs
**bethametasone, dexamethasone

PRECIPITATE LABOR
-extremely rapid labor and delivery occurring less than
3 hrs after onset of uterine activity
Risk factors:
1. Multiparity
2. Trauma
3. History of rapid labors
Signs and symptoms
1. Ruptured membranes
2. Heavy bloody show
 MATERNAL COMPLICATIONS PLACENTAL PROBLEMS
1. Soft tissue lacerations I. IMPLANTATION IN LOWER UTERINE SEGMENT
2. Hemorrhage Placenta previa
3. Infection - Low-lying placenta
4. Hypotonic post- delivery hemorrhage - Partial Placenta Previa
FETAL COMPLICATIONS - Total Placenta Previa
1. Hypoxia, anoxia - Marginal Implantation
2. Sepsis Risk factors
3. Intercranial hemorrhage 1. Multiparity
2. Advanced maternal age
3. Past cs births
UTERINE PROLAPSE -downward displacement of Signs and symptoms
uterus into vaginal canal 1. Painless vaginal bleeding
Complications:
Cause 1. Preterm Labor
1. Overstretching of uterine supports 2. PROM
2. Trauma to levator ani ms 3. IUGR
4. Congenital anomalies
Maternal risk factors
1. Birth of large infant
2. Prolonged 2nd stage of labor ABNORMAL PLACENTAL IMPLANTATION
3. Instrument birth
1. Placenta Accreta -deep attachment of placenta
to myometrium
First degree cervix in lower part of vagina - So deep placenta will not loosen and deliver
Second degree cervix @ vaginal opening
Third degree uterus protrudes through intoitus Management:
a. Hysterectomy -surgical removal of uterus
Management: b. Methotrexate destroy retained fragments
1. Surgery
2. Vaginal pessary device that fits in vagina and 2. Placenta Increta -adherent to uterine wall and
holds uterus in place invade myometrium
3. Placenta Percreta firmly attached to uterine
UTERINE RUPTURE wall and penetrate through myometrium
Risk factors
1. Previous cs
2. Prolonged labor Risk factors
3. Abnormal presentation 1. Post partum hemorrhage
4. Multiple gestation 2. Uterine peforation
5. Obstructed labor 3. Infection
Signs and symptoms
1. Sudden severe pain during strong labor
contraction
2. Complete rupture of layers
3. Hemorrhage
4. Signs of hypovolemic shock
Management
1. Fluid replacement and oxytocin
2. Laparotomy -control bleeding and repair
3. Cesarean hysterectomy
4.
 ABNORMAL PLACENTAL FORMATION 2. Lacerations
1. PLACENTA SUCCENTURIATA a. Cervical
placenta that has one or more accessory lobes b. Vaginal
connected to main placenta by blood vessels c. Perineal
2. PLACENTA CIRCUMVALLATE
- Double layor amnion and chorion 3. Uterine Inversion -uterus turning inside out
3. BATTLEDORE PLACENTA Signs and symptoms
- cord is inserted marginally rather than a. Large amount of blood gushes from vagina
centrally b. Fundus is no longer palpable
4. VELAMENTOUS INSERTION OF THE CORD c. Show signs og blood loss
- Cord seperates into small vessels that reach - Hypotension
placenta by spreading acroos a fold of - Dizziness
amnion - Paleness
5. VASA PREVIA - Diaphoresis
-umbilical vessel of velamentous cord insertion Management
cross the cervical os and deliver before the a. Discontinue Oxytocin
uterus b. IV fluid
c. Administer O2
PREMATURE SEPARATION OF THE PLACENTA
ABRUPTIO PLACENTA 4. Subinvolution
Causes: Causes
1. High parity a. Small retained placentalk fragments
2. Advanced maternal age b. Mild endometritis
3. Short umbilical cord c. Uterine myoma
4. Smoking Management
Signs and symptoms a. Methylergonovine -improve uterine
1. Sharp, stabbing pain tone and complete involution
2. Couvelaire uterus b. Oral antibiotic
3. Signs of hypovolemic shock 5. Retained Placental Fragments
-ultrasoud
-blood serum (hCG)
NURSING CARE OF HIGH-RISK POST PARTAL CLIENT a. Succenturiate
A. Post partum Hemorrhage b. Accreta
-vaginal birth: 500ml or more Management
- cs birth: 1000ml or 10% decrease in hct level a. D and C
b. Methtrexate
1. UTERINE ATONY relaxation of the uterus c. Hysterectomy
Risk factors
a. Multiple gestation 6. Perineal Hematoma -collection of blood in
b. Hydramnios SQ layer perineal tissue
c. Macrosomia Signs and symptoms
d. Uterine myoma a. Severe pain in perineal area
Signs and symptoms b. Purplish discoloration and swelling
a. Abrupt gush of blood vaginally c. Firm globe and feels tendr on palpation
b. Hypovolemic shock
- Falling BP
- Rapid weak thread pulse
- Shallow respirations
- Pale clammy skin
Management
1. Fundal massage
2. Administer oxytocin
3. Bimanual compression