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Nursing Care of the Client

with High Risk Labor and


Her Family
Complication with the Power
(The Force of Labor)
Inertia– is a time-honored term to
denote that sluggishness of
contractions, or the force of labor
has occurred.
Dysfunctional labor– is more
current term which occur at any
point in labor, but is generally
classified as primary(occurring at
the onset of labor) or secondary (
occurring later in labor).
qThe risk of maternal postpartal
infection and hemorrhage and
infant mortality is higher in
women who have a prolonged
labor than in those who do not,
therefore, it is vital to recognized
and prevent dysfunctional labor
to the extent possible.
Common Cause of
Dysfunctional Labor
qInappropriate use of
analgesic
qPelvic bone contraction that
has narrowed the pelvic
diameter so that a fetus
cannot pass
qPoor fetal position
qExtension rather than flexion
qCervical rigidity
qPresence of a full rectum or
urinary bladder that impedes
fetal descent
qMother becoming exhausted
from labor
qPrimigravida status
Factors result from prolonged
labor
Hypotonic Uterine
Contraction
ØThe most apt to occur during the
active phase of labor.
ØThe number of contractions is usually
low or infrequent.
ØThey may occur after the
administration of analgesia,
especially if the cervix is not dilated
to 3-4cm or if bowel or bladder
distention prevents descent or firm
engagement.
Ønot exceedingly painful, because of
Hypertonic Contraction
Ø Are marked by an increase in resting tone
to more than 15mmHg.
Ø Tend to occur frequently and are most
commonly seen in the latent phase of
labor.
Ø this type of contraction tend to be more
painful than usual, because the
myometrium becomes tender from
constant lack of relaxation and the
anorexia of uterine cells that results.
qa danger of hypertonic
contraction is that the lack of
relaxation between
contractions may not allow
optimal uterine artery filling—
lead to fetal anorexia early in
latent phase of labor.
Nursing Care
qrest
qpain relief with a drug such as
morphine sulfate
qchanging the client’s gown
qdarkening room lights
qdecreasing noise and stimulation
qif deceleration in the FHR is
abnormally long in first stage of
labor or lack of progress with
pushing occurs, cesarean birth is
Comparison of Hypotonic and
Hypertonic Contraction
CRITERIA HYPERTONIC HYPOTONIC

Phase of Labor Latent Active

Symptoms Painful Painless


MEDICATION

Oxytocin Unfavorable Favorable reaction


reaction
Sedation Helpful Little value
Uncoordinated
Contractions
Ømay occur so closely
together that they do not
allow good cotyledon filling,
because they occur so
erratically, it may be
difficult for a woman to rest
between contractions or to
use breathing exercises with
Nursing care
qoxytocin administration
may be helpful in
uncoordinated labor to
stimulate a more effective
and consistent pattern of
contraction with a better,
lower resting tone.
Complication of Labor
Ineffective Uterine Force
qUterine contraction are
the basic force moving
the fetus through the
birth canal.
qAbnormal, ineffective
contractions can lead to
an ineffective labor.
Contraction Rings
Øthe ring usually appears
during the second stage of
labor as a horizontal
indentation across the
abdomen and is warning sign
that severe dysfunctional
labor is occurring.
Øit is form of retraction of the
upper uterine segment, the
uterine myometrium is much
2 types of contraction rings
(dysfunctional labor)
1.Constriction ring--- a simple
type, which can occur at any
point in the myometrium and
at any time during labor.
2.Pathologic Retraction Ring---
( Bandl’s ring) the most
common form, that occurs at
the junction of the upper and
the lower uterine segments.
Nursing care

qAdministration of IV
morphine sulfate or the
inhalation of amyl nitrite
may relieve a retraction
ring.
qtocolytic may be
administered to halt
contractions.
Precipitate Labor
ØOccur when the uterine contractions
are so strong that the woman gives
birth with only a few, rapidly
occurring contractions.
Øa labor that is completed in fewer
than 3 hours.
Øcan be predicted from a labor graph if,
during the active phase of dilatation,
the rate is greater than 5 cm/hour in
nullipara or 10cm/hour in multipara.
q
qContraction can be so forceful
that they lead to premature
separation of the placenta,
placing the mother and the fetus
at risk of hemorrhage.

Nursing Care

qtocolytic may be administered to


reduce the force and frequency
of contraction.
Uterine Rupture
qDuring labor, it is always possible.
qit is serious, because it accounts for
as many as 5% of all maternal
deaths.
qOccurs when the uterus undergoes
more strain than it is capable of
sustaining.
qmost commonly occur when the a
vertical scar from a previous
cesarean birth or hysterotomy repair
tears.
Nursing Management
qAdminister emergency fluid replacement
therapy as ordered.
qanticipate use of IV oxytocin to attempt to
contract the uterus and minimize
bleeding.
qprepare the mother for a possible
laparotomy as an emergency measure
to control bleeding and achieve repair.
qbe prepared to offer information to the
support person and to inform about the
fetus outcome, the extent of surgery
and the woman’s safety.
qallow them a time to express emotions
Inversion of the Uterus
ØRefers to the uterus turning inside out
with either birth of the fetus or
delivery of the placenta.
ØIt may occur if traction is applied to
the umbilical cord to remove the
placenta or if the pressure is applied
to the uterine fundus when the
uterus is not contracted.
ØWhen this happen, a large amount of
blood suddenly gushes from the
vagina.
qif the loss of blood
continues, the woman will
show signs of blood loss:
hypertension, dizziness,
paleness, or diaphoresis.
Nursing Management
qAdministered oxygen by mask
and assess vital fluid volume.
qprepared to perform
cadiopulmonary resuscitation if
the woman’s heart should fail
from the sudden blood loss.
qAdministration of oxytocin after
manual replacement helps the
uterus to contract and remain to
its natural place.
Amniotic Fluid Embolism
Øoccurs when amniotic fluid is forced
into an open maternal uterine
blood sinus through some defect in
the membranes or after membrane
rupture or partial premature
separation of placenta.
Øthis condition may occur during
labor or in the postpartal period.
Problem with the
Passenger
Prolapse of the Umbilical
Cord
Øa loop of the umbilical cord slips down
in front of the presenting fetal.
Ømay occur at any time after the
membranes rupture if the presenting
part is not fitted firmly into the
cervix.
Øit tends to occur most often with the
following conditions:
1.Premature rupture of the membranes
2.Fetal presentation other than
cephalic
3. Placenta previa
4. Intrauterine tumors preventing the

presenting part from engaging


5. A small fetus

6. CPD preventing firm engagement

7. Hydramnios

8. Multiple gestation

qTo rule out the prolapse, always


assess fetal heart sounds
immediately after rupture of the
membranes ossuring either
spontaneously or by amniotomy.
Therapeutic Management
qManagement is aimed toward
relieving pressure on the cord,
thereby relieving the compression
and the resulting fetal anoxia. This
may be done by placing in a gloved
hand in the vagina and manually
elevating the fetal head off the cord,
or by placing the woman in a knee-
chest or trendelenburg position,
which causes the fetal head to fall
back the cord.
Multiple Gestational
qa woman with a multiple gestation
usually causes flurry of excitement
in a birthing room.
qTwins may be born by cesarean birth
to decrease the risk that the
second fetus will experience
anorxia, this also is often the
situation in multiple gestation of
three or more, because the
increased incidence of cord
entanglement and premature
Oversized Fetus( Macrosomia)
qSize may become a problem in a fetus
who weighs more than 4,000-4,500
g( approximately 9-10 lb)
qan oversized infant may cause uterine
dysfunction during labor or at birth
because of overstretching of the fibers
of the myometrium.
qA large infant born vaginally has a higher-
than-normal risk of cervical nerve palsy,
diaphragmatic nerve injury, or fractured
clavicle because of shoulder dystocia.
Shoulder Dystocia
Øis a birth problem that increasing
in incidence along with the
increasing average weight of
newborns.
Øproblem occurs at the second
stage of labor, when the fetal
head is born but the shoulder are
too broad to enter and be born
through the pelvic outlet.

Øthis is hazardous to the
mother because it can result
to vaginal or cervical tears.
Øit is hazardous to the fetus if
the cord is compressed
between the fetal body and
the bony pelvis.
Fetal Anomalies
Fetal anomalies of the head such
as hydrocephalus( fluid-filled
ventricles) or
anencephaly(absence of the
cranium) can also complicate
birth, because the fetal
presenting part does not engage
the cervix well.
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