The woman who develops a

complication during labor and birth

Hypotonic Uterine Contraction

The number of contractions is usually low or
infrequent
May occur after the administration of
analgesia especially if the cervix is not
dilated to 3 or 4 cm or if bowel and bladder
distension prevents descent or from
engagement.

Management
Start oxytocin
infusion
Amniotomy, to further speed
labor
In the first hour after birth palpate
the uterus and assess lochia every
5 minutes.

Hypertonic
Contractions
Are marked by an increased in resting
tone.
Management:

Rest and pain relief with a drug such

as morphine sulfate.
Darkening room lights.
Decrease noise and stimulation
Cesarean birth maybe necessary.

POSTMATURE
PREGNANCY
General information
Defined as those pregnancies lasting beyond
the end of the 42nd week.
Fetus at risk due to placental degeneration and
loss of amniotic fluid
Decreased amounts of vernix also allow the
drying of the fetal skin, resulting in a dry,
parchment like skin condition

Medical management
Directed toward ascertaining precise fetal
gestational age and condition, and
determining fetal ability to tolerate labor
Induction of labor and possibility cesarean
birth
Nursing Interventions
Perform continual monitoring of maternal/fetal
vital signs
Support mother through all testing and labor

PROLAPSED UMBILICAL
CORD
General information
Displacement of cord in a downward direction,
near or ahead of the presenting part, or into the
vagina
May occur when membranes rupture.
Associated with breech presentation, unengaged
presentations and premature labor
Obstetric emergency if compression of the cord
occurs, fetal hypoxia may result in CNS damage
or death.
Assessment findings
Vaginal examination identifies cord prolapsed
into vagina

PROLAPSED UMBILICAL
CORD

 Nursing Interventions
Check FHT immediately when membranes
rupture, and again after next contraction, or
within 5 minutes; report decelerations
If fetal bradycardia, perform vaginal
examination and check for prolapsed cord
If cord prolapsed into vagina, exert upward
pressure against presenting part to lift part off
cord, reducing pressure on cord

 Get help to move the mother into a position where

gravity assist in getting presenting part off cord
(knee chest position or severe trendelenburgs)
Administer oxygen for immediate cesarean birth
If cord protrudes outside vagina, cover it with
sterile gauze moistened with sterile saline while
carrying out above tasks. Do not attempt to
replace cord.

FETAL
DISTRESS
General information
Cord compression
Placental abnormalities
Preexisting maternal disease
Assessment findings
Decelerations in FHR
Meconium-stained amniotic fluid with
a vertex presentation

Nursing interventions:
Check FHR on appropriate basis
Conduct vaginal exam for presentation and
position
Place mother on left side, administer oxygen,
check for prolapsed cord, notify physician
Support mother and family
Prepare for emergency birth if indicated

DYSTOCIA
General information
Any labor/delivery that is prolonged or difficult
Usually results from a change in the
interrelationships among the 4 Ps that is the factors
in labor and delivery
Frequently seen causes include:
disproportion between fetal presentation
(usually the head) and the maternal pelvis
(CPD)
if disproportion is minimal, vaginal birth may
be attempted if fetal injuries can be
minimized or eliminated.
cesarean birth needed if disproportion is
great.

 problems with presentation

any presentation unfavorable for
delivery (e.g. breech, shoulder,
face, transverse lie)
posterior presentation that does
not rotate, or cannot be rotated
with ease.
cesarean birth is the usual
intervention
problems with maternal soft tissue

Nursing Interventions
Individualized as to cause
Provide comfort measures for client
Provide clear, supportive descriptions
of all actions taken
Administer analgesia if ordered
Prepare oxytocin infusion for induction
of labor as ordered.
Monitor mother/fetus continuously
Prepare for cesarean birth if needed

Shoulder dystocia
Shoulder dystocia happens
when after delivery of the
head the anterior shoulder
is trapped and arrested
behind symphisis pubis.
Fetal complications:
1. Erbs palsy
2. Fracture humerus and
clavicle
3. Abnormal neurologic
examinations

shoulder dystocia.flv

Management of shoulder dystocia

Mc Roberts maneuver- flexing legs of the

parturient sharply over the abdomen

Woodcorkscrew maneuver- rotating

anterior shoulder 180 degrees to dislodge
it

Cleidotomy- cutting the

clavicles
Rubins maneuver- rocking the
shoulders from side by side
by applying force over the
abdomen
Suprapubic pressure
Strong fundal pressure
Rotate posterior arm to
anterior position
Extraction of posterior arm
All procedures should not take
more than five minutes

PRECIPITOUS LABOR
AND DELIVERY
General Information
Labor less than 3 hours
Emergency delivery without clients
physician or midwife
Assessment findings
As a labor is progressing quickly,
assessment may need to be done rapidly.
Client have history of previous precipitous
labor and delivery

 Nursing Intervention:

If you have to deliver the baby

yourself:
Asses the clients affect and ability to
understand directions, as well as
other resources available
Stay with the client at all times
Do not prevent birth of the baby
Maintain sterile environment if
possible

 Rupture membranes if necessary

Support babys head as it emerges,
preventing too-rapid delivery with
gentle pressure
Use gentle aspiration with bulb
syringe to remove blood and mucus
from nose and mouth
Deliver shoulders after external
rotation, asking mother to push
gently
Provide support for babys body as
it delivered

 Hold baby in a head down position

to facilitate drainage of secretions
Promote cry by gently rubbing over
back and soles of feet
Dry to prevent heat loss
Place baby on mothers abdomen
Check for signs of placental
separation
Check mother for excess bleeding,
massage uterus prn

 Hold placenta as it delivers

Cut cord when pulsation cease, if
cord clamped available, if no
clamps keep it intact.
Wrap baby in dry blanket, give to
mother, put to breast if possible
Check mother for fundal firmness
and bleeding
Record all pertinent data
Comfort mother and family as
needed

SPONTANEOUS DELIVERY
The encirclement of the largest head diameter
by the vulvar ring is known as crowning.
RITGEN MANEUVER
* gloved hand is used to exert pressure on the
chin of the fetus through the perineum just in
front of the coccyx
* allows controlled delivery of the fetal head
* favors extension of the fetal head

RITGEN MANEUVER

Vaginal delivery of breech

presentation

PINARD MANEUVER

MAURICEU MANEUVER

PRAGUE MANEUVER

External
Cephalic
Version

AMNIOTIC FLUID
EMBOLISM
General information
Escape of amniotic fluid into the maternal
circulation, usually in conjunction with a pattern
of hypertonic, intense uterine contractions,
either naturally or oxytocin induced.
Obstetric emergency; may be fAtal to the
mother or to the fetus.
Assessment findings
Sudden onset of respiratory distress,
hypotension, chest pain, signs of shock
Bleeding
Cyanosis
Pulmonary edema

Nursing Intervention
Initiate emergency life support
activities for mother.
administer oxygen
utilize CPR in case of cardiac arrest
establish IV line for blood transfusion
administer medication to control
bleeding as ordered
prepare for emergency birth of baby
keep client/family informed as
possible

INDUCTION OF
LABOR
General Information
-Deliberate stimulation of uterine
contractions before the normal
occurrence of labor.
Medical management
Amniotomy (the deliberate rupture of
the membrane)
Oxytocins, usually Pitocin
Prostaglandin in gel/suppository form to
improve cervical readiness

Assessment findings
Indication for use
Postmature pregnancy
Preeclampsia/eclampsia
Diabetes
Premature rupture of membranes

Condition of fetus; mature,

engaged vertex fetus , no
distress
Condition of mother; cervix
ripe for induction, no CPD

Nursing Interventions
Explain the procedure to client
Prepare appropriate equipment and
medications.
Amniotomy; a small tear made in
amniotic membrane as part of
sterile vaginal exam
Oxytocin (Pitocin); IV administration
piggybacked to main IV

 Know the continuous monitoring

and accurate assessment are
essential.
Discontinue oxytocin infusion when
fetal distress, hypertonic
contractions occur, signs of
obstetric complications appear.
(hemorrhage/shock, abruption
placenta, amniotic fluid embolism)
Notify physician of any untoward
reactions.

RUPTURED UTERUS
A ruptured uterus is
characterized by a
tearing or splitting of the
uterine wall during labor;
it is usually a result of a
thinned or a weakened
area that cannot
withstand the strain and
force of uterine
contraction.

ASSESSMENT
Risk factor:
1. Multiparity
2. Obstructive labor
3. Improper use of pitocin
4. Large fetus
5. Weakened, old cesarean section
scar
6. External forces such as trauma
Clinical manifestations:
Pain above the symphysis pubis
Sudden, acute abdominal pain
during a contraction
Vaginal bleeding, shock; fetal
distress

Uterine Rupture.flv

Treatment:
Surgical: laparotomy to
remove fetus, followed
by a hysterectomy.
Medical management:
1. Blood transfusion
2. Prophylactic antibiotics

Nursing Intervention:
Provide nursing management
associated with hemorrhage.
Assess for early diagnosis:
Maternal mortality rate is high
Prognosis for fetus is poor; fetus
usually dies as a result of anoxia
caused by placental separation.

INTRAUTERINE FETAL
DEATH
Intrauterine fetal death is also called
fetal demise.
ASSESSMENT:
Absence of FHR and fetal
movement.
Negative pregnancy test result
Ultrasound examination
determines absence of FHR and
occurrence of fetal skull collapse.

Nursing Intervention:
Goal: To support the couple through the
grieving process.
Encourage expression of feelings; do
not minimize the situation or event.
Provide opportunity for the couple to
spend time with still born, if they so
desire.
Monitor for complication.