Ricci Chapter 21; ATI Chapters 10 and 16
What is “DYSTOCIA”? Summarize the common problems associated with dystocia.
Difficult labor that may be prolonged or extraordinary painful. “Dysfunctional” labor.
Various reasons
Hypotonic contractions too weak, ineffective
Hypertonic contractions too strong,
uncoordinated
Extremely large fetus
Fetus is awkward/bad position
Less than ideal maternal pelvic structure
Mom’s state of mind – if she’s in a psychological
distress.
Assessment
Excessive pain
Fetal distress
Uncoordinated/disorganized contractions
Labor not progressing
Therapeutic Management
Assess for fetal distress – notify MD as appropriate
Administer medications as ordered – pain meds, IVF, tocolytics
Promote rest
If hypotonic contractions are occurring, oxytocin (Pitocin) may be indicated. Begin appropriate monitoring of mother and
baby and titrate appropriately.
Turn and reposition
PRECIPITOUS LABOR (power)
Delivery of baby in 3 hours or less from beginning of labor to the end.
More common in multiparous mothers
risk for those with a hx of precipitous delivery
Assessment
Rapidly progressing labor Many ED’s and OB triage units have
Strong close together contraction Precipitous Delivery Kits prepared
Feeling pressure to push early in labor --- “this baby Stay with mother, provide emotional support as pain
is coming now!” is typically more intense and due to rapid progression
Hemorrhage and inability to administer pain meds so quickly
Tears
Therapeutic Management Patient Education deep breathe, stay calm, focus on
Prepare to potentially deliver baby if MD or midwife pushing
will not arrive in time Higher risk of laceration
Have supplies for delivery readily available
HYPERTONIC UTERINE DYSFUNCTION (power) strong, too frequent contractions. The uterus muscle stays contracted and
cannot fully relax, which causes pain!
Does not contribute to the progression of labor (dilation, effacement, etc.). Can result to uteroplacental insufficiency leading to
fetal hypoxia.
Therapeutic Management
Maintain hydration
Promote bed rest and relaxation + comfort measures
Place client in lateral position
Provide O2 by mask
HYPOTONIC UTERINE DYSFUNCTION (power) weak and ineffective contractions. Sometimes contractions stop altogether.
Can be caused by exhaustion.
Rev. Fall 2019. Maria Jabeguero
, Intrapartum Complications
Want to rule out cephalopelvic disproportion – mom’s pelvis is too small. Ruled out by pelvimetry (hand in vagina and does quick
measurements) or U/S.
Therapeutic Management
Augment labor give oxytocin to help restart contractions.
Make sure FHR and MHR are good before starting Pitocin.
POSTERIOR PRESENTATION (passenger) most common.
Engagement of fetal head in the left or right occiput-transverse position. Fetus is born facing upward instead of normal downward
position.
Therapeutic Management
proceed with labor, preparing the mother for along labor.
Comfort measures and maternal positioning to help promote fetal head rotation.
BREECH (passenger) buttocks or foot first rather than the head. Risk for trauma is high.
SHOULDER DYSTOCIA (passenger) shoulder gets stuck. Seen in macrosomia babies or
maternal pelvis being too small.
Therapeutic Management:
Immediate interventions call for help, position change (McRoberts), flex and abduct her
thighs.
Put mom in McRoberts position (picture A) mother’s thighs are flexed and abducted as
much as possible to straighten the pelvic curve.
Suprapubic pressure used (picture B). Light pressure is applied just above the pubic bone,
pushing the fetal anterior shoulder downward to displace it from above the mother’s
symphysis pubis.
Risks to mother and baby:
Brachial plexus palsy injury or fractured clavicle for the newborn (on purpose or
on accident).
Birth injury of the body for mom (tears, bruises)
MULTIFETAL PREGNANCY (passenger) more than one fetus leading to uterine over
distention and resulting to possible hypotonic uterine contractions + abnormal presentations of the babies.
MACROSOMIA (passenger) Macrosomic babies are big babies that will take longer to deliver.
More than 4000 g
Leads to fetopelvic disproportion (fetus too big for small pelvis)
Complications include: fetal injury, maternal and fetal trauma, fetal abnormalities, ↑ risk for vacuum or forceps assisted births.
If detected early, it is wise to plan for a c-section.
PRETERM LABOR (PTL)
Term = 37-40 weeks gestation
Preterm = before 37 weeks, but after viability --- 20-36.6 weeks gestation
with contractions THAT produces cervical change.
Viability = the time when the baby could survive outside the womb.
Usually between 20-24 weeks, depending on who you ask
20 weeks is considered viability by most texts
23 weeks is the earliest a hospital will revive a fetus (and only some hospitals) ethics
Baby at risk for respiratory difficulty due to underdeveloped lungs and other organs.
Biggest mortality and morbidity problem.
Assessment
Regular contractions Laboratory and diagnostic testing: How does each
Cramping test help to predict or explain PTL?
Changing in vaginal discharge (maybe it was white Blood/urine testing (UA, CBC) --- to rule out
and thick, now it is thin and brown or bloody) infection
Pelvic pain Fetal fibronectin sampling
Low back pain Cervical length measurement
PROM or PPROM (risk for infection) Amniocentesis – test L:S ratio!
Rev. Fall 2019. Maria Jabeguero
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