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Complications OB
Complications OB
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LABOR AND DELIVERY COMPLICATIONS
A.
Preterm Labor
Preterm labor is labor that begins after 20 weeks gestation and before 37 weeks gestation.
Etiology
Clinical Manifestation
Diagnostic
Medical Management
PROM
Incompetent cervix
Multiple gestation
Previous history of Preterm labor
DES exposure
Emotional stress
Hydramnios
Placenta previa
Abruptio placenta
Maternal age <18 or >35
Low back pain
Suprapubic pressure
Vaginal pressure
Rhythmic uterine contractions (2 uterine contractions lasting 30 seconds within
15 minutes)
Cervical dilatation <4 cm & effacement 50% or less
Expulsion of cervical mucus plus
Bloody show
MCHN
Abejo
Nursing Management
(before 38 weeks
Contributing Factors
Incompetent cervix
Trauma
Infection
Clinical Manifestation
Risk For
Prolapsed cord
Infection
RDS
Management
MCHN
Abejo
Definition
Synonyms
Predisposing Factors
Initial Sign
Late Sign
Cardinal Sign
Disease Complication
Best Position
Confirmatory Test
Best Major Surgery
Bedside equipment
Best Drug
Nature of the drug
History of the Disease
Nursing Diagnosis
Nursing Intervention
MCHN
Abejo
OTHER MANAGEMENT:
Reposition client to trendelenburg or knee- chest position
Oxygen
Push presenting part upward
Apply moistened sterile towels
Delivery as soon as possible
D. Dystocia
Difficult, painful, abnormal progress of labor of more than 24 hours
OCCURRENCE
TREATMENT
HYPERTONIC LABOR
PATTERNS (Primary
inertia)
Latent phase of labor
Rest and sedation
Fetal monitoring
CAUSES
1.
Passageway
a. Contracted pelvis
b. Unfavorable pelvic shapes
Management:
i. Evaluate pelvic diameters
ii. Continue labor with careful monitoring
iii. Perform assisted vaginal or caesarean delivery
2.
Psyche
a. Fear, anxiety ad tension increase stress and decrease uterine contractility
b. Stress interferes with the clients ability with her contractions
c. Stress increase fatigue
Management:
i. Monitor clients psychologic response to labor
ii. Determines clients level of stress
iii. Provide support
iv. Encouraged relaxation
MCHN
Abejo
E.
Precipitate delivery
- Labor that is completed within 3 hours
A pregnant patient with a known history of crack cocaine use is in labor must be prepared for a precipitous labor
and notify the neonatologist of the infants high-risk status.
If a patient has a precipitous labor at risk, the result of the labor process would be laceration of the soft tissues,
uterine rupture, and excessive uterine bleeding.
ASSESSMENT
Predisposing Factors:
1. Multiparity
2. History of rapid labor
3. Premature or small fetus
4. Large bony pelvis
NURSING INTERVENTION
Management:
1. Monitor client and fetus closely
2. Possibly administer tocolytic agents
3. Prepare for emergency birth
Risks:
1. Perineal lacerations & Hemorrhage
When delivering the neonate, you should deliver the
head between contractions. This will prevent the head
from being delivered too suddenly, thuds preventing a
possible tearing of the perineum.
3.
F. Uterine Rupture
The two findings on physical exam indicate uterine rupture is loss of uterine contour and palpable fetal part.
The number one risk factor for uterine rupture is previous cesarean section.
COMPLETE
Sudden sharp abdominal pain during
contractions
Abdominal tenderness
Cessation of contractions
Bleeding into abdominal cavity & sometimes
into vagina
Fetus easily palpated, FHT ceased
Signs of shock
INCOMPLETE
Abdominal pain during contractions
Contractions continue, but cervix fail to dilate
Vaginal bleeding may be present
Rising pulse rate and skin pallor
Loss of fetal heart tones
MCHN
MANAGEMENT
Oxygen
CPR
Intubation
Delivery
Abejo