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Lowdermilk: Maternity Nursing, 8th Edition

Chapter 22: Labor and Birth at Risk

Key Points Print
Preterm labor consists of cervical changes and uterine contractions occurring between 20
and 37 weeks of pregnancy. Preterm birth is a birth occurring before the completion of
37 weeks of gestation.
Most infant deaths and the most serious morbidity occur in the 16% of preterm infants
who are born before 32 weeks of gestation.
The major risk factors for spontaneous preterm birth include a previous preterm birth,
multiple gestations, bleeding after the first trimester of pregnancy, and a low maternal
body mass index.
More than half of preterm births occur in women without obvious risk factors.
The cause of preterm labor is unknown.
Nurses should teach pregnant women to detect the early symptoms of preterm labor.
Many health care providers recommend modified bed rest for women at high risk of
preterm birth.
Tocolytics are used to delay birth long enough to institute interventions that reduce
neonatal morbidity and mortality.
The most commonly used tocolytic is magnesium sulfate.
One of the most effective interventions is antenatal glucocorticoid administration,
which accelerates fetal lung maturity.
Premature rupture of membranes (PROM) is the spontaneous rupture of the amniotic
sac and leakage of amniotic fluid before the onset of labor at any gestational age. Preterm
premature rupture of membranes (PPROM) is a rupture before 37 weeks of gestation.
The most common maternal complication of preterm PROM is infection of the amniotic
cavity, called chorioamnionitis.
Dystociaa long, difficult, or abnormal laboroccurs in 8% to 11% of all births.
Maternal causes of dystocia include ineffective uterine contractions or bearing-down
efforts, changes in the pelvic structure, positioning during labor and birth, and psychologic
responses to labor. Fetal causes include anomalies, excessive fetal size, malpresentation,
malposition, and multifetal pregnancy.
Interventions for dystocia include external cephalic version, cervical ripening, induction
or augmentation of labor, forceps- or vacuum-assisted birth, and cesarean birth.
Induction of labor is indicated when continuing the pregnancy could be dangerous for the
woman or fetus and when there are no contraindications to artificial rupture of membranes
or augmentation of uterine contractions.
Cervical ripening using chemical measures, such as administering prostaglandins, or
mechanical measures, such as inserting a balloon catheter, can increase the success of
labor induction.
Mosby items and derived items 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Key Points Print


Synthetic oxytocin (Pitocin) may be used to induce or augment labor.

Cesarean birth is the birth of a fetus through a transabdominal incision in the uterus.
Maternal complications of cesarean birth include aspiration, hemorrhage, atelectasis,
endometritis, abdominal wound dehiscence or infection, urinary tract infection, injuries to
the bladder or bowel, and complications related to anesthesia.
After a cesarean birth, the nurse should stress that the woman is a new mother first and a
surgical patient second.
A postterm pregnancy poses risks to the mother and the fetus.
Obstetric emergencies include meconium-stained amniotic fluid, shoulder dystocia,
prolapsed cord, rupture of the uterus, and anaphylactoid syndrome of pregnancy.

Mosby items and derived items 2010 by Mosby, Inc., an affiliate of Elsevier Inc.