COMPLICATIONS OF LABOR

I.PRETERM LABOR

 Labor that occurs after 20th and 37th week of

gestation
RISK FACTORS

1.Maternal factors
a. Maternal infection (leading cause), illness or
disease (renal/cardiovascular), diabetes mellitus
b. premature rupture of membranes (PROM)
c. bleeding
d. uterine abnormalities/overdistention,
incompetent cervix
e. Previous preterm labor, spontaneous or induced
abortion, preeclampsia, short interval (less than
1yr.) between pregnancies.
f. Trauma, poor nutrition probably due to low
socioeconomic status, no prenatal care, lack of
childbirth experience
g. Extremes of age, decreased weight (less than 100
lb.) and less height (less than 5 ft.)
h. Lack of rest/excessive fatigue
i. Smoking
j. Extreme emotional stress
2.Fetal factors
a. Multiple pregnancy

b. Infections

c. Polyhydramnios

d. Congenital adrenal hyperplasia

e. Fetal malformations
3.Placental factors

a. Placental seperation
b. placental disorders
4. Unknown cause
COMPLICATIONS

 Prematurity
 Fetal death

 Small-gestational age

 Increase perinatal morbidity and mortality

TREATMENT

 Hospitalization- prevent premature delivery

1. Bed rest on left lateral recumbent

2. Adequate HYDRATION: oral and parenteral

3. Monitoring

a. Uterine contractions and irritability q1-2 hours

(to determine increasing or decreasing
contractions)
b. Vital signs as major drugs employed can alter
them
c. Intake and output
d. Cardiac and respiratory status and distress signs.
e. Cardiac and respiratory status and distress signs.
f. Cervical consistency, dilation, and effacement
g. Fetal well-being
h. Early signs of edema is a possible complication of
ritodrine use.
4. Promotion of physical and emotional comforts:
keep client informed of progress.
5. Administration of tocolytics to arrests labor by
causing relaxation of the uterus, examples;
magnesium sulfate, terbutaline, and ritodrine
a. Contraindications to arresting premature
labor
*advanced pregnancy
* ruptured bag of waters
* maternal diseases like bleeding complications,
PIH, cardiovascular disease
* fetal distress
* presence of fetal problems like Rh
isoimmunization
6. Administrations of corticosteroids like
etbamethasone (celestone) to enhance
maturation of fetal lungs by stimulating the
production of surfactant when there are
contraindications to attempts to arrest preterm
labor
a. Labor ordered drugs according to protocol.
b. Assess effects of drugs on labor and fetus.
c. Monitor for side effects on the drugs.
DISCHARGE

Once contractions have stopped, and maternal and

fetal conditions stabilized, the client is
discharged
Health teachings should include measures to
prevent recurrence of premature labor:
1. Maintain bed rest, left lateral preferred.
2. Well-balanced diet; high iron, vitamins and
important minerals
3. Continuation of oral medications (yutopar)at
home
4. Frequent prenatal visit every week for the
duration of the remaining weeks.
5. Activity/lifestyle evaluated and restricted as
necessary
6. Illnesses: chronic- monitored; acute-treated STAT
7. Provide client teaching: symptoms of preterm
labor and prompt reporting to the physician when
present.
OTHER INTERVENTIONS

 Provision of psychological support and

encouragement.
II.PRECIPITATE LABOR

 short labor that lasts for 2-3 hours or less

RISK FACTORS

 Multiparity- the most common/important factor

 Trauma

 Large pelvis and lax soft tissues

 Small fetus

 Labor induction by oxytocin and rupture of

membranes
 Severe emotional stress
COMPLICATIONS

 Maternal
a. Laceration
b. Hemorrhage
c. Infection
d. Uterine rupture if birth canal is not readily
distensible
e. Hypotonic contractions- hemorrhage
Fetal
a. Hypoxia, anoxia
b. Sepsis
c. Intracranial hemorrhage
TREATMENT

 Episiotomy
 Delivery
ASSESSMENT FINDINGS
 Tetanic-like contractions
 Rapid labor and delivery
 Signs and symptoms of impending delivery
a. Desire to push
b. Strong contractions
c. Ruptured membranes
d. Heavy bloody show
e. Bulging rectum and sever anxiety
NURSING IMPLEMENTATIONS
 Never leave the client
 Monitor FTH q15 min. To detect ditress from fetal
hypoxia secondary to tetanic contractions.
 Provide emotional support
a. Reassure that you will stay.
b. Explain precipitate labor in simple terms.
c. Inform the client of what is happening.
d. Provide care until the physician/help arrives.
e. Assist client in retaining a sense of control over what
is happening.
 Assist with delivery
a. Never hold the baby back
b. Put on the sterile gloves if available, if there is
still time.
c. Have client pant and not push
d. Rupture the membranes when head crowns
e. Gently slip the cord over the head, with free
hand if the cord is draped around the neck.
f. Use gentle pressure to fetal head upwards toward
the vagina to prevent damage/injury to fetal head
and vaginal lacerations.
g. Deliver head in-between contractions.
h. Shoulders are usually born spontaneously after
external rotation; if not, use gentle, downward
pressure move anterior shoulder under symphysis
pubis and then use upward pressure for the
delivery of posterior shoulder.
i. Right after the head is delivered and before the
shoulders are out, suction the mouth and nose
using the bulb syringe, if available; if not, use
towel to wipe blood and mucus from the mouth
and nose.
j. Support the fetal body during expulsion.
k. Care for the cord:
 if materials are available, clamp cord in two places
and cut between with clean knife or scissors
 If there is no available instrument for cord
clamping and cutting, just double tie using the
cleanest possible piece of cloth or string (e.g., a
clean handkerchief ) ensuring that there is no
pulsation between the two ties to prevent
transfusing newborn blood to the outside which
will lead to neonatal hemorrhage and shock.
l. Allow the placenta to seperate naturally. Wrap
placenta, cord and baby together. Have the fetal
side near the newborn.
m. Place infant on mother’s abdomen, or better still
encourage mother to breastfeed to induce uterine
contractions and for reassurance that all is well
n. Institute measures as prescribed in the third and
fourth stage of labor.
o. Handle delivery gently to prevent injury to mother
and baby.
III. DYSTOCIA

*prolonged difficult labor and/or delivery because of

problems with the factors in labor
(4 P’s)
RISK FACTORS

1. Faults of the passengers

a. Abnormal position, persistent occiput posterior
(failure of the vertex to rotate)
b. Malpresentations (shoulder, face, brow, breech)
c. Hydrocephaly
d. Large fetus (over 4000 grams)
e. Abnormal life (transverse) and multiple pregnancy
2. Faults of the passages
a. Cervical inertia
b. Contracted pelvis
c. Cephalopelvic disportion (CPD)
d. Non-gynecoid pelvis
e. Cervical scar tissue from previous surgery
3. Faults of the primary power

a. Hypertonic uterine inertia

b. Hypotonic uterine inertia
4. Faults of the person/client: poor psychosocial
responses which are influenced by the following
factors:
a. Education and preparation
b. Previous experiences
c. Readiness
d. Support system
e. Maternal position
f. Race and culture
g. Environment
h. Socioeconomic status
COMPLICATIONS

 Maternal exhaustion and dehydration

 Infection

 Traumatic operative births

 Fetal distress

 Birth injuries

 Perinatal mortality
TREATMENT

 Bedrest
 Sedation for hypertonicity

 Stimulation with oxytocin for hypertonicity

 Caesarean section

 Forceps as indicated
DIAGNOSIS

 Vaginal examination
 Leopold’s maneuvers

 Pelvimetry

 Ultrasonography

 Diagnosis of type of dystocia

NURSING IMPLEMENTATION

 Prepare client for assist in various diagnostic

examinations
 Promoter rest and comfort: lateral position is
comforting
 monitor:

* labor: uterine contractions, cervix

* fetal well-being: FTH, movement, passage of
meconium
 Give reassurance and support.
 Administer oxytocin as ordered for hypotonic
uterine inertia to augment labor.
a. The patient should not be left alone. The nurse
monitors the rate of flow, the maternal response in
terms of uterine contraction changes and cervical
dilation/effacement changes. Physician must be
present within
the unit or within the floor and available throughout
the procedure.
Safety alert: a oxytoxic drugs labor induction and
augmentation may cause uterine hypertonicity and
lead to serious complications as uterine rupture,
abruptio placenta, and fetal distress. The woman
with oxytocin drip should not be left alone!
b. Client must be in true labor-cervix at least 3 cm.
c. No mechanical obstruction or uterine
overdistention or multiple fetuses.
d. With indications for oxytoxin: no history of CS
(rupture, fetus in good condition, client under 35
y.o and less than para 5
Hypotonic uterine inertia
Onset: late onset; usually in the active phase
Contractions: weak, painless
Tension not synchronous
Causes: overdistention, advanced age,
increased parity, contractures, fetal
malposition, analgesia/anesthesia
Treatment: enema, walking if not
containdicated; amniotomy, oxytocin
Hypertonic uterine inertia
Onset: Early onset; usually as early as the
latent phase
Contractions: strong, painful
Uncoordinated, increased contractions but
ineffective in bringing about further dilation
Causes: primigravidity, young age, injudicious
use of oxytocin
Treatment: sedation
e. Monitor VS, drip rate of IV oxytocin carefully and
frequently. Maternal hypotension and
hypertension can result from oxytocin drip. BP is
therefore the single, most important vital sign to be
monitored.
f. Assist with delivery: after failed trial labor (usually
6 hours)
*vaginal delivery and caesarean section
g. After delivery, observe mother and infant for signs
of injuries and signs of difficult interaction related
to/resulting from difficult labor. Promote bonding.
IV. PREMATURE RUPTURE OF
MEMBRANES (PROM)

 Rupture of the membranes before term/labor;

unconnected with labor
ASSESSMENT FINDING

 Maternal report of passage of fluid per vagina

 Determination of alkaline amniotic fluid and not
acidic urine or vaginal discharge.
DIAGNOSIS

 Nitrazine test: change in the colon of nitrazine

paper from yellow (acidic vaginal pH=4-6)to blue
color because of neutral to slightly alkaline
amnioyic fluid (pH=7-7.5)
 Ferning test: amniotic fluid, high in sodium
content, will assume a ferning pattern when dried
on the side.
 Sterile speculum examination: direct
visualizations if fluid from cervical os is the most
reliable diagnosis of PROM.
COMPLICATIONS

 Maternal infection/chorioamnionitis- most

common
 Cord prolapse

 Premature labor
NURSING IMPLEMENTATION

 Maintain bed rest. Do not allow ambulation to

prevent prolapse of the umbilical cord.
 Calculate gestational age

 Monitor maternal vital signs and fetal well-being.

 Observe and record the character, amount, color,

and odor amniotic fluid
 Be alert for early signs of infections: fever, chills,
malaise, and signs of labor onset
 Monitor for signs of prolapsed cord

 Provide appropriate treatment as ordered

*if there are signs of infection: antibiotics and

immediate delivery.
*if without signs of infection, induction of labor
delayed, fetus is healthy
 Provide psychological support:
*explain the procedures and findings
*support client and family
*inform if progress
*prepare client and family for early interruption of
pregnancy as indicated.
UTERINE RUPTURE

 Rupture of the uterus because of the stress of

labor with extrusion of uterine contents into
the abdominal cavity.
RISK FACTORS

 Previous CS scar- most common

cause/contributory factor
 Improper use of oxytocin

 Overdistention of the uterus

 Strong contractions with non-progressive labor

 Abnormal presentation

 trauma
 Injudicious obstetrics: application of forceps
when the cervix is not yet fully dilated; second
stage of labor fundal pressure; forced delivery of
fetus with abnormality (hydrocephaly)
 III-advised podalic version
ASSESSMENT FINDINGS

 Sudden acute abdominal pain and tenderness

 Cessation of uterine contractions and FHT
 Presenting part no longer felt through the cervix
 A feeling in the mother that something happened
inside her
 Signs of external bleeding; signs of shock and
presence of predisposing factors
COMPLICATIONS

 Hemorrhage or shock
 Maternal or fetal mortality:considered the most
common complication of labor that may result to
maternal and fetal deaths
 Infection from traumatized tissues
TREATMENT

 Laparotomy to deliver the fetus

 Hysterectomy for complete rupture (although in
most cases, the uterus may be sutured and left in)
 Blood, plasma, and IV fluid replacement

 antibiotics
NURSING IMPLEMENTATION

 Stay with the client; call for assistance.

 Promptly implement supportive measures.
*positioning: shock position
*provision of warmth
*prompt IV infusion: D5LRS
 Notify the physician inform support person
 Prepare for immediate surgey and provide
psychological support
VI. FETAL DISTRESS

Fetal condition resulting from

fetal hypoxia
RISK FACTORS

 Dystocia
 Cord coil, cold compression

 Improper use of oxytocin, analgesia/anesthesia

 DM, cardiac disease, & other co-existing in the mother

 Bleeding complications in the third trimester like

placenta previa and abruptio placenta
 Pregnacy induced hypertension (PIH) and supine
hypotensive syndrome
ASSESSMENT FINDING TRIAD SYMPTOMS

 FHT above 160 or below 120 per minute

 Meconium-stained amniotic fluid in a non-breech
presentation
 Fetal hypermobility/hyperactivity
NURSING IMPLEMENTATION

 Reposition mother to left lateral recumbent (LLR).

This relieves pressure on inferior vena cava (IVC),
thereby, increasing venous return resulting in
increased perfusion of placenta and fetus
 Stop oxytocin drip if being infused

 Administer oxygen per mask at 6 to 7 liters per

minute
 Correct hypotension
*elevate legs
*increase IV rate (increase hydration) provided the
IV fluid is plain and with no oxytocin
*turn mother to her left if it is a casse of vena caval
syndrome
 Monitor FHT continously
 Notify the physician

 Prepare for emergency CS if indicated

VII. VENA CAVAL SYNDROME/SUPINE
HYPOTENSION SYNDROME

 Partial occlusion of the vena cava from the pressure

of the pregnant uterus causing shoc-like symptoms
 The pressure of the enlarged uterus on the inferior
vena cava and aorta especially during the
contractions causes a reduction in the blood flow to
the heart-> reduced cardiac output ->SUPINE
HYPOTENSIVE SYNDROME-> decreased blood
flow to feto-placental unit->fetal distress
RISK FACTORS

 Conditions where the uterus is extra large:

*multiple pregnancy
*polyhydramnios
*DM
 Obesity

 Prolonged supine position

NURSING IMPLEMENTATION

 Prevention: LLR or left lateral recumbent for

women in labor; avoid the supine position
 Management: repose mother to left star in case of
vena cava syndrome or use a wedge-shaped
pillow under the women’s right hip to shift the
weight of the uterus/fetus of the woman’s aorta
and inferior vena cava; monitor tones frequently.
VIII. AMNIOTIC FLUID EMBOLISM

 The escape of amniotic fluid into maternal

circulations through the placental site and
into the maternal circulations through the
placental site and into the pulmonary
arterioles
RISK FACTORS

 Premature or normal rupture of membranes. The

risk of having amniotic fluid embolism starts from
the moment the bag of water rupture
 Abruptio placenta

 Difficult labor (hypertonic intense uterine

contractions)
INCIDENCE

 Rare but usually fatal; mortality in the first

hour in 25% of pregnant women with
amniotic fluid embolism

prognosis
 Usually fatal for both mother and baby
ASSESSMENT FINDINGS

 Maternal Respiratory Distress

*acute dyspnea
*cyanosis
*sudden chest pains.
*pulmonary shock and edema
 Circulatory collapse: signs of shock
 Secondary: uncontrolled bleeding from
disseminated coagulation (DIC)
TREATMENT
*CARDIORESPIRATORY SUPPORT
 Oxygenation stat
 Improve hydration

*IV fluid and plasma

*whole blood, fibrinogen transfusion
*monitor fluids I & O
 Digitalis for failing cardiac function
 Heparin as ordered; be ready with antidote
protamine sulfate
 Antibiotics

 Delivery: forceps (if the cervix is fully dilated) or

vaginal (if cervix is open and dilating well)
 Continued monitoring of mother and the fetus
NURSING IMPLEMENTATIONS

 Institute measures to support life.

*place on shock position as indicated.
*oxygenate promptly
*maintain and monitor fluids and blood
transfusion
*provide warmth
*administer ordered drugs
 Inform family of the woman’s condition;
provide support.
 Transfer to ICU when stabilized for close
monitoring and intensive care
OPERATIVE OBSTETRICS

I. INDUCTION OF LABOR
-deliberate initiation of
labor or uterine
contractions before
spontaneous onset.
INDICATIONS

 Diabetic mother –may be by 36 to 37 weeks

 Postmaturity; placental insuffeciency

 Increasing symptoms of toxemia (PIH)

 Severe erthroblastosis fetalis; prolonged PROM

 Maternal or physician convenience (not a valid

indication)
METHODS OF INDUCTION

 Administration of pituitary hormones or synthetic

substitute: PITOCIN-most used
*initiates and sustain uterine contractions
*strict monitoring: maternal and fetal VS and
uterine contractions- length, intensity, and
frequency
 Artificial rupture of membranes ( amniotomy) causes
stronger contractions because the hard fetal head
exerts greater pressure on the cervix; performed by a
physician
*prepare amnioton, pair of sterile gloves , and
lubricant
*explain procedure to client/couple
*provide psychological support
*check FTH immediately after the BOW is ruptured
 Strippingthe membranes: separating the
membranes from the lower uterine segment
without rupturing the membranes-
>membranes and amniotic fluid now act as a
wedge to effect cervical dilatation
PREREQUISITES FOR SUCCESSFUL
INDUCTION
 Mature fetus; mother at , or near term
 No CPD

 Soft and easily pliable cervix with moderate

amount of dilatation and effacement
 Fetal head fixed in inlet

 No contraindications for the use of oxytocin like CS

scar, hypertonic contractions, CPD, fetal distress,
and placenta previa
NURSING IMPLEMENTATION

 Explain plan of induction and all procedures as they

are being performed to minimize anxiety; reassure to
fetal well-being during induction
 Close monitoring of mother and fetus

*rationale: pituitary (posterior) extract is very powerful

and can cause violent uterine contractions
*BP, pulse, respiration, FTH, and contractions are
monitored every 15 mins.
 careful administrations of oxytocin
-10 IU of pitocin is added to 1 liter of 5% dextrose in
water and piggybacked to the main line (the major IV
line without medication)
 stop the infusion if any of these condition exist:

*FTH is greater than 170 bpm or less than 120 bpm;

late decelerations; meconium passage in cephalic
presentation
*maternal hypotension
*strong, sustained contractions
 Evaluate success of induce: 3 contractions in
10 minutes present with about 50 mmHg
pressure on the average in intensity
 Induction requires that the physician is in the
area while the patient is receiving treatment
 In the event that fetal distress develops, do the
following:
*stop the oxytocin infusion; run at faster rate the
IV solutions without oxytocin.
*turn client to the left side
*administer oxygen per mask
*refer to the physician
OPERATIVE OBSTETRIC

II. FORCEPS DELIVERY

- Delivery of the baby using obstetrical

instrument- the forceps which consists
of the blade, shank, handle, and a lock
INDICATIONS/RISK FACTORS
 Fetal factors
*second stage of labor fetal distress
*abnormal presentation or arrested descent
*preterm labor to protect fetal head from injuries
 Maternal factors
*top shorten the second stage of the labor
*ineffective expulsive effort/poor progress
*exhaustion and medical diseases like cardiac
disease.
CRITERIA/PREREQUISITES

 Full dilation of the cervix

 Ruptured bag of water

 Engage head

 Empty bowel and bladder

 No CPD

 Episiotomy

 anesthesia
TYPES

Low/outlet forceps: fetal headon

perineal floor
Midforceps: fetal head at the level
of the ischial
COMPLICATIONS/PROGNOSIS

Maternal
*lacerations
*hemorrhage
*uterine rupture
*uterine rupture
*uterine prolapse
*cystocle
*rectocele
 Fetal
*facial paralysis (Bell’s palsy)
*increased perinatal morbidity and mortality
*intracranial hemorrhage
*brain damage
*skull damage
*tissue trauma
*cord compression
NURSING IMPLEMENTATIONS

 Prepare client and family

 Provide psychological support to
allay/decrease anxiety
 Monitor FHT continuously

 Assess mother and infant for complications

OPERATIVE OBSTETRICS

III.CAESAREAN SECTION

-Delivery via an abdominal incision

INDICATIONS

 CPD: leading cause of primary caesarean section

 Previous CS: leading cause of second caesarean
section
 Contracted pelvis

 Fetal distress

 Dystocia

 DM, PIH
 Placenta previa; abruptio placenta
 Postmaturity

 Rh incompatibility

 Abnormal fetal positions and presentations

 Cord prolapse

 Fetal abnormalities, like hydrocephalus

 Pelvic tumors

 Vaginal infections: herpes

NURSING IMPLEMENTATION

 Pre-operative: follow regular preparation for an

abdominal/pelvic surgery
 Post-operative
a. Ensure a patient airway and prevent respiratory
obstruction; equip the postpartal recovery room with
suction and oxygen. If under general anaesthesia,
position patient on her side to promote drainage of
secretions; turn and assist with coughing and deep
breathing q2 hours.
 In the recovery room, monitor V5 q5 min. Until
stable; q15 min. for 1hr; and q30 min. Until
discharged to the postpartal floor.
 Monitor uterine fundus gently to ensure that it is
firm. The fundus may be palpated by placing a
hand to support the incision, but do not tamper
with the abdominal dressing.
 Check the dressing and perineal pad q15 min. for at
least one hour. To evaluate lochial amount
accurately, do pad count or weigh perineal pads, if
feasibl.
 Monitor I&O. Observe urine for bloody tinge which
is danger sign of trauma to the bladder during
surgery.
 Maintain fluid and electrolyte balance.
* clear liquids after passage of flatus (requirement
to oral intake)
*early resumption of solids
 Provide assistance during mother/father-infant
interaction
*provide emotional support
*promote bonding
*be present during entire initial breastfeeding time
 Administer drugs as ordered
*oxytoxics: to ensure a firm fundus
*analgesics: to provide relief of postoperative
pain.
*antibiotics: to prevent puerperal sepsis
 Encourage early exercises following caesarean
section
 Assess for symptoms of complications hemorrhage,
infection, and leg thrombophlebitis
*assist in regular turning/repositioning in bed
*passive, then active leg exercises
*assess for danger signs: local redness (rubor), warm
to touch (calor), swelling (tumor) and pain (dolor).
Validate by eliciting the Homan’s sign: calf pain
upon dorsiflexion of the leg.
IV. ANALGESIA AND ANAESTHESIA IN
LABOR
 Analgesia: the relief of the pain and pain
perception; analgesia can be provided by a variety
of techniques including drugs.
Analgesic are drugs that relieve pain and pain
perception.
1. Narcotics

a. Strong analgesic drugs that produce sedation and

relaxation
Exercise
Foot & leg exercises
Abdominal tightening, pelvic
tilting/ rocking, knee rolling
Pelvic floor exercise, curl-ups,
hip hitching
Time to start Purpose
As soon as possible, especially To improve circulation,
after epidural anaesthesia, as reduce edema, and prevent
peripheral circulation is vein thrombosis (DVT)
sluggish -> high risk for DVT
Can be practiced gently after To ease backache and
24 hours flatulence, the abdominal
tightening tones the deep
transverse abdominal
muscles, which are the main
support of the spine, and will
help prevent backache in the
future
After 4 to 5 days when woman To prevent stress
is more comfortable incontinence
Exercise
Strenuous keep-fit exercise
aerobics competitive sports
Time to start purpose
10 to 12 weeks after the To keep fit help regain
surgery and only after strength
ensuring that pelvic floor
muscles are functioning
effectively

SAFETY ALERT: THE EXERCISE THAT SHOULD NEVER BE PERFORMED ARE DOUBLE LEG AND
SITS UP. LIFTING SHOULD BE AVOIDED ; IF INEVITABLE, KEEP THE OBJECT AS LIGHT AS
POSSIBLE AND CLOSE TO THE BODY, BEND KNEES AND STRAIGHTEN BACK
b. Depress newborn’s respiration
c. Given in active labor (when cervix is about 4 to 6 cm.)
2. Tranquilizers
a. Produce sedation and relaxation

b. May cause excitement when there is pain

c. Given with the narcotics for potentiating effect (little

analgesic effect when given alone)
d. Examples: phenergan (promethazine HCL), valium
(diazepam), and sparine (promazine HCL)
3. Sedatives
a. Produce sedation

b. May depress fetus

c. Examples:

*seconal (secobarbital sodium)

*nembutal (pentobarbital sodium)
 Anaesthesia: the absence of sensation,
implies freedom from pain; anaesthetics are
agents that produce insensitivity to pain or
sensation; produce local or general loss of
sensation
1. general anaesthesia: the loss of sensation
from the entire body, secondary to the loss of the
consciousness produced by the intravenous or
inhalation anaesthetic agents
a.Unconsciousness prevents the brain from the
interpreting neural impulses into conscious
awareness but it is does not prevent the
transmission of neural impulses of pain
and other sensations.
b. Needed when there is an indication for rapid
induction or fetal manipulations
c. Not commonly used in obstetric because it causes
uterine atony. The woman who received general
inhalation anaesthesia should be observed for
hemorrhage in the postpartum period and should
have frequent monitoring of her uterine fundus.
d. May depress fetus
e. Induces sleep, vomiting; may cause aspiration
2. Regional:regional techniques alone or in
combianation with other techniques are commonly
used to provide analgesia for labor pain
a. causes loss of sensation from a large area of the
body
b. relieves uterine and perineal pain
c. Possible but rate complications with regional
analgesia and anaesthesia:
*trauma to nerve root or spinal cord is
possible but extremely rare and resolves within
weeks to several months. Danger signs of damage:
paresthesias or hyperalgesia in the area innervated
by that root.
*postdural puncture headache: occurs when the
dura mater of the spinal cord is punctured. The
puncture can be deliberate (introduction of the opioids
or spinal anaesthesia) or accidental (epidural
anaesthesia); causes severe pain when client is in
upright, sitting, or standing position, and relieved or
minimal when client assumes a horizontal position;
onset usually within 5 days and not responsive to
minor analgesics. Treatment: hydration (to replace
lost CSF), analgesics (may provide some relief)and oral
or IV caffeine (to cause cerebral vasoconstriction).
*hematoma in the spinal canal: rare but can
cause spinal cord compression or ischemia; a
reason why spinal and epidural anaesthesia
methods are contraindicated in the presence of
sever coagulopathies.
*diminishment of uterine contractions in
women receiving epidural analgesia with
epinephrine containing solutions.
* increased duration of the second stage of labor is
common. In the presence of epidural analgesia,
prolonged second stage of labor is defined as more
than 3 hours in nulliparous women and more than
2 hours in multiparous women.
d. Side effects: hypotension. Usually safe for the
fetus if maternal hypotension does not develop (BP
is the single most important vital sign to be
monitored with the use of regional anaesthesia)
e. Types of regional anaesthesia
*paracervical block:
-given in active phase of labor
 -produce rapid relief in the uterine pain and
contraction pain ; no effect on perineal area
- does not affect the bearing-down reflex
*peridural block:
-given in active phase or second stage of labor
-produces rapid relief from uterine and perineal
pain given in single or continuous dose
-examples:
epidural: commonly used; may cause maternal
hypotension
->fetal bradycardia
caudal: may cause maternal hypotension
->fetal bradycardia
combination: spinal-epidural
*intadural:
-given in the second stage labor
-flat position for 8 to 12 hours after
-examples:
spinal block: relieves uterine and perineal
pain; may cause maternal hypotension; rapid
onset; commonly used
saddle block: (low spinal) for rapid relief of
pain as in forceps delivery.
*pudental block:
-given in the second stage (episiotomy) and the
third stage (repair)
-a local anaesthetic agent is placed in the area of
pudental nerve through the vagina and near the
right and left ischial spines ; used for spontaneous
vaginal delivery, outlet, and low forceps extraction.
-affects perineum for 30 min. And reasonably
effective and very safe as it has no effect on fetus.
4. Local anaesthesia: local anaesthetic infiltration
a. Involves infiltration of tissue with 10 to 20 ml,
local anaesthetic, usually lidocaine (xylocaine)
b. Given in the second stage during vaginal
delivery to facilitate cutting (episiotomy)or repair
(episiorrhaphy) of the perineum and vagina.
c. usually performed by the physician just before
delivery of the fetal head ; not performed by the
nurse or midwife!
d. Has the least likelihood of complications
e. Needs sensitivity testing to xylocaine before use
because of common side effects rash, irritation and
sensitization.