Care of Mother and Child with

Labor and Delivery

Complications
WEEK 4 I NUR 192 I GROUP 4

Galang┃Galingana┃Gonzales┃Gusi┃Janolino┃Lazaro┃Leland┃Lipata
01

Compare and contrast hypertonic and

hypotonic labor patterns, including the
risks, clinical therapy, and nursing care
management.
 HYPERTONIC
LABOR
A condition in which frequent, painful, but
poor-quality contractions fail to accomplish
effective cervical effacement and dilation.
HYPOTONIC
LABOR
A condition during the active phase of labo
r in which contractions are inadequate
in frequency, intensity, and duration and a
re ineffective in causing cervical dilation,
effacement, or fetal descent.
PATTERN OF HYPERTONIC HYPOTONIC LABOR
AND HYPOTONIC LABOR
When occurs:
Most apt to occur during the active phase of labor.
HYPERTONIC LABOR More likely to occur if uterus is over distended.
May occur after the administration of analgesia.

When occurs: Number of contractions:

Occur more frequently and during the latent phase of The number of contractions is unusually low or
infrequent (not more two or three occurring in a 10-
labor; may occur in active phase.
minute period).
Contractions:
Resting tone:
Frequent prolonged contractions that are not
The resting tone of the uterus remains less than 10 mm
productive.
Hg.
Resting tone: Strength of contractions:
An increase in resting tone to more than 15 mm Hg. The strength of contractions does not rise above 25 mm
Hg.
Symptoms: Painful
Symptoms: Painless
• Lack of relaxation between contractions may not
allow optimal uterine artery filling; this could lead
to fetal anoxia early in the latent phase of labor.

• Increased discomfort due to uterine muscle cell

HYPERTONIC
anoxia.
LABOR
• Prolonged labor resulting in maternal exhaustion,
dehydration and increase incidence infection.
RISKS (maternal and fetal)

• Reduced uteroplacental exchange resulting in

nonreassuring fetal status.

• Prolonged pressure resulting in excessive molding,

caput succedaneum and cephalhematoma.
• Arrest of labor.

• Maternal anxiety and exhaustion.

HYPOTONIC
• Postpartum hemorrhage due to uterine atony.
LABOR
• Retained placenta due to ineffective myometrial
retraction. RISKS (maternal and fetal)

• Increased risk of instrumental delivery and possible

injuries to mother and baby.
• Cesarean section risk with the attending surgical HYPOTONIC
and anesthetic complications.
LABOR
• Fetal distress and birth asphyxia.
RISKS (maternal and fetal)
• Prolonged labor resulting in maternal exhaustion,
dehydration and increase incidence infection.
 CLINICAL THERAPY: MEDICAL MANAGEMENT

HYPERTONIC LABOR HYPOTONIC LABOR

Bedrest and relaxation measures. Membrane rupture (amniotomy) stimulates

contractions by the release of prostaglandins and
reflex stimulation of the uterus.
Pharmacologic sedation.
If CPD is not the problem, augmentation by
oxytocin is often started.
Administer analgesia to reduce pain and
encourage sleep.
The use of epidural analgesia and other regional
anesthesia may reduce the effectiveness of the
An intravenous infusion is frequently woman’s voluntary pushing efforts.
administered to maintain hydration and
electrolyte balance.
 NURSING CARE MANAGEMENT: HYPERTONIC LABOR
Provide support and encouragement.
Facilitate rest.
Administered pharmacologic agaents as
ordered.
Assess uterine contraction pattern.
• A uterine and fetal external monitor
should be applied for at least 15
minutes to check the resting phase of
the contractions and that the fetal
pattern is not showing a late
deceleration.
Institute supportive measure.
Provide information and encourage
questions.
• Cesarean birth would be necessary if
there is late deceleration, an
abnormally long first stage of labor or
lack of progress with pushing.
• Explain to the woman and her partner
that although the contractions are very
strong, they are ineffective and are not
achieving cervical dilatation.
 NURSING CARE MANAGEMENT: HYPOTONIC LABOR
Assess uterine contractions, vital signs and
FHR.
• In the first hour after birth following a labor of
hypotonic contractions, palpate the uterus and
assess the lochia every 15 minutes to ensure
that there are no postpartal hypotonic
contractions and inadequate to halt bleeding.
Provide support and comfort measure.
• Continuous reassurance to keep the mother
calm..
• Encourage ambulation and avoid supine
position.
• Empty bladder, consider catheterization.
• Maintain adequate hydration.
• Adequate pain relief.
• Monitor maternal input and output.
• Assess bladder distention and empty
frequently.
• Minimize vaginal exams to decrease
infection.
• Assess for signs of infection.
• Provide emotional support.
• Assist to cope with frustration of long
labor.
• Institute supportive measure to
decrease anxiety and discomfort.
• Provide information and encourage
question.
 02

Describe the possible impact of post term

pregnancy on the childbearing family.
POST TERM
PREGNANCY 01
May result in an increased Probable labor induction
possibility of:

02 Forceps or vacuum-assisted or cesarean birth

03 Decreased perfusion to the placenta

Decreased amount of amniotic fluid and possible

04 cord compression

05 Meconium aspiration

Macrosomia or a loss of fat and muscle mass resulting

06
in small-for-gestational-age (SGA) newborn
03

Relate the various types of fetal malposition

and malpresentation to the possible
associated problems.
Post term pregnancy may result in an increased
possibility of:

01 Occiput posterior position

● Persistent occiput posterior (OP) position is associated with 18% of intrapartum

caesarean sections and a high risk of assisted vaginal delivery.
● The OP position is associated with more frequent induction and augmentation
of labor and prolonged first and second stage of it.
● Chorioamnionitis
● Post-partum hemorrhage
● Third- and fourth-degree perineal tears presentation
● Wound infection and endometritis
● Associated adverse neonatal outcomes include:

• Birth trauma

• Low 5-minute Apgar score, and

• Admission to the neonatal intensive care unit

Post term pregnancy may result in an increased
possibility of:

02 Brow row Presentation

If brow presentation is diagnosed in a timely fashion and is appropriately managed, there are
typically no serious negative effects on the mother or baby. Some of the most severe
conditions resulting from mismanaged brow presentation births include:
● Hypoxic-ischemic encephalopathy

o Hypoxic-ischemic encephalopathy (HIE) is a type of brain damage caused by

insufficient oxygenated blood flow during or near the time of birth.

● Cerebral palsy

o Cerebral palsy (CP) is caused by damage or abnormalities in the part of the brain
that controls movement. Periventricular leukomalacia
Post term pregnancy may result in an increased
possibility of:

02 Brow row Presentation (cont)

● Periventricular leukomalacia

▪ Periventricular leukomalacia (PVL) is a term that refers to damage (or softening) of the brain’s
white matter around the ventricles, which are areas of the brain that are filled with
cerebrospinal fluid (1). PVL is caused by oxygen deprivation around the time of birth (birth
asphyxia).

● Seizure disorder

▪ Seizures occur from abnormal electrical discharges in the brain, which can be due to brain
damage, malformations, or chemical imbalances.

● Developmental disabilities

▪ Children with intellectual and developmental disabilities may learn at a slower rate than
other children and have a limited ability to learn new things (they may require special
education services).
Post term pregnancy may result in an increased
possibility of:

02 Brow row Presentation (cont)

Brow presentation has been linked to several risk factors and co-occurring
conditions. These include:

• Multiparity (having previously given birth)

• Premature delivery
• Fetal anomalies such as anencephaly (an absence of major parts of the
brain and skull) or anterior neck mass (a growth on the front of the neck)
• Previous cesarean delivery
• Polyhydramnios (excessive amniotic fluid: infants swallow amniotic fluid
while in utero, but this may be difficult if their neck is extended)
Post term pregnancy may result in an increased
possibility of:
03 Face Presentation
Risk factors and causes of face
presentation
• Severe hydrocephalus with enlargement of the
• Prematurity
head
• Very low birth weight
• Anterior neck mass
• Fetal macrosomia (large baby)
• Multiple nuchal cords (umbilical cord wrapped
• Cephalopelvic disproportion, or CPD
around baby’s neck more than once)
(a mismatch in size between the
• Maternal pelvis abnormalities
mother’s pelvis and the baby’s head)
• Maternal obesity
• Anencephaly (a birth defect in which
• Multiparity (the mother has previously given
the baby is missing part of the brain
birth)
and skull)
• Polyhydramnios (too much amniotic fluid)
• Previous cesarean delivery
• Black race
Post term pregnancy may result in an increased
possibility of:

03 Face Presentation
Complications associated with face presentation include the following:
• Prolonged labor • Respiratory distress/difficulty in
• Facial trauma ventilation due to airway trauma
• Facial edema (fluid build up in the face, and edema
often caused by trauma) • Spinal cord injury
• Skull molding (abnormal head shape that • Abnormal fetal heart rate
results from pressure on the baby’s head patterns
during childbirth) • Low Apgar score

A baby may be at increased risk of complications if forceps or oxytocin are used during labor. Forceps
can cause traumatic injury to the head, and oxytocin can deprive a baby of oxygen due to uterine
tachysystole/hyperstimulation (strong, frequent contractions). Hyperstimulation increases pressure on
the blood vessels in the womb, which can deprive the baby of oxygen-rich blood.
Post term pregnancy may result in an increased
possibility of:

04 Breech Presentation
Complications associated with breech presentation include the following:

● Premature rupture of membranes and premature labor.

● Cord prolapses (higher risk with footling or complete breech).
● Fetal head entrapment.
● Overly rapid descent of after-coming head, leading to rapid
compression/decompression causing intracranial hemorrhage.
● Cervical spine injuries associated with hyperextension.
● Delay in delivery, leading to asphyxia due to cord compression and placental
separation.
Post term pregnancy may result in an increased
possibility of:

04 Breech Presentation (cont)

Complications associated with breech presentation include the following:

● Traumatic injuries including fractures of the humerus, femur or clavicle, brachial plexus
injury (Erb-Duchenne palsy).

● Perinatal mortality is increased with breech presentation by a factor of between 2 and 4

regardless of the mode of delivery. Deaths are most often associated with malformations,
which are more common in breech presentation, prematurity, and intrauterine fetal
demise.

● Breech presentation is associated with an increased risk of developmental dysplasia of

the hip; an ultrasound of the hips should be performed in all babies who were breech at 36
weeks irrespective of their presentation at delivery or the mode of delivery.
Post term pregnancy may result in an increased
possibility of:

04 Breech Presentation (cont)

Risk factors for breech presentation:
• Lax uterus (usually associated with high
maternal parity).
• Uterine anomalies (eg, bicornuate or
septate uterus) or tumour.
• Placenta previa.
• Abnormal pelvic brim.
• Maternal smoking.
• Maternal diabetes.
• Fetal malformation (eg, hydrocephalus).
• Multiple pregnancy.
• Polyhydramnios or oligohydramnios.
• Low birth weight (preterm delivery or
intrauterine growth restriction).
• Previous breech delivery.
Post term pregnancy may result in an increased
possibility of:

05 Transverse Lie
Transverse presentation can cause serious complications during delivery.
Some of the consequences are listed below:

• Obstructed labor
• Umbilical cord or hand prolapse.
• Postpartum hemorrhage
• Birth trauma
• Rupture of the uterus
• This should be treated as a medical emergency and attended to immediately, as the cord may
come out of the uterus before the baby and then the baby will need to be delivered quickly.
Post term pregnancy may result in an increased
possibility of:

05 Transverse Lie

Women with the following conditions are at a high risk for transverse presentation:

• High ratio of amniotic fluid to fetus

• Uterine abnormality
• Placenta previa
• Fibroids in the uterus
• Factors preventing fetal head engagement in the mother’s pelvis
• Narrow or contracted pelvis
• More than 2 babies in the womb
 04

• Discuss the identification, management,

and care of fetal macrosomia.
01
01 Identification of Clinical Risk Factors

▪ Maternal diabetes ▪ Excessive weight gain

▪ Maternal impaired glucose
intolerance
▪ Multiparity
▪ Previous macrosomic infant
▪ Prolonged gestation
▪ Maternal obesity
▪ Male fetus
▪ Parental stature
▪ Need for labor
augmentation
▪ Prolonged second stage
02 Palpation of fetus in utero

Leopald’s Maneuver

▪ Methods to determine position,

presentation and engagement of fetus.

The volume of amniotic fluid, the size and

configuration of the uterus and maternal body
habitus complicate estimation of the size of the
fetus by palpation through the abdominal wall.
03 Ultrasound of fetus

Ultrasound

▪ A practical method for screening

pregnant women for fetal macrosomia.

Prenatal diagnosis is based on two-dimensional ultrasound formulae, but accuracy

is low, particularly at advanced gestation. Three-dimensional ultrasound could be
an alternative to soft tissue monitoring, allowing better prediction of birth weight
than two-dimensional ultrasound.
04 X-ray Pelvimetry

X-ray Pelvimetry
▪ A radiological investigation that involves the
measurement of different anthropometric
dimensions of the pelvis. The pelvic inlet
and outlet play an important role in labor
outcome.

Implication: Clinical examination might be very uncomfortable for the mother, X-ray.
05
01 Management of Fetal Macrosomia
involves the following:

▪ Cesarean birth performed if fetus is greater than 4500 g

▪ Continuous fetal monitoring if labor is allowed to progress
▪ Requires notification of physician for early decelerations, labor
dysfunction, or nonreassuring fetal status.
▪ Patient's obstetric history, her progress during labor, the
adequacy of her pelvis and other evidence suggestive of fetopelvic
disproportion should be used in determining an intervention,
such as cesarean section.
06
01 Care of newborn with Macrosomia
requires:

▪ Assessment of newborn for:

● Cephalhematoma - is an accumulation of blood under the
scalp. During the birth process, small blood vessels on the
head of the fetus are broken as a result of minor trauma.
● Erb’s palsy - is a paralysis of the arm caused by injury to the
upper group of the arm's main nerves
● Fractured clavicles - is a break in the collarbone, one of the
bones in the shoulder
07
01 Care of mother after birth of newborn
with Macrosomia requires:

▪ Fundal massage to prevent maternal hemorrhage from

overstretched uterus
▪ Close monitoring of vital signs
 05

Delineate the nursing care for the woman

with more than one fetus.
 INCREASED NUTRITION
01
Mothers carrying two or more fetuses need more calories, protein, and other nutrients,
including iron. Higher weight gain is also recommended for multiple pregnancy. The Institute
of Medicine recommends that women carrying twins who have a normal body mass index
should gain between 37 and 54 pounds. Those who are overweight should gain 31-50 pounds;
and obese women should gain 25-42 pounds.

INCREASED REST
02
Some women may also need bed rest — either at home or in the hospital depending on
pregnancy complications or the number of fetuses. Higher-order multiple pregnancies often
require bedrest starting in the middle of the second trimester. Preventive bed rest has not
been shown to prevent preterm birth in multiple pregnancy.
 MORE FREQUENT PRENATAL VISITS
03
Multiple pregnancy increases the risk for complications. More frequent visits may help detect
complications early enough for effective treatment or management. The mother's nutritional
status and weight should also be monitored more closely.

04
MATERNAL AND FETAL TESTING
Testing may be needed to monitor the health of the fetuses, especially if there are pregnancy
complications.

05
CERVICAL CERCLAGE
Cerclage (a procedure used to suture shut the cervical opening) is used for women with an
incompetent cervix. This is a condition in which the cervix is physically weak and unable to stay
closed during pregnancy. Some women with higher-order multiples may require cerclage in early
pregnancy.
 TOCOLYTIC MEDICATIONS
06
Tocolytic medications may be given, if preterm labor occurs, to help slow or stop
contractions of the uterus. These may be given orally, in an injection, or intravenously.
Tocolytic medications often used include magnesium sulfate.

CORTICOSTEROID MEDICATIONS
07
Corticosteroid medications may be given to help mature the lungs of the fetuses. Lung
immaturity is a major problem of premature babies.

REFERRALS
08
Referral to a maternal-fetal medicine specialist, called a perinatologist, for special
testing or ultrasound evaluations, and to coordinate care of complications, may be
necessary.
POSTNATAL PERIOD CARE
• Careful monitoring of weight gain, regular capillary blood glucose estimations
• Educate the client that expressed breast milk is the best for small babies.
• Reassure the client that lactation responds to the demands made by babies sucking at the
breast.
• At feeding times, provide support for the mother and advice on positioning and fixing babies.

Care for the mother:

• Slow involution of the uterus increases ‘’after pains'’ so analgesia should be offered.
• Recommend a high calorie diet
• Teach extra support to handle twin babies
 06

Compare and contrast abruptio placentae and

placenta previa, including implications for the
mother, and fetus, and nursing care.
 Placenta Previa Abruptio Placentae

1. Placenta is near or covers the cervical opening. 1. Placenta detaches prematurely from the uterus
An ATTACHMENT ISSUE!! It is the abnormal
1. What can cause premature detachment of the attachment of the placenta in the uterus near
placenta? or over the cervical opening.

Risk Factors include: 1. Causes of the placenta attaching abnormally?

• Chronic hypertension
• Development of preeclampsia • Maternal age >35 years old
• Previous placental abruption • Multiples
• Trauma to abdomen • Already had a baby
• Cocaine or smoking • Drug use: cocaine or smoking
• PROM (premature rupture of the membranes) • Scarring in the uterus from surgery: fibroid
• Multiples removal, c-section etc.
• Many pregnancies in the past
 Placenta Previa Abruptio Placentae

3. Serious complications: Bleeding. Severe, 3. Placental abruption can cause life-threatening

possibly life-threatening vaginal bleeding problems for both mother and baby. For the
(hemorrhage) can occur during labor, delivery mother, placental abruption can lead to: Shock
or in the first few hours after delivery. due to blood loss. Blood clotting problems.

3. If placenta previa demands early delivery of a 3. Placental abruption can deprive the baby of
premature baby, the baby can experience oxygen and nutrients
several negative effects including low birth
rate and breathing problems that may cause
brain damage and cerebral palsy.
 Placenta Previa
5. Nursing Interventions for Placenta Previa
• Pelvic rest: no vaginal exams or sexual
intercourse, douching throughout the rest of
the pregnancy (don’t want to cause injury to the
vulnerable placenta presenting at the cervical
opening)
• No abdominal manipulation
• If woman is experiencing NO bleeding or very
light bleeding: bed rest, no strenuous exercise
or sexual intercourse for the rest of the
pregnancy until baby is ready for delivery
Abruptio Placentae
5. Nursing Interventions for Abruptio Placentae
• Assess bleeding: vital signs per protocol every
15 minutes, pad count, may be concealed
(monitor and mark fundal height and
abdominal girth)
• No abdominal manipulation or vaginal exams
until placenta previa ruled out with ultrasound
• Left side lying position NO SUPINE (due to
bleeding)
 Placenta Previa Abruptio Placentae

5. Nursing Interventions for Placenta Previa 5. Nursing Interventions for Abruptio

Placenta
• If woman is experiencing bleeding:
hospitalized to monitor baby and mom • Monitor baby continuously with external
monitoring: fetal heart tone

• Type and cross match, CBC, clotting levels,

Rh Factor (if Rh negative will need RhoGAM
shot)

• Needs IV (pick 18 gauge or bigger) for

transfusion of blood products may be giving
IV fluids and blood products

• Prep for delivery of baby: vaginal if baby and

mom stable OR c-section if baby or mom are
showing signs of distress
07

Contrast the identification, management, and

nursing care of woman with amniotic fluid
embolus, hydramnios, and oligohydramnios.
 Amniotic Fluid Embolism
Obstruction of a blood vessel by amniotic fluid.
01 Identification of AFE
Amniotic Fluid Embolism

• It is a rare complication of the intra- and postpartum periods that is

associated with a high incidence of maternal and fetal death.
• For mothers, the mortality rate is as high as 80%; approximately 50% of
neonates who survive this event have neurological impairment
(Schoening, 2006).
• The origins of the problem are not clear, but it is hypothesized that
amniotic
01 Identification of AFE
Amniotic Fluid Embolism

• Obstruction of the pulmonary vessels leads to respiratory distress and

circulatory collapse. Hemorrhage, disseminated intravascular coagulation, and
pulmonary edema are present to some extent in women who experience an
amniotic fluid embolism.
• AFE is not preventable because it cannot be predicted although maternal
factors (including multiparity, abruptio placentae, tumultuous labor) and fetal
problems (including macrosomia, meconium passage, death) have been
associated with an increased risk for development (Cunningham, 2005)
01
Identification of AFE
Implications Signs and Symptoms

Sudden onset respiratory distress Dyspnea

Acute hemorrhage Cyanosis
Circulatory collapse Frothy sputum
Cor pulmonale Chest pain
Hemorrhagic shock Tachycardia
Coma and maternal death Hypotension
Fetal death if birth not immediate Mental confusion
Massive hemorrhage
02 Management of AFE
The immediate management includes the administration of oxygen by face mask
or cannula at a rate of 8–10 L/min; or resuscitation bag to deliver 100% oxygen.
Nursing interventions center on support of resuscitation
efforts:

• Prepare for intubation and mechanical ventilation.

• Initiate or assist with cardiopulmonary resuscitation (CPR). Position the
pregnant woman in a 30-degree lateral tilt to displace the uterus.
• Administer intravenous fluids and blood (e.g., packed cells; fresh frozen
plasma).
02 Management of AFE
The immediate management includes the administration of oxygen by face mask
or cannula at a rate of 8–10 L/min; or resuscitation bag to deliver 100% oxygen.
Nursing interventions center on support of resuscitation
efforts:

• Insert indwelling urinary catheter; measure hourly urine output.

• Continuously monitor maternal–fetal status.
• Prepare for emergency birth once the woman is stable.
• Provide ongoing information and emotional support to the woman and
her family.
03 Nursing Care of AFE

• Give immediate and vigorous treatment.

• Give oxygen by face mask.
• Maintain normal blood volume through administration of plasma and
intravenous fluids.
• Prevent development of disseminated intravascular coagulation (DIC).
Serious complications can occur.
• Administer whole blood and fibrinogen.
• Monitor the patient’s vital signs.
• CPR as needed
• Prepare for CVP line insertion
• Deliver the fetus as soon as possible.
 Hydramnios
The condition of having too much amniotic fluid
01
Identification of Hydramnios
Hydramnios/Polyhydramnios

• It is also known as polyhydramnios. Polyhydramnios occurs when there is excess

fluid of more than 2,000 ml or an amniotic fluid index above 24 cm (normal volume
at term: 500 to 1,000 ml).
• Polyhydramnios may cause:
• Fetal malpresentation because the additional uterine space can allow the
fetus to turn to a transverse lie.
01
Identification of Hydramnios
Hydramnios/Polyhydramnios

• Premature rupture of the membranes from the increased pressure, which then
leads to:
• Additional risks of infection
• Prolapsed cord
• Preterm birth.
01 Identification of Hydramnios
Possible Causes

• A birth defect that affects the baby's gastrointestinal tract or central

nervous system
• Maternal diabetes
• Twin-twin transfusion — a possible complication of identical twin
pregnancies in which one twin receives too much blood and the other too
little
• A lack of red blood cells in the baby (fetal anemia)
• Blood incompatibilities between mother and baby
• Infection during pregnancy
01 Identification of Hydramnios
Signs & Symptoms

• Rapid enlargement of uterus

• Shortness of breath
• Lower extremity varicosities
• Hemorrhoids
• Increased weight gain
• Stomach discomfort
• Labor pains (contractions)
02 Management of Hydramnios
Management of hydramnios during pregnancy:

• Termination of pregnancy by high artificial rupture of membranes if the

fetus is dead or malformed
• Expected treatment if the fetus is healthy:
• Rest
• Sedative
• Salt Restriction
• Treatment for underlying cause as diabetes and toxoplasmosis
• Termination of pregnancy if the condition gets worse
02 Management of Hydramnios
Management of hydramnios during labor:

• Malpresentation, cord presentation/ cord prolapse should be detected and

labor should be managed according to the condition
• When cervix is half dilated, Drew Smith catheter (allows the excessive
amount of liquor to be drained away slowly) is passed to rupture hind water.
This will initiate uterine contractions which can be enhanced by oxytocin
• Active management of third stage is carried out to guard against
postpartum hemorrhage
03 Nursing Care of Hydramnios

• Woman with severe polyhydramnios may be admitted to a hospital for bed

rest and further evaluation
• Maintain bed rest since it helps to increase uteroplacental circulation and
reduces pressure on the cervix, which may help prevent preterm labor
• Teach the woman that it is vitally important to report any sign of ruptured
membranes or uterine contractions
• Encourage her to eat a high-fiber diet to avoid constipation. Suggest a stool
softener if diet alone is ineffective.
03 Nursing Care of Hydramnios

• Assess vital signs as well as lower extremity edema frequently

• Amniocentesis can be performed to remove some of the extra fluid
• To prevent the sudden loss of fluid and the accompanying danger of a
prolapsed cord during labor, membranes can be “needled” (a thin needle is
inserted vaginally to pierce them)
• Assess fetus after birth for factors that may have interfered with the ability to
swallow
 Oligohydramnios
The condition of having too little amniotic fluid.
01 Identification of Oligohydramnios

Cause of Oligohydramnios

• Any medical condition that affects your baby's ability to urinate, such as problems with
his kidneys or urinary tract
• The placenta pulls away from the uterus, or cannot bring enough blood to the baby
• Membranes in the womb rupture (tear) before labor, called premature rupture of
membranes (PROM)
• Fetal growth problems from intrauterine growth restriction
• Pregnancy that continues past the due date
• Pregnancy with more than one baby
• Medical problems in the mother, such as diabetes, preeclampsia, high blood pressure,
smoking, or dehydration
01 Identification of Oligohydramnios

Oligohydramnios

• Measure through amniotic fluid index (AFI) evaluation or deep pocket measurements.

• If an AFI shows a fluid level of fewer than 5 centimeters (or less than the 5th
percentile), the absence of a fluid pocket 2-3 cm in-depth, or a fluid volume of less
than 500mL at 32-36 weeks gestation, then a diagnosis of oligohydramnios would be
suspected.
02 Management of Oligohydramnios

• Close monitoring by Electronic Fetal Monitoring (EFM)

• Rupture the membranes in active phase of labor
• Amnioinfusion in case of meconium staining
• If Fetal Heart Rate (FHR) abnormality: Immediate Cesarean delivery (CS)
03 Nursing Care of Oligohydramnios

• Monitor maternal and fetal status closely, including vital signs and
fetal heart rate patterns.
• Monitor maternal weight gain pattern, notifying the health care
provider if weight loss occurs.
• Provide emotional support before, during, and after ultrasonography.
• Inform the patient about coping measures if fetal anomalies are
suspected.
• Instruct her about signs and symptoms of labor, including those
she’ll need to report immediately.
• Reinforce the need for close supervision and follow up.
03 Nursing Care of Oligohydramnios

• Assist with amnioinfusion as indicated.

• Encourage the patient to lie on her left side.
• Ensure that amnioinfusion solution is warmed to body temperature.
• Continuously monitor maternal vital signs and fetal heart rate
during the amnioinfusion procedure.
• Note the development of any uterine contractions, notify the health
care provider, and continue to monitor closely.
• Maintain strict sterile technique during amnioinfusion.
 8

Identify common complications of the third

and fourth stages of labor.
COMMON COMPLICATIONS OF THE THIRD
AND FOURTH STAGES OF LABOR

The most common complications are:

Retained Placenta

• Retention of placenta beyond 30 minutes after birth.

• Potential problems that may arise from complication include hemorrhage,
shock, puerperal sepsis, and risk of recurrence in next pregnancy.

Lacerations

• Tears in the vagina or in the skin and muscle around its opening.
• Potential problems that may arise from complication include stool leakage,
painful intercourse, and infection.
COMMON COMPLICATIONS OF THE THIRD
AND FOURTH STAGES OF LABOR (CONT)

The most common complications are:

Placenta Accreta

• An unusually deep attachment of the placenta to the uterine myometrium, so

deep that the placenta will not loosen and deliver.

• Hysterectomy may be done to remove the uterus or treatment with methotrexate

to destroy the still-attached tissue may be necessary.
09

Discuss perinatal loss, including etiology,

diagnosis, and the nurse’s role in facilitating
the family’s grief work..
PERINATAL
LOSS FETAL FACTORS
Results from three factors:
01 Fetus has or develops disorder incompatible
with life

MATERNAL FACTORS
02 Mother has disorder such as diabetes,
preeclampsia, advanced maternal age, Rh
disease, uterine rupture or ascending maternal
infection that creates hostile environment for
the fetus

PLACENTAL OR OTHER FACTORS

03 Certain conditions such as abruptio placentae,
placenta previa, or cord accident cut off blood
supply to fetus, leading to death
DIAGNOSIS Test to Determine Cause of Fetal Loss
Fetal Testing Maternal Testing
May be made when
• Fetal blood tests and x- • Diabetes testing
- Mother notices lack of rays • CBC with platelet count
• Autopsy or MRI • Kleihauer-Betke test
movement in fetus or at
• Placental studies • Abnormal antibody
regularly scheduled
• Chromosomal studies (if testing (lupus
physician’s visit when indicated) anticoagulant,
fetal heart tone cannot anticardiolipin
be found. antibodies)
• TSH levels
• Infectious disease
testing (rubella, syphilis,
malaria, toxoplasmosis,
cytomegalovirus)
• Hereditary thrombophilia
testing
• Toxicology testing
 Nursing Care
involves supporting the family through the grief work:
• Assist family through labor and
birth.
• Provide for woman’s physical
needs after birth.
• Encourage family members to
express and share their thoughts
and feelings about loss.
• Give family an opportunity to view,
hold, name infant.
• Prepare items for family to keep to
remember infant.
• Provide opportunities for religious or
spiritual counseling and cultural
practices.
• Visit or phone family after discharge
to assist in closure.
• Make referral to appropriate perinatal
loss counseling services if indicated.
 10

Delineate the effects of pelvic

contractures on labor and birth.
CEPHALOPELVIC DISPROPORTION (CPD)

A condition in which the size, shape, or position of

the fetal head prevents it from passing through the
lateral aspect of the maternal pelvis or when the
maternal pelvis is of a size or shape that prevents
the descent of the fetus through the pelvis; term
used when the maternal bony pelvis is not large
enough or appropriately shaped to allow for fetal
descent.
CEPHALOPELVIC DISPROPORTIONS MAY
RESULT TO:

Oxygen deprivation
01
Many physicians allow labor to progress for far too long. And if it is prolonged, oxygen-deprivation
injuries may occur. These injuries can lead to hypoxic-ischemic encephalopathy, cerebral palsy,
and developmental delays. Furthermore, the trauma from continued labor may result in serious
intracranial hemorrhages (brain bleeds).

Shoulder dystocia
02
When CPD is present, the baby is more likely to have shoulder dystocia injuries, including Erb’s
Palsy or Klumpke’s palsy.
CEPHALOPELVIC DISPROPORTIONS MAY
RESULT TO:

Prolapse of the umbilical cord

03
It occurs when the umbilical cord slips down in front of the fetal part. CPD may result in prolapse
when membranes rupture and the fetal part is not fitted into the cervix.

Premature rupture of membranes

04
Rupture of the fetal membranes before the onset of labor. Premature rupture of membranes may
occur if the mother has CPD.
11

Describe the psychologic factors that may be

accelerated secondary to complications
during labor and birth.
 Occurs when a mother repeatedly faces uncontrollable, stressful
Helplessness situations, then does not exercise control when it becomes
available.

Pain during labor is caused by contractions of the muscles of the

Pain uterus and by pressure on the cervix. Women experience labor
pain differently — for some, it resembles menstrual cramps; for
others, severe pressure; and for others, extremely strong waves
that feel like diarrhea cramps.

Delayed pushing sometimes causes labor to last longer, puts

Loss of Control
women at higher risk of postpartum bleeding and infection, and
puts babies at a higher risk of developing sepsis.
 Loss of Several possible reasons for a
Self-Esteem decline in self-esteem during
pregnancy, including physical
changes to the body, rampant
hormones, stress over the baby’s
development, and concerns about
the future.

Lack of knowledge and fear of the

Anxiety unknown during pregnancy and
childbirth make mothers fearful,
worried, and anxious.
References:

Pillitteri, A. (2014). Maternal & child health nursing: Care of the childbearing & childrearing family.

London, M. L., Ladewig, P. W., Davidson, M. R., Ball, J., Bindler, R. M. G., & Cowen, K. J. (2017). Maternal & child
nursing care.

Pillitteri, A., & Silbert-Flagg, J. (2018). Maternal and Child Health Nursing: Care of the Childbearing and
Childrearing Family, 8th Ed. Lippincot Williams and Wilkins: USA.

Murray, D. (2019). Cephalopelvic disproportion. Retrieved from https://www.verywellfamily.com/cephalopelvic-

disproportion-4687525

Dike NO, Ibine R. Hypotonic Labor. [Updated 2020 Nov 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564403/
References:

Marie, X. (2011). Childbirth at risk labor related complication. Retrieved from

https://www.slideshare.net/sikyu11/child-birth-at-risk-labor-related-complication-9

Thomas, D.P. (2015). Complications at third stage of labor. Retrieved from

https://www.slideshare.net/deepthyphilipthomas/complications-of-third-stage-of-labour

Mayo Clinic. (2020). Pregnancy week by week. Retrieved from https://www.mayoclinic.org/healthy-

lifestyle/pregnancy-week-by-week/in-depth/placenta/art-20044425

Mayo Clinic. (2019). Vaginal tears in childbirth. Retrieved from https://www.mayoclinic.org/healthy-

lifestyle/labor-and-delivery/multimedia/vaginal-tears/sls-20077129?s=6

Mayo Clinic. (2020). Placenta accreta. Retrieved from https://www.mayoclinic.org/diseases-

conditions/placenta-accreta/symptoms-causes/syc-
20376431#:~:text=Placenta%20accreta%20is%20a%20serious,severe%20blood%20loss%20after%20delivery.

OMICS Online (n.d.). Nursing Care for Oligohydramnios. Retrieved from

https://www.omicsonline.org/blog/2015/05/04/11097-Nursing-Care-for-Oligohydramnios.html
THANK YOU!