Kisinamal,Lovely B.
BSN – II
Interventions
 Review the history of labor, onset, and
duration.
 Note timing/type of medication(s). Avoid
administration of narcotics or of epidural
block anesthetics until the cervix is 4 cm
dilated.
Note the condition of cervix. Monitor for
signs of amnionitis. Note elevated
temperature or WBC; odor and color of
vaginal discharge.
 Assess uterine contractile pattern
manually (palpation) or electronically via
external, or internal monitor with internal
uterine pressure catheter (IUPC).
Evaluate the current level of fatigue, as
well as activity and rest prior to onset of
labor.
Note effacement, fetal station, and fetal
presentation.
Evaluate degree of hydration. Note
amount and type of intake.
Rationale
Accommodating in distinguishing potential causes, required
demonstrative investigations, and suitable mediations.
Uterine brokenness might be brought about by an atonic or a
hypertonic state. Uterine atony is named essential when it
happens before the beginning of work (dormant stage) or
auxiliary when it happens after grounded work (dynamic
stage).
A hypertonic contractile example may happen because of
oxytocin incitement; sedation/absense of pain given too soon
(or in abundance of requirements) can restrain or capture
work.
An inflexible or unripe cervix won't enlarge, approaching
fetal plunge/work progress. Improvement of amnionitis is
straightforwardly identified with length of work, so
conveyance ought to happen inside 24 hr after break of
layers.
Useless constrictions stretch work expanding the danger of
maternal/fetal intricacies. A hypotonic example is reflected
by regular, gentle withdrawals estimating under 30 mm Hg
by means of IUPC or "delicate as jaw" per palpation. A
hypertonic example is reflected by expanded recurrence, a
raised resting tone for every palpation or more prominent
than 15 mm Hg by means of IUPC, and conceivably
diminished power of constrictions. Note: Intensity of
constrictions can't be estimated by an outer screen.
Abundance maternal fatigue adds to auxiliary brokenness, or
might be the aftereffect of delayed work/bogus work.
These pointers of work progress may distinguish a
contributing reason for delayed work. For instance, breech
show isn't as viable a wedge for cervical expansion as is
vertex show.
Prolonged labor can result in a fluid-electrolyte imbalance as
well as depletion of glucose reserves, resulting in exhaustion

Graph cervical dilation and fetal descent
against time (i.e., Friedman curve).
Review bowel habits and regularity of
evacuation
Encourage client to void every 1–2 hr.
Assess for bladder fullness over
symphysis pubis.
Place client in lateral recumbent position
and encourage bed rest or sitting
position/ambulation,as tolerated.
Have emergency delivery kit available.
Remain with the client if possible, arrange
for the presence of doula as appropriate;
provide a quiet environment as indicated.
Palpate the abdomen of thin client for
the presence of pathological retraction
ring between uterine segments. (These
rings are not palpable through the vagina
or through the abdomen, in the obese
client).
Investigate reports of severe
abdominal pain. Note signs of fetal
distress, cessation of contractions,
presence of vaginal bleeding.
Prepare client for amniotomy, and assist
with the procedure, when the cervix is 3–4
cm dilated.
and prolonged labor with increased risk of
uterine infection, postpartal hemorrhage, or precipitous
delivery in the presence of hypertonic labor.
May be used on occasion to record progress/ prolongation of
labor.
Bowel fullness may hinder uterine activity and interfere with
the fetal descent.
A full bladder may inhibit uterine activity and interfere with
the fetal descent.
Relaxation and increased uterine perfusion may correct a
hypertonic pattern. Ambulation may assist gravitational
forces in stimulating normal labor pattern and cervical
dilation.
May be needed in the event of a precipitous labor and
delivery, which are associated with uterine hypertonicity.
Decrease external stimuli may be important
to allow sleep after administration of medication to a client
in the hypertonic state. Also helpful in decreasing the level
of anxiety, which can contribute to both primary and
secondary uterine dysfunction.
In obstructed labor, a depressed pathological ring (Bandl’s
ring) may develop at the juncture of lowerand upper uterine
segments, indicating an impending uterine rupture.
May indicate developing uterine tear/acute rupture
necessitating emergency surgery. Note: Hemorrhage is
usually occult since it is intraperitoneal with hematomas of
the broad ligament.
Rupture of membranes relieves uterine overdistension (a
cause of both primary and secondary dysfunction) and
allows presenting part to engage and labor to progress in the
absence of cephalopelvic disproportion (CPD). Note: Active
management of labor (AML) protocols may support

Administer narcotic or sedative, such as
morphine, pentobarbital (Nembutal), or
secobarbital (Seconal), for sleep as
indicated.
Use nipple stimulation to produce
endogenous oxytocin or initiate infusion
of exogenous oxytocin (Pitocin) or
prostaglandins.
Prepare for forceps delivery, as necessary.
Assist with preparation for cesarean
delivery, as indicated, e.g., malposition,
CPD, or Bandl’s ring.
amniotomy once presenting part is engaged to accelerate
labor/help prevent dystocia.
May help distinguish between true and false labor. With
false labor, contractions cease; with true labor, a more
effective pattern may happen following a rest. Morphine
helps promote heavy sedation and eliminate hypertonic
contractile pattern. A period of rest conserves energy and
reduces utilization of glucose to relieve fatigue.
Oxytocin may be necessary to increase or institute
myometrial activity for a hypotonic uterine pattern.It is
usually contraindicated in hypertonic labor pattern because it
can accentuate the hypertonicity, but may be tried with
amniotomy if the latent phase is prolonged and if CPD and
malpositions are ruled out.
Excessive maternal fatigue, resulting in ineffective bearing-
down efforts in stage II labor, necessitates the use of forceps.
Immediate cesarean birth is indicated for Bandl’s ring or
fetal distress due to CPD. Note: Once labor is diagnosed, if
delivery has not occurred within 12 hr, and amniotomy and
oxytocin have been used appropriately, then a cesarean
delivery is recommended by some protocols.