COMPLICATIONS WITH THE POWER (The Force of Labor)

A. INEFFECTIVE UTERINE FORCE

- Uterine contractions are the basic force moving the fetus through the
birth canal. Contractions occur because of interplay of enzymes,
electrolytes, proteins and hormones.

The causes of ineffective uterine force depend on the 3 types of dysfunction:

1. HYPOTONIC CONTRACTIONS
Number of contractions: not more 2 or 3 occurring in a 10-minute period
Resting tone: less than 10mmHg
Strength of contractions: does not rise above 25 mmHg
Phase of labor: Active
Symptom: Painless

2. HYPERTONIC CONTRACTIONS
Resting tone: more than 15 mmHg
Contractions: Frequent prolonged contractions that is not productive.
Phase of labor: Latent
Symptom: Painful

3. UNCOORDINATED CONTRACTIONS
- With uncoordinated contractions, more than one pacemaker may be
initiating contractions or receptor points in the myometrium may be acting
independently of the pacemaker.
- A fetal and uterine external monitor must be attached to the woman to
assess thee rate, pattern, resting tone and fetal response to contractions for
at least 15 minutes.
 B. DYSFUNCTIONAL LABOR AND ASSOCIATED STAGES OF LABOR
Dysfunction at the First Stage of Labor
1. Prolonged Latent Phase

It lasts longer than 20 hours in a nullipara or 14 hours in a multipara.

This may occur if the cervix is not “ripe” at the beginning of labor.
It can be managed through helping the uterus to rest, providing
adequate fluid for hydration and pain relief.

2. Protracted Active Phase

This phase is prolonged if cervical dilatation does not occur at a rate

of at least 1.2 cm/hr. in a nullipara or 1.5 cm/hr. in a multipara, or if
the active phase lasts longer than 12 hours in a primigravida or 6
hours in a multigravida.
Oxytocin is prescribed during a protracted active phase to augment
labor

3. Prolonged Deceleration Phase

A deceleration phase has become prolonged when it extends beyond

3 hours in a nullipara or 1 hour in a multipara. It most often results
from abnormal fetal head position. Cesarean birth would also be
necessary in a prolonged deceleration phase.

4. Secondary Arrest of Dilation

A secondary arrest of dilatation has occurred if there is no progress in

cervical dilatation for longer than 2 hours. Again, cesarean birth may
be necessary.

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Dysfunction at the Second Stage of Labor
1. Prolonged Descent

Prolonged descent of the fetus occurs if the rate of descent is less than 1.0
cm/hr in a nullipara or 2.0 cm/hr in a multipara. It can be suspected if the
second stage lasts over 2 hours in a multipara.
A semi-Fowler’s position, squatting, kneeling, or more effective pushing
may speed up the descent.

2. Arrest of Descent

Arrest of descent results when no descent has occurred for 2 hours in a

nullipara or 1 hour in a multipara
The most likely cause of arrest of descent in the second stage of labor is
CPD, so cesarean birth is necessary.

C. PRECIPITATE LABOR
Precipitate labor occurs when uterine contractions are so strong that a
woman gives birth with only a few and rapidly occurring contractions.
Grand multiparity facilitates this kind of labor, or it can also happen after
induction of labor by oxytocin or amniotomy. Contractions can be so
forceful they lead to premature separation of the placenta or lacerations
of the perineum, placing the woman at risk for hemorrhage.

D. INDUCTION AND AUGMENTATION OF LABOR

Induction of labor means labor is started artificially. Augmentation of
labor refers to assisting labor that has started spontaneously but is not
effective.
It is not used as an elective procedure until the fetus is at term (over 39
weeks).
Before induction of labor is begun in term and post term pregnancies,
the following conditions should be present:
o The fetus is in a longitudinal lie.

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 o The cervix is ripe, or ready for birth.
o The presenting part is the fetal head (vertex) and is engaged.
o There is no CPD.
o The fetus is estimated to be mature by date (over 39 weeks).

E UTERINE RUPTURE
Rupture occurs most commonly when a vertical scar from a previous
cesarean birth or hysterotomy repair tears. When uterine rupture
occurs, fetal death will follow unless immediate cesarean birth can be
accomplished.
If a uterus should rupture, the woman experiences a sudden, severe
pain during a strong labor contraction, which she may report as a
“tearing” sensation.

F. INVERSION OF THE UTERUS

Uterine inversion refers to the uterus turning inside out with either birth
of the fetus or delivery of the placenta. When an inversion occurs, a
large amount of blood suddenly gushes from the vagina.
Never attempt to replace an inversion. Never attempt to remove the
placenta if it is still attached.
An IV fluid line should be inserted to restore fluid volume. Administer
oxygen by mask, and assess vital signs. Be prepared to perform
cardiopulmonary resuscitation (CPR) if the woman’s heart should fail
from the sudden blood loss.

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 G. AMNIOTIC FLUID EMBOLISM
It occurs when amniotic fluid is forced into an open maternal uterine
blood sinus through some defect in the membranes.
It is not preventable because it cannot be predicted.
The risk for disseminated intravascular coagulation (DIC) is high, further
compounding her condition. In this event, she will need continued
management. Most likely she will be transferred to an ICU.