NCM 109: CARE OF MOTHER CHILD, AND AT RISK OR WITH PROBLEMS

NURSING CARE OF CLIENT WITH COMPLICATIONS OF LABOR BIRTH [COMPLICATIONS

WITH THE POWER]

CAMARINES SUR POLYTECHNIC COLLEGES

ALLYSSA LEILA E. ORBE, BSN-2A
2nd SEMESTER A.Y. 2023 – 2024

PROBLEMS OF LABOR • Pelvic bone contraction that has

➢ POWER narrowed the pelvic diameter so a
▪ The power, or the force that fetus cannot pass (cephalopelvic
propels the fetus. disproportion ICPD) such as could
➢ PASSENGER occur in a woman with rickets
▪ The fetus. • Posterior rather than anterior fetal
➢ PASSAGEWAY position or extension rather than
▪ The birth canal. flexion of the fetal head
➢ PSYCHE • Failure of the uterine muscle to
▪ The woman’s and family’s contract properly or condescension
perception of the event of the uterus as with a multiple
pregnancy excessively oversized
LABOR fetus
➢ Also called childbirth • A nonripe cervix
➢ The process of your baby leaving the • Presence of a full rectum or urinary
uterus bladder that impedes fetal descent
➢ Mother is in labor when there is regular • A woman becoming exhausted from
contractions labor
➢ Contractions: muscles of the uterus gets • Inappropriate use of analgesia
thight and then relax (excessive or too early
➢ Cause of contraction: administration)
▪ Oxytocin
▪ Adenosine triphosphate INEFFECTIVE UTERINE FORCE
▪ Calcium, phosphate, ➢ Hypotonic Contractions
epinephrine. ➢ Hypertonic Contractions
➢ Uncoordinated
SIGNS OF TRUE LABOR
• Begin irregularly but become regular HYPOTONIC UTERINE FORCE
and predictable • Contractions is usually slow and
• Felt first in lower back and sweep infrequent
around to the abdomen in a wave • There are only 2-3 contractions
• Continue no matter what the occuring within a 10- minute period.
woman’s level of activity • The strength of contractions does
• Increase in duration, frequency, and not rise above 10 mmHg, and they
intensity occur mostly during the active phase
• Achieve cervical dilatation of labor
• Increase risk of postpartal
False Contractions True Contractions hemorrhage
Begin and remain Begin irregularly
irregular but become regular HYPOTONIC HAPPENS WHEN
and predictable • After administration of analgesia
Felt first abdominally Felt first in lower • Bowel and bladder distention
and remain back and sweep • Uterus is overstretched due to
around to the multiple gestation
abdomen in a wave • Large fetus
Often disappear with Continue no matter • Polyhydramnios
ambulation or sleep what the woman’s • Uterus that is lax from grand
level of activity multiparity
Do not increase in Increase in
duration, frequency, duration, HYPERTONIC CONTRACTION
or intensity frequency, and • Hypertonic contractions are marked
intensity by an increase in resting tone to
Do not achieve Achieve cervical more than 15 mmHg
cervical dilatation dilatation • Hypertonic contractions tend to
occur more frequently and during the
COMPLICATIONS WITH THE POWER latent phase of labor
➢ The force of Labor • They are more painful than usual
and they make the woman frustrated
RISK FACTOR with her breathing techniques
• Primigravida status because they are ineffective

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 NCM 109: CARE OF MOTHER CHILD, AND AT RISK OR WITH PROBLEMS
NURSING CARE OF CLIENT WITH COMPLICATIONS OF LABOR BIRTH [COMPLICATIONS
WITH THE POWER]
CAMARINES SUR POLYTECHNIC COLLEGES
ALLYSSA LEILA E. ORBE, BSN-2A
2nd SEMESTER A.Y. 2023 – 2024
• The lack of relaxation between
contractions may not allow optimal
uterine artery filing that could lead to
fetal anoxia
• 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.
• 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.
COMPARISON OF HYPOTONIC AND
HYPERTONIC CONTRACTION
Hypotonic Hypertonic
Most Active Latent
common
phase of
occurence
Symptoms Limited pain Painful
Medication Favorable Unfavorable
used reaction helpful
Oxytocin Little value
Sedation
UNCOORDINATED CONTRACTIONS
• More than one pacemaker may be
initiating contractions with
uncoordinated contractions, or
receptor points in the myometrium
may be acting independently of the
pacemaker.
• It would be difficult for the woman to
rest between contractions because
they occur erratically.
• A fetal and uterine external monitor
must be attached to the woman to
assess the rate, pattern, resting
tone, and fetal response to
contractions for at least 15 minutes.
• Oxytocin administration can also be
done to stimulate a more effective
and consistent pattern of
contractions with a better, lower
resting tone.
DYSFUNCTIONAL LABOR AND
ASSOCIATED STAGES OF LABOR
PROLONGED LATENT PHASE
• When contractions become
ineffective during the first stage of
labor
• A latent phase that lasts longer than
20 hours in a nullipara or 14 hours in
a multipara
• Relaxation between contractions is
inadequate, and the contractions are
only mild (less than 15 mmHg).
PROTRACTED ACTIVE PHASE
• Usually associated with fetal
malposition or cephalopelvic
disproportion (CPD)
• 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
PROLONGED DECELERATION PHASE
• When it extends beyond 3 hours in a
nullipara or 1 hour in a multipara
• Prolonged deceleration phase most
often results from abnormal fetal
head position.
DYSFUNCTION AT THE SECOND
STAGE OF LABOR
PROLONGED DESCENT
• Occurs if the rate of descent is less
than 1.0 cm/hr in a nullipara or 2.0
cm/hr in a multipara.
• Can be suspected if the second
stage lasts over 2 hours in a
multipara
ARREST OF DESCENT
• Results when no descent has
occurred for 2 hours in a nullipara or
1 hour in a multipara.
• Failure of descent occurs when
expected descent of the fetus does
not begin or engagement or
movement beyond o station does
not occur.
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 NCM 109: CARE OF MOTHER CHILD, AND AT RISK OR WITH PROBLEMS
NURSING CARE OF CLIENT WITH COMPLICATIONS OF LABOR BIRTH [COMPLICATIONS
WITH THE POWER]

CAMARINES SUR POLYTECHNIC COLLEGES

ALLYSSA LEILA E. ORBE, BSN-2A
2nd SEMESTER A.Y. 2023 – 2024

PRECIPITATE LABOR ➢ The first change of the uterus in early

• Describes labor that’s quick and labor
short.
• Baby is born within three hours of SCORING OF THE CERVIX FOR
regular contractions started. READINESS FOR ELECTIVE INDUCTION

PRECIPITATE LABOR COMPLICATIONS SCORING

• Heavy bleeding or hemorrhaging Rating 0 1 2 3
from the vagina or uterus Factor
• Tearing or lacerations to the cervix Dilatation 0 1-2 3-4 5-6
or vaginal tissues (cm)
• Lacerations to the perineum Effacement 0- 40- 60- 80
• Shock after giving birth (%) 30 50 70
Station -3 -2 -1 to +1
INDUCTION & AUGMENTATION OF 0 to
LABOR +2

INDUCTION OF LABOR STRIPPING THE MEMBRANES

• Labor is started artificially
• Augmentation of labor refers to
assisting labor that has started
spontaneously but is not effective
INDUCTION OF LABOR INDICATIONS
(TO USE)
• Preeclampsia/eclampsia
• Severe hypertension
• Diabetes
• Rh sensitization
• Prolonged rupture of the membrane
• Intrauterine growth restriction
• Post maturiy
INDUCTION OF LABOR INDICATIONS
(NOT TO USE)
• Multiple gestations
• Polyhydramnios
• Grand parity
• Older than 40 years
• Have previous uterine scars
OXYTOCIN
➢ A hormone released by the pituitary
gland that causes increased contraction
of the uterus during labor and stimulates
the ejection of milk into the ducts of the
breasts
INDICATION
• The fetus is in a longitudinal lie.
• The cervix is ripe, or ready for birth.
• The presenting part is the fetal head
(vertex) and is engaged.
• There is no CPD
• The fetus is estimated to be mature
by date (over 39 weeks).
➢ Involves the doctor sweeping their
(gloved) finger between the thin
membranes of the amniotic sac in the
uterus
➢ It’s also known as a membrane sweep.
➢ This motion helps separate the sac
HYGROSCOPIC SUPPOSITORIES
➢ A device designed to dilate (stretch
open) the cervical os by cervical
insertion of a conical and expansible
material made from the root of a
seaweed (Laminaria digitata or
Laminaria japonica)
PROSTAGLANDIN
➢ Prostaglandins are hormone-like
substances that affect several bodily
functions, including inflammation, pain
and uterine contractions
INDUCTION OF LABOR BY OXYTOCIN
➢ Used to initiate labor contractions if a
pregnancy is at term
➢ Hyperstimulation is usually defined as
five or more contractions in a 10-minute
period or contractions lasting more than
2 minutes in duration or occurring within
60 seconds of each other
ADVERSE EFFECT OF OXYTOCIN
• Nausea
• Vomiting
• Cardiac arrhythmias
• Uterine hypertonicity
• Tetanic contractions.
• Uterine rupture
• Severe water intoxication
• Fetal bradycardia

Cervical Ripening
➢ The process of softening and effacing
the cervix as well as stimulating early
cervical dilation.

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 NCM 109: CARE OF MOTHER CHILD, AND AT RISK OR WITH PROBLEMS
NURSING CARE OF CLIENT WITH COMPLICATIONS OF LABOR BIRTH [COMPLICATIONS
WITH THE POWER]

CAMARINES SUR POLYTECHNIC COLLEGES

ALLYSSA LEILA E. ORBE, BSN-2A
2nd SEMESTER A.Y. 2023 – 2024

NURSING IMPLICATIONS • Fundus is no longer palpable

• Prepare IV solution by adding 1 ml
(10 International Units) to 1.000 ml MANAGEMENT
of designated IV fluid. • IVT
• Use an infusion pump to ensure • Administer oxygen mask
accurate control of infusion rate • Assess VS
• Regulate infusion rate to establish • Immediately given anesthesia to
uterine contractions similar to a relax muscles
normal labor pattern.
• Monitor frequency, duration, and AMNIOTIC FLUID EMBOLISM
strength of contractions during ➢ Occurs when amniotic fluid into an open
infusion maternal blood sinus
• Assess maternal pulse and blood
pressure, and watch for possible
hypotension. If hypotension occurs,
discontinue drug and notify primary
care provider.
• Continuously monitor fetal heart rate
for signs of fetal distress.
• Monitor intake and output and watch
for signs of possible water
intoxication, such as headache or
vomiting. Limit IV fluids to 150 ml/hr.
• Prepare the woman for birth

UTERINE RUPTURE
➢ Spontaneous tearing of the uterus
➢ Rare and an immediate emergency
➢ Uterine rupture occurs during labor.

CONTRIBUTING FACTORS
• Prolonged labor
• Abnormal presentation
• Mutiple gestation
• Unwise use of oxytocin
• Obstructed labor
• Traumatic maneuvers of forceps or
traction

TWO TYPES OF UTERINE RUPTURE

COMPLETE
• Rupture through the endometrium.
Myometrium, and peritoneum
• Retracted uterus and extrauterine
fetus
• Signs of hypovolemic shock

INCOMPLETE
• Peritoneum is intact
• Localized tenderness and persistent
aching pain

INVERSION OF THE UTERUS

➢ Uterus turning inside out with either birth
of the fetus or delivery of the placenta
➢ Uterine inversion occurs following
delivery

SIGNS
• Sudden gush of blood