Nursing care of a family

experiencing a complication
of labor or birth
Precipitate
labor
Can be predicted from a labor
graph if during the active
phase of dilatation, the rate is
greater than 5cm/hr ( 1cm
every 12 minutes) in a
nullipara or 10cm/hr ( 1cm
every 6 minutes) in a
multipara.
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Precipitate
labor
Caution a multiparous woman by
28 week of pregnancy about the
tendency of having a brief labor
time.

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augmentation of
labor
When labor contractions are ineffective, several
interventions such as induction and
augmentation of labor with oxytocin or
amniotomy (artificial rupture of the
membranes) maybe initiated.

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augmentation of
labor
Induction of labor means labor is artificially
started.
Augmentation of labor refers to assisting
labor that has started spontaneously but is not
effective.

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Induction and
augmentation of
labor
Because either of the two carries a risk
of uterine rupture or premature
separation of the placenta, it should be
cautiously in women with multiple
gestation, polyhydramnios, gran
parity , older than 40, or have a
previous uterine scars.
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augmentation of
labor
Oxytocin is an effective uterine stimulant but
there is a thin line between adequate
stimulation and hyperstimulation.
Before induction of labor is begun in term and
post-term pregnancies, certain conditions should
be present
▪ Fetus is in a longitudinal line
▪ Cervix is ripe , or ready for birth
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▪ Presenting part is the fetal head and is engaged
Cervical ripening
Is when the cervical consistency changes from
firm to soft.
Is the first change of the uterus in early labor,
because dilatation and coordination of uterine
contraction will not occur.

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Cervical ripening
Bishops rule

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Cervical ripening
Several procedures can be done to help cervical
ripening.
1. Stripping the membranes – separation of the
membranes from the lower uterine segment
manually using a gloved finger in the cervix.
2. Hygroscopic suppositories- suppositories of
seaweed that swell on contact with cervical
secretions can be inserted. 10
Cervical ripening
Several procedures can be done to help cervical
ripening.
3. Prostaglandin insertion- Dinoprostone is
inserted into the posterior fornix of the vagina.
4. Misoprostol- drug used in assisting to ripen
the cervix.

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Induction of labor
by oxytocin
After the ripening of the cervix, administration of
oxytocin can be used to initiate labor
contractions.
Administered intravenously, so that, uterine
hyperstimulation should occur, it can be quickly
discontinued.

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Dangers of
hyperstimulation
A Fetus needs 60 to 90 seconds
between contractions in order to receive
adequate oxygenation from placental
blood vessels.

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Dangers of
hyperstimulation
Hyperstimulation is 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 can have a
potential to interfere with placenta filling
and fetal oxygenation.
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Induction of labor
by oxytocin
Oxytocin is administered and is commonly mixed
in a proportion of 10 IU in 1000mL of Lactated
Ringer’s.
Side effect of oxytocin is that it causes peripheral vessel
dilation, and can lead to extreme hypotension. Nursing
management should be monitoring of pulse and blood
pressure.
Decrease in urine flow which leads to water intoxication.
Nursing management would be observe for danger signs,15
Augmentation by
oxytocin
Used when labor contractions are weak , irregular or
ineffective.
Be certain the drug is increased in small increments
only and fetal heart sounds are well monitored.

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Uterine rupture
Occurs more often in women who have a
previous cesarean scar.
Contributing factors: prolonged labor,
abnormal presentation, multiple gestation,
unwise use of oxytocin, obstructed labor
and traumatic maneuvers of forceps or
traction.
If uterine ruptures occurs, fetal death would
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follow.
Uterine rupture
Rupture can be complete- going through the
endometrium, myometrium and peritoneum.
Rupture can be incomplete- leaves the
peritoneum intact.
Signs for complete Signs for incomplete
rupture: rupture:
Severe pain with tearing Localized tenderness and a
sensation persistent aching pain over
Uterine contractions stops the area in the lover uterine
segment 18
Hemmorhage
Uterine rupture
Nursing management
Educate client on medical interventions would
be cesarean hysterectomy(removal of the
damaged uterus) or tubal ligation
Be prepared to offer information to support
person about fetal outcome.

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Inversion of the
uterus
Refers to the uterus turning inside out with
either birth of the fetus or delivery of the
placenta.
It may lie in the within the uterine
Cavity or protrude from the vagina.

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Inversion of the
uterus Nursing management
1. Never attempt to replace an inversion because handling of
the uterus could increase bleeding
2. Never attempt to deliver the placenta because it would
create a larger area for bleeding.
3. Halt oxytocin administration.
4. Assess vital signs.
5. Be prepared to perform CPR if patients’ heart suddenly stops
due to blood loss.
6. Assist in the replacement of the uterus.

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