Aldrine L.

Robles
BSN4B1
1. Problems with maternal soft tissue

 A full bladder may impede the progress of labor, as can myomata uteri,
cervical edema, scar tissue, and congenital anomalies.

 Emptying the bladder may allow labor to continue; the other conditions
may necessitate caesarean birth.

2. Dysfunctional uterine contractions

 Contraction may be too weak, too short, too far apart, ineffectual

 Classification

A.) Primary: inefficient pattern present from beginning of labor; usually

prolonged latent phase.

B.) Secondary: efficient pattern that changes to efficient or stops; may occur
in any stage.
Assessment findings:
Progress of labor is slower than expected rate of dilatation,
effacement, descent for specific client.
Length of labor prolonged; prolonged latent phase (>20 hrs
in nullipara pt. or >4 h in a multipara pt), protacted active
phase dilatation np. <1-2cm, mp <1.5cm; protacted
descengt <1 cm per hr change in station in the nullipara pt.
or <2 cm per hour in the mp pt.
Maternal exhaustion/ distress
Fetal distress
Arrest of descent: no progress in fetal station greater than
1 hour

Nursing intervention:
Individual as to cause
Provide comfort measures for client
Provide client, supportive descriptions of all actions taken
Administer analgesia if ordered
Monitor mother/ fetus continuously
 Previous
Ineffective Alteration in Alteration of fetal Maternal psychological
uterine pelvic size, position, position and response to past
contraction or structure presentation, and during labor and experience of
power number of fetuses. birth labor and
delivery

This interacts with Insufficient

the labor progress contractions
Compromised are produced
efforts due to
analgesia
Poor
Poor
descent of
dilatation and
the fetus
effacement of
Complications to the fetus: the cervix
Neonatal asphyxia
Fetal injuries and fractures
Fetal distress Occurrence of
Acute
Complications to the mother: extended and pain
Vaginal laceration painful labor Vaginal
Infection hemorrhage:
Maternal exhaustion Maternal
vaginal decrease
Post partum hemorrhage blood volume
laceration
Signs/ symptoms:
Pain

Increase heart rate, pulse, body temp.

Increased BP

Diaphoresis

Body weakness

Exhausted appearance

SOB

Nasal flaring

Anxiety

Restlessness

Vaginal hemorrhage
Medical Management:
1.Treatment for contraction abnormalities involves stimulation of
labor through the use of oxytocin. An intrauterine pressure catheter
may be used.

2.Management for maternal passageway or fetal passage

problems involves delivery in the safest manner for the mother and
fetus.

A.If the problem is related to the inlet or midpelvis, a CS delivery is

indicated.

B. If the size of the outlet is the problem, a forceps or vacuum

extraction maybe perform.

Surgical Management:

1. Caesarean in necessary for delivery of the fetus

Acute pain related difficulty in labor.
Promoting comfort:
Relaxation technique such as breathing techniques during labor
Changing position
Support person
Pain medications

Anxiety related to threat of change in health status of self and

fetus.
Decreasing anxiety:
Give brief explanation to the women about the nature of contraction
associated with induce labor
Provide anticipatory guidance regarding use of meds, procedures
and equipment.
Prepare for caesarean if necessary

Powerlessness
Provide rest period
Relaxation technique
Support person
Deficient knowledge related to measures that can be used to
enhance labor and facilitate birth.
Teach proper breathing techniques used during labor
Educate about the complication of the delivery
Explain client that caesarean is necessary due to difficult labor.

Ineffective individual coping related to inadequate support

system.
Support mechanism:
Stay with the patient during labor process
Encourage patient to discuss about her condition
THE END