PROBLEMS WITH THE POWER

NR-NUR 122, AY 2021-2022 Academics.

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PRECIPITATE LABOR &
BIRTH
• occur when labor lasts less
than 3 hours & results in
rapid birth

• uterine contractions are so

strong
 Causes
• abnormally low resistance
in maternal soft tissues

• abnormally strong uterine

contractions
Contributing Factors
• Multiparity

• large pelvis

• previous precipitate labor

• small baby in a favorable position

 Signs &
Symptoms
• Intense pain

• Increase HR, temp., & BP

• Diaphoresis

• Restlessness

• Hypertonic contractions
 Risks of Precipitous
Labor
A. Maternal

• Uterine rupture

• Lacerations of the cervix, vagina, & perineum

• Postpartum hemorrhage
 Risks of Precipitous
Labor
B. Fetal-neonatal

• Hypoxia

• Cerebral trauma

• Pneumothorax
 Clinical Therapy
• Close monitoring in the last few
weeks of pregnancy.

• If cervix softens & begins to dilate,

the woman may be scheduled for
immediate induction of labor.
 Assessment
• 1. Identify clients at increased risk

• 2. During labor, presence of one or both of the following factors

may indicate potential problems:

accelerated cervical dilatation(more than 2 cm/hr in multigravida

& more than 1.2 cm/hr in primigravida) & fetal descent
intense uterine contractions w/ little uterine relaxation between
contractions
 Nursing Diagnoses
• Acute pain related to hypertonic contractions

• Acute pain related to rapid labor process

• Risk of deficient fluid volume related to haemorrhage

• Risk for infection

• Risk for injury related to rapid labor & birth

 Nursing Plan & Implementation
• Closely monitor uterine contractions & cervical dilatation & keep
an emergency birth pack at hand.
• Stay in constant attendance if possible.
• Promote comfort & rest.
• Fetus is monitored for signs of hypoxia
• If the woman receiving pitocin develops an accelerated labor
pattern, pitocin is discontinued immediately, & woman is turned
on her left side to improve uterine perfusion.
 Evaluation
• The woman & her baby are closely monitored during
labor, & a safe birth
occurs.

• The woman maintains optimal comfort.

UTERINE PROLAPSE
• uterus has descended
from its normal position
in the pelvis farther down
into the vagina

• extent of the prolapse is

determined by the location
of the cervix in the vagina
 Causes
• Pregnancy & trauma incurred during childbirth

• Loss of muscle tone

• Tumor in the pelvic cavity

• Genetics
 Risk Factors
• One or more pregnancies & vaginal births

• Giving birth to a large baby

• Increasing age

• Frequent heavy lifting

• Chronic coughing
 Risk Factors
• Frequent straining during bowel
movements

• Some conditions, such as

obesity, chronic constipation &
COPD
 Types
• First degree (mild)

• Second degree
(moderate)

• Third degree (severe)

 Signs & Symptoms
• Mild uterine prolapse - no s/sx

• Moderate to severe uterine prolapse may experience the following:

 Sensation of heaviness or pulling in the pelvis

 Tissue protruding from the vagina

 Urinary difficulties, such as urine leakage or urge incontinence

Signs & Symptoms
Trouble having a bowel movement

 Low back pain

 Feeling as if sitting on a small ball or as if something is falling out of

vagina

 Symptoms that are less bothersome in the morning & worsen as the
day goes on
 Painful sexual intercourse
Diagnostic Tests
• pelvic exam

• ultrasound or MRI
Therapeutic Management
• Lifestyle changes

• Vaginal pessary

• Surgical repair
Nursing Management
• encompasses emotional support & teaching regarding the disorder &
treatments
• use of lubricants may be suggested
• avoid lifting or straining
• emotional support & guidance to obese patients in their attempt to lose
weight
• Preventive techniques - prenatal & postnatal Kegel exercises
 UTERINE
RUPTURE
• A tear in the wall
of the uterus

• Rupture of the uterus

during labor is rare
 Causes
• uterine overdistention

• external or internal version

• iatrogenic perforation

• excessive use of uterotonics

• failure to recognize labor dystocia with excessive uterine contractions

against a lower uterine restriction ring
 Risk Factors
• prior uterine surgery including CS

• fetal malpresentation

• Grandmultiparity

• operative vaginal birth

• oxytocic induction of labor

Classifications
• Complete rupture

• Incomplete rupture
 Signs & Symptoms
• Sudden , severe abdominal pain during a strong labor contraction, which
may be reported as a “tearing’’ sensation

• Minimal to diffuse vaginal bleeding

• Concealed hemorrhage may occur in the abdominal cavity or broad

ligaments, undetected until woman becomes symptomatic from
hypovolemic shock
Signs & Symptoms
• Shock
• Deterioration of FHS
• fetal oxygenation - late decelerations, reduced viability,
tachycardia, & bradycardia.
• Absent fetal heart sounds
• Cessation of uterine contractions (complete rupture)
 Assessment
• Identify risks factors

• Maternal history – previous CS & uterine surgery, & trauma

• Maternal uterine activity – contraction frequency, intensity,

duration, & resting phases

• Abdomen should be assessed for signs of abdominal trauma,

bruising, tenderness, pain, & rigidity
 Therapeutic
Management
• Fluid replacement therapy

• Oxytocin

• Emergency exploratory laparotomy with cesarean

delivery

• Blood transfusion

• Uterus may be either repaired or needs to be removed

 Nursing Management
• Focus on prevention of uterine rupture induced by aggressive
use of oxytocin

• Immediate recognition & stabilization of the client

• Notification of the physician

• Offering explanation & reassurance to the client & family

Nursing Management
• Monitor vital signs

• Ensure IV access w/ fluid volume replacement

• Discontinue oxytocin

• Administer oxygen inhalation

UTERINE INVERSION
 uterus turns inside out
with either birth of the
fetus or delivery of the
placenta
Risk Factors
• Short umbilical cord
• Excessive traction on the umbilical cord
• Excessive fundal pressure
• Fundal implantation of the placenta
• Retained placenta & abnormal adherence of the placenta
• Vaginal births after previous CS
Risk Factors
• Rapid or long labor
• Previous uterine inversion
• Certain drugs such as magnesium sulphate
• Vigorous manual removal of the placenta
• Weakness of the uterine musculature
• Uterine abnormalities
Signs & Symptoms
• Incomplete inversion

• Complete inversion

• Prolapsed inversion

• Total inversion
Signs & Symptoms
• Hemorrhage

• Sudden appearance of a vaginal mass

• Fundus is not palpable in the abdomen

• show signs of blood loss – hypotension, dizziness, pallor or diaphoresis

 Diagnostic
Test/Procedure
• usually based on clinical s/sx

• UTZ
 Therapeutic Management
• Administration of drugs to soften uterus
during reinsertion

• Manual reinsertion of the uterus

• Abdominal surgery

• Antibiotics
 Therapeutic Management
• Intravenous fluids

• Blood transfusion

• Intravenous administration of oxytocin

• Emergency hysterectomy
 Nursing Management
• Recognize signs of impending inversion, & immediately notify
physician & call for assistance.

• Take steps to prevent or limit hypovolemic shock.

• Measure & record vital signs every 15 minutes