It can arise in any of the four components of the labor process:

1. The power, or the force that propels the fetus (uterine

contractions)
2. The passenger – the fetus
3. The passageway or the birth canal
4. The psyche – the woman and family perception of the event
 Nursing Diagnosis
• Pain related to induction and labor process
• Fear related to uncertainty of pregnancy outcome
• Anxiety related to medical procedures and apparatus necessary
to ensure health of woman and fetus
• Fatigue related to loss of glucose stores through work and
duration of labor
• Ineffective coping related to lack of knowledge or lack of preparation for
labor
• Fatigue related to prolonged labor
• Risk for ineffective tissue perfusion related to excessive loss of blood with
complication of labor
• Risk for injury (maternal or fetal) related to labor involving a multiple
gestation pregnancy
• Anticipatory grieving related to nonviable monitoring pattern of fetus
 a. Uterine Inertia
- sluggishness of contractions
• Causes :
1. Inappropriate use of analgesics
2. Pelvic bone contraction
3. Poor fetal position
4. Over distention due to multiparity, multiple pregnancy,
polyhydramios or excessive large baby
 Types of Uterine Inertia
• A. primary (hypertonic) uterine dysfunction
- Relaxations are inadequate and mild, thus are ineffective. Since uterine
muscle are in a state of greater than normal tension, latent phase of the first
stage of labor is prolonged.
• B. Secondary (hypotonic) uterine dysfunction
- Contractions have been good but gradually become infrequent
and of poor quality and cervical dilatation stops
 Precipitate delivery can lead to :
1. Extensive lacerations
2. Abruptio placenta
3. Hemorrhage due to sudden release of pressure, leading to shock
 Prolonged labor
• In primis, labor lasting more than 18 hours and in multis, more than 12
hours
• Can lead to :
1. maternal exhaustion
2. Uterine atony
3. Caput succedanum
4. Cephal hematoma
 Uterine Rupture
• Occurs when the uterus undergoes more straining that is capable of sustaining
• Causes :
1. Scar from a previous classic cesarian section
2. Unwise use of oxytocin
3. Overdistention
4. Faulty presentation
5. Prolonged labor
• Signs and symptoms:
1. Sudden severe pain
2. Hemorrhage and clinical signs of shock (restlessness, pallor, decreasing
BP, increasing respiratory and pulse rates)
3. Change in abdominal contour, with two swellings on the abdomen : the
retracted uterus and the extrauterine fetus
• Management:
- hysterectomy
 Uterine Inversion
• Fundus is forced through the cervix so that the uterus is turned inside out
• Causes:
1. Insertion of the placenta at the fundus, so that the fetus is rapidly delivered
especially if unsupported, the fundus is pulled down
2. Strong fundal push when mother fails to bear down properly during the
second stage of labor
3. Attempt to deliver the placenta before signs of placental separation
appears.
 Amniotic Fluid Embolism
• Occurs when amniotic fluid is forced into an open maternal blood sinus
through defect in the membranes or after partial premature separation of
the placenta.
• Solid particles in the amniotic fluid enter maternal circulation and reach
the lungs as emboli.
• Signs and symptoms are dramatic
 woman in labor suddenly sits up and grasps her chest because of inability
to breathe and sharp chest pain
Turns blue and then the typical bluish-gray color associated with
pulmonary embolism
Death may occur in a few minutes
 Trial Labor
• If a woman has borderline (just adequate) pelvic measurements but fetal
position and presentation are good.
• May be continued for as long as there is progressive fetal descent of the
presenting part and cervix continues to dilate actively
• Management
1. Monitor FHTs and uterine contractions
2. Keep bladder empty to allow all available space to be used by the fetus
3. Emotional support
 Premature Labor and Delivery
• Uterine contractions occur before 38th week of gestation
1. If there is no bleeding and cervical dilatation and fetal heart sounds are good,
premature uterine contractions can be stopped by the following drugs:
• Ethyl alcohol (Ethanol) IV – blocks the release of oxytoxin
Side effects :
Nausea and vomiting
Mental confusion. (same side effects when alcohol is taken orally in excessive
amounts)
• Vasodilan IV - a vasodilator.
Side effects:
Hypotension
Tachycardia
• Ritodrine – a muscle relaxant given orally
• Bricanyl – a known bronchodilator
• If premature uterine contractions are accompanied by progressive fetal descent and
cervical dilatation, premature delivery is inevitable.
 It may not be shorter than full term labor
 Pain medications are kept to a minimum because analgesics are known to cause
respiratory depression. As it is, premature babies already have enough difficulty
breathing on their own; giving analgesics, therefore would add up to the problem.
 Implication : give emotional support to the mother such that she focuses her
attention not on her own needs but those of her baby.
• Steroids (glucocorticoids) are given to the mother to help in the
maturation of the fetal lungs by hastening the production of surfactants.
• Caudal, spinal or Infiltration anesthesia is preferred because it does not
compromised fetal respiration
• Episiotomy is not necessarily smaller than in full term deliveries; may
even be larger so that the preemie can be delivered at the shortest possible
time, since excessive pressure on the fragile preemie’s head can cause
subarachnoid hemorrhage that could be fatal.
• Forceps may be applied gently
• Cord is cut immediately, rather than waiting for pulsations to stop,
because preemies have difficult time excreting large amounts of bilirubin
that will be formed from the extra amount of blood.
Instrumental Deliveries
• https://www.slideshare.net/shenell/problems-during-labor-and-delivery-20
2
• East West Comprehensive Course Review book for the Nurse Licensure
Examination, Vol 1; 4th edition, 2006