NURS 306 week 6 Lecture
Week 6
Chapter 10 – High-Risk Labor & Birth
Dystocia
Abnormal labor that’s gonna delay the labor
Factors influencing Labor
Powers
Uterine contractions (is UC ineffective?)
Passenger
Fetal aspects/position
Fetal size
Passage
Pelvis of the mom (appropriate/inappropriate to have VD)
Risk Factors
Congenital uterine abnormalities
Bicornuate uterus (uterus is in heart shape)
Malpresentation of the fetus
Occiput posterior
Face presentation
OP presentation - c/o back pain
Cephalopelvic disproportion
Pelvic of the mom is too small, and head of baby is too big
Tachysystole of uterus w/ oxytocin
Too many contractions (>5 UCs in 10 mins)
Maternal fatigue & dehydration
Mom is too tired to push – cannot progress anymore
Administration of analgesia or anesthesia early in labor
Give med too early
2nd, 3rd 4th dose – less effective
When strong UC occurs, pain med won’t work anymore
Get fatigue very fast
Extreme maternal fear or exhaustion
Fear about labor
Result in catecholamine release interfering with UC
Hypertonic Uterine Dysfunction
Uncoordinated Uterine Activity
Contractions: frequent, painful, but ineffective in promoting dilation and effacement
Mom has contraction, but not producing any cervical dilation
Risk for…
Exhaustion
r/t prolonged labor
Fetal intolerance of labor
Asphyxia
r/t decr. placental profusion
Risk Factors
Nulliparous woman (1st baby)
UC – not strong enough to promote cervical dilation
,NURS 306 week 6 Lecture
If mom complains of pain, and don’t see any progress of labor in SVE (baby at
same station)…
,NURS 306 week 6 Lecture
it’s time it’s possible to do something more to induce labor
Extra oxytocin / prostaglandins
Assessment Findings
Painful, frequent UCs w/ inadequate uterine relaxation btwn UCs w/ little cervical
change
Start to c/o pain
Time to amend the labor
Give something extra for the labor
Oxytocin
Cause more strong contraction
For cervical dilation
Give only when they have cervical dilation OR active labor
Category II or Category III FHR
r/t prolonged labor and inadequate uterine relaxation
Medical Management
Evaluate labor progress
Evaluate cause of labor dysfunction
Hydrate
Improve uterine perfusion
Improve coordination of UCs
Pain MGMT
Get more sleep – prevent exhaustion
Admin medications
Strengthen the UCs
Oxytocin / Pitocin
NOTE: give only when pt is ready - has some cervical dilation or in
active labor
If not, risk for uterus fatigue or uterus rupture
Nursing Actions
Promote rest
Become more effective if mom sleeps for several hours
Admin pain medication
Demerol, morphine
Relaxation
Warm shower / tub bath
Quiet environment
Minimal interruption
Hydration
Assess FHR & UCs
Evaluate labor progress with SVE
Hypotonic Uterine Dysfunction
Insufficient uterine contractions to promote cervical dilation and effacement
Not strong enough to produce any cervical dilation
No cervical change
Risk for
, NURS 306 week 6 Lecture
Exhaustion & infection
r/t prolonged labor
Fetal intolerance to labor
Asphyxia
Only way to see
With the progress of labor
Cervical change
IUPC (strength of contraction)
IUPC pressure <25 mmHg
TOCO is not that accurate because it doesn’t tell us how strong
Risk Factors
Multiparous
More problems in active phase
Extreme fear
Catecholamine release
Interfering w/ uterine contractility
Assessment Findings
Decr. frequency, strength, and duration of UCs
Little or no cervical change in active labor
< 0.5 cm/hr progress in cervical dilation for a primiparous woman
< 1.0 cm/hr progress in cervical dilation for a multiparous woman
Incr. fear & anxiety levels
Medical Management
Evaluate labor progression
Determine the cause of dysfunction
Admin medications
Oxytocin for strong UCs
Consider OB interventions
Augment labor w/ oxytocin
Perform amniotomy
Perform cesarean birth
Last resource
When signs of fetal intolerance of labor presence
Nursing Actions
Assess uterine activity
Assess maternal and fetal status
Stimulate uterine activity to achieve a normal labor pattern
Ambulate
Change of position
Hydration
IV fluid
Max maternal fluid volume
Correct maternal hypotension
Improve placental perfusion
Augment labor w/ oxytocin
Perform SVE (evaluate labor progress)
Good aseptic technique
Precipitous Labor
Stop & Drop
Labor that lasts fewer than 3 hour from onset of labor to birth
Experience higher anxiety and pain level
Week 6
Chapter 10 – High-Risk Labor & Birth
Dystocia
Abnormal labor that’s gonna delay the labor
Factors influencing Labor
Powers
Uterine contractions (is UC ineffective?)
Passenger
Fetal aspects/position
Fetal size
Passage
Pelvis of the mom (appropriate/inappropriate to have VD)
Risk Factors
Congenital uterine abnormalities
Bicornuate uterus (uterus is in heart shape)
Malpresentation of the fetus
Occiput posterior
Face presentation
OP presentation - c/o back pain
Cephalopelvic disproportion
Pelvic of the mom is too small, and head of baby is too big
Tachysystole of uterus w/ oxytocin
Too many contractions (>5 UCs in 10 mins)
Maternal fatigue & dehydration
Mom is too tired to push – cannot progress anymore
Administration of analgesia or anesthesia early in labor
Give med too early
2nd, 3rd 4th dose – less effective
When strong UC occurs, pain med won’t work anymore
Get fatigue very fast
Extreme maternal fear or exhaustion
Fear about labor
Result in catecholamine release interfering with UC
Hypertonic Uterine Dysfunction
Uncoordinated Uterine Activity
Contractions: frequent, painful, but ineffective in promoting dilation and effacement
Mom has contraction, but not producing any cervical dilation
Risk for…
Exhaustion
r/t prolonged labor
Fetal intolerance of labor
Asphyxia
r/t decr. placental profusion
Risk Factors
Nulliparous woman (1st baby)
UC – not strong enough to promote cervical dilation
,NURS 306 week 6 Lecture
If mom complains of pain, and don’t see any progress of labor in SVE (baby at
same station)…
,NURS 306 week 6 Lecture
it’s time it’s possible to do something more to induce labor
Extra oxytocin / prostaglandins
Assessment Findings
Painful, frequent UCs w/ inadequate uterine relaxation btwn UCs w/ little cervical
change
Start to c/o pain
Time to amend the labor
Give something extra for the labor
Oxytocin
Cause more strong contraction
For cervical dilation
Give only when they have cervical dilation OR active labor
Category II or Category III FHR
r/t prolonged labor and inadequate uterine relaxation
Medical Management
Evaluate labor progress
Evaluate cause of labor dysfunction
Hydrate
Improve uterine perfusion
Improve coordination of UCs
Pain MGMT
Get more sleep – prevent exhaustion
Admin medications
Strengthen the UCs
Oxytocin / Pitocin
NOTE: give only when pt is ready - has some cervical dilation or in
active labor
If not, risk for uterus fatigue or uterus rupture
Nursing Actions
Promote rest
Become more effective if mom sleeps for several hours
Admin pain medication
Demerol, morphine
Relaxation
Warm shower / tub bath
Quiet environment
Minimal interruption
Hydration
Assess FHR & UCs
Evaluate labor progress with SVE
Hypotonic Uterine Dysfunction
Insufficient uterine contractions to promote cervical dilation and effacement
Not strong enough to produce any cervical dilation
No cervical change
Risk for
, NURS 306 week 6 Lecture
Exhaustion & infection
r/t prolonged labor
Fetal intolerance to labor
Asphyxia
Only way to see
With the progress of labor
Cervical change
IUPC (strength of contraction)
IUPC pressure <25 mmHg
TOCO is not that accurate because it doesn’t tell us how strong
Risk Factors
Multiparous
More problems in active phase
Extreme fear
Catecholamine release
Interfering w/ uterine contractility
Assessment Findings
Decr. frequency, strength, and duration of UCs
Little or no cervical change in active labor
< 0.5 cm/hr progress in cervical dilation for a primiparous woman
< 1.0 cm/hr progress in cervical dilation for a multiparous woman
Incr. fear & anxiety levels
Medical Management
Evaluate labor progression
Determine the cause of dysfunction
Admin medications
Oxytocin for strong UCs
Consider OB interventions
Augment labor w/ oxytocin
Perform amniotomy
Perform cesarean birth
Last resource
When signs of fetal intolerance of labor presence
Nursing Actions
Assess uterine activity
Assess maternal and fetal status
Stimulate uterine activity to achieve a normal labor pattern
Ambulate
Change of position
Hydration
IV fluid
Max maternal fluid volume
Correct maternal hypotension
Improve placental perfusion
Augment labor w/ oxytocin
Perform SVE (evaluate labor progress)
Good aseptic technique
Precipitous Labor
Stop & Drop
Labor that lasts fewer than 3 hour from onset of labor to birth
Experience higher anxiety and pain level
