NURS 306 week 6 studyguide
Week 6 study guide: Labor complications and
obstetrical emergencies
Dystocia (dysfunctional labor)
Dystocia is abnormal labor that results from abnormalities of the power, the passenger, or the
passage. Atypical uterine contractions patterns prevent the normal process of labor and its
progression. Contractions can be hypotonic (weak, inefficient, or completely absent absent) or
hypertonic (excessive frequent, uncoordinated, and of strong intensity with inadequate uterine
relaxation) with failure to efface and dilate the cervix. Dystocia is the most common reason for
primary cesarean sections.
• Factors Influencing Labor:
o Powers of labor (uterine contractions [UCs])
o Passenger (fetal position)
o Passage (pelvic abnormality)
• Risk Factors (Congenital abnormality with mom):
o Cephalopelvic disproportion (CPD)- fetal head is larger than maternal pelvis.
o Malpresentation or malposition of fetus- baby position.
o bicornuate uterus- septum in the uterus (separation of the uterus that causes
complications and can’t distend properly).
o Tachysystole- contracting frequently every 1-2 minutes. Causing inadequate labor
o Maternal fatigue or dehydration.
o Pain medication too early.
o Maternal fear.
o Hormone release of large amount catecholamines that prevent oxytocin from
releasing normally and causes abnormal contraction pattern.
Hypertonic Uterine Dysfunction (precipitous labor risk
factor)
Hypertonic uterine dysfunction is nonproductive, uncoordinated, painful, uterine contractions
during labor that are too frequent/ painful and too long in duration and do not allow for
relaxation of the uterine muscle between contractions (uterine tetany). Hypertonic contractions
do not contribute to the progression of labor (cervical effacement, dilation, and fetal descent).
Hypertonic contractions can result uteroplacental insufficiency leading to hypoxia.
,NURS 306 week 6 studyguide
• Uncoordinated Uterine Activity: frequent and painful, and not effective uterine
contractions and not producing cervical dilations. Patient is at risk for severe exhaustion.
• Risk Factors: Patient is at risk for severe exhaustion. Fetal intolerance. Efixia. Nulliparous
woman are more subject to abnormal early labor.
• Assessment Findings:
o Painful, frequent UCs with inadequate uterine relaxation between UCs with little
cervical changes.
o May be Category II (indeterminate) or Category III (abnormal) fetal heart rate
(FHR) related to prolonged labor and inadequate uterine relaxation
• Medical Management:
o Evaluate labor progress.
o Evaluate cause of labor dysfunction.
o Hydrate to improve uterine perfusion and coordination of UCs.
o Provide pain management to allow the woman to sleep and prevent exhaustion.
• Nursing Actions:
o Promote rest to try to break the pattern of frequent
but ineffective UCs. The pattern typically becomes effective when the woman
sleeps for a period of several hours and awakens in a normal labor pattern of
active labor. Methods used to promote uterine rest are: Administration of pain
medication such as Demerol or morphine as per order to decrease labor
contractions and allow the uterus to rest
o Promotion of relaxation: Warm shower or tub bath, Quiet environment, Minimal
interruptions to allow for long period of sleep
o Hydrate the woman with IV or PO fluids if tolerated. Dehydration can result in
dysfunctional labor.
o Assess FHR and UCs
o Evaluate labor progress with a sterile vaginal exam (SVE). ■ Inform the woman
and family of the progress of labor and explain interventions
o Inform the care provider of the woman’s response and progress in labor.
Review: Hypertonic Uterine Dysfunction is uncoordinated uterine activity. Risk
Factor: Nulliparous women are more subject to abnormal early labor.
Hypotonic Uterine Dysfunction
Hypotonic uterine dysfunction occurs when the pressure of the UC is
insufficient (IUPC pressure <25 mm Hg) to pro- mote cervical dilation and
effacement. Typically, the woman makes normal progress during the latent
phase of labor, but during active labor the UCs become weaker and less
effective for cervical changes and labor progress. The woman is at risk for
exhaustion and infection related to the prolonged labor, and the fetus is at
risk for fetal intolerance of labor and asphyxia.
,NURS 306 week 6 studyguide
• Insufficient uterine contractions: Not sufficient enough in strength to produce cervical
dilation.
• Thus, insert the IUPC to determine to measure how strong the contractions are in
mmHg. Only way to determine this is external palpation. This is utilized to measure the
true intensity of the contraction enabling us to calculating Montevideo units. We want
them to calculate between (<200; not adequate contractions)200-250 (>250;
contractions that are too strong).
• Risk Factors:
o Multiparous women often have more problems in the active phase.
o Extreme fear may result in catecholamine release, interfering with uterine
contractility.
• Assessment Findings:
o Decreased frequency, strength, and duration of UCs
o Little or no cervical change: Less than 0.5 cm/hr progress in cervical dilation for a
primiparous woman in active labor. Less than 1.0 cm/hr progress in cervical
dilation for a multiparous woman in active labor
o Increased fear and anxiety levels
• Medical Management:
o Evaluate labor progression.
o Determine the cause of the dysfunction.
o Consider obstetrical interventions: Augment labor with oxytocin. Perform
amniotomy. Perform cesarean birth when other interventions have failed or when
there are signs of fetal intolerance of labor.
• Nursing Actions:
o Assess uterine activity.
o Assess maternal and fetal status
o Stimulate uterine activity to achieve a normal labor pattern using the following
methods: Ambulate and change the position of the woman to promote comfort
and labor progress. Hydrate with IV or PO as per orders as dehydration can result
in dysfunctional labor. Administer IV fluids to maximize maternal fluid volume, to
correct maternal hypotension and improve placental perfusion. Augment labor
with oxytocin as per protocol.
o Evaluate labor progress with SVE.
, NURS 306 week 6 studyguide
o Inform the woman and the family of the progress of labor and explain
interventions.
o Provide emotional support. Anxiety levels can increase due to prolonged labor;
increased anxiety and fear can interfere with effective UCs.
o Maintain good aseptic technique to minimize the risk of infection if ROM:
Minimize vaginal exams and Maintain perineal cleanliness.
o Inform the care provider of the woman’s response and progress in labor.
Review: Hypotonic Uterine Dysfunction occurs when the pressure of the UC is
insufficient. Risk Factors: Multiparous women often have more problems in the
active phase. Extreme fear may result in catecholamine release, interfering
with uterine contractility.
Precipitous Labor
Precipitous labor is a labor that lasts fewer than 3 hours from onset of labor to birth.
Women who experience a precipitous labor often have higher anxiety and pain levels related
to the rapid and intense labor experience. Precipitous labor and/or birth places the woman at
risk for postpartum hemorrhage related to uterine atony or lacerations. It places the
fetus/neonate at risk for hypoxia and at risk for central nervous system (CNS) depression
related to hypoxia from the rapid birth.
• What is it? Less than 3 hours from onset of labor to birth
• Risk Factors: Grand multiparity and/or History of precipitous labor
• Assessment Findings:
o Hypertonic UCs (tetanic UCs) that are occurring every 2 minutes or more
frequently, lasting greater than 60 seconds and strong.
o Potential for Category II (indeterminate) or Category III (abnormal) FHR and
nursing actions are based on FHR pattern.
o Rapid cervical dilation such that labor is less than 3 hours.
Week 6 study guide: Labor complications and
obstetrical emergencies
Dystocia (dysfunctional labor)
Dystocia is abnormal labor that results from abnormalities of the power, the passenger, or the
passage. Atypical uterine contractions patterns prevent the normal process of labor and its
progression. Contractions can be hypotonic (weak, inefficient, or completely absent absent) or
hypertonic (excessive frequent, uncoordinated, and of strong intensity with inadequate uterine
relaxation) with failure to efface and dilate the cervix. Dystocia is the most common reason for
primary cesarean sections.
• Factors Influencing Labor:
o Powers of labor (uterine contractions [UCs])
o Passenger (fetal position)
o Passage (pelvic abnormality)
• Risk Factors (Congenital abnormality with mom):
o Cephalopelvic disproportion (CPD)- fetal head is larger than maternal pelvis.
o Malpresentation or malposition of fetus- baby position.
o bicornuate uterus- septum in the uterus (separation of the uterus that causes
complications and can’t distend properly).
o Tachysystole- contracting frequently every 1-2 minutes. Causing inadequate labor
o Maternal fatigue or dehydration.
o Pain medication too early.
o Maternal fear.
o Hormone release of large amount catecholamines that prevent oxytocin from
releasing normally and causes abnormal contraction pattern.
Hypertonic Uterine Dysfunction (precipitous labor risk
factor)
Hypertonic uterine dysfunction is nonproductive, uncoordinated, painful, uterine contractions
during labor that are too frequent/ painful and too long in duration and do not allow for
relaxation of the uterine muscle between contractions (uterine tetany). Hypertonic contractions
do not contribute to the progression of labor (cervical effacement, dilation, and fetal descent).
Hypertonic contractions can result uteroplacental insufficiency leading to hypoxia.
,NURS 306 week 6 studyguide
• Uncoordinated Uterine Activity: frequent and painful, and not effective uterine
contractions and not producing cervical dilations. Patient is at risk for severe exhaustion.
• Risk Factors: Patient is at risk for severe exhaustion. Fetal intolerance. Efixia. Nulliparous
woman are more subject to abnormal early labor.
• Assessment Findings:
o Painful, frequent UCs with inadequate uterine relaxation between UCs with little
cervical changes.
o May be Category II (indeterminate) or Category III (abnormal) fetal heart rate
(FHR) related to prolonged labor and inadequate uterine relaxation
• Medical Management:
o Evaluate labor progress.
o Evaluate cause of labor dysfunction.
o Hydrate to improve uterine perfusion and coordination of UCs.
o Provide pain management to allow the woman to sleep and prevent exhaustion.
• Nursing Actions:
o Promote rest to try to break the pattern of frequent
but ineffective UCs. The pattern typically becomes effective when the woman
sleeps for a period of several hours and awakens in a normal labor pattern of
active labor. Methods used to promote uterine rest are: Administration of pain
medication such as Demerol or morphine as per order to decrease labor
contractions and allow the uterus to rest
o Promotion of relaxation: Warm shower or tub bath, Quiet environment, Minimal
interruptions to allow for long period of sleep
o Hydrate the woman with IV or PO fluids if tolerated. Dehydration can result in
dysfunctional labor.
o Assess FHR and UCs
o Evaluate labor progress with a sterile vaginal exam (SVE). ■ Inform the woman
and family of the progress of labor and explain interventions
o Inform the care provider of the woman’s response and progress in labor.
Review: Hypertonic Uterine Dysfunction is uncoordinated uterine activity. Risk
Factor: Nulliparous women are more subject to abnormal early labor.
Hypotonic Uterine Dysfunction
Hypotonic uterine dysfunction occurs when the pressure of the UC is
insufficient (IUPC pressure <25 mm Hg) to pro- mote cervical dilation and
effacement. Typically, the woman makes normal progress during the latent
phase of labor, but during active labor the UCs become weaker and less
effective for cervical changes and labor progress. The woman is at risk for
exhaustion and infection related to the prolonged labor, and the fetus is at
risk for fetal intolerance of labor and asphyxia.
,NURS 306 week 6 studyguide
• Insufficient uterine contractions: Not sufficient enough in strength to produce cervical
dilation.
• Thus, insert the IUPC to determine to measure how strong the contractions are in
mmHg. Only way to determine this is external palpation. This is utilized to measure the
true intensity of the contraction enabling us to calculating Montevideo units. We want
them to calculate between (<200; not adequate contractions)200-250 (>250;
contractions that are too strong).
• Risk Factors:
o Multiparous women often have more problems in the active phase.
o Extreme fear may result in catecholamine release, interfering with uterine
contractility.
• Assessment Findings:
o Decreased frequency, strength, and duration of UCs
o Little or no cervical change: Less than 0.5 cm/hr progress in cervical dilation for a
primiparous woman in active labor. Less than 1.0 cm/hr progress in cervical
dilation for a multiparous woman in active labor
o Increased fear and anxiety levels
• Medical Management:
o Evaluate labor progression.
o Determine the cause of the dysfunction.
o Consider obstetrical interventions: Augment labor with oxytocin. Perform
amniotomy. Perform cesarean birth when other interventions have failed or when
there are signs of fetal intolerance of labor.
• Nursing Actions:
o Assess uterine activity.
o Assess maternal and fetal status
o Stimulate uterine activity to achieve a normal labor pattern using the following
methods: Ambulate and change the position of the woman to promote comfort
and labor progress. Hydrate with IV or PO as per orders as dehydration can result
in dysfunctional labor. Administer IV fluids to maximize maternal fluid volume, to
correct maternal hypotension and improve placental perfusion. Augment labor
with oxytocin as per protocol.
o Evaluate labor progress with SVE.
, NURS 306 week 6 studyguide
o Inform the woman and the family of the progress of labor and explain
interventions.
o Provide emotional support. Anxiety levels can increase due to prolonged labor;
increased anxiety and fear can interfere with effective UCs.
o Maintain good aseptic technique to minimize the risk of infection if ROM:
Minimize vaginal exams and Maintain perineal cleanliness.
o Inform the care provider of the woman’s response and progress in labor.
Review: Hypotonic Uterine Dysfunction occurs when the pressure of the UC is
insufficient. Risk Factors: Multiparous women often have more problems in the
active phase. Extreme fear may result in catecholamine release, interfering
with uterine contractility.
Precipitous Labor
Precipitous labor is a labor that lasts fewer than 3 hours from onset of labor to birth.
Women who experience a precipitous labor often have higher anxiety and pain levels related
to the rapid and intense labor experience. Precipitous labor and/or birth places the woman at
risk for postpartum hemorrhage related to uterine atony or lacerations. It places the
fetus/neonate at risk for hypoxia and at risk for central nervous system (CNS) depression
related to hypoxia from the rapid birth.
• What is it? Less than 3 hours from onset of labor to birth
• Risk Factors: Grand multiparity and/or History of precipitous labor
• Assessment Findings:
o Hypertonic UCs (tetanic UCs) that are occurring every 2 minutes or more
frequently, lasting greater than 60 seconds and strong.
o Potential for Category II (indeterminate) or Category III (abnormal) FHR and
nursing actions are based on FHR pattern.
o Rapid cervical dilation such that labor is less than 3 hours.
