complications during labor and delivery - hard copy

7/23/2019 Complications During Labor and Delivery - Hard Copy

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COMPLICATIONS

DURING LABOR

AND DELIVERY

(Part I) Prolonged Labor (a!l"re to #rogre$$)

Mal#re$entat!on

Pre%at"re R"#t"re o Me%brane

Prepared By:

KrizeleAnn M. Santos,RN

Luz C. Echaluce,RM

Milaros !. Blanza,RM


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"utline

#. $e%inition &'rie% description o% the said

pro'le()case*

##. Causes

###. Sins)Sy(pto(s&+est)$ianostics*

#. +reat(ent)Manae(ent

. Nursin Consideration&nursin care as nurse

and (id-i%e*


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PROLONGED LABOR(a!l"re to

#rogre$$)

also no-n asfailure to progress, occurs -hen la'or lasts %or appro/i(ately 01

hours or (ore i% you are a %irst2ti(e (other, and 34 hours or (ore i% you ha5e

pre5iously i5en 'irth. A proloned latent phase happens durin the %irst stae o%

la'or.

Note: Nor(al la'or is de%ine as presence o% reular pain%ul uterine contractions

'eco(in proressi5ely stroner and (ore %re6uent acco(panied 'y e%%ace(ent

and proressi5e dilatation o% the cer5i/ and decent o% the presentatin part.

Latent P&a$e

Latent phase is the preparatory phase o% the uterus and the cer5i/ 'e%ore the

actual onset o% la'or.

Nor(al latent phase is a'out :

7 hours in pri(i

4 hours in (ulti

#n a partoraph the la'or process di5ided into:

Alert Line 2 start at the end o% the latent phase and end -ith the %ull

dilatation o% cer5i/ &31c(* in 8 hours. & 3c()hr. dilatation*

Action Line 2 its dra-n %our hours to the riht o% the alert line. An inter5al o%

4 hours is allo-ed to dianose delay in acti5e phase and then appropriate

inter5ention is done.

La'our is considered a'nor(al -hen cer5icorap crosses the alert line

Latent Phase that ends -ith the cer5i/ is 9 c( dilated.

Acti5e Phase starts -ith cer5ical dilatation o% 4 c(. Cer5i/ should dilate at least 3

c( per hour


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Ca"$e$

nripe cer5i/

Malposition and (alpresentation

Cephalopel5ic disproportion

Pre(ature rupture o% the (e('ranes

A'nor(al uterine contraction

Contracted pel5is

Conenital (al%or(ation o% the 'a'y

'!r$t Stage!ailure to dilate the cer5i/ is due to:

!ault in po-er ; a'nor(al uterine contraction such as

2uterine inertia

2in coordinate uterus contraction

!ault in passae

2contracted pel5is

2cer5ical dystocia

2pel5ic tu(or or e5en %ull 'ladder

!ault in passener

2(alpresentation

2conenital a'nor(alities o% the %etus

"thers: Early ad(inistration o% sedati5es and analesics 'e%ore acti5e la'or

'eins.

Seond StageSluish or non descent o% the presentin part in 0ndstae due to:

!ault in po-er

2uterine inertia

2ina'ility to 'ear do-n


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2epidural analesia

2constriction rin &Bandl


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Sluish or non descent o% the presentin part e5en a%ter %ull dilatation o%

the cer5i/

aria'le derees o% (oldin and caput %or(ation in cephalic presentation

#denti%ication o% the cause o% prolonation

Danger$'etal

+he %etal ris is increased due to the co('ined e%%ects o%:

?ypo/ia

#ntrauterine #n%ection

#ntracranial stress or he(orrhae

#ncreased operati5e deli5ery

Maternal

+here is increased incidence o%:

$istress

Postpartu( he(orrhae

+rau(a to the enital tract

#ncreased operati5e deli5ery

Puerperal sepsis

Treat%entManage%entPre+ent!on

Antenatal or early intranatal detection o% the %actors liely to produce

proloned la'or

se o% partoraph

Chane o% posture in la'or other than supine to increase the uterine

contractions

A5oidance o% la'or dehydration

Treat%ent


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ainal e/a(ination is done to 5eri%y the %etal presentation, position and

station

Clinical pel5i(etry is done, i% only uterine acti5ity is su'opti(al

A(nioto(y and or o/ytocin in%usion is ade6uate

Caesarean section is done -hen 5ainal deli5ery is unsa%e

N"r$!ng Con$!derat!onOb$er+at!on

+e(perature should 'e taen 4 hourly.

#n%ection (ay de5elop -here there has 'een proloned rupture o%

(e('ranes.

ainal s-a's (ay 'e taen and 'road spectru( anti'iotics co((ented-hen in%ection is suspected.

Pulse and 'lood pressure are recorded hourly or (ore %re6uently i% the

-o(an


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MALPRESENTATION

Malpresentation2 -here the %etus is lyin lonitudinally, 'ut presents in any

(anner other than 5erte/

BREEC?

!ACE

BR"@

S?"L$ER

C"MP"N$

Malposition2 -here the %etus is lyin lonitudinally and the 5erte/ is

presentin, 'ut it is not in the "ccipito Anterior position

"ccipito +rans5erse

"ccipito Posterior

BREEC? PRESEN+A+#"N

presentation o% the %etal 'uttocs, nees, or %eet in la'or the %eet (ay 'e alonside the 'uttocs &co(plete 'reech presentation* the les

(ay 'e e/tended aainst the trun and the %eet lyin aainst the %ace &%ran 'reech

presentation* or one or 'oth %eet or nees (ay 'e prolapsed into the

(aternal 5aina &inco(plete 'reech presentation*.


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+ypes o% Breech Presentation

#. !ran &E/tended* Breech Presentation

##. Co(plete &!le/ed* Breech Presentation

###. !ootlin Breech Presentation


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'ACE PRESENTATION

2head is hyper e/tended

2presentin part is %ace

2 deno(inator is chin &(entu(*

2 'et-een la'ella chin

2 presentin dia(eter is su'(ento're(atic &.>c(*


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D!agno$!$

#s caused 'y hypere/tension o% the %etal head so that neither the occiput nor

the sinciput are palpa'le on the 5ainal e/a(ination.

"n a'do(inal e/a(ination, a roo5e (ay 'e %elt 'et-een the occiput and

the 'ac.

"n the 5ainal e/a(ination, the %ace is palpated, the e/a(iner


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$ianosed in la'or 'y 5ainal e/a(ination:palpatin anterior

%rontanele,supraor'ital ride and nose.

M+: "nly can 'e achie5ed 'y deli5er 'y caesarean section

S/OULDER PRESENTATION

"ccurs as a result o% trans5erse lie or o'li6ue lie

Predisposin %actors F placenta pre5ia,hih parity,pel5ic tu(our,uterine

ano(aly

"n a'do(inal e/a(ination, neither the head nor the 'uttocs can 'e %elt at

the sy(physis pu'is and the head is usually %elt in the %lan


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"n 5ainal e/a(ination, a shoulder (ay 'e %elt, 'ut not al-ays. $elay in

dianosis ris cod prolapse and uterine rupture

$eli5ery should 'e 'y Caesearean Section.

COMPOUND PRESENTATION

"ccurs -hen an ar( prolapses alonside the presentin part. Both theprolapsed ar( and the %etal head present in the pel5is si(ultaneously

Manae(ent:

Replace(ent o% the prolapsed ar(
http://image.slidesharecdn.com/malpresentationsmalpositions-130302074142-phpapp02/95/malpresentationsmalpositions-32-638.jpg?cb=1362210795http://image.slidesharecdn.com/malpresentationsmalpositions-130302074142-phpapp02/95/malpresentationsmalpositions-32-638.jpg?cb=1362210795


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Assist the -o(an to assu(e the nee2chest position

Push the ar( a'o5e the pel5ic 'ri( and hold it there until a contraction

pushes the head into the pel5is.

Proceed -ith (anae(ent %or nor(al child'irth

#% the procedure %ails or i% the cord prolapses, deli5er 'y caesarean section


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PREMATURE RUPTURE O'

MEMBRANE (PROM)

Spontaneous rupture o% (e('rane any ti(e 'eyond 00nd -ees o%

prenancy 'ut 'e%ore the onset o% la'or

#ncidence: 31G o% all prenancies

+-o types2:

; +er( PR"M

; Preter( PR"M

+er( PR"M 2 rupture o% (e('ranes 'eyond 98th -ees o% estation 'ut

'e%ore the onset o% la'our 2 incidence: 7G o% all prenancies

Preter( PR"M 2 rupture o% (e('ranes 'e%ore 98 co(pleted -ees o%

estation 2 incidence: 0 to 9G o% all prenancies

Po$$!ble Ca"$e$

; #ncreased %ria'ility o% the (e('ranes

; $ecreased tensile strenth o% (e('ranes

; Polyhydra(nios

; Cer5ical inco(petence

; Multiple prenancy

; #n%ections e.. chorio2a(nionitis, +# lo-er enital tract in%ections

; Cer5ical lenth = 0.> c(

; Prior preter( la'our

; Lo- BM# &= 3 )(0 *


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D!agno$!$

?#S+"RH

Patient co(plains o% dischare o% clear %luid &li6uor* 5ainally

EIAM#NA+#"N

Speculu( e/a(ination ; sho-s li6uor drainin throuh cer5ical os

$#!!EREN+#AL $#AN"S#S

?ydrorrhoea ra5idaru( a state -here periodic -atery dischare occurs

pro'a'ly due to successi5e decidual landular secretion

#ncontinence o% urine

In+e$t!gat!on$

E/a(ination o% collected %luid %ro( posterior %orni/:

a. !ern test, crystallization o% li6uor -hen dried on a slide

'. Nile 'lue sulphate &1.3G* test %or orane %etal cells

c. Lit(us test or Nitrazine paper test %or detection o% p? &p? 'eco(es J to

J.0**

Manage%ent

Manae(ent o% PR"M depends on:

3. estational ae o% %etus

0. @hether the patient is in la'our or not

9. Any e5idence o% sepsis

4. Prospect o% %etal sur5i5al in that institution, i% deli5ery occurs

&Maternal pulse, te(perature and %etal heart rate (onitored 4 hourly and

start prophylactic 'road spectru( anti'iotics*


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complications during labor and delivery - hard copy

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