dysfunctional labor as one of the intrapartal complications

7/30/2019 Dysfunctional Labor as one of the Intrapartal complications

1/23

Dysfunctional LaborReported by:

Agripo, Kenje Kate T.


2/23


3/23

- Problems related to passenger include fetal or

an unusually large fetus

- Problems related to power include pelvic

contractures- Problems related to power include uterine

contractions that are hypotonic, hypertonic, or

uncoordinated

- Inappropriate use of analgesia(excessive or too

early administration)

Causes:


4/23

- Poor fetal position (posterior rather than

anterior position)

- Cervical Rigidity (unripe)

- Presence of a full urinary bladder that

impedes fetal descent

- Woman becoming exhausted from labor- Primigravida status

Causes:


5/23

Prolonged Latent Phase

1st Stage of Labor:

- Uterus is at hypertonic state

- May occur if:

The cervix is not ripe at the beginning of labor

and time must be spent getting truly ready forlabor

Excessive use of an analgesic early in labor

- Management of this phase caused by Hypertonic

contractions:

Helping the uterus to rest

Providing adequate fluid for hydration

Pain relief with a drug such as Morphine Sulfate


6/23

Prolonged Latent Phase

1st Stage of Labor:

- Management of this phase caused by Hypertonic

contractions:

Changing linens and the womans gown

Darkening room lights

Decreasing noise and stimulation

- If these measures is not effective:

Cesarean birth or amniotomy

Oxytocin infusion to assist labor if necessary

Latent Phase lasts: Longer than 20 hours 14 hours


7/23

Protracted Active Phase

1st Stage of Labor:

- Usually associated with Cephalopelvic disproportion

(CPD) or fetal disposition

- Dysfunctional labor during the dilatational division

of labor tends to be hypotonic , in contrast to the

hypertonic action at the beginning of labor.

CERVICAL DILATION: 1.2 cm/hr 1.5 cm/hr

ACTIVE PHASE LASTS: 6 Hours


8/23

Prolonged Deceleration Phase

1st Stage of Labor:

-Results from abnormal fetal head position

(cesarean birth is frequently required)

Deceleration of: 3 hours 1 hour

Secondary Arrest of Dilatation-This occur when there is no progress in

cervical dilatation for longer than 2 hours

(cesarean birth)


9/23

Prolonged Descent

2nd Stage of Labor:

- Occurs if the rate descent is less than 1.0 cm/hr in

Nullipara or 2.0 in Multipara

- Both prolonged active phase of dilatation andprolonged descent:

Contractions have been good quality and proper

duration

Effacement and beginning dilatation haveoccurred

But then contractions become infrequent

,poor quality and dilatation stops.


10/23

Prolonged Descent

2nd Stage of Labor:

- Management:

Rest and Fluid intake, as advocated for

hypertonic contractions

Rate of Descent: 1.0 cm/hr 2.0 cm/hr


11/23

Arrest of Descent

2nd Stage of Labor:

- Failure of descent has occurred when expected

descent of the fetus does not begin or engagement

beyond 0 station has not occurred.- Results when no descent has occurred for 1 hour in

Nullipara or 2 hours in Multipara

- Causes:

Cephalopelvic disproportion

No Descent occur: 2 hours 1 hour


12/23

- A ridge that may form around the uterus at the

junction of the upper and lower uterine segments

during the prolonged second stage of an

obstructed labor.

- The lower segment is abnormally distended and

thin, and the upper segment is abnormally thick.

- Warning sign that severe dysfunctional labor is

occurring

Contraction Ring


13/23

-Diagnostic test:

Ultrasound

-Most frequent type is : Pathologic Retraction Ring

(Bandls Ring)

Usually appears during 2nd stage of labor

and palpated as a horizontal indentationacross the abdomen.

Contraction Ring


14/23

Pathologic Retraction Ring- Occurs in early labor caused by uncoordinated

contractions

- Fetus is gripped by the retraction ring and c

annot advance beyong the point and undeliveredplacenta will be held

- Nursing interventions:

Administration of IV morphine sulfate

Inhalation of amyl nitrite may relieve aretraction ring

Administration of Tocolytic to halt

contractions


15/23

Precipitate Labor- Birth occur when uterine contractions are so strong

that a woman gives birth with only few, rapidly occurring

contractions.

- Labor that has completed in fewer 3 hours.

- Causes:

Grand multiparity

Induction of labor by oxytocin or amniotomy.

Active Phase of

Dilation:

RATE

5 cm/hr (1cm/12

minutes)

10 cm/hr (1 cm/6

minutes)


16/23

-Change in the cervical consistency from firm to soft

-Until this has occurred, dilation and coordination of

uterine contractions will not occur.

Evaluating Cervical Readiness

BISHOPs Scale

-A tool to assess whether the patient is ready

for labor

-5 Factors:

Cervical dilation

Cervical Effacement

Station

Consistency

Position

Cervical Ripening


17/23

Hygroscopic Suppositories

-Suppositories of a seaweed that swell on

contact with cervical secretions

-Inserted to gradually and gently urge dilation

Bishops Scale


18/23

Prostaglandin Gel-most commonly used method of speeding

cervical ripening

-Such as: Misoprostol

-Procedure done: Women should remain in bed in a side-lying

position to prevent leakage

FHR should be monitored continuously for

at least 30 minutes after each application

-Side effects:

Vomiting, fever, diarrhea, and hypertension


19/23

1.) Induction of Labor- Initiate labor before the time when it would have

occurred spontaneously because a fetus is in danger ,

labor does not occur spontaneously and fetus appears to

be at term

- Primary reasons: Presence of pre-eclampsia

Eclampsia

Severe hypertension

Diabetes

Rh sensitization

Induction of Labor by Oxytocin

-Initiates contraction in uterus at pregnancy term

-Administered Intravenously


20/23

2.) Augmentation of Labor

-Assisting labor that has started spontaneously but is not

effective

-Required if labor contractions begin spontaneously but

then so weak, irregular, or ineffective(hypotonic) that

assistance is needed to strengthen them-Risk:

Uterine rupture

Decrease in the fetal blood supply from poor

cotyledon Premature separation of the placenta

-Cautiously used with women:

Multiple gestation, Hydramnios, Grand parity, Maternal

age older than 40 yrs. Old , Previous uterine scar


21/23

DIAGNOSIS Risk for Fetal Injury Relatedto prolonged labor


22/23

IMPLEMENTATION 1.Assess FHR manually orelectronically

-Note variability, periodic

changes, and baseline rate

2.Note uterine pressures

during resting and contractile

phases via intrauterine

pressure catheter, if

available.


23/23

EVALUATION The fetus fetal heart tone isnormal as evidenced by 120-

140 bpm

dysfunctional labor as one of the intrapartal complications

Documents