Labor Complications
I. Precipitous Labor
A. Define: Labor that is completed in less than three hours. More common with the multiparous
woman. Poses
... [Show More] risk of trauma to the fetus as well as trauma to the maternal soft tissue.
B. Dilatation: 5 cm or more per hour in primiparas and up to 10 cm per hour for multiparas
C. Most common causes:
a. Abnormally low resistance in maternal soft tissues. = Allows for rapid cervical dilatation
and fetal descent.
b. Abnormally strong uterine contractions
D. Risks with Precipitous Birth:
a. Maternal: (1) Abruptio placenta due to abnormally strong contractions (2) Extensive
lacerations of the cervix, vagina, and perineum (3) Postpartum hemorrhage due to lack
of relaxing periods between contractions. The uterus will get too fatigued and become
soft and boggy (muscle atony)
b. Fetal: (1) Meconium-stained fluid that may be aspirated at birth (can end up with
meconium aspirated syndrome) (2) Low apgar scores (3) Intracranial trauma from rapid
birth and the resistance of the birth canal to the fetal head
E. Management of women with Hx of Precipitous birth:
a. Early preparation for labor
b. Closely monitor women’s contractions and cervical dilatation
c. Emergency birth pack kept near the bed
d. Nurse stays in constant attendance, should not leave mother, have others call MD/CMN
if labor is precipitous
e. Assist to comfortable position, provide quiet environment
f. Support the perineum in case of delivery
g. Fetus is monitored for hypoxia
h. If meconium staining of amniotic fluid present, fetus’ mouth and nares will be suctioned
after head is born to prevent aspiration with first breath (Dele suction is used)
i. Drugs such as Magnesium sulfate and terbutaline may be used to slow the UCs. A lot of
times baby is out before you can get the drugs
F. Interventions (NCLEX)
1. Have a precipitous delivery tray available (hemostats, scissors, cord clamp)
2. Stay with the pt at all times
3. Provide emotional support and keep the pt calm
4. Encourage the pt to pant between contractions
5. Prepare for rupturing membranes when the head crowns, if they are not already ruptured
6. Do not try to prevent the fetus from being delivered
7. If delivery is necessary before the arrival of health care provider, do the following:
a. Apply gentle pressure to the fetal head upward toward the vagina to prevent damage to
the fetal head and vaginal lacerations; support the perineal area. Both actions constitute
the Ritgen maneuver
b. Support the infant’s body during delivery
c. Deliver the infant between contractions, checking for the cord around the neck
d. Use restitution to deliver the posterior shoulder
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e. Use gentle downward pressure to move the anterior shoulder under the pubic
symphysis
f. Bulb suction the infant’s mouth first and then suction the nares
g. Dry and cover the infant to keep the body warm
h. Place the infant on the mother’s abdomen or breast to induce uterine contractions
II. Passage
A. Episiotomy: surgical incision of the perineal body
a. Risk factors: primigravida status, large/macrosomia baby, occiput-posterior position, use
of forceps/vacuum, shoulder dystocia, and white race
b. Two types:
i. Midline: avoids muscle fibers and major blood vessels. Use when perineum of
adequate length and no difficulty anticipated.
1. Advantages: (1) less blood loss (2) less painful (3) heals quickly
2. Disadvantage: May extend to anus and major perineal trauma likely to happen
ii. Mediolateral: 45-degree angle. Use if have a short perineum, macrosomia, and
instrument assisted birth.
1. Advantage: More room (because it cuts at an angle)
2. Disadvantages: (1) More painful - because it is at an angle (2) More blood loss (3) Takes
longer to heal
B. Lacerations: may be present when bright red bleeding persists even though uterus is contacted.
More common in young, nulliparous, have an epidural block, undergo instrument use at birth,
or have an episiotomy.
a. First: Perineal skin and the vaginal mucosa. (Most superficial. They don’t repair this one)
b. Second: Perineal skin, vaginal mucosa, fascia, muscles of the perineal body.
c. Third: Perineal skin, vaginal mucosa, fascia, muscles of the perineal body involving the
anal sphincter.
d. Fourth: A third degree laceration but goes through the rectal mucosa.
i. Due to involvement of anal muscle/anal sphincter, nothing per rectum in [Show Less]