OB Exam 3 Study Guide
Chapter 10: High Risk Labor and Birth
Dystocia/Failure to Progress
• Dystocia - difficult labor that is characterized by
... [Show More] abnormally slow labor progress, which
can be due to lack of progressive cervical dilation, lack of decent of the fetal head, or
both.
o Abnormal labor results from abnormalities of:
§ Power of labor (uterine contractions and maternal expulsive efforts)
§ Passenger (fetal presentation, position, or development)
§ Passage (maternal bony pelvis or soft tissue)
o Arrest of labor
o Risk factors include:
§ Congenital uterine abnormalities such as bicornuate uterus
§ a uterine malformation that is produced due to impairment in the
fusion of Mullerian ducts
§ Malpresentation of the fetus such as occiput posterior, or face
presentation
§ Cephalopelvic disproportion
§ Tachysystole of the uterus with oxytocin
§ Maternal fatigue and dehydration
§ Administration of analgesia or anesthesia early in labor
§ Extreme maternal fear or exhaustion
§ Can result in catecholamine release interfering with uterine
contractility
o Diagnosis is often mistakenly made before the woman has entered active phase
of labor and, therefore, before adequate trial of labor
§ Most common reason for c-section
Hypertonic vs Hypotonic Uterine Dysfunction
• Hypotonic - occurs when the pressure of the UC is insufficient to promote cervical dilation and
effacement (contractions may be every 6 minutes apart)
o IUPC measurement < 25mmHg
o Woman at risk for exhaustion and infection related to prolonged labor
o Fetus at risk for fetal intolerance of labor and asphyxia
• Hypertonic - uncoordinated uterine activity
o Contractions are frequent (about 1 - 1½ minute apart) and painful but ineffective in
promoting dilation and effacement
o When this occurs in early labor, it may be referred to as prodromal labor
o Woman at risk for exhaustion related prolonged labor
o Fetus at risk for fetal intolerance of labor and asphyxia related to decreased placental
perfusion
*If there is no resting phase between contractions, no oxygenated blood to fetus. This can lead to fetal
death.
Precipitous Labor and Birth
Labor that lasts less than 3 hours from onset of labor to birth. This can be extremely painful and can
cause damage.
• Risk factors
o Grand multiparity
o History of precipitous labor
• Assessment findings
o Hypertonic UCs (tetanic UCs) occurring every 2 minutes or more frequently, lasting
greater 60 sec and strong
o Potential 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 hrs.
• Medical Management
o Prepare for and stand by for precipitous birth
§ Can cause rips, tears, bruising, etc.
§ Baby comes “shooting out” like a cannon
§ Baby comes out bruised which puts them at increased risk for jaundice
• Nursing actions
o Remain in the room with the woman since birth is often very rapid with precipitous
labor
o Monitor FHR and UCs every 15 minutes
o Assess labor progress and cervical change closely with SVEs
§ Assess cervix if the woman states she feels pressure or feels like the baby is
coming. This may be a sign of impending birth
o Support the woman and the family [Show Less]