Chapter 18: Labor at Risk

1. Chapter 18: Labor at Risk

2. Dysfunctional Labor (Dystocia) • Labor dystocia is an abnormally slow progression of labor. • Nursing interventions include carefully monitoring the woman's labor pattern. • Compare the woman's progress with expected norms, and notify the RN or the health care provider when progress deviates from the expected. • Assist the woman in repositioning and keeping her bladder empty, frequently monitor the adequacy of the contraction pattern, and administer pain relief interventions.

3. Fetal Malpresentation • Two types of fetal malpresentation are breech and transverse lie (shoulder presentation). • For breech presentation, the health care provider may use external version, allow the woman to attempt vaginal delivery, or perform a cesarean delivery. • For transverse lie, external version or cesarean delivery is needed.

4. Premature Rupture of Membranes • PROM is spontaneous rupture of the amniotic sac before the onset of labor in a full-term fetus; preterm PROM is PROM in a pregnancy that is less than 37 weeks' gestation. • In both cases, the woman presents to the delivery suite with uncontrollable leaking of fluid from the vagina. • Monitor the woman's temperature frequently to detect early signs of infection.

5. Preterm Labor • For PTL, if the membranes are not ruptured and cervical dilation is less than 3 cm, tocolytics and injectable steroids may be ordered to stop the labor long enough to allow the fetal lungs to mature. • Assessment • Common nursing diagnoses • Interventions

6. Post-Term Pregnancy and Labor • Complications associated with post-term pregnancy include oligohydramnios which can lead to cord compression, meconium staining of the amniotic fluid that can lead to meconium aspiration syndrome, macrosomia, and fetal death. • Client education for the woman carrying a post-term pregnancy includes discussing the plan of care. Frequently labor is induced. • Frequent fetal kick counts and NSTs are used to monitor fetal well-being. Instruct the woman to report decreased fetal movement immediately.

7. Fetal Demise • During labor induction of a woman with fetal demise, monitor the contraction pattern to avoid uterine hyperstimulation. • Monitor the woman for signs of disseminated intravascular coagulopathy. Provide emotional care for the woman and her family.

8. Emergencies Associated with Labor and Birth • AFE occurs suddenly during labor or in the immediate postpartum period. • The woman becomes acutely dyspneic, apprehensive, hypotensive, and cyanotic. Treatment is supportive, and the woman requires care in the intensive care unit.

9. Emergencies Associated with Labor and Birth (cont.) • Shoulder dystocia occurs when the fetal head is born but the shoulders fail to deliver. • McRoberts maneuver and suprapubic pressure are two interventions that require the active involvement of the nurse. • Carefully observe the newborn for signs of birth injury.

10. Emergencies Associated with Labor and Birth (cont.) • Umbilical cord prolapse occurs when the umbilical cord slips down in front of the presenting part. • Unless pressure is immediately relieved, the fetus will die or will experience permanent brain injury from lack of oxygen. • An immediate cesarean delivery is required.

11. Emergencies Associated with Labor and Birth (cont.) • History of a previous uterine scar increases the risk of uterine rupture during labor. • Ominous fetal heart rate patterns on the fetal monitor are usually the most significant sign of rupture. • Prompt cesarean delivery is necessary to save the fetus and the woman.