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Prob With The Power

This document discusses problems that can occur during labor and delivery, including dystocia (difficult labor). It describes two types of uterine dysfunction - hypertonic and hypotonic - that can cause ineffective contractions and lack of cervical dilation. It also discusses abnormal progress in the first and second stages of labor, such as a prolonged latent phase, active phase, or descent phase. Nursing and medical management strategies are provided for each problem, which may include monitoring, analgesics, oxytocin administration, amniotomy, or cesarean section if there is lack of progress or fetal distress.

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Pauline Navarro
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137 views4 pages

Prob With The Power

This document discusses problems that can occur during labor and delivery, including dystocia (difficult labor). It describes two types of uterine dysfunction - hypertonic and hypotonic - that can cause ineffective contractions and lack of cervical dilation. It also discusses abnormal progress in the first and second stages of labor, such as a prolonged latent phase, active phase, or descent phase. Nursing and medical management strategies are provided for each problem, which may include monitoring, analgesics, oxytocin administration, amniotomy, or cesarean section if there is lack of progress or fetal distress.

Uploaded by

Pauline Navarro
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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PROBLEMS WITH THE POWER

a. Dystocia (Difficult Labor)


1. Hypertonic Uterine Dysfunction
- frequent contractions at midsegment of the uterus with decreased intensity and increased
uterine tone occurring during the latent phase of labor.
 Ineffective in causing cervical dilatation or effacement to progress
 Uterus does not relax complete between contractions
 Occurs before 4cm dilation
Maternal risk
 Loss of control related to the intensity of pain and lack of progress
 Exhaustion
Nursing management
 Decrease noise and stimulation
 Monitor FHT and labor progress
Medical management
 Monitor uterine contractions
 Initiate therapeutic rest measures (bed rest)
 Administer analgesic (morphine sulfate)
 CS birth indications – the presence of late deceleration, abnormally long first stage of
labor and lack of progress with pushing
Hypotonic Uterine dysfunction
 Low or infrequent contractions
 Contractions that is not increasing beyond 2 to 3 in a 10minute period
 Resting tone of the uterus remains less than 10mmHg
 Strength contractions does not rise above 25mmHg
 Most occur on the active phase of labor
Cause
 Administration of analgesia
 Bowel or bladder distention
 Overstretched uterus due to multiple gestation
 Macrosmia
Maternal risk
 Ineffective cervical dilatation
 Prolonged labor
 Ineffective uterine contraction during the post-partal period
 Possible post-partal hemorrhage
 Risk for infection
Nursing management
 Palpate uterine fundus
 Monitor BP
 Monitor lochia every 15 minutes
Medical management
 Administration of oxytocin – strengthen contractions and increase their effectiveness
 Amniotomy (artificial rupture of membranes) - to improve labor and further speed labor

ABNORMAL PROGRESS IN LABOR


DYSFUNCTION ATHE FIRST STAGE OF LABOR
Prolonged Latent Phase
 Ineffective contractions during the first stage of labor
 >20 hours in a nulliparous patient
 > 14 hours in a multiparous patient
Causes
 Cervix is not “ripe”
 Excessive use of analgesic early in labor
Signs and symptoms
 Hypertonic uterus
 Inadequate relaxation
 Mild & ineffective contractions – less than 15mmHg
Nursing management
 Changing linen and woman’s gown
 Darkening room
Medical Management
 Help uterus to relax
 Adequate fluid for rehydration
 Pain relief (morphine sulfate)
 Oxytocin infusion to assist labor may be necessary
 Cesarean birth
Prolonged Active Phase
 Dilatation <1.2 cm in nulliparous
 Dilatation <1.5 cm in multiparous
 Active phase lasts > 12 hours in primigravida
 Active phase lasts >6 hours in multigravida
Cause
 Fetal malposition and malpresentation
Signs and symptoms
 Hypotonic uterus
 Ineffective cervical dilation
Management
 Ultrasound to show that CPD is not present
 Oxytocin to enhance labor
 If the cause is fetal malposition or CPD, CS birth is done
Prolonged Deceleration Phase
 Deceleration phase extends beyond 3 hours in a nullipara or 1 hour in multipara
Cause
 Abnormal fetal head position
Signs and symptoms
 >3 hours in nullipara, >1 hour in multipara
Management
 Cesarean delivery
DYSFUNCTION WITH THE SECOND STAGE OF LABOR (EXPULSION STAGE)
Prolonged Descent
 Descent is <1cm/hr in a nullipara, <2cm/hr in a multipara
 Infrequent contractions and of poor quality and dilatation stop
Management
 Rest
 IV fluid therapy
 Amniotomy
 If membranes have not ruptured, rupturing them may be applicable
 IV oxytocin
 Semi- fowler's position, squatting, kneeling, or more effective pushing may speed descent
Arrest of Descent
 no descent has occurred for 1 hour in a multipara or 2 hours in a nullipara
 Movement beyond 0 a station has not occurred
Cause
 CPD
Management
 Oxytocin to assist labor if vaginal birth

https://nurselabs.com/problems-fetal-position-presentation-size-passage
https://www.glowm.com/section_view/heading/Abnormal%20Labor:%20Diagnosis%20and
%20Management/item/132

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