OB Exam 3 Study Guide: Chapter 10: High Risk Labor and Birth

OB Exam 3 Study Guide Chapter 10: High Risk Labor and Birth Dystocia/Failure to Progress • Dystocia - difficult labor that is characterized by 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