ASSESSMENT OF COMPLICATIONS DURING THE LABOR PROCESSProblems with the POWERPowerPoint PresentationHYPOTONIC DYSFUNCTIONSlide 5Slide 6TREATMENTSlide 8What do you think?HYPERTONIC DYSFUNCTIONNormal vs. HypertonicNursingSlide 13CEHALOHEMATOMACAPUT SUCCEDANUMTreatmentRUPTURE OF UTERUSSlide 18Slide 19PRECIPITOUS LABORSlide 21Slide 22HEMATOMAFetal/Neonatal implicationsSlide 25NURSINGSlide 27Slide 28PROLONGED LABORSlide 30Slide 31Do you remember?Problems with the PASSENGERSlide 34MALPOSITIONOcciput Posterior PositionsSlide 37Interventions for rotation to anterior POSITIONSSlide 39Slide 40Slide 41Slide 42Slide 43Slide 44MALPRESENTATIONTransverse LieSlide 47Slide 48Slide 49Breech PresentationSlide 51Slide 52What did you learn?Compound PresentationSlide 55Slide 56PROLAPSED CORDSlide 58Face/Brow PresentationCephalic Presentation Chin (M)Cephalic PresentationCephalic PresentationShoulder (A)Slide 64DEVELOPMENTAL ANOMALIESMACROSOMIASlide 67Slide 68HYDROCEPHALUS (will be covered extensively in SG#9)Slide 70Slide 71Slide 72Slide 73Slide 74Slide 75PROBLEMS WITH THEPASSAGEWAYPELVIC SHAPESSlide 79PROM & PPROMEtiology (cannot always be identified)Maternal and infant risk for:Slide 83Slide 84Treatment: >37 weeks gestationPROM & NursingFERNINGFERNING: MicroscopicNitrazine paperWhen to D/C home? (very rare)PRETERM LABORPreterm laborSlide 93AssessmentAssessment continuedTREATMENT of Preterm LaborTocolytic Agents = STOP labor!Slide 982nd line tocolyticsSlide 100Improving the Outcome…..Nursing CareLABOR INDUCTIONSlide 104Why induction?ContraindicationsAMNIOTOMYSlide 108Slide 109ProstaglandinsPitocinFORCEPS & VACUUM EXTRACTIONSFORCEPS EXTRACTIONSPIPER forcepsSlide 115Slide 116Slide 117VACUUM EXTRACTIONSSlide 119Slide 120MULTIPLE GESTATIONSSlide 122Types of twinsSlide 124Slide 125Slide 126Slide 127DiagnosisSlide 129Slide 130Slide 131Slide 132THE END!ASSESSMENT OF ASSESSMENT OF COMPLICATIONS COMPLICATIONS DURING THE DURING THE LABOR PROCESSLABOR PROCESSStudy Guide #6Study Guide #6Prof. Unn HidleProf. Unn HidleUpdated Spring 2010Updated Spring 2010Problems with the Problems with the POWERPOWERUterine dysfunctionUterine dysfunctionHypotonic dysfunctionHypotonic dysfunctionHypertonic dysfunctionHypertonic dysfunctionPrecipitous laborPrecipitous laborProlonged laborProlonged laborHYPOTONIC HYPOTONIC DYSFUNCTIONDYSFUNCTIONContractions Contractions TOO WEAKTOO WEAK to be effective to be effectiveOverstretched uterine muscleOverstretched uterine muscle<2-3 contractions in a 10 minute period<2-3 contractions in a 10 minute periodActive phaseActive phaseWoman may be “fairly comfortable” due to Woman may be “fairly comfortable” due to weak contractionsweak contractionsLeads to fatigue and frustrationLeads to fatigue and frustrationFetal distress may occur with prolonged Fetal distress may occur with prolonged labor (hypoxia usually labor (hypoxia usually NOTNOT seen) seen)CAUSES:CAUSES:Twin gestation (overstretched Twin gestation (overstretched uterus)uterus)Large fetusLarge fetusHydramnious (>how much Hydramnious (>how much amniotic fluid?)amniotic fluid?)Grand multiparityGrand multiparityCPD (cephalo-pelvic CPD (cephalo-pelvic disproportion)disproportion)Maternal implicationsMaternal implicationsIntrauterine infectionIntrauterine infectionPP hemorrhage (insufficient uterine PP hemorrhage (insufficient uterine contractions PP)contractions PP)Stress and lack of coping abilities Stress and lack of coping abilities leading to leading to EXHAUSTIONEXHAUSTIONFetal/Neonatal ImplicationsFetal/Neonatal ImplicationsFetal distress (only if Fetal distress (only if significantlysignificantly prolonged)prolonged)Fetal sepsis (ascending pathogens Fetal sepsis (ascending pathogens through birth canal)through birth canal)TREATMENTTREATMENTAttempt to treat underlying causeAttempt to treat underlying causeIV hydrationIV hydrationCorrect electrolyte imbalanceCorrect electrolyte imbalanceUPRIGHTUPRIGHT maternal position maternal positionFavor fetal descentFavor fetal descentPromotes effective contractionsPromotes effective contractionsOverall, assess if a NVD is at all possible:Overall, assess if a NVD is at all possible:Validate with pelvimetry (passage / passenger)Validate with pelvimetry (passage / passenger)Test for true gestational ageTest for true gestational ageCheck for malpresentationCheck for malpresentationR/O fetal immaturity (<37 weeks)R/O fetal immaturity (<37 weeks)If appropriate, give PITOCIN to If appropriate, give PITOCIN to improve quality of contractionsimprove quality of contractionsAmniotomyAmniotomy (stimulate labor (stimulate labor process)process)Distinguish between hypotonic Distinguish between hypotonic active labor versus a long latent active labor versus a long latent phasephaseLast resort: Last resort: C-SECTIONC-SECTIONWhat do you think?What do you think?Following amniotomy, the nurse would Following amniotomy, the nurse would implement which of the following as implement which of the following as important nursing actions? (may pick important nursing actions? (may pick more than one)more than one)Position the mother in lithotomy position for Position the mother in lithotomy position for deliverydeliveryPlace a clean underpad on the bed.Place a clean underpad on the bed.Listen to fetal heart tones.Listen to fetal heart tones.Observe the color and consistency of the Observe the color and consistency of the amniotic fluid.amniotic fluid.Take vital signs Q4H to monitor for infectionTake vital signs Q4H to monitor for infectionHYPERTONIC HYPERTONIC DYSFUNCTIONDYSFUNCTIONContractions are Contractions are uncoordinated and erraticuncoordinated and erratic in in their frequency, duration and intensitytheir frequency, duration and intensityContractions are Contractions are ineffective BUT painfulineffective BUT painfulLatent phase: significantly prolonged Latent phase: significantly prolonged Ineffective dilation and effacementIneffective dilation and effacementUterine resting tone b/t contractions is Uterine resting tone b/t contractions is HIGHHIGH, , decreasing uterine blood flowdecreasing uterine blood flowThis ischemia will eventually This ischemia will eventually decreases fetal decreases fetal oxygenationoxygenation supply supplyCONSTANT PAIN!!!CONSTANT PAIN!!!Important to distinguish b/t hypertonic condition Important to