Complications During Labor and Birth: The Three P's

12 Questions

Which of the following is NOT a tocolytic agent?

Corticosteroid

What is the key characteristic of premature rupture of membranes?

Fluid leak in the cervix and pooling in the posterior fornix of the vagina

What is the purpose of prophylactic antibiotic therapy in premature rupture of membranes?

To decrease the occurrence of Chorioamnionitis

Which of the following is NOT a cause of dystocia (difficult labor)?

Mother's emotional state

Which of the following is NOT a potential intervention for premature rupture of membranes?

Induction of labor

Which of the following is NOT a characteristic of abnormal duration of labor?

Maternal fever

What is a common factor that can cause complications during labor due to ineffective uterine force?

Dysfunctional labor

Which condition may necessitate the use of tocolytic agents?

History of preterm birth

What is a potential nursing diagnosis for a family experiencing complications during labor related to the loss of glucose stores?

Fatigue

Which complication of labor involves abnormal duration of labor?

Dystocia

What is used during labor to assess fetal wellbeing and assure a healthy infant?

IV fluid administration

What can cause complications during birth related to problems with fetal position or size?

External cephalic version

Study Notes

Complications During Labor and Birth

The Three P's: Power, Passenger, and Passage can cause complications during labor or birth
Power: ineffective uterine force, dysfunctional labor, and associated stages of labor
Passenger: umbilical cord prolapse, multiple gestation, and problems with fetal position, presentation, or size
Passage: inlet contraction, outlet contraction, trial labor, external cephalic version, forceps birth, and vacuum extraction

Assessment of a Family Experiencing a Complication of Labor or Birth

Assessment is based on careful uterine and fetal monitoring
Recognition of hypertonic and hypotonic contractions, and mapping of lengths of phases and stages of normal labor
Recognition of abnormal fetal response to uterine contractions, and abnormal position of fetus or fetal heart sounds
Accurate assessment of pelvic inlet, outlet, and midpelvis

Nursing Diagnoses of a Family Experiencing a Complication of Labor or Birth

Fatigue related to loss of glucose stores during prolonged labor
Risk for ineffective tissue perfusion of woman and/or fetus
Risk for deficient fluid volume related to length of labor
Risk for maternal and/or fetal injury related to a labor complication and/or required medical treatment
Anxiety related to uncertainty of pregnancy outcome

Risks of Labor and Delivery

Preterm labor and birth
Premature Rupture of Membranes (PROM)
Dystocia
Abnormal duration of labor
Prolapsed Cord

Preterm Labor and Birth

Preterm labor: onset of regular contractions of the uterus that cause cervical changes between 20 and 37 weeks of gestation
Preterm birth: birth before the end of the 37th week of gestation
Factors predisposing to preterm labor and birth: history of preterm birth, PROM, multiple gestation, bacterial vaginosis, intraamniotic infection, bleeding, uterine/cervical abnormalities
Tocolytic agents (e.g. Ritodrine, Terbutaline, Magnesium sulfate) may be prescribed to inhibit contractions
Corticosteroid may be given to accelerate fetal lung maturation

Premature Rupture of Membranes (PROM)

Spontaneous rupture of membranes before the onset of labor
Characterized by fluid leak in the cervix and pooling in the posterior fornix of the vagina
(+)nitrazine test, (+)ferning under microscopic exam
Prophylactic antibiotic therapy may be given to decrease the occurrence of Chorioamnionitis