Complications During Labor and Birth: The Three P's

Study Notes

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 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

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

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

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